Polycystic Ovary Syndrome

According to some research, polycystic ovary syndrome (PCOS) has affected 1 in 15 women over the earth. 1 It is characterized by increased insulin levels as well as increased androgens which affect a women’s skin (including acne and hirsutism-increased hair growth), weight, reproductive system, and can put a woman at a higher risk for diabetes later in life. I’ve seen first hand how this can affect women and wanted to offer a few suggestions for relief.

The primary cause of PCOS is still unknown. It is attributed to environmental factors, possibly dysfunction in the hypothalmic-pituitary axis, or possibly from abnormal insulin activity. 1 I personally believe all of these probably come into play to some degree and are all related. Environment is probably the hardest of these factors to change because you literally have to live somewhere else which may not be possible. Lifestyle is the factor that can be the most readily changed depending on the motivation of the person doing the change.

There are a couple of things that are important and should be discussed. Seeing as how PCOS is a problem characterized by insulin problems it is necessary that a woman get a strong handle on what is going to increase and decrease her blood sugars. Junk carbs (refined carbs-white bread, most anything that comes in plastic, junk food, food with added sugar) and excessive use of carbohydrate should be avoided. I think most people know this but I said it anyway. Repition is important to learning! Eating lots of processed food also has the downfall of usually having junk fat in them too. Soybean oils, sunflower oils, corn oils and others that are man made should be avoided.

Another important thing to remember is that even though one can change his/her lifestyle, it may still take time to make the changes in the body. Some may come more quickly than others, patience and perseverance are important when tackling something like this.

I want to discuss a couple of supplements that may be beneficial if you are suffering from PCOS. I want to make it clear though that although they have been shown to be beneficial, a lifestyle/diet change is the most powerful thing a person can do long term, especially since these supplements are a little pricey.

Myo-inositol

The first supplement is myo-inositol (referred to as inositol for the rest of this article series). It was once considered of the B-vitamins but it can be produced by the body. Apparently inositol and d-chiro-inositol (another form) have insulin-sensitizing capabilities.2 3 This has shown to be helpful for women with PCOS. Lets take a look at the studies.

The first looked at women with oligomenorrhea or amenorrhea (infrequent or completely absent periods) gave them 2gm of inositol and 200mcg of folic acid twice daily. The women were followed for 6 months. 18 women maintained ovulation during the 6 month follow up and 10 pregnancies resulted. There were 2 spontaneous abortions. Not bad, the only real big problem was this study was placebo controlled so we don’t know if there would have been a significant difference if compared to women on placebo. 4

In another uncontrolled study, 46 women were given the same regimen as above plus 3mg melatonin/day. These women had undergone in-vitro fertilization but due to poor oocyte (egg) quality were unable to conceive. After being treated with the inositol, oocyte quality improved and 13 pregnancies occured. Four resulted in spontaneous abortion. 5

46 women with hirsutism were given inositol in another study for 6 months. Several labs were compared at 6 months with baseline in each women. Hirsutism decreased significantly after therapy. Total androgens (like testosterone), FSH and LH (hormones that stimulate sex hormone production) concentrations decreased while oestradiol concentrations increased. Insulin resistance was significantly decreased after therapy.6

In yet another study 47 women were randomized to placebo of folic acid and 45 women were given 4gm inositol and 400mcg folic acid daily. Ovulation frequency in the treatment group was significantly greater than placebo, 25% vs 15%. The effect of the inositol was rapid according to the researchers. Leptin levels were also reduced. There was no difference in fasting glucose concentrations or insulin levels between groups but leptin levels were decreased in the treatment group.7

D-chiro-Inositol (DCI for this article)

This is the other form of inositol that appears to have benefit for insulin sensitivity. Lets take a look at some of the studies for this form.

Researchers looked at 44 obese women, 22 randomized to placebo and 22 were given DCI at 1200mg/day, for 6 weeks. Testosterone, blood pressure and triglycerides were measured during this time. All 3 endpoints decreased significantly in the DCI group, but no change was noted in the placebo group. It is also noteworthy that 19 of the 22 women in the DCI group ovulated, while only 6 in the control group ovulated. 8

In a placebo controlled trial, 10 lean women were given 600mg DCI daily and 10 other lean women were given placebo. They were followeed for 6-8 weeks. Plasma insulin after an oral glucose test was reduced in the DCI group and remained the same in the placebo group. Free testosterone was reduced by 73% in the DCI group and 6 women in the DCI group ovulated while only 2 did in the placebo group.9 It’s really too bad that this study was only 20 women. But they are positive and should give us a good reason to try this in a larger population.

Women with PCOS appear to excrete DCI at a higher rate from the kidneys than women without PCOS. Researchers looked at 26 normal women compared with 23 women with PCOS and measured the output of DCI and inositol. The DCI was excreted at about 6x the rate in PCOS as normal controls. Inositol appeared to have no significant difference, although I must admit I’d be interested to see what it would be if they population they looked at was larger. 10

Buckwheat

Buckwheat

Buckwheat farinetta is a more natural source of DCI for those that are interested. I’ve read that certain brands can have 600mg per 1/2 cup. I can’t substantiate those claims but it may be an alternative for those who don’t want to buy supplements and would rather use food. Since I can’t tell you exactly how much DCI is in every cup I can’t recommend any particular recipe. But the brand Buckwheat Farinetta is reported to have the level I just listed. So a batter made with 3 cups of that flour that yields say 12 muffins would give you a total of 300mg per muffin. So you’d need to eat 2-3 muffins a day to get a dose around what the studies were using. So some food for thought.

I hope this information is useful because I know of the heartache some couples have had in trying to conceive with this problem. If you have an experience with d-chiro-inositol or myo-inositol please let me know. I’d love to hear if it has been useful to you.

CIAO

1.http://www.sciencedaily.com/releases/2007/08/070831204314.htm

2.Corrado, F., et al. “The effect of myoinositol supplementation on insulin resistance in patients with gestational diabetes.” Diabetic Medicine 28.8 (2011): 972-975.

3.Larner, Joseph. “D-chiro-inositol–its functional role in insulin action and its deficit in insulin resistance.” Experimental Diabetes Research 3.1 (2002): 47-60.

4.Papaleo, Enrico, et al. “Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction.” Gynecological Endocrinology 23.12 (2007): 700-703.

5.Unfer, Vittorio, et al. “Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte quality: a prospective, longitudinal, cohort study.” Gynecological Endocrinology 27.11 (2011): 857-861.

6.Minozzi, M., G. D’Andrea, and V. Unfer. “Treatment of hirsutism with myo-inositol: a prospective clinical study.” Reproductive biomedicine online 17.4 (2008): 579-582.

7.Nestler, John E., et al. “Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome.” New England Journal of Medicine 340.17 (1999): 1314-1320.

8.Gerli, S., et al. “Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS.” Eur Rev Med Pharmacol Sci 11.5 (2007): 347-354.

9. Iuorno MF, et al. “Effects of d-chiro-inositol in lean women with polycystic ovary syndrome” Endocr Pract. 2002 Nov-Dec;8(6):417-23

10.Baillargeon, Jean-Patrice, et al. “Altered D-chiro-inositol urinary clearance in women with polycystic ovary syndrome.” Diabetes Care 29.2 (2006): 300-305.

Case Closed on Vitamin Supplementation?

VitamindA couple new studies came out recently looking at the effects of vitamin supplementation on heart disease. You can find one of the abstracts to the article here: http://annals.org/article.aspx?articleid=1789246

A second looking at cognitive function is here: http://annals.org/article.aspx?articleid=1789250

The third about cancer is here: http://annals.org/article.aspx?articleid=1767855

An article decrying their use can also be found here: http://annals.org/article.aspx?articleid=1789253

The authors in their title say, “Stop wasting money on vitamin and mineral supplements”. Pretty strong words. The question is though, do they have a point? Should we really stop taking all those supplements and give up on vitamins?

From reading only the abstract of the first linked study they gave a multivitamin w/minerals to people who had recently had a heart attack. They were followed for 5 years and then tallied up CV events to see what happened. The conclusion was that they didn’t do anything. They did mention adherence was poor in both vitamin and placebo group and was a limitation of the study. This is yet another study that is adding to a body of research condemning vitamins and minerals to scientific research death. At least that what the spin is that is being put on this.

The second looking at cognitive function. They sampled 5947 male physicians aged 65 years or older and gave them multivitamins or placebos. During the following years they assessed mental and cognitive function through phone calls. The observed no difference between the 2 groups. The authors noted,

“Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin”.

I think this is a point worth discussing in a minute.

The third was pooled results from multiple studies looking at the incidence of heart disease and cancer with different vitamins and multivitamins. The only positive outcome was that there was a small decrease in cancer rates in the multivitamin group but only for men, not for women. Of note was that folic acid seemed to decrease mortality, albeit non significantly and increased cancer incidence. That is probably a post in and of itself.

So the conclusion of these studies is that vitamins don’t seem to do a whole lot other than put people’s money in the hands of companies that make them. I think there is some truth to this but we have to look at it in context.

Limitations

For starters, the first 2 studies were done in doctors. Socioeconomic status does seem to correlate very well with health. 1 Not to mention doctors have access to other doctors more readily and are able to pay for things that people who make less would be able to buy, like a monthly prescription every single month. I’m not trying to dog on doctors here, just pointing out that at looking at such a specific population you can’t infer those results to the rest of humanity.

The first team admitted that many of the subjects didn’t take the vitamins as prescribed. They state,

“Many people in both groups stopped taking the pills, did not take the pills as often as they were instructed, or stopped participating in the study before it was planned to end. Therefore, it is harder to draw firm conclusions about what high-dose multivitamins and minerals may do.”

This is kind of a big deal. If people aren’t adhering to the prescribed method of treatment the power to detect differences will crumble. This raises questions too. Did the doctors feel that the vitamins were worthless to begin with and had no confidence in their use as beneficial? Could the doctors detect if they were given placebo? Did the doctors feel that medicinal treatment was enough? I don’t of course know the answers but if the authors are will to list this as a limitation then we should be asking these questions and think about how they might affect the outcome.

The second study lists the following as a limitation,

Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin.”

Are vitamin doses too low? Possibly. This is a common complaint of vitamin advocates. Is the claim founded? I don’t know. I don’t have access to the data. My guess is that if a common multi was used then many advocates will say that the doses were probably too small. Then there’s the question of synthetic vitamins vs naturally occurring vitamins. Again I can’t answer this. Many will say it doesn’t matter, that they are both equally useless, while advocates will claim there is a big difference.

The other part of this claim is that the population, doctors, may be too well nourished to receive a benefit, in essence that they weren’t deficient to begin with. This is a valid point. If you have no insufficiency then giving something you already have is like trying to reinforce concrete that’s already reinforced. You might make it a bit stronger, but not significantly.

Another question in this particular case is whether or not the nutrients found in typical multivitamins would affect cognition anyway. Specific fats and cholesterol are needed and not present in your regular multi. Plus there are other known factors such as heavy metals and inflammation that lead to cognitive decline. Are these addressed in a multi? No.

In both cases we know nothing of lifestyle of these doctors. Do they have a standard american diet? Do they exercise regularly? What is their intake of polyunsaturated fats and processed junk? I don’t know but they are relevant questions to both heart disease and cognitive decline. In some cases it’s possible to conclude that if there is a lot of other factors like inflammation that was accounted for both diseases, then using a multi would be like trying to rebuild a sandcastle while the tide is coming in. Every time you build up a wall the tide just washes it away. In this case no amount of any vitamin is going to stop the degradation of either the heart or the brain. In these cases the offender must be removed before healing can occur.

The opposite argument here is that if the doctors were all indeed in decent health or at least had sufficient raw material (good nutrition) then a multi also do nothing in this case. It’s the whole “if you’re not deficient then you don’t need more” argument against vitamins. This is a valid argument and one that I would argue as well. Food should be the primary source of nutrients for the body. Humans weren’t meant to live on crap and get nutrition from pills. Genetics and individual variation play a part in what one might need but overall it should be what type of food goes into the mouth that produces health. That leads to the next point which was brought out in the limitations.

veggiesNourishment

Are you well nourished? I can’t answer that but taking a multi may or may not take care of a deficiency. If a person is any kind of health conscious and have done some research they tend to find that eating whole unprocessed foods is ideally the way to go. But even when one is eating the best they can, depending on where they get their food or where it was grown, or depending on environmental factors or stress there may be a lack or overuse of one nutrient or more. Covering that with a multi is probably a little much and you may not even be covering the right one. Nutrition is also a growing science and we are understanding more and more as time goes on, especially the interplay between different nutrients and how those usually are packaged together in whole food. Eating the whole egg for example instead of just the white or eating a little liver from time to time with the meat. Cod liver oil has both vitamin D and A which need to go together. Plants have hundreds of phytonutrients that are beneficial and use each other in the body to produce health. Separating them out into a few constituent components like in a multivite is not necessarily going to produce good health.

On the flip side of that coin is the fact that sometimes it’s hard to get the nutrients you need. Living in the Pacific Northwest, I’m vitamin D deficient if I don’t use a supplement. Right now in December we’ve had some beautiful sunny days, but no matter how naked I am and no matter how long I stay in the sunlight right now, vitamin D just isn’t going to be produced. I have to get it some other way. Vitamin K2 is also in short supply in the western diet, unless you know where to find it. You can use a supplement or you can use butter oil and grass fed milk and butter and cheeses. CoQ10 levels drop as people age and unless you are eating a lot of heart from animals you probably aren’t getting any significant amount from your diet. Maybe you don’t have enough selenium or zinc because of dietary deficiency or  because of dietary choice, such as veganism or eating strictly a protein diet, neither of which I think are useful except in short periods of time and for a specific purpose.

Purpose

This is the crux of what supplements should be used for. When somebody asks me what multivitamin they should take I ask them what the purpose of using one is. I’d say in a great deal of people a multi probably isn’t needed. A lot of what is probably needed is to correct the deficiency. In some cases more may be needed. In others like in schizophrenia it may be a dependence on a vitamin that requires its continual use, in this case vitamin C and Niacin.  So ask yourself, what is the point of using a multi? Can I correct the problem with my diet? Is it a narrow problem that only needs a few nutrients acting in synch or it is more comprehensive then that?

The unadjusted numbers in the first study did show that there was a small reduction in cancer rates using the multi. Could this be done using better nutrition? I think so. Some people may need that multi to help prevent or treat problems, but I’m willing to bet that the majority should correct their life and their diet and then see what is needed. Vitamins have a purpose, I have no doubt about that, but they must be used with a specific purpose in mind. Throwing a whole bunch of synthetic vitamins at a vague problem probably wont’ solve anything, as evidenced by these studies. Remember that a “one pill to cure them all” mentality won’t do a whole lot but focusing down a problem and treating the problem or problems is a much better use of time and resources. I use some vitamins like Cod Liver Oil/Butter oil and I use it for a specific purpose along with some vitamin D. The rest I try to accomplish with food, covering other things as needed. What do you think?

CIAO

1.Adler, Nancy E., and Joan M. Ostrove. “Socioeconomic status and health: what we know and what we don’t.” Annals of the New York academy of Sciences 896.1 (1999): 3-15.

Gingerly Attacking the Flu

gingerGinger is a treatment that has been used for a long time for a variety of things. Some can use it for nausea and vomiting, especially in pregnancy. It has also been used as a digestive aid and anti-inflammatory.

Today we’ll look at its effect on the immune system and how that affects flu and colds.

In a study looking at fresh ginger and dried ginger, researchers used assays to see if human respiratory syncytial virus (HRSV) would cause plaque formations in respiratory mucosal cell lines. In short the fresh ginger seemed to work by decreasing the plaque formation. Ginger also decreased viral attachment and internalization and higher concentrations could stimulate IFN-beta to possibly counteract the infection. 1

I think it’s important to remember that fresh ginger and not powdered ginger is what worked. This makes sense because in fresh foods there are chemicals that are active that disappear over time and will make the treatment ineffective. Garlic is very similar. Allicin in garlic is present in fresh garlic when the garlic is crushed. This goes away when dried and may be one reason why dried garlic doesn’t seem to work well in the studies of them.

Speaking of….

Garlic is another thing you can do to help prevent the flu or colds. In a Cochrane review of garlic they concluded that people that take garlic regularly have fewer incidences of colds then controls. It was a small trial they reviewed because many others didn’t meet their criteria. 2

So what do we do with this info? A few things.

First for Ginger

If you think you might be getting a cold or the flu, get some ginger, a lot, and juice it. If you don’t have a juicer then cut it up and make some tea with it. If you have the juice you can mix it with some lemon and maybe a little honey. Sip on that for a few hours, don’t down it all at once. Make some more when it’s gone and do that for a day or two. You’ll feel better. It is quite strong.

And for garlic

garlicTake a small clove and crush it. You can chew it if you want but like the ginger it is quite strong. Swallow whole or minced. If your stomach is sensitive then have it with some food. Just make sure it is crushed in some way. Don’t used pre-minced garlic. Make sure it’s fresh. The only two side effects I can think of for this are upset stomach (so take it with food if it causes this) and of course garlic odor. This is better to do as prevention than treatment in my opinion and based on the study but you could certainly use it for treatment. The most important thing is that you start right away. Don’t wait 48 hours and then decide you should try something. The sooner you can prevent more viruses from adhering and spreading, the faster you’ll be able to nip those nasty viruses in the butt.

 

Rest

If you feel like a cold or flu is coming on, get some rest. I know some people can’t avoid going to work or doing other things in life you just have to do, but if you can, lie down and sleep and relax and let your immune system do its thing early rather than stressing it for another 12-15 hours during the day. Remember that stress is a killer of you, not the flu.

Enjoy your winter season wherever you are and remember to stay safe from flu and colds.

CIAO

  1. Chang, Jung San, et al. “Fresh ginger (< i> Zingiber officinale</i>) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines.” Journal of ethnopharmacology (2012).

http://summaries.cochrane.org/CD006206/garlic-for-the-common-cold

Smacking Down Influenza

fluThe flu is a royal pain in the butt! I mean ROYAL! Anyone that has had it will know this is true. It is the beginning of flu season. I’ve been seeing cases in the pharmacy and people are coming to get their Tamiflu to help stop the flu in its tracks. Another problem during this season is colds. Viruses are flying everywhere and susceptible people are getting hammered. What can we do? Plenty.

First, about Tamiflu. For starters it is plenty expensive and the best it could do in a Cochrane Review was a reduction of symptoms by 21 hours. Now I know 21 hours is a day for a person and that can make a difference for some, the problem is the Cochrane group found no reductions in hospitalizations or transmission of the virus. That means whether you get the drug or not, your chances of going to the hospital are the same and from what we can tell now your chances of spreading it are the same.

On top of this much of the data for anti flu medications like Tamiflu (oseltamavir) have not even been published. According to the Cochrane group,

“We identified that a large number of studies, including data from 60% of the people who have been involved in randomised, placebo-controlled phase III treatment trials of oseltamivir, have never been published. This includes the biggest treatment trial ever undertaken on oseltamivir that on its own included just over 1,400 people of all ages,” noted Jefferson. “We are concerned that these data remain unavailable for scrutiny by the scientific community.”1
In other words, they’ve done a bunch of trials and aren’t publishing them. What gives? Maybe it’s not as effective as they claim, but without the trials we really just don’t know.

So if you’re wanting other ideas for dealing with the flu this wintery season, here are a few tips.

Wash Your Hands

You’ve all heard this and it’s true. You need to wash your hands regularly, especially around meal times. If you’re in a public place and touch a doorknob or handle or anything else somebody has touched, wash your hands. It really does help.

Get plenty of Vitamins

A diet rich in vitamins, especially A, C, D and minerals like zinc can help quite a lot. All of these are important for proper function of the immune system. Cod liver oil is great for A and D. C is easily obtained through fruits and leafy greens that haven’t been cooked. Vitamin C does help reduce the risk some according to the Cochrane group. 2  I would go with at least 1-2 grams a day and if you think you’re starting to get sick then up it to 1gm every hour or two until loose stool. Anytime I’ve ever had a cold this has help tremendously.

Get rid of the junk

Sugar and refined garbage will weaken your immune system and put you at risk for infection. Eat whole foods that aren’t refined and keep plenty of greens and good fats in your diet. This probably is one of the most important things to do.

Reduce Stress and Rest

Lack of sleep and a hectic schedule will increase your stress hormones and impede immune function. The best is to reduce stress and get good rest. Sometimes this is easier said than done, but this is one of those “ounce of prevention is better than pound of cure” type things. In the next article we’ll look at a few things to do if you think you’re coming down with something.

CIAO

1. http://www.cochrane.org/features/neuraminidase-inhibitors-preventing-and-treating-influenza-healthy-adults-and-children
2. http://summaries.cochrane.org/CD000980/vitamin-c-for-preventing-and-treating-the-common-cold

Bone Buffet Part 3

In part 1 we discussed some of the major players in bone health, including vitamin D, magnesium and calcium. In part deux, we discussed K2 and its role in helping the bones stay strong. In part 3 we now discuss exercise and its effect on the bones.

Squatting will build you some strong hip bones

Squatting will build you some strong hip bones

Just like muscles need stimulus to grow, bones need stimulus to stay strong. Stimulus is in this case another word for load bearing exercise. The body is a marvelous adaptive machine that will change its structure as needed to cope with its environment. If little load bearing activity is done, there is little reason that the bones would need to be as dense because there is no load. Essentially your body recruits what it needs for the job. If you are moving a piano out of your house and into a new one, you’ll probably recruit some stout men with muscle to do it. But if you’re only moving a few light boxes now and again you won’t need those manly men to help. Your body is no different. If you’re not moving pianos regularly there is no reason for your body to get muscular and your bones to get stronger.

In one study, sedentary females were randomly assigned to either a training or a control group. The training group did progressive high-impact exercises 3x per week for 18 months. Bone mineral density (BMD) was measured at different sites in the lower limbs by x-ray absorptiometry. Women in the training group had increased measurements in the femoral neck, a common hip fracture site. No difference was seen at non-weightbearing sites. While this study doesn’t look directly at breaks, BMD is important to keeping the bone stronger if a fall is to occur. 1

Another study looked at the back muscle strength of elderly women aged 58-75 years old. 27 women had performed progressive resistive back-strengthening exercises for 2 years and 23 were controls. The BMD in the spine was the same after 2 years, but after the 10 year follow-up the women who had done the exercise had the higher BMD. There were a total of 14 vertebral fractures in the control group and 6 in the exercise group, a difference that was significant. 2

In a meta-analysis out of the Netherlands researchers found that in randomized controlled trials, reduction or reversal of bone mass was consistent for both the lumbar spine and femoral neck, common fracture sites. 3

Another study looking at young men 19-25 years assessed the effects of high intensity powerlifters with lower intensity “recreational trainees” and control. While the high intensity lifters experienced increases in BMD in the spine, femoral neck and trochanter, the lower intensity and control had no differences except in the trochanter region. 4 It seems that lifting in a manner that defies gravity is what really makes the bones want to get stronger. Load bearing exercise such as jogging, stair climbing, squatting and deadlifting force your skeleton against gravity. Non-load bearing exercise like swimming and cycling, while also very good at conditioning, don’t do so much for the bones in terms of density.

Good eats with the proper nutrition and good exercise with the right emphasis in load bearing types of activities are good for your bones. Staying active and proper nutrition is really important for all aspects of life though not just your bones. The nutrients we discussed in part 1 and deux are important for not just bones but other aspects of life and exercise keeps your body and your brain sane and functioning. I personally believe that the biggest obstacle for most people when it comes to lifestyle is their brains telling their bodies they can’t do something. As soon as the brain gives up the body doesn’t stand a chance. Find something fun that you enjoy doing and can do regularly and eat clean and healthy most of the time. I think a piece of cherry pie is ok once in a while, but I can count on one hand how many times a year I get it. I should probably be nicer to myself.
CIAO

1. Heinonen, Ari, et al. “Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures.” The Lancet 348.9038 (1996): 1343-1347.
2. Sinaki, M., et al. “Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women.” Bone 30.6 (2002): 836-841.
3. Wolff, I., et al. “The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre-and postmenopausal women.” Osteoporosis international 9.1 (1999): 1-12.
4. Tsuzuku, S., et al. “Effects of high versus low-intensity resistance training on bone mineral density in young males.” Calcified tissue international 68.6 (2001): 342-347.

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Bone Buffet Part Deux

Bring on the Bone Buffet Part deux

Last time we talked about some of the nutrients that are needed for bone health. Vitamin D, calcium, phosphorus, and magnesium are all important components. We also discussed some of the problems with just using vitamin D and calcium, those being that although they do seem to help in some cases, they don’t help in all cases. What else do we need?

Vitamin K2

K2

K2

K2 is a fat soluble vitamin which has different biological properties than K1. K1 (phylloquinone) is what is found is green vegetables and is responsible for the clotting of the blood. K2 (menaquinone) has different functions in the body, although it may also help in coagulation of blood. One of the main functions seems to be in how calcium is used in the body. K2 helps Gla protein and osteocalcin in bone formation. Chris Masterjohn has a great article about it here: http://www.westonaprice.org/fat-soluble-activators/x-factor-is-vitamin-k2#bone.

Commercially available preparations exist as two main forms; MK4 and MK7. Others are available but these two forms are the most studied. MK4 has a shorter half-life and for clinical purposes may necessitate a multiple dosing regimen per day to be effective for those who want to supplement. MK7 is the form that is found in Natto and also commercially. It has a longer half-life and probably only needs to be taken once daily.

Lets take a look at some of the studies that make K2 a winner and part of your bone buffet.

In a meta-analysis researchers looked at several studies using K2 and looking at fractures. The results were overall very good. K2 decreased hip, vertebral and all other fractures significantly over placebo. 1

A 2 year study in Japan showed that the incidence of spine fracture was reduced by 19.4% with patients taking 45mg K2 per day over placebo. Both groups were taking 120mg elemental calcium per day. 2

In another study out of Japan, subjects received either calcium, vitamin k2, etidronate (a bisphosphonate/osteoporosis drug) or both etidronate and K2. The group on both K2 and etidronate had the least amount of fractures. K2 alone was about the same as etidronate alone and calcium alone faired the worst. The graph is showed here. 3

K2 alone does as well as a drug and in combination really decrease fractures

K2 alone does as well as a drug and in combination really decrease fractures

One problem with a lack of vitamin K is arterial calcification. This is that soft tissue calcification that I was discussing in the last article. It appears that vitamin k is useful for keeping the arteries clear of calcium. This is discussed in an article. 4 In another article, researchers compared two groups of people, 1 group using coumarins (blood thinning drugs) and healthy controls. They found that the degree of calcification in the subjects using coumarins had more arterial calcification in the femoral artery than those not using them. 5 Calcification in the arteries is a really bad thing. I mean really bad. This is one of the steps toward creating clots and creating blockages that could easily become fatal.

K2 seems to be a winner is this bone buffet. K2 also seems to be linked with cardiovascular health and cancer. That will likely be a topic coming soon. So where do you get K2?

Butter from grass fed cows, egg yolks, chicken liver, goose liver, Brie and Gouda cheeses and Natto (fermented soy) are all natural sources.

Butter is one of my favorite sources of fat soluble vitamins!

Butter is one of my favorite sources of fat soluble vitamins!

It is the bacteria in your gut that determine how much you get without eating these types of foods. It is speculated that some people who have absorption issues may not absorb the K2 like others would, increasing the need for supplementation and the need to heal up the gut. The supplements mentioned above are available online. I will say that the doses used in the studies are typically 45mg/day. The online brands are between 100mcg and 1000mcg. So if you got the 1000mcg dose (1mg) you’d need 45x that to match the studies. I don’t know if that amount is truly needed or if smaller amounts would work just as well, but it is something to consider. I believe Thorne makes a liquid form that will more easily get you that amount, but it’s expensive for a 30 day supply.

A dose of 45mg/day doesn’t appear to be harmful so taking that amount should be fine. The RDA isn’t established but reference intakes are around 100mcg/day.

In part 3 we’ll discuss 1 more key factor in good bone health…stress!

CIAO

  1.  Cockayne, Sarah, et al. “Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials.” Archives of internal medicine 166.12 (2006): 1256.
  2. Shiraki, Masataka, et al. “Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis.” Journal of bone and mineral research 15.3 (2000): 515-521.
  3. Iwamoto, Jun, Tsuyoshi Takeda, and Shoichi Ichimura. “Combined treatment with vitamin K2 and bisphosphonate in postmenopausal women with osteoporosis.” Yonsei Medical Journal 44.5 (2003): 751-756.
  4. Theuwissen, Elke, Egbert Smit, and Cees Vermeer. “The role of vitamin K in soft-tissue calcification.” Advances in Nutrition: An International Review Journal 3.2 (2012): 166-173.
  5. Roger J. M. W. et al. “Chronic coumarin treatment is associated with increased extracoronary arterial calcification in humans.” Blood Journal 2010 115: 5121-5123

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Bone Buffet Part 1

There has been a lot of talk over the past decade or so of howHive 5 skeleton bones need vitamin D to be strong. Doctors give out vitamin D and calcium all the time at the pharmacy and many people take them on their own because they think they need both the calcium and the D to have strong bones. While it is true that humans do require calcium and vitamin D for strong bones it’s a bit like saying that if I eat lots of protein my muscle are going to be Greek god status and awesome. While it’s true that your muscles need plenty of protein to get big and stay big, eating lots of protein in and of itself will do absolutely nothing to grow muscles. So what’s the deal with bones?

Minerals

Bones are made of calcium phosphate crystals that are on a collagen matrix. Calcium is important just as phosphorus is important for the imbedding of these crystals in the matrix. Osteoblasts (bone cell builders) lay down the materials to build bone, while osteoclasts (bone cell destroyers) will break down these crystals and liberate the calcium into the blood stream. This process is happening all the time. Parathyroid (PTH) hormone is one of the hormones responsible for this process.

PTH also increases activated vitamin D production for use in the gut so more calcium is absorbed. Magnesium is needed for proper function of the cells in the bone and calcium regulation due to vitamin D. Magnesium is also needed for the conversion of active vitamin D. If a person is taking vitamin D and is already low on magnesium, the body will get it from somewhere and the muscles are likely to suffer from depletion, causing twitching, restless leg and cramping, according to Dr. Carolyn Dean. 1 She even says angina and heart attacks may be a magnesium deficiency problem, but that’s for another post. Studies looking at bone density and magnesium intake haven’t been very conclusive one way or the other however. So if we have a magnesium deficiency we potentially have a problem with vitamin D and sensitivity to PTH and responsible for bone health. 2,3

Calcium is important because that is primarily what our bones are made of, at least the inorganic part of them. Along with phosphorus, these two combine to make the crystals that form the rigidity of the bones.

Vitamin D

Vitamin D of course is a big player in this game. D helps with calcium absorption and helps maintain a normal level of PTH indirectly. People with high levels of PTH all the time have low bone density and are at higher risk for fractures. The problem we see though is that some studies show that D alone or in conjunction w/calcium either do little or nothing depending on the study. What gives?

One study looked at several studies containing thousands of patients. The patients were primarily elderly people in institutions. Vitamin D alone didn’t seem to do much, while vitamin D and calcium did reduce the risk of hip and non-vertebral fractures, but there wasn’t any difference with vertebral fractures.3 When looking at patients who received vitamin D analogues, the risk of hypercalcaemia (too much calcium in the blood) increased.

One study from the Women’s Health Initiative looked at Vitamin D 400IU and Ca 1000mg daily. The risk of vertebral fractures went down, but the hip fractures stayed the same. 5

Problems

One problem that has been highlighted in the last couple of years is the increased risk of cardiovascular disease with the use of supplemental calcium and vitamin D. In the Women’s Health Initiative researchers found an increase risk of cardiovascular events if they weren’t taking them at the beginning of the study. Women who were already taking them didn’t seem to be at increased risk. 6

Soft tissue calcifications have also been reported with calcium supplementation. You read about those from time to time on different websites and on the news and indeed that is a problem if it is occurring. The only tissues that are supposed to be calcifying are teeth and bones. Calcifications in the arteries are indeed problematic for people because they lead to heart disease and death. I will discuss this more in Part 2, but if this is happening then it needs to be stopped because calcification of soft tissue really is a problem.

I personally don’t think supplementation with calcium is always necessary. For people that can tolerate dairy, it is a good source of calcium. Leafy greens are also an excellent source and should be part of a diet anyway. Spinach, kale and collard greens will get you there. Sardines are also a great source. People who used the buffered form of vitamin C also get some calcium from those tablets (buffered C is usually Calcium Ascorbate). A balanced and healthy diet will get you all the calcium you need.

Vitamin D is present in certain foods like milk (added) and certain fish (oysters, salmon) as well as eggs. Most of the D is made by our bodies though when our skin comes in contact with the UVB from the sun. The only problem is most of us are indoors and for only 4 months or so a year are the rays actually strong enough to create D. Cod liver oil is a great way to get both A and D and then of course there is supplementation. If that is the route you’re going, use D3 as it is the type that we produce before it’s converted to its active form.

Magnesium is also problematic because according to some research, almost 70% of Americans are magnesium deficient. 7 Magnesium can be obtained from nuts and greens. Supplements exist as well. Ionic magnesium can be purchased in water from WaterOz in Idaho. Magnesium orotate and glycinate are also very good and absorbed well. I would avoid Magnesium oxide unless you’re looking for a good laxative and nothing else. It doesn’t get absorbed well and really does have the ability to clear out your bowels. I also think taking magnesium 2-3 times a day at smaller doses is better than 1 bigger dose daily. It gives the bowel a chance to absorb smaller amounts of magnesium and doesn’t overload it to cleanse your bowel, like magnesium oxide will. I might add that I have anecdotal reports from people that say the magnesium helps them relax and sleep better.

These nutrients are essential to bone health. They are indeed part of a buffet for your bones, but they aren’t the whole story. I think many of the studies performed have not shown really good results for bone health is because the researchers are too focused on 1 or 2 things and aren’t looking at the whole picture. Again I think it’s the whole “eat lots of protein to build big muscles” analogy. It’s true you need these nutrients for bones, but there is more to it than that. We’ll explore more of this is part 2.

CIAO

1.    http://www.naturalnews.com/042007_magnesium_bone_health_dr_carolyn_dean.html

2.  Carpenter, T. O. “Disturbances of vitamin D metabolism and action during clinical and     experimental magnesium deficiency.”  Magnesium research: official organ of the International Society for the Development of Research on Magnesium 1.3-4 (1988): 131

3.   Zofková, I., and R. L. Kancheva. “The relationship between magnesium and calciotropic hormones.” Magnesium research: official organ of the International Society for the Development of Research on Magnesium 8.1 (1995): 77.

4.   Avenell, A., et al. “Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis.” ACP J Club 144.1 (2006): 14.

5.   Cauley J, et al “The Women’s Health Initiative calcium plus vitamin D supplementation trial: Health outcomes 5 years after trial completion” ASBMR 2012; Abstract 1136.

6.   Bolland, Mark J., et al. “Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis.” BMJ: British Medical Journal 342 (2011).

7.   “Dietary Magnesium and C-reactive Protein Levels,” Journal of the American College of Nutrition, Vol. 24, No. 3, 166-171 (2005).

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.