Monthly Archives: April 2010

Bone Density Mistakes

Break Your Bones 2: Bone Density Mistakes

Competency: #5 The Way to Eat

Reference:  Building Bone Vitality by Michael Castleman and Amy Joy Lanou, McGraw Hill 2009

Bone Mineral Density.  It’s how we measure your risk for a broken bone.  We put you under a big machine that takes a snap shot of how many calcium atoms you have in your bone and we call that your bone mineral density (BMD).  The premise of all that is the more calcium you have in your bones, the stronger your bones should be.  It’s an interesting hypothesis.  We even have guidelines to suggest that you should have scans done of your bone mineral density starting at certain ages.  We’ve done millions of them.  DEXA stands for Dual-Energy X-ray Absorptiometry.  They are expensive.  They tell you how dense your bones are.  There is clear evidence that very low-density bones have a higher risk of fractures.

As a consequence, most research on osteoporosis in the last 30 years has switched from fractures to BMD studies.  Theses studies are faster and cheaper to do than fracture studies that require waiting around for folks to break bones.  Unfortunately, they do not study the problem of fractures directly.  They study bone density which is one step removed from what matters to you and me, fractures.   Does doing any intervention change your BMD or does it change your fracture risk?  We have presumed they are the same.  They aren’t.

Here’s the rub.  Castlemann and Lanou review all 141 fracture studies published in the medical literature and elegantly show that the fracture studies don’t support the calcium hypothesis.  What they point out is that of the 141 studies, only 47 studies, or 33%, produce significant statistical results that support extra calcium reducing fractures.   But 75 of the 141 show no beneficial effect on fractures from extra calcium or milk.  That’s a problem.  Research is messy.   But this is a two to one ratio against benefit, over decades of research.  I’ve personally been on the camp of the calcium side, because there has just been so much momentum with guidelines and tests and everyone just doing it.  It seems like the right thing to do.  Besides, the milk industry does very effective advertising.

But is it true?  Maybe we should rethink this again.  We need an alternative hypothesis to consider in a thoughtful way.  Particularly when we realize that there are cultures and societies that have less than 1% of the hip fractures than we do in America.  When the best research we can come up with consistently shows in a ratio of two studies to one that adding more calcium doesn’t do it, it’s time to throw in that towel and figure out just what it is that does do it.

What is the alternative hypothesis?  The alternative is acid and the need for your kidneys to keep your body in acid-base balance when you eat acid.  Where do you get acid from?  Animals.  Next week, we’ll explain how.

WWW.  What will work for me.  The evidence is piling up.  We know that societies that eat more plants have less fractures.  Now we understand the reason.  Acid comes from animal protein.  I need to learn this stuff.   We all do.  Next week, more details.

Drink More Milk?

Topic:  Break Your Bones 1:  Drink More Milk

Competency: #5  The Way to Eat

Reference:  Building Bone Vitality by Michael Castleman and Amy Joy Lanou, McGraw Hill 2009

It’s common knowledge.  You have to have milk or dairy to get calcium and your bones are made of calcium. Right? Our health guidelines suggest that you should have 3 servings of dairy products each and every day to get enough calcium.  In fact, we even encourage you to take a supplement of calcium.  To let you know where I stand, I personally take a supplement of calcium each and every day.  Oops!  I’m changing and will share with you my journey. Here’s why.  The above referenced book is my change agent.  I’ve been reading this stuff for years and this book has finally put all the information in one place.  Read this book, or else the next few weeks of this email.

Here is the evidence.  First of all, if you were to hypothesize that drinking milk was good for you, you would then suggest that the more milk you drink, the fewer fractures you would have.  Turns out to be dramatically not true.  The problem is this.  Women in New Guinea eat 1/40 the amount of milk that Americans do and have 1/50 the amount of hip fractures (3 per 100,000 risk versus 145 for American Caucasians).  That’s a 1500 point gradient.  The same is true at every point in-between.  You can find a virtual linear inverse relationship for the amount of calcium you consume and the risk for fractures.  The more dairy and calcium you consume, the more fractures you have.  The World Health Organization has called this the “calcium paradox” and has been puzzling over it for over 20 years.  That is just plain confounding.  It doesn’t make sense, does it!

What could explain it?  The Vitamin D theory is clearly part of the solution.  We have moved indoors in the last 100 years and our D levels have dropped.  So that is part of the formula.  Taking enough D does reduce fracture rates dramatically.  But it can’t explain the whole phenomenon.  We’ve turned into Wii playing couch potatoes in the last 40 years and stopped playing outdoors.  Our exercise rate keeps going down, so that could be part of it.  Again, not all.  Could it be race?  African Americans have much better hip fracture rates than Caucasian Americans.  But that is countered by the fact that Nigerians in Africa have 1 per 100,000  risk of a hip fracture, much lower than American Blacks (60/100,000).  So, race probably isn’t the whole story either.

I’ve got an attitude about fractured hips and broken bones in the elderly.  My family has had many fractures from falls and including one death from the complications of a broken hip.  Broken bones are dangerous.  We all get to live in our own homes, independent and autonomous until we start to fall.  When we fall, we break things, and that puts us on the road to final decline.  Keeping bones strong is a big priority.  The time to start is now.

WWW:  What Will Work for me?  I have to sort this out. Join me on my journey.  Next week, it will be about the real story.  There is a solution that is right in front of our noses.  I’m going to explain it.   Stay tuned. (Big hint: it’s all about what you choose to eat, and we’ll explain why.  If you want a head start, go buy yourself some spinach.)


How to Change Your Genes, The Science of Epigentics

How to Change Your Genes, The Science of Epigentics

Reference:  Time Magazine, Jan 18, 2010

Competence:  Environment

Well, I get home from work each day and change into my jeans.  That’s not what we are talking about here.  I want you to change how your genes are expressed.  Each of us was only provided with 25,000 different genes.  But did you know that your epigenome might be as big as 25,000,000 change points?  Now, that makes for some variety!  What is your epigenome and why is important for you to understand it?

Your epigenome is all about how your genes are expressed.  Brain cells and blood vessel cells both have the same chromosomes in them, but one is an electrical computer and the other is a pulsing piece of plumbing.  Each express themselves differently.  As simple as it sounds, it comes down to sticking a single carbon onto your DNA or onto the histone proteins that wrap up your DNA and keep it safe.  How you translate your DNA is then managed by how many methyl groups you have attached, where they are attached and how your DNA reading proteins react to them.   What you do in your own life then changes how many methyl groups are added or subtracted.  The implications are huge.

Here are some examples of how we know your epigenome plays itself out.  We know, for example, that the Vitamin D exposure you have as a child sets your risk developing multiple sclerosis when you are thirty or forty, and probably also for insulin dependent diabetes.  We are pretty certain from twin studies with lupus patients that the amount of genetic risk for developing lupus is directly related to the amount of methyl groups attached to the genes that are associated with lupus.  Time Magazine details the story of the first pioneer in epigenetics, Lars Bygren, followed the life stories of Swedish farmers who went through famines in the 1800s.  Their grandchildren were still having an impact on their health based on the amount of starvation and overfeeding that occurred 100 years ago.  The DNA didn’t change, but the way it was expressed played through not just the individual, but through generations.  In fruit fly epigenetic experiments, you can show that it can take up to 30 generations to weed out the epigenetic changes.

Here’s what’s interesting for you and me.  You continue to set how your genes are expressed throughout your life.  The food you eat sets off different genetic responses within hours.  You can alter your methylation just by making sure you get lots of B vitamins, in particular B12 and folate.  What are the foods that give you abundant folate?  Dark green spinach.  B12 comes from meat.  Only.

WWW. What will work for me.  You are not doomed by your DNA.  You can bend it to your will.  You can express your genes within your lifetime, one way or another.  The food group most strongly associated with longevity is leafy dark green vegetables.  Have some spinach for dinner tonight!  Methylate away.