At the first booth I approached at the NNFA Trade show I made a reservation for an osteoporosis scan. Mrs. Duke had hers a year or so earlier. Following her scan, they recommended Miacalcium nasally. Here we are now in salmon country. Rumor has it that Miacalcium is made from salmon bones. The Trade Show scan, hopefully not scam, was called an "Achilles & Solo Ultrasonometer" (statistically 68% of repeat scans will fall within 1 standard deviation.) I was sample no. 236 at 1:27 p.m., 4/25/99, and my stiffness index was 122 ± 2. That's within the green light region. (As I read their green, yellow, and red light zones, anything below 80 is caution and below 60 is danger.) I copied this to nutpre@primenet.com to see if that is correct. Hereís their answer, ìYes at 122 you are in the green zone. If you need any other questions answered call us at 800-246-4494.î Their scale was for women only and the monitor said that no follow-up was required for this male, to keep up with what I'm doing. My Ethiopian accomplice chimed in, "Keep walking in the Amazon barefooted." So, I put my shoe and sock back on the right foot, and resumed walking to see all my buddies at the trade show. But I'll continue my exercise and tip-toe exercise and walking. This guy said, re my osteoporotic fears, much the same as my HMO physician had said after my prostatic gauge: "Keep up whatever you've been doing."

DEFINITION

Osteoporosis is a disorder of inadequate skeletal strength predisposing to fracture. It is one of the most common human conditions associated with advancing age. Both nutritional and hormonal insufficiencies are involved. (Binkley and Suttie, 1995) Dorland's Medical Dictionary (1974) defines osteoporosis as, "abnormal rarefaction of bone, seen most commonly in the elderly...It may be accompanied by pain, particularly of the lower back; deformities such as loss of stature; and pathological fractures. It may be idiopathic or secondary to other diseases, such as thyrotoxicosis." The Journal of the American Medical Association (JAMA) says postmenopausal osteoporosis results largely from accelerated bone loss occurring in the years following menopause. "Estrogen replacement effectively abrogates this increase in bone breakdown and appears to decrease fracture rates. Despite the development of several promising alternatives, estrogen remains the standard for treatment of postmenopausal osteoporosis and the only drug with labeling approval for its prevention." (Insogna, Concato and Henrich, 1996).

EPIDEMIOLOGY

Since true cures are not yet reported, prevention is still the word. As Dr. John Lee puts it, "Present osteoporosis management emphasizes prevention rather than cure since true reversal has proven unobtainable by conventional methods...The annual cost of these (osteoporotic) fractures in the U.S. has been estimated at over $6 billion and the personal cost in quality and quantity of life is incalculable... Osteoporosis predominantly affects white postmenopausal women in whom the incidence, if one lives long enough, is 100%.² Werbach (1993) says it affects 1 in 4 women over 65. Eight percent of men develop it in their lifetime. Hudson (1997) says osteoporosis fractures will develop in one-half of women and one-fifth of men over 65. In a symposium, Anderson (1996a) states that the lifetime risk for a woman to suffer a hip fracture is as high as 15%. Approximately 2.5 million cases will occur annually by year 2025 compared to some 800,000 today. A woman is twice as likely as a man to suffer hip fracture. The risk is doubled every 7th year after one passes 70. Direct hospital costs for a hip fracture, excluding costs for follow-up health care, now amount to $15,000-20,000 per patient. Hudson (1997) summarizes that osteoporosis affects 25 million Americans and is associated with 1.5 million fractures annually. There are at least 500,000 vertebral crush fractures annually, with ten times as many in women than men. The costs of treating osteoporotic fractures, $18 billion, is rising each year.

Andy Weil (Self healing), Oct. 1996) reminds us that diet, exercise, genetics and sex hormone levels (estrogen in women, testosterone in man) all influence epidemiology. Some 50-80% of osteoporosis is genetically controlled, with small boned Chinese, European or Japanese women especially prone.

Now that we have this problem sewn up, the progress of science will do what it often does best, and throw a monkey wrench into our plans. In a recent in vitro and controlled in vivo human study, Serafini et al. (1996) confirmed the antioxidant effect of commercial Chinese green and Earl Grey black tea with and without milk. Teas were prepared with boiling water and were typical commercial products. In vitro, both green and black teas strongly inhibited peroxidation, and green tea was 6 times more protective than black tea. The addition of whole milk had no effect on the system.

HERBAL APPROACHES

Neither Hoffmann (1985), Mowrey (1986), the Theisses (1989), nor Weiss (1988) index osteoporosis, indicating how new or unimportant it must have been to their indexers.

Alfalfa (Medicago sativa): Even in a book ominously entitled Adverse Effects of Herbal Drugs (De Smet et al., 1992) we read that alfalfa may contain enough estrogenic compounds to cause deleterious estrogenic effects in cattle (37 ppm coumestrol). When fed to pullets, coumestrol increases the age of maturity and depresses egg production (Leung and Foster, 1995). Pure coumestrol, as measured by rodent assays, is 200 times less potent than pure estrone, and nearly 3,000 times less potent than diethylstilbestrol. But alfalfa may contain 10-200 ppms coumestrols, with its usual associates biochanin, genistein and formononetin, which also occur in many estrogenic clover species. Phytoestrogens in these plants may produce side effects such as difficult labor, infertility, and full-term fetal death or abortion. These could well be synergic with the coumestrol. All are fungicidal. Nature would favor synergy over antagonisms in closely related compounds from a given species. All are estrogenic. If they are proven synergic as fungicides, perhaps we should investigate their synergic potential as phytoestrogens.

Avocado (Persea americana): As our tastiest vegetable source of vitamin D, avocado may be as useful with osteoporosis as it is with baldness and skin ailments. One patent covers its use for arthritis, if not osteoporosis. One kg avocado oil reportedly contains 20,000 IU vitamin A, 40,000 IU vitamin D and 300 IU vitamin E (Hampton, 1987). (That is richer than butter or eggs, if we can believe this surprising reference from Aubrey Hampton, picturesque character, fabricator (and inventor) of more than 100 natural cosmetic products, and author of Natural Organic Hair and Skin Care.) The role of vitamin D in skeletal maintenance is well known. Naturopaths suggests 350-400 IU/day, attainable with only 10 g avocado. If we can believe that citation, it is a pleasing and not-too fattening prescription. Boston scientists have been using vitamin D alone or sun lamps in treating elderly women at a retirement center. (There's a paradox here. Avocado, though our best source of vitamin D, has a bad Calcium: Phosphorus (Ca:P) ratio, about 1:4, where 1:1 is closer to today's recommendations. Anderson, 1996b). I'm trying to reconfirm this avocado data. Meanwhile don't trust your milk labels. "Although milk is considered to be the major food source of vitamin D, three separate studies have shown that less than 20% of milk samples evaluated from all sections of the United States...contained the amount of vitamin D stated on the label.² ( Holick, 1996)

Black Cohosh (Cimicifuga racemosa): Recent papers have been heralding black cohosh for osteoporosis. The Journal of the Society of Obstetricians and Gynaecologists of Canada (Nov/Dec 1998) concluded that a black cohosh preparation, Remifemin, is a useful alternative for menopause in their compilation on menopause and osteoporosis. Steve Foster's 1999 article on black cohosh in HerbalGram #34 is even more positive.

Black Pepper (Piper nigrum): USDA's Stephen Beckstrom-Sternberg, Ph.D. (Molecular Biology) and J. A. Duke, Ph.D. (Botany) in a 1994 paper entitled, Potential for Synergistic Action of Phytochemicals in Spices, note that black pepper contains at least 8 anesthetic compounds listed in their database (www.ars-grin.gov/~ngrlsb/), including, 4 antiaggregant, 8 antiinflammatory, 4 antioxidant, 6 antiulcer, 14 bactericidal, 21 cancer-preventive, 10 fungicidal, 6 hypotensive, 23 insect-repellant (more than any other spice), 31 pesticidal, 7 sedative and 8 spasmolytic compounds. More than any other spice, black pepper has 4 osteoporotic compounds. Since 1992, they estimate these numbers will have nearly doubled for many of these activities as their bibliographic research continues and their database grows. Duke has for nearly a decade argued that evolution, within a given species, would select for synergy and against antagonisms among these pesticidal compounds which we often borrow for medicines. (Beckstrom-Sternberg, S.M. and Duke, J.A. 1994).

Bugleweed (Lycopus spp.): If fluorine is useful (and not harmful), and if De Smet's Lycopus observations are valid, bugleweed is the best dietary source of fluorine. Can I believe the De Smet (1993) entry of 0.09% (=900 ppms) for Lycopus europaeus when my highest entries were parsley and nettle at up to 8 ppm, ZMB, dill and bitter melon closer to 5 ppm, moringa leaves, pistachio nuts and rhubarb at 4, coconut and currant at 3 and brazilnut, cabbage, carrot, cauliflower, cloudberry, ginger, apple, pecan and tomato at closer to 2 ppm (dry matter basis). DHEA (Dihydroepiandrosterone): Though not herbal in itself, DHEA may be regulated by adrenal herbs like licorice. Dr. Susan Lord, MD, Resident in Family Practice, Metro-Health Center, Cleveland hints that DHEA may indeed be the fountain of youth. She says that in low physiologic doses, it can enhance ones health. "Used like a medicine in higher doses, it appears to ameliorate many serious disease processes.² The following have been associated with low DHEA levels: Alzheimer's, autoimmune diseases (including AIDS), cancer, cardiopathy, Chronic Fatigue Syndrome, diabetes, high cholesterol, infections, obesity, osteoporosis, and senility. The most abundant steroid hormone in the body, DHEA is synthesized by the adrenals, ovaries and testes. Secretion peaks at age 25 and decreases by 80-90% at age 70. An increase in DHEA has increased bone mass in postmenopausal women. Autoimmune patients (lupus, MS, rheumatoid arthritis, and ulcerative colitis) usually have very low levels of DHEA, especially if they are taking steroids. Supplemented lupus patients experienced significantly improved kidney problems. Experienced physicians may prescribe 5-15 mg, 2 x daily to women, and more than 100 mg to men. (Lord, 1995)

Evening Primrose (Oenothera biennis): Prudent use of Essential Fatty Acids (EFAs) and their metabolites may reduce bone matrix collagen degradation while increasing bone mineral content. With increasing evidence that prostaglandins and prostaglandin inhibitors influence bone metabolism, it's nice to look at prostaglandin precursors in EPO and fish oils. Best results are maintained with about 3:1 ratio EPO:fish oil. It has long been known that we need a proper balance between omega-6 EFA's and omega-3's like ALA, with the target ratios 2:1 to 6:1 (Brown, 1996; Claasen, N. et al.. 1995) This year, I'll try my strange new antiosteoporotic bean or tofu salad, ALA:GLA salad, with evening primrose leaves, evening primrose oil or seeds, purslane leaves and walnut oil or seeds, (maybe with a little non-aromatic fish oil, maybe even anchovies, and appropriate spices), giving the homeostatic equilibrium-seeking body the opportunity to approach an evolutionarily appropriate ALA:GLA ratio. I don't know how to balance these, but I'll bet my genes do.

Horsetail (Equisetum arvense): Holding a patent for a given activity for a given plant does not necessarily make the plant efficacious. Albert Leung, Ph.D., Pharmacognistic Consultant, and Steven Foster, Herbalist, in their Encyclopedia of Common Natural Ingredients, report that there is a French patent for using the isolated silica compounds from horsetail for bone fractures, osteoporosis, and for the repair and/or maintenance of connective tissue, nails and teeth. Silica, necessary for the formation of articular cartilage and connective tissue, is taken up by the plant in the form of a bioavailable monosilicic acid, according to Leung and Foster (1995). (Canadians warn that irreversible brain damage could possibly accrue to the thiaminase poison in thiamin deficient individuals). According to Seaborn and Nielsen (1993) aging and low estrogen levels decrease the ability to absorb silicon (Reichert, 1994) Because silicon affects cartilage composition, including articular cartilage, inadequate silicon nurture may be of consequence in some joint disorders such as osteoarthritis. French studies suggest that silicon levels in the human aorta also decrease with age as the silicon concentration in arterial walls decrease with the development of atherosclerosis. The recommended intake is 5 to 10 mg elemental silicon per day (Seaborn and Nielsen, 1993). Horsetail is rich in silicon, hence may have an impact on the health of connective tissue throughout the body. (Reichert, 1994)

Jute (Corchorus olitoria): Folic acid levels have been shown to reduce levels of homocysteine, which is implicated in osteoporosis. Homocysteine concentrations in postmenopausal women may play an osteoporosigenic role, interfering with collagen cross-linking, leading to a defective bone matrix. It¹s hard to get folic acid in the diet but the jute, known as Jew¹s mallow, is the best source in my database. My highest credible entries are edible jute at 32 ppm, spinach at 27, endive at 25, asparagus at 18, parsley at 18, okra at 10, pigweed at 10, and cabbage at 9 ppm's, on a calculated zero moisture basis.

Kale (Brassica oleracea var. acephala): Kale is currently the # 1 source of vitamin K in my database. Shearer's work in London suggests that vitamin K (phylloquinone) intake is inadequate in a large percentage of his elderly subjects. Dutch studies show that supplementation with vitamin K in deficient persons alone improves osteoblastic cell function. Recent research suggests important and underrecognized roles of lipoproteins, especially chylomicrons, in the delivery of vitamin K to skeletal and other tissues from the intestine. (Anderson, 1996a). Highs for vitamin K in the FNF database, largely derived from Shearer et al. (1996) are in ppm: kale (6.18), parsley (5.48), spinach (3.80), cabbage (green) (3.39), watercress (3.15), broccoli (1.79), soybean oil (1.73), brussels sprouts (1.47), lettuce (1.29), rapeseed oil (1.29 ppm), and mustard greens (0.88). Salad anyone? Leafy veggies in general have better Ca:P ratios than nuts, grains and root crops. The high phylloquinone leafy veggies have 2:1 to 4:1 Ca:P ratios. People not consuming the leafy veggies will build up unfavorably high phosphorus levels proportional to calcium. High phosphorus may correlate with high parathyroid which may correlate with high bone resorption and hence, bone turnover. One to four Ca:P ratios will trigger persistently elevated concentrations of PTH (parathyroid hormone).

Kudzu (Pueraria spp.): Hudson (1997) cites animal studies that daidzein and genistein, both better represented in kudzu root than in soybean, directly stop bone demineralization. Kudzu root reportedly contains 950 mg daidzein and 315 mg genistein versus 45 and 15 respectively for one strain of soybean (Kaufmann et al., 1997).

Pigweed (Amaranthus spp.): On a dry weight basis, pigweed leaves are one of our best sources of calcium, at 5.3%. If the dry pigweed is 5.3% calcium, that translates to 50,000 mg/kg, meaning that 1/10th cup (10 g, 1/3 ounce) would provide the 500 mg supplementation which yielded significantly greater bone content and density after 18 months with 11-year old girls (Teegarden and Weaver, 1994). A 30 g serving would provide the 1000-1500 mg calcium (with 400-800 IU vitamin D) that the USDA suggests postmenopausal women should consume daily to minimize bone loss. (Dawson-Hughes, 1996) That would also contribute the calcium needed to lower your chances for heart problems. (But some recommend taking calcium with meals, which, if they contain plants, also contain fiber). Some people speculate that the fiber in the pigweed might interfere with the uptake of the calcium. But that same fiber can be good for your heart. A Harvard study of more than 40,000 men over 6 years showed that men in the top quintile had 1/3 the chance of succumbing to heart attack as those in the bottom quintile. And if you get a lot of exercise (and sunshine) planting, picking and processing your pigweed, you are less likely to suffer heart attack, stroke or osteoporosis. Another Harvard study of 75,000 middle-aged nurses showed that those who exercised most had only about half the chance of suffering stroke. And if you, a middle aged man, walked briskly to your pigweed patch for at least 40 minutes per week, you¹d lower your risk of adult-onset diabetes some 50% (Bricklin, 1995).

Purslane (Portulaca oleracea): Prevention Magazine (June 1995) had an ad hinting that about 72% of Americans get insufficient magnesium. Magnesium deficiency has been found in patients with asthma, debility, diabetes, headache, hypertension, hypocalcemia, hypokalemia, irregular heartbeat, migraine, osteoporosis, pallor, tremor. In an article on PMS, an author suggests turning to leafy greens, legumes and whole grains." (Purslane {highest at nearly 2% on a dry weight basis}, greenbean, poppyseed, oats, cowpea and spinach were the best dietary sources of magnesium in my database). An RDA of 450 mg for a 100-kg individual (Dreosti, 1995) would command only 25 g dry purslane (ZMB).

Soy (Glycine max): Science News opened the New Year 1999 with high praise for soy. Even the title ³Soy Compounds Help Preserve Bones², disseminates the soy message. Two studies reviewed suggest that soy helps prevent the bone loss that might cause fractures and osteoporosis in the elderly. One (Arjmandi et al.) found that rats in simulated menopause made more bone than they broke down only when fed diets rich in soy proteins, but the authors concluded that "for soy protein to reverse bone loss, long term consumption may be necessary." (Am. J. Clinical Nutrition Dec. 1998). The same journal reported another study that stated the phytoestrogens, mainly daidzein and genistein, "are responsible for the bone sparing effects." How the compounds spur growth remains unknown. The authors suggest soy as an adjunct to, not a replacement for, Estrogen Replacement Therapy. James Anderson, MD, University of Kentucky College of Medicine, and long involved with Food "Farmacy" Research, had much earlier indicated that soy protein may reduce the risk of breast cancer and osteoporosis.

Urinary calcium excretion can be an indicator of bone mineral density and calcium balance. Some people blame the high rate of osteoporosis in the west on the hypercalciuric content of too much animal protein. Compared to animal protein, soy protein causes less urinary excretion of calcium. ³Parenthetically, the isoflavones in soybeans may also directly inhibit bone resorption.² (Messina, 1995). Hudson (1997) says, a bit hyperbolically, that: ³Soy is the only dietary source of daidzein. . .Daidzein is similar in shape to a drug called Ipriflavone which is used in Europe to treat osteoporosis." In fact, the roots of kudzu contain some 25 times more daidzein than soybean does. (Kaufman et al., 1997) Many and more of those isoflavones can be found in several other species of more palatable legumes, thank goodness. And as Tori Hudson hints, ³Much like the drug Tamoxiphen, with a beneficial effect on bone density with simultaneous anti-estrogenic effects in breast tissue, medicinal and dietary phytoestrogens may offer these same benefits.² But Hudson wisely cautions, ³evidence to support the use of botanical medicines that contain phytoestrogens for prevention and treatment of osteoporosis is currently theoretical.² (Hudson, 1997) And the following hints, as do several studies, that some of genistein's effects may be reversed with high doses. Anderson, Ambrose, and Garner (1995) concluded that low dose genistein (1 mg/day, but not high-dose {10 mg/day}-take note supplement manufactures and capsule poppers) acts similarly to Premarin, administered orally at 5 ug/day in the feed for preventing bone loss in experimental rats.

Stinging Nettle (Urtica dioica): As one of our best sources of the androgenic mineral boron, the folkloric aphrodisiac, fluorine and as a good source of calcium and silica, stinging nettle may actually help osteoporosis thru both mineral and androgenic activity. Roger Libby, Ph.D., Sex Therapist, wrote in 1995, that Urtica dioica helps release free testosterone by blocking its conversion to dihydrotestosterone. Clearly Dr. Libby is promoting these herbs, some of which I respect. Hudson (1997) notes that in vitro androgens, like testosterone (lower in postmenopausal women with osteoporosis), stimulate osteoblasts to differentiate and proliferate. Androgen derivatives like anabolic steroids, seem to increase bone density of the forearm, femoral diaphysis and vertebrae as well as elevate total body calcium. Their use may also be associated with protection against vertebral fractures. Patients on a mix of estrogen and testosterone showed increases in bone density (2.5-5.7%), while it remained unchanged in patients on just estrogen. (Hudson, 1997) But if we are to believe that blocking the conversion of testosterone to DHT helps prevent osteoporosis (a mild form of estrogenization), then we should also consider saw palmetto as another good candidate for osteoporosis.

Wild Yam (Disocorea villosa): I close with some words from Dr. John Lee, author of Osteoporosis Reversal - The Role of Progesterone. (Internat. Clin. Nutr. Rev. 10(3): 384, 1990. and his book on natural progesterone): ³Conventional treatment of oestrogen, with or without supplemental calcium and vitamin D, tends to delay bone mass loss but cannot reverse it...Addition of fluoride in doses up to 30-40 mg/day can result (after several years) in a modest increase in bone mass but provides no protection against vertebral fracture and even increases the incidence of non-vertebral (i.e. hip) fractures. Natural progesterone...is synthesized by over 5000 plants (I disagree) and is inexpensively extracted from yams.² (I disagree). He may be referring to steroid precursors like diosgenin, solasodine, etc. (I have no record of progesterone in my FNF database). He rightly surmises that estrogenic hormones like progesterone can help increase bone density and prevent osteoporotic fractures. With topical progesterone for his postmenopausal patients, bone density improved significantly (5-40%) in 97%. Lee strongly suggests women regulate their hormonal balance with natural progesterone from Dioscorea villosa. But alas, wild yam contains no natural progesterone, unless it is spiked.

Dr. Beckham (1995) shares my feelings about "natural" progesterone: "progesterone activity in plants is unlikely although some herbs, such as Vitex agnus-castus, have an effect on luteinising and follicle-stimulating hormones on prolactin." Self-testing, Beckham found that neither internal nor external use of Aletris, Dioscorea, Smilax, Trigonella, Viscum nor Yucca significantly increase blood progesterone levels - at least in post menopausal women.

PHYTOCHEMICALS

Methoxatin or pyrroloquinoline quinone (PQQ), widely distributed in animals, microbes and plants seems to be necessary for normal bone reproduction and skin in rodents. Levels as low as 0.5 to 1 nM will prevent problems in these regards. It inhibits lipid peroxidation at 11 uM. It is an excellent scavenger of superoxide anion and protects heart tissue against reperfusion injury. Beer and citrus juices contain free PQQ. (Decker, 1995)

Warfarin has been reported to effectively treat calcinosis in a patient with systemic sclerosis. Warfarin has been reported to have no effect or an adverse effect on fracture healing. Oral anticoagulant therapy has been reported to have other effects on calcium metabolism and mineralization. Vitamin K can potentially effect urinary calcium excretion. Experimental vitamin K deficiency in rats produces hypercalcuria. In one group of postmenopausal women, 1 mg/day supplemental phylloquinone decreased urinary calcium excretion in that subpopulation that had pre-existing enhanced Calcium excretion ("fast losers") but had no influence on the rest. Though it may be prudent to consider oral anticoagulants as potential risk factors in osteoporosis, data are inconclusive. But in their table 2, they say, "Vitamin K supplementation decreases bone loss and calcium excretion.² (Binkley and Suttie, 1995) Dutch intervention studies (Welten et al., 1995) find that calcium supplementation of about 1,000 mg/day in premenopausal women can prevent the loss of 1% of bone/year at all bone sites except the ulna. A Scottish study (Shapses et al., 1995) showed that short-term changes in calcium but not protein intake alter the rate of bone resorption in healthy subjects. The rate of bone resorption is decreased by a one-gram/day increase in dietary calcium. But at 600 mg day there is elevated bone resorption. More than 50% of adult US females consume less than this. Andy Weil suggests 1,000-1,500 mg supplemental calcium citrate per day.

Although a phytoestrogen-rich diet may help prevent osteoporosis in vegetarian women, the same protection is not conferred to vegetarian males. Vegetarian and Japanese women have a lower incidence of osteoporosis and fractures than women. Coumestrol derivatives have also improved the bone structure in chicks and rats. (Beckham, 1995)

Wallis (1995) reports on the Nurses Health Study of 120,000 nurses. Estrogen is the most effective means of preventing the thinning of the bones that makes older women so vulnerable to fractures. If treatment begins at menopause, it can cut the risk of hip fractures by 50%, and it lessens devastation even when started at age 70. (Wallis, 1995)

NUTRITIONAL:

Increase natural calcium to 800-1,000 mg/day (Conservative Rosenfeld {1991} says every woman should consume at least 1,000 mg of calcium a day beginning in her teens and increase it to 1,500 mg as she approaches menopause.) For so long, the FDA and physicians have told us we are getting enough calcium and that we don't need to supplement. Dr. Robert P. Heaney, MD, tells us in JAMA, that "most Americans are not getting enough calcium". So the story still goes, if your doctor has diagnosed you correctly (and they're wrong more than half the time with Lyme disease) and if you're not deficient in any nutrient ("most Americans are not getting enough calcium", if Heaney is correct); and if there is no unrelated ailment comorbid with your ailment, chances are your physicians silver bullet will help. But if most of us are deficient in calcium, and all herbal leaves contain calcium, your herbalist has a better chance of helping you than your physician's silver bullet (especially if you have incipient osteoporosis).

Heaney summarizes the conclusions of the NIH Consensus Development Panel on Optimal Calcium Intake:

(1) Calcium is important for bone health throughout life.
(2) Most Americans are not getting enough calcium.
(3) The optimal intakes turn out to be higher than we had thought.

Certain foods contain antiabsorbers (e.g. oxalate and phytate) but these are usually already complexed with calcium, e.g. this makes the calcium in rhubarb and spinach unavailable. But the oxalate is also unavailable, and cannot interfere with coingested calcium.. "Of substances tested to date, only wheat bran exhibits residual antiabsorber effects (it decreases the availability of calcium in the milk we pour on the bran). Heaney states that you get 10% more of your calcium if you take it with your meals. Dr. John P. Bilezikian, MD, NIH Consensus Development Panel on Optimal Calcium Intake, replies that the ideal is to get calcium through foods, such as low fat dairy products, broccoli, calcium-set tofu, kale, some legumes, canned fish, nuts and seeds. The panel recommends taking calcium supplements between meals, to minimize its interference with iron absorption for those women with marginal iron stores. (Iron interference occurs for most calcium sources, including milk). Bilezikian reiterates that "Americans of all ages are not getting enough calcium in their diet.² The panel states that optimal calcium intake is an important factor in achieving and maintaining optimal peak bone mass, and in preventing the bone loss that inevitably accompanies the aging process.

Although the role of vitamin D in skeletal maintenance is well known, recent studies suggest that vitamin K may also play an important role. The major source is phylloquinone (vitamin-K-1) of plant origin. Menaquinones (vitamin K-2) are produced by bacteria in the gut. (Binkley and Suttie, 1995) Most (about 60-70%) of daily dietary intake of phylloquinone is lost to the body by excretion, suggesting the need for a continuous dietary supply to maintain tissue reserves. Subclinical deficiencies, while having no effect on hemostasis, may affect bone health. Phylloquinone is ubiquitous in dietary components, but very variable. In cabbage, the outer (greener) leaves contain 3-6 times more phylloquinone than the inner leaves (Shearer, Bach and Kohlmeier, 1996). That¹s why I dice those outer leaves up in my soups, before Mrs. Duke throws them away.

Diminish phosphorus (Anderson's (1996a) research indicates that multiple nutritional factors, including low intakes of calcium coupled with high intakes of phosphorus (and also protein and sodium) may adversely affect the maintenance and retention of bone mass of young adult females. Work on low calcium-high phosphorus intakes by young adult females suggests that the persistence of parathyroid hormone concentration in the high normal range may possibly contribute to bone loss and increased risk of fracture later in life. Andy Weil (Self Healing, Oct. 1996) notes that a high phosphorus diet acidifies the blood, leading to calcium leaching from the bone to neutralize the blood. Weil also cites a study showing that cutting salt intake in half allows retention of 18% more calcium.

In addition plenty of vitamin A (15 mg/day beta-carotene) and C (2,000 mg/day) and D (350-400 IU day) or some sunshine (if not skin cancer prone) are recommended. (Murray {1992} adds 25 mg vitamin-B6, 3 x daily)

Avoid excess thyroid hormones and corticosteroids, and if possible exercise 20-30 minutes 3 times a week. Of postmenopausal women, those who habitually walked more than 7.5 miles a week had leg and pelvic bones 3-4% denser than those who walked less than 1 mile per week. "Since women lose about 1 percent of bone density every year after menopause, the walkers' apparently small gains actually meant they were preserving three to four years' worth of bone strength.² (CRH 8{1}: p. 6)

In this annual update of what's new in modern medicine, Dr. Robert M. Russell, MD, at the Jean Mayer USDA Center at Tufts University, reports a study of postmenopausal 50-70-year old white women which showed that intense strength training preserved bone density at the femoral neck and spine, while increasing muscle mass and strength. With pneumatic devices, the women performed 5 exercises twice a week: abdominal flexion, back extension, hip extension, knee extension, and lateral pull downs. He concludes, "Resistance exercise should be added to the traditional approaches used in the fight against osteoporosis, since exercise will influence not only bone density, but also 2 other major risk factors in osteoporotic fractures: muscle weakness and diminished muscle mass." (Russell, 1996)

ALLOPATHY

Martindale does not index osteoporosis, but there is extensive discussion under sodium fluoride. At the recommended dose, 60-75 mg, up to half of patients experience side effects, especially arthritic and gastritic. "Carefully controlled studies are still required to access (sic) the value of this treatment." (Martindale, 1989).

FOOD FARMACY

Switching back from "light" bread (as my mother used to call the white bread), to whole wheat might have made the difference in my mother, though she held up well until 95. White bread is missing nearly 3/4ths of the magnesium, which is low in 3/4ths of our diets. Added to calcium, magnesium is much more effective at promoting bone density than calcium alone (Duke, 1995a). Two years supplementation with 200-300 mg/day dietary Mg and 250 to 750 mg supplemental calcium appears to have prevented fractures and resulted in a significant increase in bone density in participants, 97% of whom had osteoarthritis of the spine. No side effects were reported. (Sojka, 1995) Whiting (1995) notes that increasing calcium for prevention of osteoporosis to the levels suggested by the 1994 Consensus Development Panel on Optimum Calcium Uptake, i.e. 1,000-1,500 mg/day for adolescents and adults, will contribute to an inhibition of iron absorption, perhaps by 50%. High intakes of dietary calcium will inhibit the iron uptake, if both are taken at the same time. It is recommended that calcium be taken between meals. Japanese scientists (Ohta et al., 1995) showed that mice fed fructooligosaccharides absorbed about 25% more calcium and magnesium than those not given fructooligosaccharides.

High boron foods could help. USDA studies showed that low-boron women, moved to a supplemental 3 mg/day for eight days, lost 40% less calcium, one-third less magnesium, and slightly less phosphorus through the urine. According to Dr. F. Nielson, study director, "Boron had a remarkable effect on indicators that the body is conserving calcium or preventing bone demineralization." (CMR Nov. 9, 1987)

COUNTERINDICATIONS

Avoid alcohol and caffeine, and restrict sucrose. Lay off the booze. Studies suggest that blood levels of an important bone-making compound decrease some 80% within minutes of consuming ethanol. Two drinks a day can significantly increase risk of osteoporosis. (Men's Health, Jan/Feb/1996. p 94-5)

BOTTOM LINE

I try, but often fail, to exercise, moderately vigorously, at least 30 minutes a day, in one 30-minute period or three 10-minutes periods (Of postmenopausal women, those who habitually walked more than7.5 miles a week had leg and pelvic bones 3-4% denser than those who walked less than 1 mile per week.). Surprisingly, I almost concur with a JAMA MD (NIH Consensus Development Panel on Optimal Calcium Intake), who replied that the ideal way to get calcium is through foods, such as low fat dairy products, broccoli, calcium-set tofu, kale, some legumes, canned fish, nuts and seeds. I'd also go for those dark leafy veggies, also rich in boron, fluorine, and magnesium. I'd enjoy my ALA:GLA bean salad, Bone Broth and Genistein Gumbos (for the phytoestrogens), avocado salad for the vitamin D (if I couldn't enjoy the sunshine) and recommend that my wife take even more of them proportionately than I do. I'd take my tea with cloves and clovers, to make sure I was getting a good bit of manganese as well as estrogenic isoflavones.