Rethinking Osteoporosis

(Image: Kateryna Kon / Shutterstock)

Osteoporosis is often called “The Silent Killer,” because in and of itself, it has no symptoms and most people who have it are quite unaware that they are losing bone until they experience a fracture. As we all know, a major fracture in advanced age raises the risk for a wide range of sometimes deadly comorbidities.

The condition we know as osteoporosis occurs when the body loses too much bone, makes too little bone, or both. In essence, it is a loss of proper balance between bone formation and bone resorption. What causes this shift?  Here is my take on the subject.

At the macro level, the quality and health of bone is influenced by gender (estrogen/testosterone status), age, race, activity level, and diet. Lifestyle factors also play a big role: stress, use of steroid medications, smoking, toxin exposures, and even the quality of an individual’s emotional relationships affect bone metabolism.

At the molecular level, osteoporosis can develop as a result of chronic metabolic acidosis, oxidative stress (lack of sufficient antioxidants), and neurohormone imbalances.  

Chronic Metabolic Acidosis

Bone is so sensitive to even small changes in pH that if the pH dips by even one-tenth, changes in bone will ensue. A dip in pH can stimulate excessive osteoclastic activity, inhibit osteoblastic action, and accelerate the loss of bone mineral density. The net result is less new bone-formation, and increased bone resorption.

The best way to keep this in check is to maintain a healthy acid/alkaline balance. That begins by knowing one’s pH. First morning urine pH assessment provides a good indication of overall cellular/ tissue pH and of overnight Net Acid Excess (NAE). This method makes use of paper pH strips, and is much more user-friendly than the longer and more invasive 24-hour urine collection method.

A healthy after-rest urine pH range is in the range of 6.5 – 7.5.  During prolonged sleep, the body concentrates excess acids in the urine and this capacity varies, based on toxin loads and an individual’s ability to actively excrete them.

While some question the value of the first morning urine test, we continue to find that after six or more hours of rest the high contrast Hydrion pH paper (with a test range of 5.5-8) provides a useful measure of net acid status. It is also inexpensive and convenient for measuring mineral reserve status, particularly magnesium and potassium, which are important for acid-alkaline balance.

The foods we eat play the biggest role in regulating acid/alkaline balance. A metabolically alkaline diet includes foods that have a buffering, alkalinizing effect on cell chemistry (Budde RA, Crenshaw TD, J. Anim. Sci. 2003; 81:197-208). This is often different from a food’s ash residue (Gonick HC, et al. Am J Clin Nutr. 1968; (21): 898-903).

Failure to recognize this distinction has led to a lot of confusion among clinicians and among people eager to follow an “alkaline” diet.

For example, citrus fruits are alkalinizing because the metabolism of citrate, malate, succinate, and fumarate generates more than twice as much bicarbonate buffer as there is acid in the food itself. Citrus fruit and similar foods are acidic in their food state (and tart on the tongue) yet alkaline-forming in the body.

The subject of alkalinizing diet is vast. Suffice to say that it is very important to limit intake of dietary sugars and refined flours that lack naturally occurring potassium and magnesium (Tzanavari T, et al. Curr Dir Autoimmun. 2010; 11:145-156.). Diets high in sugar, low in fiber, high in pro-inflammatory omega-6 edible oils (soybean, safflower, canola and corn oil) and lacking in anti-inflammatory omega-3s (fish oil, borage, flax seeds and purslane) increase acidity and impair immune defense and repair functions.

A plethora of nutrients– in food form as well as in supplements– be helpful in promoting bone strength and mitigating the risk of osteoporosis (Table 1)

I’ve developed a comprehensive but patient-friendly approach called The Alkaline Way, which can guide people in making the dietary and lifestyle changes needed to shift acid-base balance toward greater alkalinity.

Oxidative Stress

Oxidative stress is the result of an imbalance between the accumulation of free radicals or reactive oxygen species (ROS) in cells, and the ability to neutralize and eliminate these reactive compounds. Left unchecked, oxidative stress can cause cellular and tissue damage.

In the context of bone health, oxidative stress alters the bone remodeling process causing an imbalance between osteoclast and osteoblast activity. This is a major factor in osteoporosis.

By counteracting the destructive action of ROS, antioxidants promote the activation and differentiation of osteoblasts, foster the mineralization process, and reduce osteoclast activity. In preserving bone strength and structural integrity, antioxidants are valuable allies, with both direct and indirect activity on bone.

In this context, vitamin C (ascorbate) is key. I often refer to ascorbate as the “mother antioxidant.”

To increase antioxidant reserves and to provide a self-assessment of oxidative stress, I recommend a C Cleanse self-assessment. This process shows a patient how much ascorbate he or she needs to take, to manage oxidative stress and stimulate repair.

The assessment involves taking repeating doses of buffered, l- ascorbate powder dissolved in water, in increments of 15 minutes, until there is a complete evacuation of the digestive tract (very watery stools). The buffered ascorbate mobilizes toxins and eliminates them from the body via the GI tract.

The amount of ascorbate needed to induce this flush will tell you a lot about someone’s overall ascorbate status. To begin the C Cleanse, start with 0.5 teaspoon per glass of water if someone is generally healthy; 1 teaspoon if someone is slightly unwell, and 2 teaspoons if someone is ill.

The flush-inducing dose can also be used to calculate how much supplemental ascorbate someone should take on an ongoing basis. I generally recommend taking 75% of the flush-inducing amount daily, although it is fine to start anywhere between 5-50% of the cleanse dose with simultaneous digestive repair.

Flavonoids like quercetin dihydrate and oligomeric proanthocyanidins are also helpful in filling antioxidant requirements. 

Stress Hormone & Neurochemical Balance

Neurohormonal balance–termed “eustress”—enables and promotes bone renewal. In contrast, chronic states of distress–characterized by neurohormonal imbalances—have a blunting effect on bone renewal, and predispose people to bone loss.

Unfortunately, overstimulated and under-functioning adrenals, thyroid, pancreas, and ovaries or testes are all too common in our society. I believe these hormonal imbalances play central roles in the development of osteopenia and osteoporosis.

We know that elevated cortisol interferes with osteoblast formation and dramatically decreases bone-building. People with chronically elevated cortisol may be at risk for osteoporosis.

Similarly, estrogen regulates bone remodeling, and bone is also a “target organ” for thyroid hormone. Irregularities in ovarian or thyroid function will be reflected as changes in bone integrity.  Neurochemicals like epinephrine and serotonin also play a role. In the brain, serotonin acts via the hypothalamus and influences bone growth. In depression and chronic stress, high norepinephrine levels are associated with bone loss.

The musculoskeletal system is especially vulnerable to inflammation, so we want to do all that we can to help patients reduce inflammation and oxidative stress.

Immune hypersensitivity pulls minerals from bones and impairs repair responses. We can identify substances that trigger immune reactions via key lymphocyte response assays, and then use the results to guide people in finding substitutes for the immune-reactive items in their diets.

Consider measuring C-Reactive Protein (hsCRP) in patients at risk for osteoporosis. It is a good predictive biomarker for inflammation and oxidative stress. Higher levels of hsCRP are associated with increased fracture risk.

Exercise, Relaxation & Sleep

There’s no question that physical activity stimulates bone repair and preservation of BMD. Putting it simply, the mechanical stresses of exercise will promote bone-building at any age.  It need not be strenuous or exertive. Even one hour per day of walking will have myriad benefits.

Restorative sleep also helps. So will stress-reducing activities like tai chi, yoga, and meditation. Anything that promotes parasympathetic nervous system activity while reducing sympathetic overdrive will be helpful in promoting bone repair and reducing osteoporosis risk.

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