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Preventing Degenerative Disease -
Prevention of Osteoporosis
Nutrients and how they aid in the fight against osteoporosis.
Another Arthritis: Rheumatoid Dr. Strands Supplement Recomendations for those with this medical issue: I add 1,500-2,000 mg of
glucosamine sulfate and about 100-200 mg of
grape-seed extract. l have no problem if they also add 400 to 600 mg
chondroitin sulfate or even 100 mg of MSM if the patients feel these help. l do not feel the medical evidence is strong enough at this time to absolutely recommend them as optimizers.
Pharmaceutical Grade Supplements Arthritis/Osteoporosis
Dr. Ray Strand: HOW DOES THE OLD SAYING GO? WE ALL CAN COUNT ON TWO things in life: death and taxes. As I write this chapter, I groan with new awareness of the quickly approaching tax deadline. But I'm also reminded of a third thing most all of us can count on in life-arthritis. It's true: approximately 70 to 80 percent of people in the U.S. over fifty years of age suffer to some extent with the most common type of arthritis called ostecarthutis, also known as degenerative arthritis.
You are probably much too familiar with the symptoms of early morning stiffness, mildly swollen joints, and joint pain. Osteoarthritis is by far the most common chronic degenerative disease that I see in my office. Affecting men and women alike, it can involve every joint in the body, including the neck and lower back. As arthritis gets worse, it can cause significant discomfort, pain, and even disability.
Osteoarthritis is mainly a degeneration of the cartilage in the joints. But it can also involve the synovial lining (the lining of the joint) and the underlying bone. As the joint cartilage begins to wear down, it causes increased stress to the bone. In response to this intensified stress, the bone actually becomes denser. It is very common to see bone spurs forming around the joint as a result.
You may have heard a family member or friend say he needs to have a joint replaced because he has "bone on bone." What he is really saying is that the cartilage (the cushion) of his joint is entirely gone. Since degenerat1ve arthritis primarily involves the weight-bearing joints (hips and knees), repeated mechanical stress caused by excessive weight, trauma, or activity is a contributor to the development and progression of this disease.
How is the Joint Actually Damaged?
Articular cartilage covers the ends of our bones, while joints like the knees also have additional cartilage that acts as a cushion between the bones. Cartilage is primarily made up of collagen fibers, glycoproteins, and proteoglycans. The structural integrity of human cartilage is continually going through a cycle of building up and breaking down. In other words, our bodies need to be building cartilage at the same rate as it's wearing down in order to maintain healthy joints. Again, a balance is the key. When a joint begins to wear out, we know that either the breakdown of cartilage has increased or the production of cartilage has decreased.
That osteoarthritis is an inflammatory disease is a well-known fact. If you observe anyone with arthritic hands, you can actually see how inflamed and swollen the joints of the fingers and hands become. Have you ever wondered what exactly is causing the inflammation and how this leads to damage of the cartilage' The answer is a multifaceted one, because there are actually several sources for inflammation that occur within the joint, as you can see in the box below.
Causes of Inflammation in Our Joints
Cytokines are some of the leading causes of joint inflammation. These proteins carry messages between cells and regulate immunity and inflammation. Two of the most important cytokines are tumor necrosis factor alpha (TNF a) and interleukin one beta (IL 1B). These are highly concentrated in the joints of people who have osteoarthritis.
Proteases enzymes that cause the breakdown of proteins, also have been shown to create inflammation in the joint. Proteases are under the control of the cytokines. Some have anti-inflammatory qualities and some have pro inflammatory (inflammation creating) qualities. Obviously. In arthritis the pro-inflammatory proteases are winning.
Phagocytes (neutrophils) are attracted to the inflamed joint in an attempt to clear this reaction and prevent damage to the cartilage and synovial lining. But as you have just learned in the last chapter this inflammatory response is not always a good thing. Neutrophils can actually lead to more inflammation in the joint.
The ischemia reperfusion phenomenon is a, process that sounds difficult but actually is simple. As we use a weight-bearing joint like a hip or knee the pressure created by our weight when we walk, or especially when we run blocks the blood flow to the cartilage. This is known as ischemia or lack of blood supply. When we take our weight off the joint. The pressure lessens and blood is allowed to return to the cartilage (this is called reperfusion). This process. As well as the sources of inflammation I've just listed. Causes excessive production of free radicals. In turn, the free radicals heavily tax the antioxidant defense system and cause oxidative stress.
When the antioxidant defense system is overwhelmed, oxidative stress within the joint causes damage to the cartilage and synovial lining of the Joint. When the body cannot rebuild cartilage fast enough, the joint begins to deteriorate.
The basic traditional treatment of both ostecarthritis and rheumatoid arthritis is the use of non-steroidal anti-inflammatories (NSAIDS) and aspirin. While these drugs reduce inflammation in joints, they are also responsible for the frequent adverse side effects of stomach ulcers and upper-gastrointestinal (GI) bleeding. In fact more than one hundred thousand admissions to hospitals in the U.S. per year and more than sixteen thousand deaths each year are the result of upper-GI bleeding caused by the use of NSAIDS.
In response to the dangerous effects of these NSAIDS, pharmaceutical companies have developed a group of new NSAIDS that primarily block just the COX-2 enzymes. Drugs called COX-2 inhibitors arrived on the market with great fanfare because they caused significantly less Gl side effects. Unfortunately, these have side effects as well, including bowel perforation as well as upper Gl bleeds although not nearly as frequent as the first generation NSAIDS.
My greatest concern regarding the tremendous use of NSAIDS by arthritis patients is the fact that these drugs merely provide pain relief without attacking the underlying cause of the disease-oxidative stress. Patients with severe rheumatoid arthritis are also being treated with more potent anti-inflammatory drugs like prednisone and gold or chemotherapeutic drugs like methotrexate or Imuran.
Antioxidant Supplements
Anyone who is suffering from degenerative arthritis needs to take a potent, well-balanced antioxidant and mineral supplement. Strong evidence exists that patients who suffer from arthritis are deficient in several antioxidants and supporting nutrients such as vitamin D, vitamin C, vitamin E, boron (a mineral), and vitamin B3.4 As you have been learning throughout this book, you need to supply all these antioxidants at optimal levels in an attempt to bring oxidative stress under control.
Peggie was taking all of these nutrients in supplementation, as well as another important one: glucosamine sulfate.
G1ucosamine Sulfate
Glucosamine is one of the basic nutrients for the synthesis of cartilage.
It is a simple amino sugar that is the primary building block of proteoglycans, which are the molecules that give cartilage its elasticity. Unlike NSAIDS and aspirin, glucosamine does not simply cover up the pain but rather helps to rebuild the damaged cartilage. Early studies showed short-term benefits of the use of glucosamine sulfate; however, most physicians remained unimpressed.
In 1999 a three-year, large, randomized sample, placebo-controlled, double-blind clinical trial (the sort of studies doctors really like) was reported at the Annual Meeting of the American College of Rheumatology. This study showed that glucosamine not only reduced the pain and inflammation of arthritis but actually stopped the deterioration of the cartilage. What was even more impressive was the tact that there was evidence of actual cartilage re-growth-just as in Peggie's case. The placebo group members, who took the traditional NSAIDS, continued to experience rapid deterioration of their joints. 6
This study, along with several others, has shown the significant health benefit for arthritis patients who take glucosamine sulfate supplements in the 1,500-2,000-mg range, with virtually no side effects. Even more exciting is the fact that when the patients in the clinical trial discontinued their glucosamine, the pain did not return for weeks and even months later.7
NSAIDS, on the other hand, have significant side effects such as ulcers upper GI bleeding, and possible liver damage, as I noted earlier. Considering that these drugs do absolutely nothing to slow down the degenerative process and in fact may accelerate it, we must wonder why NSAIDS are some of the most prescribed medications in the world. To the dismay of pharmaceutical companies, more and more physicians are recommending glucosamine sulfate to their patients.
The results I have seen in my practice are impressive. Even though I recommend glucosamine to all my arthritis patients, I also prescnbe NSAIDS for quick relief. It is exciting to discover my patients who decide to take glucosamine eventually hardly ever need to take their NSAIDS. When they are wlllmg to add the antioxidants, minerals, essential fats, and grape-seed extract they do even better.
I'm not alone in my convictions. Many of my orthopedic friends support the use of glucosamine too, since they realize that being able to delay a joint replacement is ultimately in the patient's best interest.
Chondroitin Sulfate
Chondroitin sulfate is often combined with glucosamine sulfate to create a one-two punch. Chondroitin makes up part of the proteoglycans and isresponsible for attracting water into the cartilage. This makes the cartilage more
pliable and spongy. Without this important nutrient the carnlage becomes drier and more fragile.
I personally feel that the most important nutrient is still glucosamine sulfate. Oral chondroitin needs to be studied more thoroughly in larger number of patients, allowing more plausible evidence as to whether chondroitin ~s really a player or not. I also believe MSM (a natural anti-inflammatory) needs to be studied more thoroughly. But I have had several patients who experienced a significant response when they added it to their regime.
Several studies show improvement in patients with arthritis who are getting additional chondroitin. But many of these positive studies have involved actual IV injections of chondroitin and some researchers are concerned that chondroitin is not effectively absorbed through the Gl tract. Some say that it is broken down then absorbed and reassembled within the joint cartilage. I feel further studies are needed to determine its overall importance in the treatment of osteoarthritis R
Osteoporosis
Osteoporosis is a nutritional deficiency at literally epidemic proportions in the U.S. In one of the richest, most well-fed nations of the world, more than 25 million Americans are living with the crippling effects of osteoporosis at a cost of about $14 billion each year to the U.S. economy. At least 1.2 million fractures occur each year in the United States as a direct result of osteoporosis.9 I have actually seen patients fracture hips as they simply walked into my office, without any kind of fall or injury. Spontaneous compression fractures of the vertebrae and of the back cause tremendous pain and suffering in my patients with osteoporosis.
Osteoporosis has been presented to the American public as a disease merely dependent on estrogen and calcium. In response to this national crisis, the health-care community is treating menopausal women with Hormonal Replacement Therapy (HRT) in an effort to curb any onset of osteoporosis.
Although many believe that HRT can slow the progression of osteoporosis, it may do more harm than good. In 1997 the New England Journal of Medicine reviewed several studies involving women who took estrogen replacement for more than five to ten years. The results shocked reviewers, revealing more than a 40 percent increase in breast cancer. The pharmaceutical companies quickly responded to this negative report by convincing the doctors that the benefits of HRT far outweighed the risks, often boasting that other clinical trials had shown that patients who took HRT decreased their risk of heart attacks, strokes, and Alzheimer's dementia."
Two other major studies, however, the Heart and Estrogen/Progestin Replacement Study (HERS) and The Women's Health Initiative Study, did not show any slowing of the progression of heart disease. In fact some evidence suggested that the patients taking HRT had an increase in the incidence of heart attacks, especially in the first year. Interestingly, these studies did show that those taking HRT experienced a significant decrease in LDL (bad) cholesterol and a significant increase in HDL (good) cholesterol. So why did these patients have an increased risk of heart disease?
I believe the answer appeared in other studies that have shown women who take synthetic HRT had a tremendous increase in their C-reactive proteins, which you may recall is a measure of the inflammation in the artery. It is a much better predictor of future heart attacks than is cholesterol-especially in women. Remember, heart disease is an inflammatory disease of the artery, not a disease of cholesterol.
When women who want to avoid osteoporosis consider synthetic Hormonal Replacement Therapy in light of these new clinical studies, perhaps the good does not outweigh the bad-especially when you consider the well-known increased risk of developing blood clots in the legs and gall bladder disease in those patients taking HRT. Several new drugs have arrived on the market for osteoporosis, such as Fosomax, Actonel, Evista, and Calcitonin, which have the ability to actually increase bone density. Doctors are recommending these drugs more and more instead of HRT, primarily because of the growing concern over the adverse effects of long-term HRT therapy. Short-term studies using these drugs have demonstrated a significantly decreased risk of fractures and repeat fractures." For a thorough discussion about these and other problems women face during their menopausal time, I recommend Dr. Christiane Northrup's book, entitled The Wisdom of Menopause.
Not Just Calcium-Bones Are Living Tissue
Remember Mr. Bones, the skeleton that graced the back of the biology room in high school and college? He was the lead character in many a great prank as well as the main player on the comprehensive exam. Though the popular plastic model has taught lots of kids about bones, we often think of "bare bones" (like his) instead of bone that is active, living tissue, which is continually remodeling itself through osteoblastic (bone forming) and osteoclastic (bone resorbing) activity.
Bone is not just a collection of calcium crystals; rather it is living tissue constantly engaged in biochemical reactions that are dependent on many different micronutrients and enzyme systems. Therefore, like any living tissue, bone has diverse nutritional needs.
The American diet, with its high intake of white breads, white flour, refined sugars, and fat, is terribly deficient in many of these essential nutrients. Our nation's diet is also high in meats and carbonated beverages, which increase the intake of phosphorous and decrease our absorption of calcium. Inadequate intake of any nutrients required for bone health contributes to osteoporosis.
Another common myth that teams up with Mr. Bare Bones is that calcium is all we need for strong bones and to stave off osteoporosis. But the truth is that a variety of essential nutrients must be present, not just calcium, to have any success in decreasing the amount of osteoporosis in this country.
In order to reduce the risk of fractures of the spine, hip, and wrist, we must pay attention to several important factors: preserving adequate bone mass, preventing the loss of the protein matrix part of the bone, and making sure that the bone has all the proper nutrients it needs to repair and replace damaged areas of bone. Nutritional supplementation plays a vital role in all three areas of preserving and building bone.
Nutrients and how they aid in the fight against osteoporosis.
Calcium
There is no doubt that calcium deficiency can lead to osteoporosis. But studies show skeletal calcium depletion in only 25 percent of postmenopausal women. Indeed, calcium supplements in these women did seem to increase bone mass, but the supplements had no effect on the other 75 percent who were not calcium deficient. Recent studies of calcium and vitamin D supplementation present a slowing down of osteoporosis but in no way demonstrate that supplementation prevented it. These studies have also shown a reduction in fractures of the hip, spine, and wrist." In other words calcium is helpful, but it isn't the answer.
Calcium is an essential nutrient in the fight against osteoporosis. Both men and women should take supplements of 800-1,500 mg daily, depending on the amount of calcium they are getting in their diet. People more consistently absorb calcium citrate than calcium carbonate; but when taken with food and good levels of vitamin D, the absorption level is quite similar. Whatever form of calcium you take, you should consume it with food for optimal absorption.
Be advised that children also need this level of supplementation. In fact studies prove that children who take 800-1,200 mg of calcium daily prior to puberty will increase their bone density by 5-7 percent. This finding is significant because this increase in their bone density will carry over as they develop into young adults and throughout their lifetimes.13
Magnesium
Magnesium is important in several biochemical reactions that take place within the bone. Magnesium activates alkaline phosphatase, which is a required enzyme in the process of forming new bone crystals. And vitamin D needs magnesium to convert to its most active form. If there is a deficiency in magnesium, it can lead to a syndrome of vitamin D resistance.
Dietary surveys have shown 80 to 85 percent of Americans consume a magnesium-deficient diet.'4
Vitamin D
Vitamin D is necessary for the absorption of calcium. Vitamin D is typically produced in the skin when it is exposed to sunlight. But as you know, with age people tend to spend less time in the sun, and vitamin D deficiencies become very common.
We also take in vitamin D orally via fort)fied foods and milk, but it must then be converted to its biologically active form, vitamin D3. Often the impaired conversion of vitamin D to vitamin D3 may be more of a problem than deficient intake. This is why I recommend supplementation of vitamin D by using the active form, D3.
The New England Journal of Medicine reported a study in which researchers looked at the level of vitamin D in 290 consecutive patients admitted to the medical ward of Massachusetts General Hospital. These were patients who had been normally active and were not admitted from a nursing home. Hospital staff checked their vitamin D levels and found that 93 percent were deficient. Surprisingly, those patients who were taking a multiple vitamin were also deficient in their vitamin D levels 93 percent of the time. This finding is critical when you realize that you don't absorb any calcium without vitamin D!
The study concluded by stating that everyone should be taking vitamin D supplements and at a level significantly higher than the recommended daily allowance. In fact the researchers concluded that supplementing with 500-800 IU of vitamin D daily is critical if we are going to have any effect on the epidemic of osteoporosis.'5 And remember-you will absorb calcium much better if you take it along with vitamin D and food.
Vitamin K
Vitamin K is required to synthesize osteocalcin, a protein found in large quantities within the bone. It is therefore critical in bone formation, remodeling, and repair. In a clinical trial supplementing vitamin K in patients with osteoporosis reduced urinary calcium loss by 18 to 50 percent. This means vitamin K helps the body absorb and retain calcium rather than excrete it.'6
Manganese
Manganese is necessary for the synthesis of connective tissue in cartilage and bone. Like magnesium, manganese is lost in the processing of whole grains into refined flour. A study of osteoporotic women showed their manganese levels were only 25 percent of those of the women in the control group.'7 This nutrient also needs to be present at optimal levels if you have any desire to prevent osteoporosis.
Folic Acid, Vitamin B6, and Vitamin B12
Does this combination sound familiar? It should. Homocysteine (see Chapter 6) is not only bad for your blood vessels, but it is also bad for your bones. Individuals with severe elevations of homocysteine have been found to have sign)ficant osteoporosis as well.
Interestingly, premenopausal women have greater efficiency in breaking down methionine and thus have little buildup of homocysteine. This changes dramatically after menopause. Postmenopausal women have much higher levels of homocysteine. Could this explain in part both the increased risk of heart disease and osteoporosis in postmenopausal women?'8 The fact remains these women need higher amounts of folic acid, vitamin B6, and vitamin B12.
Boron
Boron is an interesting nutrient when it comes to bone metabolism. When study subjects took boron in supplementation, the urinary excretion of calcium decreased by approximately 40 percent. Boron also increases magnesium concentrations and decreases phosphorous levels.'19 Supplementation with 3 mg daily of boron is more than adequate.
Silicon
Silicon is important because of its ability to strengthen the connective tissue matrix, which strengthens bone. Patients with osteoporosis, in whom the generation of new bone is desirable, need increased amounts of silicon.
Zinc
This mineral is essential for the normal functioning of vitamin D. Low serum zinc levels were found in the serum and bones of patients with osteoporosis.20
Prevention of Osteoporosis
I promise you this: you do not want to get osteoporosis. I have treated several patients suffering from severe cases. It is a debilitating, painful disease. They seem to suffer continual fractures of the spine and are in extreme pain for long periods of time. As I've mapped out, osteoporosis is not simply a disease arising from a lack of calcium and estrogen. Our bodies need multiple nutrients for bone remodeling and the production of good healthy bone.
We also need to control our oxidative stress. Recent studies demonstrate that people with decreased bone density have increased oxidative stress. So you not only want to supplement with these important nutrients needed for bone production, but also take all of the antioxidants and supporting nutrients to build up your antioxidant defense system.
I encourage all my patients, both women and men, preferably before they reach forty years of age, to begin supplementation with a high-quality antioxidant and mineral tablets along with additional amounts of calcium, magnesium, boron, and silicon. It is critical for adults also to eat a healthy diet and develop a modest exercise program. Weight-bearing exercises need to be part of the program as they are a necessary component in stimulating the body to make more bone. Walking may help the lower legs but does very little for the back and hips; upper body weight resistance exercises such as lifting weights over your head are critical to anyone who is trying to protect herself or himself from this devastating disease.
Even when my menopausal patients find out they have evidence of early thinning of the bone, called osteoperlia, they usually find that they can improve their bone density with this same program. I postpone prescribing drugs like Fosomax, Actonel, Evista, or Calcitonin in this situation if my patients are willing to make some lifestyle changes: taking these high-quality supplements, along with eating an improved diet and using a weight-bearing exercise program.
I follow these patients closely by repeating their DEXA (bone density) scan in one year. If they are stable or improving, I keep them on their program and continue to follow them closely. If they experience more thinning of their bones, I will start them on one of these newer drugs.
The key to both preventing arthritis and osteoporosis is cellular nutrition. I have presented several individual nutrients here to give you a glimpse of what the medical literature is telling us about their importance.
As you've seen, preventing these potentially crippling conditions is not simply a matter of boosting a calcium or estrogen deficiency. This is just one more area in which nutritional supplements work with your body to maintain the health you have or regain that which you have lost.
"What Your Doctor Doesn't Know About Nutritional Medicine May Be Killing You."
Dr. Ray Strand
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