THE ANTI-OSTEOPOROSIS PLAN
Stephen Holt, M.D., ChB., FRCP (C) MRCP (UK), FACP, FACG, FACN
Physician, best-selling author, New York
Osteoporosis, as manifested in thin or porous bones, has been described as a disease without symptoms. It strikes like a thief in the night, and it robs adults of their health and well-being. The average person and many healthcare givers have thought about bones as inert or inactive structures, but modern science shows us that the bones in our body are highly active and alive. There are 206 bones in the human skeleton that form the framework of our body which allows us to move with agility, but we tend to take our bones for granted, and pay attention to them only when they are injured or diseased. The average person reaches a status of peak bone mass in his or her early thirties. Thereafter, there is a reduction in bone mass density in most people, especially women following menopause.
“The Thief in the Night”
Osteoporosis develops over a period of approximately 20 years from the achievement of peak bone mass to the peri-menopausal (around the menopause) female. Thus, the disease is silent for many years, like the thief in the night, but when it shows itself in broken bones, it causes pain and disability. Clearly, the issue must be to prevent this awful disease which has been inappropriately considered an inevitable consequence of aging. There are ways to decrease the amount of bone loss in many people by a combination of good nutrition and positive lifestyle. It appears that bone loss can be greatly accelerated in women after the cessation of menstrual periods (the menopause). On average, women lose one third of their total bone mass in cortical bones (hard outer bone), and as much as 50% of their trabecular bone after the menopausal period throughout their lifetime.
About 300,000 cases of hip fractures (fractures of the femaral neck) are reported in the U.S. on an annual basis. The striking loss of vertebral bone (trabecular bone) makes spinal column (vertebral fractures) quite common and multiple wedging (partial collapse) of the vertebra can cause the spinal curvature (Dowager’s hump) that is seen in advanced cases of osteoporosis. At least 80% of all spinal and femeral neck fractures are due to osteoporosis. In summary, one quarter of all women over the age of 60 years will sustain a fracture of one or more vertebral and more than one third will fracture their hip (femur). Whilst I have stressed the ravages of osteoporosis in women, men are not immune to the problem of osteoporosis.
Causes of Osteoporosis
Understanding the causes of osteoporosis is a key to preventing and treating thin bones. There is no single cause of osteoporosis. Many factors in our environment or lifestyle will affect the health of our bones and evidence exists that hereditary factors play a role. The slim-built, blue-eyed blonde-haired Northern European woman is a particular risk, and osteoporosis has been shown to “run in families.” Dietary calcium deficiency has gained widespread attention as an important cause of porous bones (osteoporosis). However, other factors, such as estrogen deficiency, lack of exercise, vitamin and trace element deficiency, pollution, excessive smoking and drinking, and a variety of other lifestyle factors may play a role. Drug treatments, including corticosteroids, anticoagulants, diuretics, anticonvulsants, and certain psychoactive medications, may cause osteoporosis. The association of thin bones with a variety of other diseases (e.g. diabetes mellitus, thyroid disease, obesity, chronic lung disease and arthritis) is well recognized.
The Antiporosis Plan
Many distinguished researchers have drawn attention to diet and nutritional supplements for the promotion of bone health and the potential prevention and treatment of osteoporosis. The most important nutrients or botanical compounds that can be used in the effective management of osteoporosis include the following:
High-quality calcium supplements. Calcium supplements of natural origin have been preferred for a variety of reasons, including their make-up and ease of absorption. Novel, new calcium supplements derived from patented technology for processing egg shells give a unique natural calcium supplement that contains 40% calcium by weight. Coral calcium from Okinawa, Japan, has become particularly popular; it is reported that this form of calcium is well absorbed and accompanied by an excellent micronutrient mineral intake that is present in coral. This subject has been reviewed in the book “Barefoot on Coral Calcium: An Elixir of Life?” (www.wellnesspublishing.com)
It is important to take calcium in a 2:1 balance with magnesium in the diet, and high-quality supplements for osteoporosis provide this balance.
Vitamin C is important for the growth and maintenance of supporting structures in bones, and vitamin D (cholecalciferol, D3) is needed for proper utilization of calcium in the diet.
Other elements have been identified as particularly important in bone function, including copper, boron, manganese, and zinc.
Exciting research shows that soy isoflavones may reverse osteoporosis and probably prevent its occurrence. The related compound ipriflavone has particular value in bone-building. Ipriflavone is a natural product that is used as a prescription drug for osteoporosis in Europe.
Horsetail and other natural sources of silica have been repeatedly suggested as valuable in bone-building.
Whilst we recognize these valuable supplements for osteoporosis, they are best taken together in combination (e.g. Antiporosis™). Many bone and joint supplements have not provided adequate calcium, and supplements that can supply 1000 mg or more of calcium daily are particularly valuable for both the prevention and management of osteoporosis. The natural sources of calcium (e.g. egg shells and coral calcium) permit holistic minerals and calcium to be given together in a convenient and natural form.
Lifestyle is extremely important in preventing and treating osteoporosis. Weight-bearing exercise, elimination of substance abuse (e.g. smoking, alcohol consumption, excessive cola and coffee drinking etc.), and a balanced diet are very important components of the “Antiporosis Plan”.
Conclusion
The drug treatment of osteoporosis has been variably successful, and some drugs have extremely serious side effects, e.g. bisphosphonates (alendronate sodium) may cause severe ulcerations and erosions in the upper digestive tract and even peptic ulcers. Some people have commented that the drug treatment for osteoporosis may be worse than the disease. This cynical statement serves little purpose, except to reinforce the importance of lifestyle, nutrition and the appropriate use of dietary supplements in the combat against osteoporosis.
Further information
Holt S, “The Antiporosis Plan,” Wellness Publishing Inc., 2002.
Brown SE, “Better Bones, Better Body,” Keats Publishing Inc., NY, NY, 1996.
Gaby AR, “Preventing and Reversing Osteoporosis,” Prema Publishing, NY, NY, 1994.
www.naturesbenefit.com
____________________________________________________________
NATURAL OPTIONS FOR
BONE AND JOINT HEALTH
BY
STEPHEN HOLT, MD
Thin bones (osteoporosis) and creaky joints (osteoarthritis) seem to be inevitable in later life. Bone and joint health is a key health initiative for the new millennium.
Osteoporosis and arthritis go hand in hand
Arthritis and osteoporosis are major public health concerns that are often resistant to conventional medical interventions. Osteoporosis results in “bone thinning” and weakness of the skeleton. It results in the likelihood of bone fractures, especially of the hip, spinal column and wrists.
Osteoporosis goes hand in hand with osteoarthritis in many people. Osteoarthritis is a disease that effects the integrity of cartilage in joints. Damage occurs to cartilage, and causes irregular surfaces and friction in the arthritic joint. Arthritis results in reduced mobility, pain, inflammation and crepitus (creaking) in joints. Although osteoarthritis is the most common form of arthritis, many other types of more aggressive arthritis can occur, such as rheumatoid disease and gout.
Recent research has implicated nutritional factors as being important in the maintenance of bone and joint health but nutritional treatments have often played a secondary role in the management of creaky joints and thin bones.
A good diet for bone and joint health
A Western diet is characteristically too high in cholesterol, saturated fat and animal protein. The key nutrients that should be present in a balanced diet to promote bone and joint health are summarized in table 1. Lifelong calcium deficiency is a very important, widely accepted cause of thin bones.
Much interest has focused on soy food as a viable, healthy alternative to animal and dairy sources of protein. It is recognized that the inclusion of soy protein (vegetable protein) in the diet may promote conservation of calcium by the body. In contrast, animal protein may tend to increase calcium loss by the body.
A balanced diet for bone health should limit caffeine, alcohol, simple sugar, excessive animal protein, excessive phosphorus, and high salt intake. The role of obesity in the causation of osteoarthritis and osteoporosis is unquestionable. Excess body weight provides stresses on weight-bearing bones and joints. This results in premature wear and tear of the skeleton. Weight control is mandatory for skeletal health. Soy foods and supplements are ideal components of weight reducing diets because they counter some of the negative health consequences of significant weight loss in the obese person. Soy isoflavones (genistein and daidzein) have beneficial effects in building bone and reversing osteoporosis.
Dangerous arthritis medicine
The most commonly used medications for the treatment of osteoarthritis are non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin. The improvement of pain and limitation of movement in arthritic joints is only relieved temporarily by the use of NSAIDs. These drugs may cause serious adverse effects, such as peptic ulceration of the stomach and duodenum, bleeding from both the upper and lower portions of the digestive tract, damage to the liver, and the risk of kidney damages, especially in the elderly.
Scientific studies show that in some circumstances, these drugs are inappropriately used for self-treatment and they may also be overprescribed. Some recent research implies that the use of NSAIDs may actually result in further damage to joints that are already damaged by the arthritic process.
Building bones and protecting joints with supplements
Bovine, chicken, and shark cartilage have been proposed as remedies of natural origin for osteoarthritis and osteoporosis. Most evidence of the beneficial effect of cartilage supplements in osteoarthritis, sports injuries, and osteoporosis has resulted from clinical studies with the shark cartilage product Cartilade®. There are many shark cartilage supplements and these may differ in their origin, mode of manufacture, and quality.
Recent studies by suggests that diets supplemented with soy protein containing isoflavones may be an effective way of preventing bone loss, especially bone loss occurring after the menopause. The mechanism of action of soy isoflavones in osteoporosis may be independent of its ability to mimic the female hormone estrogen in some circumstances. Both bone density and mineral content have been found to increase in the spine of post menopausal females who received soy protein containing isoflavones in adequate quantities. These findings are consistent with the opinion that isoflavones of soy origin are very useful in the maintenance of bone health and perhaps in the treatment of osteoporosis.
Chondroitin sulfate is a natural substance derived from animal cartilage that can be used to treat osteoarthritis. The “fuss” about chondroitin has died down as people began to realize that this compound is abundant in shark cartilage supplements; where it is present in a holistic format with calcium, collagen, glucosamine-like compound and anti-angiogenic proteins (Table 2). Chondroitin is a more expensive supplement than cartilage.
Chondroitin sulfate is believed to help nourish and protect cartilage (i.e. it is chondroprotective) and it is a natural anti-inflammatory agent.
Glucosamine is another protective effects which may assist in repairing the damage to cartilage in the osteoarthritic joint. Several studies support the notion that glucosamine has a “chondroprotective” (cartilage protecting) effect. Again, it should be emphasized that glucosamine-like compounds are plentiful in shark cartilage supplements.
Arthritis is listed among the symptoms and signs that may occur as a consequence of essential fatty acid (EFA) deficiency. There are two principal classes of EFAs that have received much attention as health-giving dietary supplements. These EFAs include fatty acids of the omega-6 series which are found principally in vegetables and in seeds, and fatty acids of the omega-3 series, which are found mainly in fish oil or in precursor formats in flax seed or in soy bean oil. Omega-3 fatty acid intake (fish oil) is important for individuals who consume a typical Western diet. Fish oil are best administered in enteric coated gel capsules to ensure palatability, enhance absorption and reduce the abdominal upset that commonly occurs with fish oil.
Many studies have confirmed the benefit of standardized extracts of the plant Boswellia serrata in the treatment of osteoarthritis and rheumatoid arthritis. Some scientists have referred to Boswellia as a nonsteroidal anti-inflammatory agent but this is not to be confused with standard NSAIDs, such as aspirin, ibuprofen and naproxen, which often cause stomach upset and may produce stomach or duodenal ulcers. Recently, the impressive ability of methylsulfonmethane (MSM) to alleviate pain and inflammation has made this supplement and ideal ingredient for natural bone and joint formulas.
The Ultimate Bone and Joint Supplement©
The combination of chondroitin and glucosamine has been inappropriately described as “The Arthritis Cure” in a book by Dr. Jason Theodasakis and his colleagues. Shark cartilage is a less expensive, holistic natural supplement with several components that confer benefits for bone and joint health (Table 2). However, combinations of several natural agents can be expected to complement each other to provide anti-inflammatory, pain relieving and bone building benefits. An ideal combination of dietary supplements includes a mixture of shark cartilage (perhaps with added glucosamine), omega 3 fatty acids, boswellic acids, bromelain, methylsulfonmethane (MSM) and soy isoflavones. Current experience would support this combination of products as synergistic (additive in effects) and safe. This type of combination therapy may be very useful in arthritis and the rehabilitation of sports injuries.
Conclusion
An optimal diet, together with a well chosen selection of dietary supplements may have more to offer in the prevention and therapy of thin bones and creaky joints than many current anti-arthritic therapies.
Nutrient Comment
Calcium Unequivocal evidence for
benefit in bone health
Fluoride Trace amounts are
beneficial, overinclusion
damages bones
Silica Enhances bone mineralization and
function of bone collagen
Zinc Facilitates calcium absorption and is
necessary for enzyme systems in
matrix building, antioxidant properties
Manganese Essential role in cartilage and
collagen formation in the skeleton
Boron Facilitates calcium and magnesium
utilization and function
Magnesium Facilitates calcium, vitamin D, and
hormonal effects on bones
Phosphorus Combines with calcium in
bones and is vital for many cellular
functions
Copper Facilitates collagen and matrix
synthesis
Soy Isoflavones Striking recent evidence for benefit in
osteoporosis
Vitamins A, B3, B6, C, D, Vitamin D is the most important
B12, K, Folate regulator of calcium and phosphorus
metabolism. Vitamins B3 and B6 are
enzymatic cofactors in collagen
metabolism. Vitamin A is vital in
osteoblast function and regulates
calcium metabolism. Vitamin C is
vital for healthy collagen synthesis.
Vitamin K is necessary for
osteocalcin synthesis, the matrix
upon which calcium is deposited in
bone. Vitamin B12 promotes
chondrocytic and osteoblastic
metabolism. Folate is an anti-
homocysteine, thereby being anti-
osteoporotic and antiatherosclerotic
Essential Fatty Acids Essential for calcium metabolism and
cell membrane function. The ratio of
Omega-3 to Omega-6 fatty acids is
distorted in Western diets. Many diets
are Omega-3 fatty-acid deficient.
Table 1
Nutrients that are required in a balanced diet to promote bone and joint health.
Components Treatment
Calcium and phosphorus This is an ideal, balanced bio-
in a 2:1 ratio available mineral supplement for
bone (it prevents osteoporosis).
Collagen, type 2 This is a nutrient with potential for the
development of the immune
tolerance phenomenon (e.g., for
rheumatoid and connective tissue
disease).
Glycosaminoglycans These are anti-inflammatory and
(Glucosamine-like) immunomodulating agents (used to
suppress inflammation and enhance
immune function with T-cell and
natural-killer-cell, modulating activity).
Antiangiogenic proteins Varying molecular weight
antiantiogenic proteins have been
repeatedly found in shark cartilage**.
The molecular weight of some of
these proteins is such that they may
cross the intestinal mucosal barrier.
These proteins have the potential for
action in many angiogenesis-
dependent diseases e.g., cancer*,
arthritis, skin disease, proliferative
retinopathy, and Kaposi’s sarcoma**.
Chondroitin sulfate, heparan, These substances are regarded as
keratan and dermatan being potentially therapeutic for
sulfates arthritis.
Table 2
Shark cartilage constituents with possible health benefits in several disease states. * The author believes that shark cartilage has been touted inappropriately as a cancer cure. **Cartilade® is the only shark cartilage protected by a world wide patent for anti-angiogenesis.
Supplement Comment
Shark Cartilage Good evidence for benefit
Reviewed in “The Power of
Cartilage”, Kensington
Publishers Inc., NY, NY, Holt S.,
Barilla J, 1998.
Glucosamine (extra) Good evidence for benefit as
described in “The Power of
Cartilage”, Kensington
Publishers Inc., NY, NY, Holt S.,
Barilla J, 1998.
Bromelain Good evidence for benefit in soft
tissue injury in peer review
literature.
Methylsulfonmethane (MSM) Good evidence documented in
“The Miracle of MSM”, Penguin
Putnam, NY, Jacob S, 1999.
Soy isoflavones Bone building as described in
“The Soy Resolution”, M. Evans
Inc., NY, 1998, Holt S.
Boswellia Good evidence documented in
“Boswellin: The Anti-
Inflammatory Phytonutrient,
Nutriscience Publishers Inc.,
Piscataway, NJ, 1996.
Table 3: Stephen Holt’s current view of the ultimate combination of dietary supplements for bone and joint health, February 1999.
Suggested reading:
Holt S., Bone and Joint Health Part 1 - The Optimal Diet, Alternative and Complementary Therapies, 4,2, 101-108, 1998.
Holt S., Bone and Joint Health Part 2 - Dietary Supplements, Alternative and Complementary Therapies, 4,3, 195-205, 1998.
Holt S., The Soy Revolution, M. Evans Inc., NY, NY, 1998.
Holt S., Saleeby, G. Gastric mucosal injury induced by anti-inflammatory drugs (NSAIDs). Southern Med. J 84(3):335-360, 1991.
Holt S., Irshad, M., Howden, C.W., Maneiro, M. Nonsteroidal anti-inflammatory drugs and lower gastrointestinal bleeding. Dig Dis Sci 38:1619-1623, 1993.
Holt S., Barilla, J.R. The Power of Cartilage, Kensington
Publishers Inc., NY, NY, 1998.
Holt S., Gagliardi, G., Fuerst, M. The Shark Cartilage Alternative
for Bone and Joint Health, Keats Publishing Inc., New Canaan,
CT, 1997.
Theodasakis, J., Adderly, B., Fox, B. The Arthritis Cure. St. Martin’s Press, NY, 1997.