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The Women's Health Initiative (WHI) study, which had placed healthy postmenopausal women on long-term hormone replacement therapy (HRT), was suddenly cancelled due to evidence of increased risks to the participants' health. The results showed that the HRT group had a higher rate of coronary heart disease, strokes, and pulmonary embolism. Breast cancer risks increased the longer the participant took HRT. Breast cancer, showed an increased risk of 26% if taken less than five years and 53% increased risk if taken longer than five years. The study was cancelled two years early because the risks of HRT proved to outweigh the benefits. [1] A retrospective study also showed those women taking only estrogen had an increased risk of ovarian cancer. [2] These unexpected developments have many concerned women wondering what the alternatives are. Many women have stopped HRT and have changed to medications such as Biphosphonates (Fosamax) and SERMs (Selective Estrogen Receptor Modulators); however, whether they reduce fracture rates and their long term risks and benefits have yet to be established. [3] While medications may have a place for high risk individuals, the message is clear that these are not suitable alternatives for prevention.
Osteoporosis is a disease characterized by loss of bone mass, deterioration of bone structure and increased risk of fracture. It is often known as "the silent thief" because if not prevented or if left untreated, bone loss can occur and progress without symptoms. Therefore, prevention of osteoporosis throughout a lifetime is essential.
Too Much Calcium? - The World Health Organization recommends 400-500mg of calcium per day for an adult. It is interesting to note that the recommended intake in the USA for calcium is much higher at 1000mg -1500 mg per day. Many people think that just taking enough calcium will solve the osteoporosis problem. However, North Americans have the highest rate of milk and calcium supplement consumption – yet still have the highest rate of osteoporosis in the world. Unless sufficient magnesium is present, calcium will not be correctly deposited into bone and instead will deposit in soft tissue, causing kidney and gallstones, joint discomfort, as well as increased atherosclerotic plaque. [4] The latest studies are revealing that diets high in magnesium, potassium, fruits, and vegetables, with adequate protein, and limited amounts of junk foods show a better accumulation and maintenance of bone density. [5, 6]
Higher Magnesium to Calcium Ratio - Osteoporosis is not generally speaking, a problem of insufficient calcium intake but rather of incorrect calcium utilization. It is magnesium that is needed to encourage the correct utilization of calcium by the body. [7] Abnormally shaped bones are built when magnesium in insufficient. [7] Abnormally shaped bones, may appear dense, but are still weaker than normal bone and can break more easily. The majority of our bone mass is laid down while we are growing, so one of the major impacts we can make as adults is to ensure that the existing bone mass we have remains strong. Magnesium is the most consistently observed nutrient to increase bone strength [6] yet dietary intake studies consistently show that large numbers of individuals may be at risk for magnesium deficiency. [7] This is why I recommend a liquid supplement that has a higher ratio of magnesium to calcium for prevention of osteoporosis. Dr. Guy Abraham MD used a ratio of 1.2:1 magnesium to calcium, along with other factors in a nine month study that resulted in a significant 11% increase in bone mass versus only 0.7% in the untreated group. When given to postmenopausal women, the same 1.2:1 ratio resulted in a bone density 16 times greater than those who followed dietary advice alone. [8]
Vitamin D & Zinc - Clinical trials have shown vitamin D enhances the absorption of calcium at the active transport sites and reduces bone breakdown. [9] Active vitamin D declines as we age and the combination of calcium and vitamin D decreases fracture rates better than calcium alone. [10, 11] Zinc is needed for protein formation in the framework of the bone. [5]
Risk Factors You Can Change:
· Ensure adequate intake, absorption and proper utilization of calcium, magnesium, zinc and vitamin D
· Eat whole foods and avoid junk foods, soft drinks and processed foods as they are low in nutrients and increase mineral loss from the body
· Eat calcium and magnesium rich food such as dark leafy vegetables, sesame seeds, chickpeas, broccoli and yogurt
· Avoid excessive protein, salt, sugar and caffeine consumption
· Avoid severe caloric restriction and yo-yo dieting as it results in bone loss
· Optimize digestion for maximum nutrient absorption
· Engage in an active lifestyle that includes both weight bearing (walking, tennis, dancing, running) and strength training exercise [12]
· Decrease alcohol consumption and don't smoke
· Minimize risk of falling
Don't wait until you reach menopause - prevention of osteoporosis throughout the life cycle is essential! If you make the lifestyle changes necessary to stop bone loss now, it may help you to avoid the use of HRT, which has been shown to have more risks than benefits.
References:
1. Women's Health Initiative., Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results from the Women's Health Initiative Randomized Controlled Trial. JAMA, 2002. 288(3).
2. James V. Lacey, Menopausal Hormone Replacement Therapy and Risk of Ovarian Cancer. JAMA, 2002. 288(3).
3. Canadian Women's Health Network, Pros and Cons of Hormone Therapy:
Making an Informed Decision.
4. Gaby, Alan R. Every Woman's Essential Guide to Preventing and Reversing Osteoporosis Prima Health, 1990.
5. Gur, A., et al., The role of trace minerals in the pathogenesis of postmenopausal osteoporosis and a new effect of calcitonin. Journal of Bone & Mineral Metabolism, 2002. 20: p. 39-43.
6. Jones, G., M. Riley, and T. Dwyer, Maternal Diet during pregnancy is associated with bone mineral density in children: a longitudinal study. European Journal of Clinical Nutrition, 2000. 54: p. 749-756.
7. Celotti, F. and A. Bignamini, Dietary Calcium and Mineral/Vitamin Supplementation: a controversial problem. The Journal of International Research, 1999(27): p. 1-14.
8. Abraham, G. E., and H. Grewal, A Total Dietary Program Emphasizing Magnesium Instead of Calcium. Effect on Mineral Density of Calcaneous Bone in Postmenopausal Women on Hormonal Therapy. Journal of Reproductive Medicine, 1990 35: 503-507.
9. Schaafsma, A., P.d. Fries, and W. Saris, Delay of Bone loss by Higher intakes of Specific Minerals and Vitamins. Critical Reviews in Food Science and Nutrition, 2001. 41(3): p. 225-249.
10. Peacock, M., Calcium Absorption Efficiency and Calcium Requirements in Children and Adolescents. American Journal of Nutrition, 1991. 54: p. 261S-265S.
11. Austin, S., Dr. Steve Austin's Osteoporosis and Nutrition Notes.
12. Hudson, T.S., Osteoporosis: An Overview for Clinical Practice. Journal of Naturopathic Medicine. 7(1): p. 27-34.
DR. CATHY CARLSON-RINK
Dr. Cathy Carlson-Rink is a licensed Naturopathic Physician and Midwife in general family practice, specializing in women's and children's health. She completed her Bachelor of Science with Honors in Physical Education, with a major in Health and Fitness and a minor in Physiology, at the University of Saskatchewan. She went on to receive her Doctor of Naturopathic Medicine (ND), with a postgraduate specialization in midwifery, from the prestigious Bastyr University in Seattle, Washington. Dr. Carlson-Rink is a longstanding member of the Canadian Naturopathic Association. |
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by Dr. Cathy Carlson-Rink
