Osteoporosis Bone Health Program

TABLE OF CONTENTS
1. Introduction
2. Risk Factors
3. Foods and Substances to Avoid
4. Useful Foods
5. Essential Nutrients
6. The Role of Curcumin
7. Facts about Fiber
8. The Pros and Cons of Soy
9. Arachidonic Acid, Tofu and Meat
10 & 11. Estrogen and Progesterone
12. What about Estrogen Replacement Therapy?
13. What about Ipriflavone?
14. What about MCHA and Sterinol?
15. Bone Healthy Exercises
16. Summary of Bone Health Program
17. Research on the Health Benefits of Acupuncture on Bone Metabolism
18. Anti-Inflammatory and Pain Protocol
19. References

INTRODUCTION
Osteoporosis afflicts more women than heart disease, stroke, diabetes, breast cancer or arthritis. Fully half of all women between the ages of 45 and 75 show signs of some degree of osteoporosis. During these years women experience a 30 to 40 percent bone loss. Recent evidence indicates that osteoporosis often begins early in life and is not strictly a postmenopausal problem.

RISK FACTORS
• Peak bone mass achieved in adulthood. The larger and denser the bones are to begin with, the less debilitating bone loss is likely to be. Small fine-boned women therefore have more reason for concern than women with larger frames and heavier bones.

• Female gender. Women are at a greater risk than men because their bones are generally less dense from the start and because their levels of bone-building sex hormones decline so dramatically after menopause. Women who have undergone early menopause, late onset of menses in adolescence and periods of amenorrhea or infrequent menses have a higher incidence of osteoporosis. Nulliparity (never having a full-term pregnancy) is also a risk factor.

• Menopause: Low levels of estrogen at menopause is associated with accelerated bone loss in women.

• Low body weight – is associated with accelerated bone loss in women.

• Postmenopausal women and men over 65 – have less efficient absorption of calcium. Increased bone resorption continues as we age and is worsened by a decrease in bone formation in women after menopause. Five to ten years after menopause there is an acceleration of bone loss that slows after age 65 when bone loss occurs at a slower rate.

• Excessive alcohol consumption-promotes bone loss. Scientific evidence links excessive alcohol consumption (seven ounces or more per week) with lower bone mass, increased bone loss and a higher incidence of fracture. Chronic, excessive alcohol intake stimulates the action of osteoclasts, which increase bone breakdown. Alcohol can also act as an enemy to folic add absorption. Excessive alcohol intake can damage the liver. Since the liver plays an integral part in activating vitamin D – which helps boost calcium absorption – prolonged heavy drinking may mean less calcium incorporated into your bones. According to Carl Germano in his book, The Osteoporosis Solution, a modest amount of alcohol, e.g. two glasses of wine per week, may be conducive to bone formation, possibly by augmenting estrogen levels.

• Cigarette smoking – causes lower bone mass. The bone mineral content of smokers is 15 to 30 percent lower in women and 10 to 20 percent lower in men.

• Depression – has been shown to be a significant risk factor for osteoporosis. This is most likely due to the increased levels of cortisol usually associated with this condition.

• Lack of exercise – is one of the primary causes of osteoporosis.

• Deficiencies in calcium, magnesium, boron, trace minerals and vitamin D.

• Family history of osteoporosis.

• Type I, or Insulin-dependent diabetes.  For reasons not yet known, these people are more likely to have osteoporosis.

FOODS AND SUBSTANCES TO AVOID
• Animal protein.  Excessive dietary protein, especially animal protein, may promote bone loss. Animal protein causes an increase in urinary excretion of calcium. Calcium is mobilized from the bone to buffer the acidic breakdown products of protein. In addition the amino acid methionine, found highest in meat, dairy products and eggs is converted to homocysteine, which in high amounts may also cause bone loss. Many high protein animal foods also contain high amounts of phosphorous, which mobilizes calcium from bones in order to maintain homeostasis in the bloodstream.

• According to Germane studies have found that raising protein intake from about 50 grams to 150 grams can double the amount of calcium excreted.  And women who consume more than 95 grams of protein a day have a higher risk of forearm fracture than those whose protein intake is less than 68 grams a day. This is another reason why dairy may not always be the best source of calcium.

• Antacids
.  Using antacids such as Tums as a source of calcium is not useful, since at best it will replace what the antacid is blocking. Antacids can actually deplete calcium levels. It has been shown that small amounts of aluminum-containing antacids increase the urinary and fecal excretion of calcium and inhibit absorption of phosphorus, creating a negative calcium balance. The calcium is excreted instead of being utilized. Aluminum containing antacids can also cause constipation and intestinal blockage.During digestion, the acidic environment of the stomach is critical to allow minerals to be absorbed property. Antacids hinder absorption by reducing acidity. And calcium carbonate – a popular antacid base – doesn’t necessarily provide adequate calcium supplementation because of its effects on stomach acid.  Antacids may also cause rebound stomach acid production, where acid levels rise above normal once the antacid wears off.

• Caffeine
.   Excessive caffeine intake is associated with:1) Increased calcium excretion. In one study adults given 300mg of caffeine excreted more than the normal amount of calcium in their urine.2) Decreased blood calcium levels.3) Alteration in levels of the hormones that influence bone metabolism.4) Increased parathyroid hormone levels, which stimulates bone breakdown.5) Decreased availability of testosterone, which can lead to a higher risk of mate osteoporosis.6) Another study revealed that caffeine is associated with decreased boneminerals in women.A cup or two a day of coffee appears to be safe. And if you’re already at risk of accelerated bone loss, take your coffee with milk.

•  Corticosteroids
.  Corticosteroids, cortisol, coricosterone, cortisone, hydrocortisone, prednisone, dexamethasone) are associated with an increased risk of osteoporosis in 50 percent of people on long-term therapy. In the presence of corticosteroids, calcium absorption and osteoblast activity decrease, while calcium excretion increases. The net results are a negative calcium balance, increased bone breakdown and ensuing bone loss. Studies have shown that steroids can inhibit the action of osteoblasts. They’re also known to lower estrogen levels, increasing the likelihood of osteoporosis.
Dr. Acharan Narula, Ph.D. also observes that if you use steroids the adrenal gland can shut down its own production of steroids. Prednisone, for example, can be a disaster for the entire health. It is, of course, good for emergency conditions. The birth control pill also lowers bone density over the long term.

• Fluoride
. Avoid fluoride in all forms including toothpaste and drinking water. There is evidence that fluoridated drinking water increases your risk of hip fractures by 20 to 40 percent.

• Olestra- has been shown to decrease absorption and blood levels of vitamin D as well as other essential nutrients.

• Refined sugar – may impact the risk of osteoporosis by increasing the loss of calcium from the body and by causing a significant increase in the fasting serum cortisol levels. A serving of refined sugar increases the urinary excretion of calcium.

• Sodium
. High sodium intake can cause an increase in urinary excretion of calcium in some individuals resulting in an overall decrease in bone strength.

• Soft drinks
. A study in children demonstrated a severe impact of soft drinks (high phosphorous beverages) on calcium levels. The more soft drinks consumed the lower the calcium level in the blood. Soft drinks cause the body to eliminate calcium as the phosphates themselves are excreted, even if calcium must be taken from the bones to do this.

• Yeast
. Yeast is high in phosphorus which competes with calcium for absorption by the body.

USEFUL FOODS
• Vegetarian diet A study conducted by The Journal of Clinical Nutrition reported that women who are vegetarians experience significantly less bone loss than women who consume meat. According to Germano women following a vegetarian diet for more than twenty years demonstrated only an 18 percent loss in bone mass by the age of 80, compared to their omnivore counterparts, who experienced a 35 percent decrease – almost twice as high.

• Dark green leafy vegetables such as kale, collard greens, Romaine lettuce, spinach and Swiss chard – are a rich source of vitamins and minerals including calcium, vitamin K and boron.Vitamin K is involved in the mineralization of bone and boron decreases the urinary excretion of calcium and magnesium.

• Soy foods. In animal studies the addition of soy to the diet was able to inhibit bone loss. The soybean protein diet was most effective in preventing bone loss in the lumbar vertebrae and somewhat in the right femur. This type of diet also significantly reduced the abdominal fat in the animal study indicating that soybean protein may stimulate the synthesis of growth hormone which is known to decrease adipose tissue mass and increase bone mass.

• More on the benefits of soy – Besides being one of the richest sources of phytoestrogens, soy is an excellent source of genistein, a type of isoflavone. According to Germane much research has shown that genistein and daidzein, another type of Isoflavone in soy, can successfully treat osteoporosis and other diseases. One study, for example, showed that genistein was as effective as estrogen in helping to retain bone mass. Genistein also inhibits the actins of a certain enzyme that osteoclasts depend on for their ability to act.

• Almonds, asparagus, beet greens, cashews, chard, rhubarb and spinach should be eaten in limited amounts as these foods are high in oxalic add which binds to calcium and renders it unabsorbable. That doesn’t mean that we should give up our greens but just eat them at a different meal than our other sources of calcium.

• Citrus fruits and tomatoes should be eaten in limited amounts as these foods may inhibit calcium intake. It is best to eat them at a different meal other than our other sources of calcium.

ESSENTIAL NUTRIENTS
One of the best ways to prevent osteoporosis and related fractures is to increase bone mass and density with nutritional intervention.

• Boron-reduces the urinary excretion of calcium by 44 percent. It also increases serum levels of 17-beta estradiol which is beneficial to bone health. Dosage: 3 mg daily.  Food sources include apples, carrots, grapes, leafy vegetables, nuts, pears and grains.

• Calcium – supplementation has been shown to decrease bone loss in postmenopausal women. Studies have shown that bone loss can be slowed by simply increasing calcium intake from 400 mg per day to 800 mg per day.Dosage: 1000 -1500 mg daily. (Calcium citrate or malate) Foods high in calcium include: kelp-300-1000 mg per 1/4 cup, collard leaves (cooked)-300 mg per cup, kale-200 mg per cup, turnip greens (cooked) 450 mg per cup, dandelion greens-150 mg per cup, tofu-150 mg per cupshrimp-300 mg per cup, yogurt-272 mg per cup, whole milk – 288 per cup, broccoli-178 mg per cup, sunflower seeds – 70 mg per 1 /4 cup, mustard greens (cooked) -180 mg per cup
CAUTION: Avoid calcium supplements made from oyster shell, purified bone meal and dolomite as these may contain substantial amounts of lead. Instead use calcium citrate and/or calcium malate. Be aware that taking higher doses of calcium may adversely affect zinc absorption.

• Calcium’s essential helpers: 
To maintain adequate levels of calcium in the blood – thereby reducing the chances that the body will steal reserves from the bones – vitamin D and magnesium are necessary. 

• Vitamin D helps turn calcium into bone. Most research suggests a 2-to-l ratio of calcium to magnesium.

 The other essential bone-building cohorts in addition to the RDAs include:
boron (3 to 6 mg), manganese (2 to 5 mg), potassium (630 mg). lysine (50mg), vitamin A (5,000 IU), vitamin B6 (1.6 to 10 mg), vitamin C (1,000 mg), vitamin E (400 IU). vitamin K (65 to 100 micrograms). And calcium maintains a delicate balancing act with phosphorus: when phosphorous levels are excessive, calcium will be excreted.

• Copper – supplementation has been shown in laboratory studies to inhibit bone resorption. Its supplementation is deemed necessary in women at risk or with diagnosed osteoporosis. Dosage: 3 mg daily.Food sources include buckwheat, crab, liver, mushrooms, peanut butter, seeds and nuts, split peas and sunflower and olive on.CAUTION: It is critical to pay attention to the zinc-to-copper ratio when supplementing with copper, since zinc competes with copper for absorption. Ratios of ten to fifteen parts zinc to one part copper are recommended, but it’s not a good idea to exceed 50 mg of zinc for a long period of time.

• Folic Acid – is involved in the breakdown of homocysteine which has the potential to promote osteoporosis if it is not eliminated adequately. Dosage: 400 mcg daily. Food sources include barley, bran, brewer’s yeast, brown rice, cheese, chicken, dates, green leafy vegetables, legumes, lentils, milk and mushrooms, etc. CAUTION: Cooking food destroys folic add. Do not take high doses of folic acid for extended periods if you have a hormone related cancer or convulsive disorder. 

Homocysteine and Osteoporosis: Homocysteine is a harmful substance that has been implicated in the development of atherosclerosis and other diseases, including osteoporosis. The conversion of harmful homocysteine to harmless methionine or cysteine requires several key nutrients including folic acid, vitamin B12 and vitamin B6.

•  Isoflavones –  Isoflavones work like estrogen to promote healthy bones, but do not have its deleterious side effects, especially the potential for cancer.  Dosage: One 100 mg capsule a day.

Isoflavones are natural plant phytoestrogens* found in foods like soy which have been shown to be extraordinarily effective against osteoporosis, and have been shown to help prevent cancer and heart disease. According to Germano, isoflavones, like estrogens, have been shown to preserve bone mass, but unlike estrogen, at appropriate doses are not associated with an increased risk of cancer or other side effects associated with high-dose HRT. In fact, isoflavones found in soy are known anticarcinogens, and may even decrease the risk of cancer.
(*Phytoestrogens are plant chemicals that exhibit estrogen like properties.)

 It is thought that isoflavones work in essentially the same way as estrogen – by enhancing the activity of osteoblasts to build bone, and  decreasing the activity of osteoclasts, which break down bone.

•   Magnesium -is essential for parathyroid hormone (PTH) production and release. PTH is essential for the activation of vitamin D and therefore absorption of calcium across the gut wall.  Magnesium deficiency can be caused by diuretic use, alcohol abuse, diabetes and chronic diarrhea. Magnesium deficiency has been shown more than once to be related to osteoporosis.  Dosage: 500mg daily. Foods high in magnesium include kelp, wheat bran, wheat germ, buckwheat, Brazil nuts, dulse, filberts, peanuts, and millet etc.
CAUTION: Too much magnesium can inhibit the body from absorbing calcium properly because it competes with calcium for absorption in the bone marrow.

•   Manganese-deficiency causes a reduction in the amount of calcium laid down in the bone and thereby an increased susceptibility to fracture. Dosage: 15 mg daily.  Foods high in manganese include avocados, nuts and seeds, seaweed and whole grains.

 •  Vitamin B6 – also plays a role in homocysteine metabolism. Animal studies have shown Vitamin B6 deficiencies to cause increased fracture healing time, impaired growth of cartilage, defective bone formation and more rapid development of osteoporosis. It may also stimulate the production of progesterone and through this hormone’s activation of osteoblasts have a distinct role in preventing osteoporosis.Dosage: 25 mg daily. Food sources include brewer’s yeast, carrots, chicken, eggs, fish, meat, peas, sunflower seeds, walnuts, wheat germ, avocado, bananas, beans broccoli, brown rice and other whole grains.

• Vitamin C – promotes the formation and cross-linking of some of the structural proteins in bone. Animal studies have shown that vitamin C deficiency can cause osteoporosis. Dosage:500 -1000 mg daily. Food sources include berries and green leafy vegetables.

• Vitamin D – enhances intestinal calcium absorption, thereby contributing to a favorable calcium balance. Vitamin D keeps the body’s blood levels of calcium in the ranges needed to maintain essential cellular functions and to promote bone mineralization. It also has potent immune effects in the body. Regarding osteoporosis, vitamin D in its various forms has been shown to inhibit the function of the osteoporosis promoting cytokine, IL-1. If one cannot get vitamin D from sunshine one must obtain it from foods such as fish, eggs, liver and vitamin D fortified dairy products. Dosage: 400 IU daily.

• Vitamin K. – is required for the production of osteocalcin the protein matrix on which mineralization occurs. Osteocalcin attracts calcium to bone tissue, enabling calcium crystal formation to occur. Dosage: 150 mcg daily. Food sources include dark green leafy vegetables. blackstrap molasses, broccoli, Brussels sprouts, cabbage, cauliflower, egg yolks, liver, oatmeal, rye, safflower oil, soybeans and wheat.

  • Zinc – is essential for normal bone formation. Dosage: 30 mg daily. Food sources include brewer’s yeast, dulse, egg yolks, fish, kelp, lamb, legumes, liver, mushrooms, oysters, poultry, sardines, seafood and soybeans.

THE ROLE OF CURCUMIN
•  According to Dr. Narula curcumin plays a major role in bone density maintenance. A study done 10 years ago at the Massachusetts Institute of Technology showed that Nuclear Factor Kappa B (NF Kappa B) is implicated in the inflammatory processes. It is a pivotal factor of chronic inflammation Osteoporosis is a slow form of bone loss – NF Kappa B is a persistent factor that is stimulating it to lose bone density.

• When NF Kappa B gets stimulated, the different inflammatory interleukins get produced. NF Kappa B is present in every cell. When it is stimulated the Response Element sits on DNA and tells the DNA to make RNA, and RNA directs the cell to make proteins such as interieukin-1 and interieukm-6 which are called chemokines or cytokines. They cause bone loss by stimulating osteoclasts. Curcumin inhibits NF Kappa B and it is a remarkable anti-inflammatory agent. Curcumin is not water soluble so it wont likely go into the cells. It will go into the lipid layer of the cell and projects its arm into the aqueous cytosol. (Vitamin E does exactly the same thing.) (Vitamin C is a water soluble anti-oxidant.) Curcumin inhibits NF Kappa B. And because NF Kappa B is involved in bone destruction, as a corollary, curcumin inhibits bone destruction.

• Studies have shown that curcumin can decrease the activity of inflammatory cytokines IL-1 and IL-8• Other references on NF Kappa B are the Journal of Experimental Medicine, Nature Medicine “NF Kappa B and Bone. The  Breaking Point“, and Journal of Molecular & Cellular Biology.

FACTS ABOUT FIBER
• According to Dr. Narula isoflavones are very important for bone density, however, high fiber diets essentially prevent the absorption of isoflavones into the blood stream of the gut. So it is not necessarily good for the elderly to take Metamucil, for example. For constipation he recommends that one eat watermelon and cantaloupe. The red color contains a slight muscular stimulant. Most mitts and vegetables don’t have much fiber. Celery and carrots are high in fiber. High fiber in moderation is OK.

• According to Germano soluble fiber which is found in oats, legumes (including soybeans), apples, and citrus mitts, may enhance the absorption of both calcium and magnesium By slowing the movement of food through the digestive tract, soluble fiber allows greater absorption of nutrients like the minerals needed for healthy bones. 

Insoluble fibers, found in wheat, wheat bran, flax seed, psyllium husks, and other grains, speed the movement of food through the digestive tract and make calcium less available to the body.

THE PROS AND CONS OF SOY
According to Ari Babaknia, MD, soy is good for your bones for the following reasons:
• Studies published in the Journal of Clinical Endocrinology and the American Journal of Clinical Nutrition support the effectiveness of soy for bone health. The positive effect of isoflavone-rich soy foods on bone tissue in numerous animal studies is seen again in recent human studies: Clinical trials funded by the NIH at major universities are showing that after the subjects ate soy foods for several months, they had significant increases in both bone mineral content and bone density.

• Also the incidence of osteoporosis and hip fracture in post-menopausal women in Japan is much lower that that of a comparable population in the West. According to a study published in The Lancet the difference is attributed to soy phytochemicals in the diet. However, according to Tim 0’Shea. DC, soy products are toxic to human metabolism. His reasons for this conclusion include the following:

• Soybeans contain high amounts of digestive enzyme inhibitors which block the function of the pancreatic enzyme trypsin.

• Soybeans contain phytic acid which can cause mineral deficiencies such as zinc deficiency in infants which can lead to excessive iron levels in infants.

• Another unwanted component of soy is hemagglutinin – an agent that causes red blood cells to clot.
• Processed soy can also contain a known carcinogen called lysinoalanine.

• Aluminum is found in some processed soy products. I mentioned the above concerns to Dr. Narula and he said these are issues of concern, but that modern science has found ways and means to remove these substances from the soy.

According to Dr. Narula:
• Trypsin inhibitors are always present in soybean flour, e.g., in soybean health bars or roasted soybeans, but not in the soybean isolate. Soy flour contains very high concentrations of trypsin inhibitors. Trypsin is an enzyme which breaks down proteins.

• Phytic acid is present in every grain, but when you process the soy to make isoflavones the phytic acid is removed. Soy processing involves the following; You take soybeans, soak them in water, throw out the water, grind the beans and boil them. When you boil it all the soluble carbohydrates come into the water and these cause gas and have very strong beany flavor. Soy milk causes gas and colic sometimes in children. In addition to soluble carbohydrates soy milk also contains protein. If you precipitate it then all the protein gets precipitated. If you leave it in the air then an the indigestible carbohydrates get broken down by fermentation in the air. When they are broken down you get tofu. Tofu, however, still has a very high concentration of phytate.In order to get isoflavones you need to treat the soy protein with a mild alkylate solution in order to break down the phytates. You take the soy flour and extract it in alcohol.  The protein is then dried to get isoflavones. Thus the undesirable parts of the soy are removed from isoflavones.

•   According to Dr. Narula hemagglutinin is present in unprocessed soybeans. However, it won’t be present in processed soybeans.

•   He does not believe lysinoalanine is present in high quality soy protein isolate. Soy product which is 70% protein is called soy protein concentrate. Soy product which is 95% protein is called soy protein isolate.

•  According to Germano phytic acid, found in legumes and the outer husk of cereal grains, binds with calcium to form an insoluble complex that prevents the absorption of calcium. You probably don’t need to worry about phytic acid, unless you’re eating a lot of beans or whole grains at the same time you’re consuming your high-calcium foods. Just eat them at a different meal that your other sources of calcium.

•  For more information on soy please refer to the Journal of Nutrition Vol 125, suppl 1995. This entire issue is devoted to soy.

ARACHIDONIC ACID, TOFU AND MEAT
• According to Dr. Narula if you cook any meat protein you will get the same ill effects as when you cook tofu. Meat membranes and fat contain arachidonic acid (AA). Fish does not. And the reason why fish oil is so good is because it modulates the AA in the human body. AA is a two-edged sword. In certain amounts it is absolutely essential. Aspirin, for example, interferes with the production of prostaglandins in the mucosa of the GI tract. The GI tract prostaglandins produce bicarbonate. Without bicarbonate you get ulcers. The HCl needs to be neutralized by the bicarbonate. (Enteric coated aspirin does less damage to the GI tract because it gets dissolved in the small intestine.)

ESTROGEN AND PROGESTERONE
• Estrogen.  When women go through menopause, their ovaries stop producing estrogen. But levels of estrogen begin to start dropping in the mid thirties. This drop in estrogen is a significant factor in the development of osteoporosis. But prevention of osteoporosis must start years in advance of menopause. The adipose tissue in women especially in the buttocks can be a source of estrogen. It is good because estrogen increases bone density.

• Progesterone- is a hormone produced by the corpus luteum that stimulates the action of osteoblasts, which build bone, and also helps decrease the withdrawal of calcium from bones. According to Germano supplementation with progesterone has been found to correct bone loss. While initial reports of progesterone treatment are promising more research is needed.

WHAT ABOUT ESTROGEN REPLACEMENT THERAPY?
The fact is estrogen replacement therapy (ERT) does work. However, here are some reasons why you might want to consider an alternative to estrogen:
 • Some studies have shown that women on ERT for ten years have experienced twice the incidence of breast cancer of women not on ERT. Some researchers,   however, have found no appreciable increase of breast cancer associated with long-term ERT treatment.

• Women on ERT are two to three times more likely to have blood clots in the deep veins of the leg. These blood clots can break loose and cause a pulmonary embolism, which can be deadly.

• Many studies in the 1970’s were peppered with reports of endometrial cancer in women who were taking estrogen alone. Researchers found, however, that when the hormone progesterone was added to the ERT regimen, the incidence of endometrial cancer dropped dramatically.

• According to a study which was reported in The Journal of the American Medical Association March 2001, postmenopausal estrogen use for 10 or more years was associated with increased risk of ovarian cancer mortality that persisted up to 29 years after cessation of use.

WHAT ABOUT IPRIFLAVONE?
• There have been many studies showing that ipriflavone seems to be helpful for increasing bone density. However, a recent study published in the Journal of the American Medical Association,2001;285:1482-1488 concluded that ipriflavone does not prevent bone loss and that it actually induces lymphocytopenia in a significant number of women.

• According to Dr. Narula a study done in Europe which was published in the Journal of Bone Calcification found that before ipriflavone even becomes useful 60% is excreted. The other 40% has to be converted into daidzein. Daidzein itself does not have much of an effect on bone density as it has to be converted into equol to have an effect on bone density. But not all people can convert it into equol. For example, if someone is on a high protein diet it will not allow the conversion of daidzein into equol On the other hand, if someone is on a high carbohydrate diet it will allow it.

WHAT ABOUT MCHA AND STERINOL?
• MCHC or MCHA (Microcystalline hydroxyapatite)  Dr. Mark Percival in Clinical Nutrition Insights, Vol. 5, No. 4.1997, cites a comparison study published in Osteoporosis International in which microcystalline hydroxyapatite concentrate (MCHC) was shown to nearly halt bone loss, whereas the calcium carbonate supplement was shown to reduce the rate of bone loss by only about a half. In another study the MCHC was shown to increase cortical bone thickness by 6.1%. Dr. Narula, however, disagrees. He feels that there is no proof that MCHA is taken up by the body.

• Sterinol – According to Lorna Vanderhaege and Patrick Bouic PhD an overproduction of interieukin-6 causes calcium to be released from bone into the blood. Sterinol switches off interieukin-6, allowing calcium to stay in the bone. Sterinol is a combination of the phytonutrient sterols and sterolins. Foods richest in sterols and sterolins include raw unprocessed nuts and seeds and their oils.

BONE-HEALTHY EXERCISES
• According to the National Osteoporosis Foundation in Washington DC, the following exercises are the most effective in combating osteoporosis: Walking, stair-stepping, hiking, dancing, weight training, jogging, skiing (downhill and cross-country), aerobics (low-impact) and treadmills.Dr. Narula recommends swimming or walking 1-2 miles every day. He says weight bearing is OK but you have to be careful not to put too much weight on the body.Dr. Hudson notes that women who exercise retain bone mass throughout life, achieve greater peak bone mass and have significantly lower risk of fractures in later life.

• Flexibility and balance exercises – such as yoga or tai chi improve balance, coordination and flexibility and give you an ease of movement that reduces your  risk of falling.

SUMMARY  OF  BONE  HEALTH  PROGRAM
1) Regular Exercise. See “Bone-Healthy Exercises” above. Try and exercise 30 • 60 minutes a day, 4 or more times a week.

2) Dietary Recommendations: Refer to “Foods and Substances to Avoid” and “Useful Foods” beginning on the second page of this article.

3) Nutritional Support: See “Essential Nutrients” section.

4) Make sure you have good kidney function. It is in the kidneys that the final transformation of vitamin D into its active form, calcitrol, takes place. This allows the body to form bone and metabolize calcium.

5) Make sure you have good liver function. The liver is responsible for converting cholecalciferol or dietary vitamin D into 25-dihydroxyvitamin D which in turn is destined to be transformed into ifs active form in the kidneys. It is very important to boost your liver function if you’re taking prescription medications or if you have elevated liver enzymes.
The following liver support protocol (modified from Germano) is recommended in such cases:
NAC (n-acetyl-1-cysteine) – 500 mg  
Alpha Lipoic Add – 200 mg
Vitamin C – 500 mg
Selenium -100 mcg  
Curcumin (standardized extract) – 200 mg   
Phosphatidylcholine – 500 mg
Standardized Milk Thistle Extract – 200 mg

RESEARCH ON THE HEALTH BENEFITS OF ACUPUNCTURE ON BONE METABOLISM
• According to one small study conducted at the University of Washington by Kuno and Cerqueira in 1995 a 29 year old man with several years of back pain was referred for a bone scan.  High resolution regional spot images of the skeleton were obtained following intravenous injections of 20 mCi 99mTC-methylene diphosphonate.  Posterior and lateral images of the skull showed focal increased uptake in several regions of the skull. Upon questioning, the patient stated that he had received acupuncture treatment for his back pain several times in the same regions as the increased uptake.  The needle placement was confirmed by the patient’s acupuncturist.  The authors concluded that acupuncture can cause enhanced bone metabolism demonstrated by increased activity on bone scans.

ANTI-INFLAMMATORY AND PAIN PROTOCOL
• Bone is a dynamic organ in a state of constant change between creation and destruction. This dynamic is mediated by osteoblasts and osteoclasts which are regulated by the cytokines released from the immune system. The following protocol which is modified from Germano is recommended whenever there is also inflammation or pain present.  The influence of the following nutrients on the pro-inflammatory cytokines has been shown in animal and culture studies to reduce osteoclast activity – which results in less bone breakdown.
The following are to be taken twice daily:
Vitamin D – 200 IU
Vitamin E – 200 IU
Curcumin – 600 mg
Boswellia Extract – 400 mg
Omega-3 Fatty Adds -1000 mg

REFERENCES

1. Babaknia. Art, MD, “Soy: Pro”, Alternative Medicine. May 2001, Issue 41,  p. 50-59
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3. Brewer, Sarah, MD. The Osteoporosis Prevention Guide, New York: Barnes & Noble Books, 1998
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5. Germano, Carl R.D., C.N.C.., L.D.N., Cabot. William. M.D. The Osteoporosis Solution New York: Kensington Books,1996
6. Hudson, Tori, N.D. Women’s Encyclopedia of Natural Medicine Los Angeles: Keats Publishing 1999
7. Kirschmann, Gayla, J, Kirschmann, John D, Nutrition Almanac, New York: McGraw- Hill, 1996
8. Kuno RS, Cerqueira MD, “Enhanced bone metabolism induced by acupuncture” J Nucl Med 1995 Dec;36(12):2246-7
9. Lee, John R, MD, Hanley, Jesse, MD, Hopkins, Virginia, What Your Doctor May Not Tell You about Premenopause, New York: Warner Books, 1999
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11. Lu. Nan, O.M.D., LAc, Traditional Chinese Medicine. A Woman’s Guide to a Trouble-Free Menopause, New York: Harper Collins. 2000
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14. Narula, Acharan. PhD, Private communication. 7-27-01
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22. Wolfe, H. Lee, Managing Menopause Naturally with Chinese Medicine, Boulder. Blue Poppy Press, 1998

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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-475-1005.