Author: Contributor

What Are the Effects of Tobacco and Alcohol Use on Bone Health?

 

Whatever a person’s age, the effects of tobacco smoking on bone health should not be ignored. The years from childhood until age 30 should be prime time for building bone mass. Consequently, if an adolescent smokes tobacco, that person probably never will develop maximum potential bone mass. The result will be a smaller skeleton and less bone mass compared to a nonsmoker. Smoking also continues to affect bone health in the individual’s 40s and 50s. Women that age begin to lose estrogen, which is very important for bones. If a woman smokes tobacco after age 40, bone loss is likely to be more rapid — and with more complications.

Heavy drinking is a health risk for many reasons, including its effect on bones. Research shows that chronic heavy alcohol use, especially during adolescence and young adult years, can dramatically affect bone health and increase the risk of osteoporosis later in life.

Tobacco Effects

Research suggests that tobacco use contributes significantly to weakened bones. Smoking tobacco can inhibit the body from using calcium effectively. Also, women who smoke generally go through menopause earlier than those who do not use tobacco. Both situations increase the risk of developing osteoporosis. According to Kathryn Diemer, M.D., professor of medicine and osteoporosis specialist at Washington University School of Medicine in St. Louis, “Nicotine is toxic to bone. The first thing I tell patients who smoke is if you don’t stop smoking, there’s very little we can do for your bones. You counteract all medications when you light up.”

Alcohol Effects

Similarly, regular consumption of more than two alcoholic drinks a day also increases the risk of osteoporosis. Experts believe that alcohol can interfere with the body’s ability to absorb the dietary calcium needed for bone formation. Dr. Diemer cautions, “Alcohol in excess causes about 2% bone loss in a year’s time. Nicotine also causes 2% bone loss. If you’re having alcohol and nicotine both in excess, then the combined bone loss is actually doubled — 8% bone loss overall.”

Summary

For your best long-term bone health, stop smoking now. Seek help from your health care team or from a support group in your community or online if you need additional assistance. At the same time limit or eliminate your alcohol consumption. These changes may seem difficult now, but the long-term benefits will make you healthier and better able to maintain your mobility and bone strength far into the future.

 

Why Do I Need To Limit Salt Intake To Improve the Condition of My Bones?

 

Chronic high sodium intake leaches calcium from bones and thus threatens structural strength over time. How can you best tame the Sodium Monster and protect your bones? First of all, Heidi Skolnik, CDN, a dietitian in the New York City area, recommends limiting the amount of processed foods in your diet. She has found items such as canned or frozen entrees and side dishes to be the major sodium “Bad Guys” for most of her clients. She offers this rule of thumb: consult the package label first. Then, if you find that an item contains more than 20% of your daily sodium value, pass it by.

Steer clear of any packaged food that will raise your total daily sodium intake above the 2300 mg (maximum) recommendation. Researchers have found that for each teaspoon of salt (equivalent to 2000 milligrams of sodium) consumed, considerably more calcium is lost in the urine.

Note: limit yourself to no more than 1500 mg of sodium each day if you have high blood pressure, are African American or are over age 51.

11 Top Tips To Reduce the Risks of Too Much Salt or Sodium Intake

• remove the salt shaker from your dining room table
• reduce the amount of salt used in food preparation; add herbs and spices instead
• in cooking, instead of salted butter or margarine, use olive oil or canola oil as a replacement
• avoid or minimize consumption of the following high-sodium items:
  • most canned or dehydrated soups and bottled salad dressings unless the nutrition label specifically states low-sodium
  • snack foods with visible salt (pretzels, chips, crackers, roasted nuts, popcorn, salted bagels)
  • cheese, especially processed cheese products
  • pickled foods and flavored condiments (sauerkraut, olives, relish, pickles, soy sauce, steak sauce, catsup)
  • smoked and cured meats (bacon, ham, lunch meat, salami, sausage, hot dogs, dried meat/jerky)
• when eating at a restaurant, ask the waitperson to order your dish to be prepared without salt
• avoid most fast-food restaurant offerings or else order special salt-free preparation there
• if you add salt to the food on your plate, never do so before you taste the dish

Can You Eat Your Way to Stronger Bones?

All the bones inside a living body are continually being broken down and rebuilt.  In fact the entire human skeleton is replaced about every ten years. In view of this turnover, what is the role of diet and nutritional supplements in supporting bone strength? Which vitamins, minerals and other nutrients are essential for good bone health? In addition to exercise there are about 20 different nutrients that important to maintain bone health and strength. What foods and supplements are best sources?

Calcium and Vitamin D – Nutrients Working Together

Research shows that adequate intake of both calcium and vitamin D is absolutely essential to strengthen bones and thereby reduce the risk of fractures.

Andrea Singer, M.D., clinical director, National Osteoporosis Foundation, stated in a recent magazine article that getting enough vitamin D through food and sunlight alone can be a difficult challenge. The risk of deficiency is especially critical in the farther northern latitudes during winter months. Dr. Singer notes that a supplement may be necessary, especially then, for some people to bridge the nutrition gap. To optimize absorption, she recommends that you take the full amount of vitamin D supplement all at once with your largest meal of the day. In a recent study at Cleveland Clinic researchers found that such supplemental intake helped boost blood levels up to 50%, even for previously absorption-resistant subjects.

According to a 2016 position paper from the National Osteoporosis Foundation, calcium has the strongest research evidence of all nutrients for its role in supporting healthy bones. With calcium, Dr. Singer states that while it may be good to get the nutrient through food sources, the daily recommendation can be problematic to reach through dietary intake alone. You may wish to consider a calcium supplement here also to make up any shortfall. If so, just remember: with this nutrient, it is always better to take half of your supplement with breakfast and the rest at lunch since it may be difficult otherwise for your body to absorb the full amount all at once.

Intake Recommendation – Vitamin D

at least 600 I U daily (vitamin D3 is the preferred form for supplement) if you are under 70 years old or 800 to 1000 I U if you are older. There is, however, currently some controversy about this calculation by the Institute of Medicine. A 2014 Canadian analysis and a 2015 study by U. S. experts, both published in Nutrients, report a statistical error in the original calculation and suggest that the current recommendation may be too low. For certainty, consider asking your doctor to test your vitamin D blood level. It should be at least 32 ng/ml to support good bone health.

 

 

Intake Recommendation – Calcium

women: 1000 mg/day until menopause or 1200 mg afterwards; men: 1000 mg until age 71 or 1200 mg afterwards

For best results remember, too, when you consume calcium, there should also be vitamin D present at the same time. The two work together synergistically. Components of one increase the benefit of the other. Vitamin D helps your body better absorb and utilize the bone-boosting calcium. Without vitamin D, less than 10% of the consumed calcium is actually absorbed.

Be sure, also, to read the nutrition label on food packages. This way you can check the level of fortification and/or enrichment with both of these nutrients. Remember: Not all versions of the same edible are “created equal“ when it comes to calcium and vitamin D enhancements.
— See sidebar for good sources of calcium and vitamin D and also for high-quality nutrition supplements —

Magnesium

Magnesium is incorporated into the structure of bone, giving resiliency and protecting against fractures. It is also essential for converting vitamin D to its active form in the body. If you include a calcium and vitamin D supplement, be sure to take a magnesium supplement too. High calcium intake causes increased magnesium loss.

Sources of Magnesium

Excellent food sources for magnesium include nuts, seeds, leafy green vegetables, whole grains and legumes.

Intake Recommendation

310 mg/day for females ages 19 to 30 years or 320 mg/day for females 31 and older (including those who are lactating); 350 – 400 mg/day during pregnancy; 400 mg/day for males ages 19 to 30 years or 450 mg/day for males 31 and older

Another Powerful Pair of Nutrients – the B Vitamins: Folate (B9) and Cobalamin (B12)

Vitamin B12 and folate nutrients work together to support bone health by helping to control the synthesis of homocysteine, a compound that stimulates the breakdown of bone. Research shows a clear link between a high level of homocysteine and risk of osteoporosis in older adults.

Sources of Folate

Best sources of folate include leafy green vegetables, broccoli, asparagus and legumes

Intake Recommendation – Folate

400 mcg/day for females (600 mcg during pregnancy; 500 mcg when lactating) and 400 mcg/day for males

Sources of Vitamin B12

For best intake of Vitamin B12 consume plenty of meat, fish and other animal products. Fortified foods including breakfast cereals and nutritional yeast can also make a significant contribution.

Intake Recommendation – Vitamin B12

2.4 mcg/day for females (2.6 mcg during pregnancy; 2.8 mcg when lactating) and 2.4 mcg/day for males

Vitamin K

Vitamin K, renowned mostly for its role in blood clotting, also helps the body to synthesize the protein needed for healthy bone formation. It has a role, too, in regulating calcium in the body by keeping the mineral in bones and out of arteries. Proteins from vitamin K, which are found in bones, work closely with calcium to help promote bone mineralization. Although vitamin D is the main generator of bone-forming cells, vitamin K is crucial in binding these cells together and mineralizing the bond. Not only does it strengthen the bones, but it also helps prevent bone fractures. Women with adequate daily intakes of vitamin K are less prone to osteoporosis and bone fractures later in life.

Vitamin K Research

A recent study compared the effects of vitamins D and K on calcium absorption. Researchers discovered that the two actually work together in a complementary way. Vitamin D appears to stimulate absorption of calcium in the gut. Vitamin K seems to reduce the amount of calcium subsequently excreted during digestion. Combining all three nutrients together for intake at the same time probably offers the very best opportunity for optimal bone health.

Individuals who are vitamin K deficient have repeatedly proven to have a greater risk of bone fracture. The Nurses’ Health Study followed more than 72,000 women for 10 years. The study found that those whose vitamin K intakes were lowest had a 30 percent higher risk of hip fracture than those with the highest vitamin K intakes. Eating a serving of lettuce or other green, leafy vegetable daily cut the risk of hip fracture in half when compared with eating only one serving a week.

Another study included more than 800 elderly men and women participating in the Framingham Heart Study. Researchers found that participants with the highest dietary vitamin K intakes had a 65 percent lower risk of hip fracture than those with the lowest intakes. They found no association, though, between dietary vitamin K intake and bone mineral density.

Sources of Vitamin K

There are two ways to obtain vitamin K. First, some foods contain preformed vitamin K. These food sources include green leafy vegetables like kale, spinach and green leaf lettuce or cruciferous vegetables like Brussels sprouts, broccoli or cabbage as well as fish, meat and eggs (in small amounts). Such foods contain a form of vitamin K called K1 that is the most active form. Second, the bacteria that live in our gut also make some vitamin K in a form called K2, which is slightly less active than K1. Vitamin K2 helps prevent calcium from depositing in arteries (the process of atherosclerosis) and instead directs more calcium to bones, where it helps bind the mineral to the skeleton.

You can meet your need for vitamin K with foods like kale, onions/scallions, Brussels sprouts, broccoli, cabbage, Swiss chard, spinach, collards, soybeans and edamame, asparagus, leeks, okra and pickles/cucumbers. Other good sources include blueberries, wheat bran, olive/soy/canola oils or dried fruits such as prunes. K2 is found in natto (fermented soybeans), cheese, grass-fed meat and liver. Also consider amping up your favorite recipes with vitamin K-rich herbs and spices. Include basil, thyme, parsley and chili powder for a flavor boost.

Intake Recommendation

90 mcg/day for females (including those who are pregnant and lactating) and 120 mcg/day for males

CAUTION!

If you take anticoagulant drugs, do not take vitamin K supplements or increase your dietary intake without consulting your doctor beforehand.

Potassium

Potassium may be more so known for facilitating communication between muscles and nerves or for removing cellular waste. It turns out, though, that the mineral also seems to have a significant role in aiding bone health. It neutralizes certain acids that would otherwise remove bone-building calcium from the body.

Sources of Potassium

Load up on potassium by eating foods like sweet potatoes, white potatoes (including their skins), orange juice and other citrus fruits, bananas, fruits from vines (blackberries, grapes, cantaloupe, honeydew melon), apricots, figs and dates, prunes and raisins. Frequently include milk and yogurt, seafood (clams, halibut, tuna, rockfish, cod), tomato juice or sauce, beans (white/kidney/lima), chickpeas, lentils, split peas, root vegetables (carrots, beets, turnips), winter squash, avocados and greens such as spinach, beet greens and Swiss chard.

Intake Recommendation

adults (18 years and up) 4700 mg per day, breastfeeding women 5100 mg/day

Creatine

In recently published nutrition research (August, 2015) D. Chilibeck based his study on 47 postmenopausal women between the ages of 50 and 64. He suggests that supplementation with creatine combined with resistance training may result in significant improvement in bone density. More research is currently underway to determine the effectiveness of this approach. There are not yet any valid studies on long-term side effects of creatine supplementation. Before you jump onto the creatine bandwagon, you might want to follow future research developments as they unfold.

Sources of Creatine

Strictly speaking, creatine is not an absolutely essential nutrient. About half of the creatine in the human body is endogenously produced, synthesized in the kidney, liver and pancreas from the amino acids glycine and arginine. Creatine is mainly stored in muscles, but about 1.5 to 2% of the body’s creatine is converted to creatinine daily.

The other half of creatine in the human body comes from dietary sources at a rate of about 1 gram per day from an omnivorous diet. Wild game is considered to be the richest source of creatine, but lean red meat and fish (particularly herring, salmon and tuna) are also good sources. Some small studies suggest that total muscle creatine is significantly lower in vegetarians than non-vegetarians, as expected, since vegetables are not a primary source of creatine. Subjects from both populations, though, do show the same levels after using supplements.

Intake Recommendation

The following supplement doses have been studied in scientific research with adult subjects:

• For athletic performance (by mouth): Many different dosing regimens have been used; however, most use a short-term “loading dose” followed by a long-term maintenance dose. Loading doses are typically 10 to 35 grams daily for 4 to 10 days. Maintenance doses are typically reduced afterward to 2 to 9 grams daily.

CAUTION!

Conclusion

Whether you opt to include nutrition supplements, to seek out fortified foods or simply to increase your intake of nutrients from conventional food sources, the choices you make today will have an impact on your bones for years to come.

 

How Can Physical Activity Promote Good Bone Health?

 

Of course you know that regular, weight-bearing physical activity (think: brisk walking, golf, jumping rope, dancing, climbing stairs, hiking or racket sports like tennis, squash and paddle tennis) can help to burn stored fat in order to achieve and maintain a healthy body weight. Have you considered, however, that some of those very same activities can also help to prevent — and even reverse — bone loss in adults? Not only does exercise improve your bone health, it also increases muscle strength, coordination and balance. It leads to better overall health in the longer term.

Weightbearing Physical Activity

QUESTION: How will you know whether an activity is weightbearing?

ANSWER: Your heel strikes the ground (or the floor or the treadmill)!

For best results look for an upright physical activity that forces you to work against gravity. Try workouts that that stress your bones and muscles more than you would otherwise do in your everyday life. Jonathan Ross, spokesperson at the American Council on Exercise, encourages such exercise. He adds a reminder that your program does not necessarily require gargantuan, regimented, daily or prolonged, strenuous work. He says that as little as 30-minute physical activity sessions four or five days a week will help you establish an effective routine.

Even if you now have low bone density, do not despair. You can still move that value back into the normal rage for healthy bones with consistent, well-planned exercise. For best results in sustaining the bone-strengthening benefit of weightbearing activity, over time you will probably need to increase the intensity, duration and amount of stress applied to bone. Get started now, and stick with the program. See the progress you can make with consistent effort.

Choosing Appropriate Activities

There are two types of weightbearing exercise: high-impact and low-impact. This differentiation refers mainly to the force that the exercise exerts against your joints, including your spine and connective tissues like ligaments and tendons. These exercises offer different benefits and pose different risks. There is no rule that you must progress to high-impact physical activity as you get fitter; although, many people choose to do so for an increased challenge or greater variety.

Keep in mind, too, that many programs combine high and low impact exercises into a single workout and that sometimes the line between categories is not clearly drawn. Balancing risk v. benefits of high and low impact exercises can be another great reason to cross train.

Some health professionals recommend that you get at least 175 minutes of moderate-intensity, low-impact exercise or else 90 minutes of high-impact, high intensity exercise per week.

High-Impact

This category includes activities where the body is making contact with — or pounding — the ground. In these workouts both feet leave the ground at the same time. Your bones react to the weight on them by building themselves up and getting stronger. High-impact physical activity includes exercise such as:

• Jogging or running/walking at a very fast pace
• Climbing stairs
• Hiking
• Plyometrics, including jumping rope, skipping and clap push-ups
• Step aerobics
• Tennis or other racket sports
• Yard work, like pushing a lawnmower or heavy gardening

High-impact exercises tend to be more intense overall and therefore burn more calories. They may even strengthen bones better than lower impact options. These exercises, however, are best performed by people who already have a baseline of fitness and are at low risk for joint problems. They can pose a higher risk for injury, especially to the ankle, knee and hip joints as well as the spine. High-impact weight-bearing exercises may not be safe for you if you are in a higher-risk category for breaking a bone.

Low-Impact

Low-impact exercises pose less jeopardy to cause fractures, but they are still able to build up your bone density. Such activities typically require that at least one foot stays in contact with the ground at all times. These options include:

• Elliptical training machines
• Aerobics (low-impact)
• Stair-step machines
• Walking at moderate pace (either outside or on a treadmill machine); race walking
• Rollerblading
• Cardio dance workouts

These exercises are most appropriate for beginners as well as for people with arthritis or osteoporosis, older adults, individuals who are obese, pregnant women and people with bone, joint or connective tissue injuries. Low-impact exercise tends to be less jarring on the body and joints and generally less intense overall. According to the American Council on Exercise, keeping at least one foot on the ground at all times also reduces your risk of musculoskeletal injury.

NOTE: Although they are excellent cardiovascular exercise choices, neither swimming nor bicycling can be considered true weightbearing physical activity. Consequently, they are not as effective as other recommended options for adding bone mass. If your musculoskeletal condition does not allow vigorous weightbearing exercise, though, swimming and cycling can be good alternatives nonetheless. They both do have some limited bone-building capacity without the risks of high-impact activities.

Strength Training

You should also consider adding strength training to your workout schedule at least two or three times a week. Working your muscles matters just as much as building up bone. Lifting weights, using the weight machines at your health club or doing calisthenics — these all are effective forms of muscle-strengthening resistance training, which is essential to bolstering bones. Strong muscles protect against falls. Your lower body functions as an anchor; so, focus on moves that work your legs and thighs.  Squats and lunges are particularly effective.

Strength training workouts can include basic moves such as standing and rising on your toes or lifting your own body weight with exercises like push-ups or squats. You may choose to use equipment such as:

• Elastic exercise bands
• Free weights
• Weight machines

Functional/Non-impact Exercises

In addition you should consider incorporating non-impact exercises to improve balance, posture and movement in everyday activities. These moves do not directly strengthen your bones. They can, though, improve your coordination, flexibility and muscle strength and thereby lower the chance that you’ll fall and break a bone.

You can — and should — do these exercises every day. To illustrate, if you have trouble getting up from a chair or climbing stairs, you probably should be including additional non-impact activities now as part of your daily exercise program. Such activities fall into three categories:

• balance exercises that strengthen your legs and challenge you to improve your equilibrium (reduce your risk of falls)
• posture exercises that improve your carriage and reduce any rounding or “sloping” of shoulders (decrease the chance of fracture to a bone especially in the spine)
• functional exercises to improve your movement and help with everyday activities (decrease your chances of falling and breaking a bone)

Yoga, tai chi, Pilates and balance-building moves (think: standing on one leg) strengthen your core and help you avoid falls.

CAUTION: some of the moves you do in these programs, especially forward-bending exercises, can make you vulnerable to risk a fracture. If you’re interested in such workouts, talk first with your doctor or ask your physical therapist to distinguish between the moves that are safe and those you should avoid.

Advice from the Trainer

Mark Matozzi, C.P.T., an ISSA Tier 3 personal trainer in Chicago, observes that while such functional/posture/balance exercises are important at any age, they become absolutely essential for most of us at about age 45. That is typically the age when cumulative wear-and-tear, progressive aging and changes in hormonal levels can combine to create a “perfect storm.”  At this point a person may become predisposed to injury even from some of the simple activities of daily living.

Matozzi says he typically recommends exercises designed to incorporate task- and context-specific practice in areas individually meaningful to his clients. For example, consider a person whose job requires repeatedly moving bulky or cumbersome objects. The appropriate workout regimen for this person would target towards heavy lifting. If, on the other hand, Matozzi’s client were the parent of young children, then exercise recommendations would differ. Recommended activities would focus more toward moderate lifting and endurance. Finally, if the individual were a marathon runner, Matozzi’s training would aim to build long-distance endurance. Above all this trainer always carefully considers each individual client’s health condition and lifestyle priorities. This way Matozzi can ensure that goals are both realistic and achievable.

Proceed with Caution

If you haven’t exercised regularly for a while, be cautious. Move forward gradually when you undertake a new physical activity program. This advice is especially important if you are currently under treatment for any chronic conditions. Medical problems such as heart disease, diabetes or high blood pressure may need to be accommodated with special activity plans. Also, if you are at high risk for bone fracture or other injury, you probably should strongly consider consulting a personal trainer or a physical therapist to develop a safe, individualized exercise program. This way you can help yourself progress steadily — and safely — toward the goal of optimal bone health.

Do Not Get Impatient

And, finally, please be patient. Even for young adults, the bone-building phase — at its speediest — takes three to four months. It may very well take longer for you if you already have osteoporosis or are older. So, even though you may not be seeing big changes on any bone density tests immediately after your first week of working out, stick with it for the longer term. Bones change slowly, but they DO change.