Food Cures (37 page)

A
ll too often, the first sign of osteoporosis is a broken bone. For my client Janice, it was her wrist. At age 64, her overall good health was the envy of more than one of her close friends—she felt good, looked younger than her age, and regularly saw her internist and gynecologist for routine checkups. Then she slipped and fell in the snow…and osteoporosis, which had been silently developing for years, made itself known.

Osteoporosis is defined by low bone mineral density (BMD), as measured by an x-ray bone density scan. If a scan shows your bone density is a bit low, your diagnosis is osteopenia, or pre-osteoporosis. If BMD is quite low, the diagnosis is osteoporosis. The results of bone density scans are expressed in terms of T scores. Scores ranging from -1.0 to-2.5 indicate osteopenia; less than-2.5 means osteoporosis.

Regardless of the cause, if you have low bone density you’re facing a higher-than-average risk of breaking a bone. If you are lucky, your doctor will recognize some of the risk factors and send you for a bone density scan
before
you have to endure the pain and recovery of a break. Unfortunately for Janice, the first clue was that sickening crunch of her wrist breaking.

When I first saw Janice, she had just started taking osteoporosis medication, but her doctor wanted her to have an intensive nutrition intervention as well. During our first meeting, I found out why she needed my help. She ate terribly, making meals from whatever food was on hand—generally lots of processed foods—without giving a thought to what nutrients she might be missing.

I rose to the challenge. For 90 minutes, I gave her a thorough lesson in osteoporosis, and a comprehensive meal plan filled with food choices rich in nutrients that would help her condition—more about these in the pages to follow. I also recommended that she start taking a calcium supplement with vitamin D
₃
(cholecalciferol, the most potent form of vitamin D). I explained the benefits of exercise, and how to alternate strength training and weight-bearing exercises. I suggested that she walk on the treadmill five times per week, 40 minutes per session, at a speed of 3.5 miles per hour. By the time Janice left, I felt confident that she had all the tools she needed to turn a corner.

Two weeks later, Janice returned to the office with her food journal filled out and ready for my evaluation. She had done nothing! Well, next to nothing. She took the calcium supplements, but she didn’t do any exercise, and, most distressing of all, she had made no changes in her diet.

Janice understood my instructions, but when it came time to implement them, she felt overwhelmed. Embracing a new way of eating meant overcoming the inertia of eating patterns she’d established decades ago. She’d never been that interested in planning and cooking meals anyway. To my eyes—brutal honesty alert!—her eating life was just so
boring
. Every day for breakfast Janice ate a toasted English muffin with peanut butter washed down with a cup of black coffee. Every morning. For years! The thing was, it didn’t matter to her. She ate the same foods day in and day out because it was just easier that way. I have nothing against peanut butter or whole wheat English muffins—that’s a fine quick breakfast—but it didn’t supply her with essential nutrients we all need and it did nothing to help her fight low bone mineral density.

I learned an important lesson from Janice. I know I advised her well nutritionally, but there’s a second, sometimes greater challenge to tackle beyond that—changing a lifetime of apparently harmless eating habits. Janice felt healthy. Janice looked terrific. But all the while, Janice’s bones had quietly been losing mass, becoming thinner and thinner. Breaking her wrist was frightening and painful, but didn’t mean she could instantly embrace a whole new way of eating.

I decided to take another tack. This time I gave Janice three specific goals to focus on. First, I told her she that if she wanted to eat the same foods for breakfast day after day, fine, but she had to switch to foods that would specifically address her needs—namely cereal with skim milk, sliced banana, and a glass of calcium-fortified orange juice. Second, she could eat whatever she wanted for dinner, but she had to eat a high-calcium appetizer. She decided on pre-dinner salad of leafy greens topped with 1 ounce of feta or shredded cheddar cheese and, in signature Janice fashion, ate that every day. And third, before bed, I instructed her to eat a snack of yogurt. Those changes alone gave her four hits of high-calcium, bone-strengthening foods (plus potassium from the orange juice, dairy, and banana; vitamin C from orange juice; folic acid from fortified cereal, orange juice, and leafy greens; vitamin K from leafy greens; and vitamin D from the morning milk). In addition, Janice decided that instead of 40 minutes of treadmill walking, she would walk her dog for an additional 15 minutes per day and join Curves gym with a friend.

At the end of a year, these few changes (with medication) helped Janice do more than arrest bone loss—she actually
increased
bone density in her spine.

Initially Janice was one of the least compliant people I’ve ever seen in my practice. So why am I telling you her story? Because you don’t have to be perfect right off the bat or at every meal to see real results. By the end of this chapter, you’ll have all the tools you need to make your bones healthier. It’s a lot of information. If you can’t do it all right away, that’s perfectly fine. Do one thing. Then do another. Eventually, all those little things add up. But you have to do something—your bones are too important to ignore.

WHAT AFFECTS OSTEOPOROSIS?

Children are taught that bones are like steel girders, the framework of the glorious structure that is the human body. The problem with that analogy is that girders are designed to last hundred of years without losing strength. In reality, bones are more like the interstate highway system—they fall apart, crack, get potholes, and then get patched up again so we can continue using them.

Nor are our bones uniformly dense. The outer layer is called
compact bone
, and it is relatively solid. But just under the compact bone is another layer called
spongy bone
, which isn’t soft, but it is porous, with holes like a sponge or Swiss cheese. And because bone is live tissue, there are also nerves and blood vessels to feed the cells, as well as other structures. Bones also contain specialized cells that help form bone (
osteoblasts
) and break down or
resorb
bone (
osteoclasts
). Osteoclasts and osteoblasts work like little construction crews, constantly remodeling, working to keep the bones healthy and strong. If your overall health is good and you eat nutritionally sound meals, there is a balance—for every bit of bone lost, an equal amount of bone is created.

With osteoporosis, though, more bone is lost than formed. As you might imagine, the spongy bone—with all its holes and slender walls—becomes weak and compromised more quickly than compact bone. Breaks can occur anywhere, but the most common sites are the hip and wrist, which are more likely bear the impact of a fall. The bones of the back (vertebrae) are also affected, but they don’t break…they are crushed. The weight of the body is enough to compress the back bones, causing a multitude of tiny fractures in the spongy bone. Over time people with osteoporosis can become shorter—they lose a little height each time a vertebra compresses.

No one knows definitively what causes some people to develop osteoporosis, but some factors are clear:

HORMONAL CHANGES

Estrogen and testosterone are important for bone health because they regulate bone loss, or resorption. Both these hormones seem to inhibit the formation of osteoclasts (the cells that break down bone), so when hormone levels are high, there are more bone-building cells than bone-destroying cells. If hormone levels fall, the balance shifts, and bone density is lost.

The question, then, is what causes levels of estrogen or testosterone to fall? The most common cause is aging. Men can develop osteoporosis when they get older as testosterone levels slowly decline. For women, menopause causes an extreme drop in estrogen, and their greatest bone loss occurs within the first ten years after menopause. That’s why many physicians recommend that women get a bone density scan when they turn 50 or when they enter menopause, whichever comes first. That first test acts as a baseline. The scan should be repeated one or two years later to get a sense of the rate of bone loss.

Menopause isn’t the only thing that triggers osteoporosis. Unfortunately, I’ve been seeing a lot of young women in my practice, women referred to me by their doctors because eating disorders have begun to ravage their bones. When a woman’s weight drops too low, her hormones get out of whack, her estrogen levels fall, and she stops menstruating. In terms of bone health, a too-thin woman in her 20s looks a lot like a post-menopausal woman in her 60s. The only real cure is for the young woman to gain enough weight to start menstruating again, and then to maximize her bone density while she can—that is, until about age 30, when bone density reaches its peak.

CORTICOSTEROIDS

Corticosteroid medications are used to treat a number of common illnesses, including asthma and some autoimmune disorders. But steroids seem to inhibit the bone-building activity, and may also increase bone resorption. It has been estimated that up to half of all people who take steroids long-term will end up with osteoporosis. Significant bone loss can occur after even a relatively short course of corticosteroids—7.5 milligrams of prednisone for two to three months may require treatment to prevent bone loss.

BODY WEIGHT

Bones get stronger if they get more use. In the earlier stages of life, exercise helps build bone. And as much as it pains me to say it, weight builds bone. When it comes to osteoporosis, thin women have a greater risk than heavy women. Think about it—bones that support a 170-pound woman work harder than bones that carry a 110-pound woman. Studies have shown that lean muscle mass helps strengthen bone density more than fat, but overall weight still contributes to strong bones.

Of course, my advice is not for you to put on a few pounds for the sake of strengthening your bones! Being overweight puts you at greater risk for so many life-threatening diseases that it is never a wise choice. But women who diet excessively to keep their weight fashionably low are hurting their bones, now and in the future.

OTHER DISEASES

Any disorder that reduces the body’s ability to absorb calcium and other nutrients can cause osteoporosis. The most common is celiac disease, an autoimmune disorder that causes the small intestines to lose their absorption capability. Previously thought to be a rare disease of childhood, celiac disease is now known to affect about 1 percent of Americans, and can strike at any age. (For more information, see Celiac Disease, Chapter 18.)

HOW FOOD AFFECTS OSTEOPOROSIS

Next to genetic predisposition, poor nutrition is the most common cause of osteoporosis. Making healthy food choices can help prevent dangerous bone loss, and food is one of the most important treatments recommended by physicians and nutritionists alike once osteoporosis is diagnosed.

GOOD FOODS TO CHOOSE

CALCIUM AND VITAMIN D

When it comes to osteoporosis prevention or treatment, the two most important nutrients are calcium and vitamin D.

Bone is made mostly of calcium. In addition, calcium fuels many other body functions, such as muscle movement, nerve operation, and immune activation. Typically, we get our daily dose of calcium from food. But if your diet isn’t the greatest, your body will use your bones as a lending institution, borrowing the calcium it needs today from the abundant supply in your bones. This creates a kind of calcium debt to your bones. If you eat enough high-calcium foods to keep functioning, any excess will be used to pay back the debt. But if you eat poorly, the debt never gets repaid. While you can skate by for a few years, eventually the debt will catch up with you in the form of weakened, thinning bones.