LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

bone density

I’ll Bet You Had NO Idea Your Bones were Damaged by this…

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Up until maybe 10 yrs ago, we considered bone as an inactive tissue that our muscles and tendons attached to and allowed us to stand upright.  Boy were we wrong!!

Increasing evidence suggests that bone plays an integral role in maintenance of body weight and is part of the connection between gut health and bone health and weight.  Basically, we now know that, when the gut is inflamed (such as with stress…), the gut produces more serotonin.  This elevated serotonin has a devastating effect on bone mass, reducing the amount of bone we have.

Loss of bone THEN, in turn, affects the fat cells surrounding our organs, increasing our risk of becoming diabetic and increasing insulin resistance.  This particular study suggests the reverse is likely truly–that becoming prediabetic will also work slowly at eating away our bones.

I don’t know about you, but there is absolutely NO way I would not want to take the best care of myself possible.  Anything less releases a maelstrom of devastation on our health.

Gastric Reflux Medications and Bone Damage

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WILL GASTRIC REFLUX MEDICINES HARM MY BONES?  First off, let me say that long term use of drugs that suppress the production of stomach acid is incredibly devastating to your long term health for a variety of reasons.  Shutting down digestion to a screeching halt opens up a Pandora’s box of potential problems that range from diarrhea, constipation, colon cancer, colitis, liver problems, small-bowel-bacterial overgrowth, malabsorption of nutrients and, in this study, fractures.  It is a very rare instance when someone makes too MUCH stomach acid.  Most of the problems that patients experience are actually from having too LITTLE stomach acid.  Supporting digestion can work wonders in most cases, as well as stress mangement (which is what usually starts the problem in the first place).Shutting down digestion to a screeching halt opens up a Pandora’s box of potential problems that range from diarrhea, constipation, colon cancer, colitis, liver problems, small-bowel-bacterial overgrowth, malabsorption of nutrients and, in this study, fractures.  It is a very rare instance when someone makes too MUCH stomach acid.  Most of the problems that patients experience are actually from having too LITTLE stomach acid.  Supporting digestion can work wonders in most cases, as well as stress mangement (which is what usually starts the problem in the first place). Read More

Diabetes , Prediabetes = Osteoporosis? The Funny Math of Physiology

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diabetes and osteoporosis linked
Photo courtesy of https://www.flickr.com/photos/naudinsylvain/

I recent taught a 12 hour CE class on gut to bone to gut on the links between the GI tract, bone and the risk of diabetes.

The links between these body systems are so far outside the realm of how we “treat” in medicine today   as to make medicine appear as up to date as bloodletting and performing surgery with a blood-stained lab coat.

Somewhere along the line the powers that be that control medicine decided that splitting the practice of medicine into specialties was a good idea. Unfortunately, the body has never respected these boundaries. As a result, the chronic diseases we see so often today quite frankly can’t be fully managed by the specialists assigned to treat them.

The endocrinologist does not and could not fully address the cardiology and neurological complaints of a diabetic patient.   The cardiologist does not and could not address the colon cancer developing in a high number of his or her heart disease patients.

This interconnected relationship exists in all systems for all diseases. This particular study does a great job of illustrating this. In it, researchers looked at the relationship between HBA1c (a marker of diabetes) and C-telopeptide (CTX-a marker of bone turnover—higher levels indicate that bone is breaking down faster).

Here’s the important factor: all the women in this study had normal glucose tolerance, meaning that they were not diagnosed as being diabetic or prediabetic.

Despite the fact that these women were not labeled as prediabetic, those with the highest levels of HBA1c also had the highest levels of bone turnover as measured by CTX. In other words, even if you have not (yet) been diagnosed with prediabetes, as you become more and more prediabetic (and ultimately diabetic) you will start losing more and more bone.

How can this happen? It has to do with the hormone osteocalcin. Osteocalcin is a hormone released from healthy osteoblasts (the cells in bone that helps us build new bone) that helps actually acts on abdominal   fat cells to help them fight off diabetes.

While this study finds an association between HBA1c and bone, it does not really give an indication of what direction the association lies. Is prediabetes bad for the bones or does poor bone health increase your risk of diabetes?

While the fact that poor bone health will increase your risk of developing diabetes (through the hormone noted above, osteocalcin), it would not surprise me to find that diabetes is also bad for the bones (not to be confused with “bad to the bone,” which would relate to something else entirely).

The bottom line is that healthy lifestyle changes geared to help with avoiding diabetes are also going to improve bone health and dietary changes to help build more bone are also going to be anti-diabetic as well.

 

Miracle Supplement for Bone or Waste of Money?

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Resveratrol can increase bone density
Photo courtesy of https://www.flickr.com/photos/naudinsylvain/

Coral calcium, Tums, dairy. The list of miracle compounds to increase bone density can be found easily on the Internet.

And if you read it on the Internet, it’s got to be true, right?

Just how many times has it been drilled into your brain that 3 servings of milk, cheese and yogurt per day will make your bones, teeth, nails and nasal hair stronger? Ok, so maybe you missed the nasal hair ad, but you get the point.

So, given all the hype (and BTW, yes the whole dairy = strong bones thing IS way more hype than reality), how can you piece together what’s good for bone health.

Luckily for you, on I’m a plane heading to dreary Chicago as I write this to teach a 12 hour class on the relationships between the gut, bone health and diabetes. So I couldn’t be more brushed-up on this topic.

Let’s get one thing out of the way first. Healthy bones are not about talking calcium supplements. This couldn’t be further from the whole story. Rather, you need to view this in the context of “bone health,” understanding that bone is not an inert tissue that we happen to attach our bones, tendons and ligaments to. Rather, bone tissue is an incredibly active tissue being affected by the health of your GI tract and, in turn, affecting your risk of diabetes. It also plays a critical role in producing immune cells, platelets and red blood cells. Do you really think calcium alone can handle this enormous task?

The list of things playing a positive or negative role in bone health are quite long, but the short list includes:

  1. Optimal levels of vitamin D
  2. Eating a plant-based diet loaded with natural calcium sources like green leafies
  3. Weight bearing exercise
  4. Avoiding drugs that affect serotonin levels (like SSRIs)
  5. Avoiding drugs that block acid production in the stomach (like Nexium)

The long list is enough to take up an entire eBook (which is in the development stages).

So what does all this have to do with this particular article? In it, researchers looked at the ability of a high dose of resveratrol (the protective compound found in red wine from the skin of the grapes as well as from peanut skins) to have an impact on bone density. They specifically looked at 74 middle-aged obese men who were pre-diabetic (Metabolic syndrome, or MetS) because being pre-diabetic is bad for your bones.

Here’s the details of the study:

  • They were given either 1,000 mg or 150 mg of resveratrol a day or a placebo daily for 16 weeks.
  • Bone alkaline phosphatase (BAP) was measured to look for how fast bone was being remodeled (higher = more bone turnover).
  • BAP increased the most with the highest dose (around 4%).
  • The volume of the bone in the lumbar spine increased 2.6% in the high dose group.

Before you go digging around in your “Principles of Bone Density” textbook you’ve right by your side, I can tell you can a 2.6% increase in bone volume in just 4 short months is pretty amazing. And all without breaking a single drop of sweat or drinking liquid from a cow’s udder meant to raise its young to an independent heifer.

Not quite in that same breath I can also tell you that 1,000 mg of resveratrol is a pretty high dose. It’s not that you’d have GI upset or grow a third limb; it’s just that this would be a pricey proposition to increase your bone density.  This much resveratrol, from a good quality source, is likely going to run around $100 / month or more.

Of course, when compared to the cost of drugs used to treat bone density, it’s still a very cheap bet. As way of comparison, the newest drug used to treat osteoporosis, Denosumab (Xgeva), runs about $2,000 per monthly injection. Makes the resveratrol look like quite a bargain.

 

Osteoporosis: Part I. Evaluation and Assessment – (03-22-01)

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Osteoporosis: Part I. Evaluation and Assessment

This is obviously a review on osteoporosis. Unfortunately, in my opinion, it serves as only a very general overview of the topic. Prevention of osteoporosis can be done on many fronts; only a portion of which are noted in the article. Avoidance of animal proteins with replacement with plant and soy proteins, avoidance of carbonated beverages, addition of fruits and vegetables and a high quality calcium supplement. In addition, always mysteriously absent is the urine test for the breakdown products of bone. This simple, non-invasive test has been used for decades in research to determine whether a therapy was having an effect on bone. Any bone density test is incomplete without this test to find out the rate at which you are breaking down bone.

Osteoporosis: Part I. Evaluation and Assessment – March 1, 2001 – American Family Physician

Read entire article here

Weight Loss Program Focuses on WHAT Organ System??

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Ok.  We’ve got a big obesity problem in the US.  And while there are any number of diet plans to try to lose weight, none I’ve come across address this organ system.

The human body does not function in systems.  It’s not like your cardiology system completely ignores your dermatological system, or your neurological system does not ignore the gastrointestinal system.  You get the idea.

So how did medicine ever decide that this was a good idea?  To blissfully think that your heart condition has no effect on your GI tract is dangerous and misguided.  Pretty much every chronic disease has multiple other chronic diseases associated with it.

So how does this relate to this particular article?  Bone produces a hormone called osteocalcin.  Osteocalcin is produced specifically by cells called osteoblasts.  Osteoblasts build bone.  This means that when bone is healthy it will secrete osteocalcin.  Osteocalcin than acts on the beta cells of the pancreas to release more insulin as well as act on fat cells to release an anti-diabetic hormone called adiponectin.  Some research even suggests that osteocalcin has the ability to increase the release of testosterone.

Pretty connected, huh?

But what happens when bone health is poor and osteocalcin levels go down?  Following these connections, poor bone health will lead to abdominal fat, weight gain and diabetes.

Wait…Poor bone health leads to diabetes??

With this as background, let’s go back to this particular study.  Researchers looked at the relationship between osteocalcin levels on fat free body mass and found a clear association.  The higher the osteocalcin levels, the lower the body fat.

Good bone health = lower body fat.

Do you toss the Atkin’s diet book and buy a book on improving bone health (preferably mine, which can be found by clicking here)?

The reality is that improving your overall health will, automatically, improve bone health.  Pretty cool.  But, before you think it’s that easy, you need to know that the presence of inflammation and stress in your gut will result in the release of more serotonin which will slow osteoblast activity.

Pretty connected, huh?

Fitness, fatness, activity as predictors of bone density in older persons – (12-19-02)

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Fitness, fatness, activity as predictors of bone density in older persons

This article may be surprising to some, but really fits right in with research that has been piling up in regards to exercise in our senior population. This study does not show a protective effect of light aerobic exercise on bone mass. This supports the need for weight/resistance training in all age groups. I’ve really began pushing the addition of this type of training in all my senior patients. I do find that the more exercise a patient does as they get older, the healthier, happier and less medicated they are. My favorite story I like to relay is about Jim, a patient in his upper 70′s. He relays how much weight he lifts daily in the thousands of pounds (all added up, it’s not an unrealistic number at all). He has arthritis but never feels it, no medications and is mentally as alert as any fifty year old.

Synergy Abstract

Read entire article here

Osteoporosis and Fractures–Are You at Risk of Breaking a Hip?

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Bone density testing is another one of those tests that seem inevitable as we age, especially for women.  You should always work to improve bone density.  For myself and my office, however, I view bone density as a powerful tool giving us the ability to look into how much your lifestyle is impacting your bone health.

We have a peripheral DXA unit and run bone density testing days in office.  I strongly promote the idea that everyone over the age of 25 should have his or her bone density checked.  Much like everything else in medicine, we normally wait to test until we are more likely to be in the crisis stage.

For me personally, I’d prefer to know if there is a problem decades earlier and make some small changes now rather than drastic changes later.

Beyond this, however, there is a much deeper discussion that I frequently have to have with patients about bone density testing.  I have had patients with very low bone density who have not had a fracture, and clearly there are those who suffer fractures despite good bone density scores.

Further complicating the issue, drugs used to treat osteoporosis like Fosamax and Actonel may raise bone density but don’t always lower the risk of fractures.  But I thought bone density = fracture risk???

The relationship is not so clear.  Actually, bone density alone only accounts for about 25% of your fracture risk.  This means that if you have a bone density test that comes back in the osteoporotic range and your doctor merely writes a prescription for Fosomax or Actonel, he or she has done a great disservice and merely scratched one aspect of fracture risk.

Hopefully, this will soon be changing.  There has been a fracture risk assessment tool developed call the FRAX tool, that is gaining ground as a much better marker of your personal risk of suffering a low impact fracture.  And guess what?  Bone density is only one small factor in this risk.  This particular article delves into the changing dynamic as it relates to predicting your risk of fractures.

So what IS included?  Here’s the list:

  • country  (because some countries have higher risks–ironically, closely associated with dairy intake…)
  • bone mineral density
  • age
  • gender
  • low body mass index
  • previous fragility fracture
  • parental history of hip fracture
  • glucocorticoid treatment
  • current smoking
  • alcohol intake (3 or more units per day)
  • rheumatoid arthritis
  • other secondary causes of osteoporosis

You can see it is a much more comprehensive list than merely checking bone density.  One thing that is not on here that I would add is your overall risk of falling.  A higher risk of falling will obviously increase your risk of suffering a fracture.  Because of this, activities like whole body vibration, yoga, tai-chi and strength training of the legs will lower your risk of a fracture because you are going to lower your risk of a fall.  Pretty simple.

None of this, however, addresses the factor of bone health in general, which I have covered in a previous blog article that can be read by clicking here.

In the meantime, this is a great opportunity to see just how fast your doctors adopt current medical research.  The FRAX tool has been around for some time now, but is clearly gaining ground in its ability to predict your risk of a fracture.  At this stage, the evidence is solid enough to make this tool almost a requirement in a conscientious, up to date on the research doctor’s office.  If your doctor is willing to order a bone density test, but ONLY recommends medications if it comes back in the osteoporotic range without any additional questions being asked, maybe it’s time to move on.

If you have had a bone density test that came back in the osteopenic range (the range that medications should ABSOLUTELY NOT be used), did your doctor recommend medications?