Archive for the ‘osteoporosis’ Tag

Menopause and a Natural Approach to Bone Health   Leave a comment

From Power Surge, written by Dearest

Bone health is a primary concern for women as they advance in age. Bone is a dynamic, living tissue subject to breakdown, repair, and rebuilding, like any other tissue in the body. Bone loss occurs when the rate of bone dissolution exceeds that of bone formation. Women actually achieve maximal bone density by their mid-thirties. In fact, skeletal bone mass naturally starts to decrease after about age 40, so it is never too early to address bone health. In addition, research has shown that it is never too late to begin preventative steps against excessive bone loss.

For many women and their health care providers, concern about bone loss is one of the main arguments for supplementing with estrogen. Estrogen replacement, however, brings with it its own concerns, and is only part of the story when it comes to bone health. Estrogen can inhibit the cells whose job it is to break bone down. This means estrogen slows down the rate of bone loss, but it will not build new bone. Testosterone and progesterone, however, appear to stimulate the cells that build bone, thereby possibly stimulating bone growth.

Hormones play a pivotal role in the process of remodeling bone, but several vitamins and minerals are indispensable for optimal bone health as well. The formation of healthy bone has two fundamental aspects: First to increase bone mass, and second to create a healthy infrastructure (known as the bone matrix) around which bone can form. Supplementing with key nutrients, along with a balanced diet and exercise program, are integral to any regime for promoting the health of your bones.

The proper nutrition for bone health goes beyond simply supplementing with calcium. Calcium deficiency may only contribute to 25% of all incidences of heightened bone loss. The form of calcium used is also important. Studies to determine the recommended daily intake of 1200-1500 mg for menopausal women used calcium carbonate. Calcium carbonate is a form of calcium our bodies may find difficult to absorb, particularly in an environment that is low in stomach acid. In addition, this recommendation includes calcium derived from dietary sources. Most women eating a standard American diet get about 700 mg of calcium from food intake. Calcium as an amino acid chelate is currently the most absorbable form of calcium available. As we age, we tend toward hypochlorhydria (low stomach acid). Calcium amino acid chelate does not require an acidic environment for absorption, but it is a good idea to supplement with a bone health formula that includes hydrochloric acid, as it can aid in the absorption of calcium and other nutrients from the diet.

Magnesium is important for the formation of a functional bone matrix. In addition, magnesium converts vitamin D to its active form, D3. This is imperative for calcium absorption. Many women with poor bone health may be deficient in the active form of vitamin D. Menopausal women in general tend also to be deficient in magnesium. Folic acid and vitamin B6 (pyridoxine) together perform a vital role in engendering the health of bone tissue. They help the body metabolize and excrete a substance known as homocysteine. High homocysteine levels are associated with defective bone formation (and, incidentally, with cardiovascular disease). Interestingly enough, menopausal women show an impaired ability to metabolize and excrete homocysteine. Furthermore, they tend as a group to be low in folic acid and vitamin B6.

Manganese, silicon, and vitamin K are all necessary for the construction of the bone matrix around which bone mineralization occurs. Vitamin K is another nutrient that is found to be low in individuals with significant bone loss. Too much vitamin K can potentially interfere with blood clotting, so it is important not to exceed approximately 200 micrograms a day of this nutrient.

Zinc and copper are also important minerals for bone health that tend to be low in menopausal women. Both minerals enhance the effectiveness of vitamin D, which promotes the absorption of calcium. Zinc and copper must be supplemented in the appropriate ratio, as imbalances may affect the proper formation of bone. Supplementation with the micronutrient boron has been shown to reduce calcium loss in post-menopausal women. Vitamin C is well known for its role in immune support, but it is also a crucial nutrient that the body needs to build bone matrix and healthy connective tissue. Vitamin C deficiencies are widespread, even with those ingesting the full RDA.

Increasing evidence points to a link between soy intake and bone health. Most of the studies that suggest dietary soy intake is associated with a decrease in the rate of bone loss are either epidemiological or based on an animal model. The amount of soy actually required for this positive effect on bone health is still undetermined. One important study that was conducted on postmenopausal women concluded the amount of isoflavones (the phytoestrogenic component of soy) needed to slow down the rate of bone loss is between 55 and 90 mg/day for at least 6 months.

Ipriflavone is a synthetic isoflavone derivative. Ipriflavone has been shown to inhibit the rate of bone loss and promote bone formation in postmenopausal women, particularly in the spine and wrist. As noted, there are many key nutrients vital for the health of our bones. A comprehensive program that encompasses proper diet, nutritional supplementation, and exercise may prove to be invaluable in preventing or minimizing bone loss.

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By Power-Surge contributor:
Dr. Holly Zapf

Hypothyroidism, The Many Myths by Kenneth Blanchard, M.D.   1 comment

THE MANY MYTHS OF hypothyroidism
By Kenneth Blanchard, M.D.

Read the transcript of Dr. Kenneth Blanchard (coming soon!)

blanchardchatThyroid disorders are extremely common and, in my opinion, are often undiagnosed or poorly treated due to a total reliance on laboratory testing and some-long standing but fundamentally flawed principles of treatment. Of the many standard teachings in this area, I believe the most common mistake physicians make in every day practice is to “rule out” hypothyroidism on the basis of laboratory tests .alone, especially use of the TSH (thyroid-stimulating hormone) test. There are few teachings in medicine more sacrosanct than an elevated TSH test as the “gold standard” for a diagnosis of hypothyroidism. I believe that there are millions of patients (mostly women) who would benefit from thyroid hormone but who are not treated because of results from this test.

A common story in popular magazines is “The Diagnosis your Doctor Will Probably Miss”. The story is that many individuals (mostly women) with symptoms like fatigue, depression, muscle aching, constipation, etc., see a physician who orders a T4 test and, on the basis of this, are told that hypothyroidism has been “ruled out”. The “smarter physician” also orders a TSH test because this is more sensitive and often reveals an abnormality even when T4 results are normal. While this scenario can happen, I believe it is far more common to find both T4 and TSH tests registering normal in the face of significant clinical hypothyroidism. In my practice, if the medical history and physical findings are highly suggestive of hypothyroidism, patients are treated with a therapeutic trial of the hormone and the results are overwhelmingly positive. As of early 2001, opinion in this field is still that the TSH test is absolute, although the upper limit of normal has been questioned, which is starting to include more individuals in this diagnosis.

Another common teaching that I believe to be fundamentally wrong is that all treatment should be done with 1OO% T4 hormone L-thyroxine (Synthroid, Levoxyl, etc.). The normal secretion of the thyroid gland contains small amounts of the T3 hormone (triiodothyronine) and I believe that giving some T3 is an important part of effective treatment for most individuals. The standard medical view is the T3 is unnecessary because T4 is converted to T3 in the body. But many patients taking the standard 100% T4 hormone report chronic fatigue, depression, menstrual abnormalities, fibromyalgia, irritable bowel syndrome (IBS), restless legs and other complaints, and these complaints are almost always better when some T3 is added. This particular teaching in medicine has been breached by a paper appearing in the New England Journal of Medicine in 1999 in which patients on standard 100% T4 were given some T3 and all patients felt better mentally and physically. The use of T3 has been standard in my practice since 1990 and I am quite sure it will be routine in the near future, although many physicians at this point still do not use T3 in addition to T4.

Thyroid hormone activity has a variety of complicated interactions with other hormones. For instance, I believe that thyroid hormone treatment is effective in PMS (premenstrual syndrome) despite the fact .that there are major studies in the literature which say this is not true. It is most likely that PMS fundamentally represents a deficiency of progesterone production prior to menstrual flow, but I believe that normalization of thyroid deficiency enables the woman to make more progesterone, thus relieving the symptoms. The woman in her mid-forties who is just starting to have irregular periods and notices some hot flashes, sweats and sleep disturbance at night can often be treated simply by optimal thyroid replacement, specifically including some T3. While such symptoms are commonly regarded as estrogen deficiency and will respond to the use of estrogen, I find that many such women have normalization of symptoms on proper thyroid therapy alone. The fundamental reason for this may well be that normalization of thyroid function enhances estrogen production by the ovaries themselves and by, the increased production of estrogen in fat tissue from adrenal hormone precursors.

If a woman at this age has frequent migraine headaches that are clearly related to the menstrual cycle (essentially premenstrual), these will often respond to balanced T4- T3 treatment, again possibly because of raising and/or stabilizing levels of estradiol. While clinical depression is not an integral part of menopause, there are many issues at this time of life that can cause emotional upset or depressed feelings. Again, use the T3 hormone in a physiologic way can be very helpful. Indeed, much of the current use ofT3 is in the hands of psychiatrists, who. use it as an adjunctive treatment for depression that is not responding well to standard antidepressants. Although this can be extremely effective, psychiatrists tend to use pharmacologic doses rather then physiologic doses. In other words, they exceed the amount needed to reproduce normal hormone balance. For virtually every purpose, a physiologic dose is desirable since excessive doses yield no additional benefits. I also disagree with the use of Armour thyroid by itself for the same reason, that it does not contain a physiologic balance of T4 to T3. The human thyroid produces roughly 95% T4 and 5% T3. Armour thyroid is an animal thyroid that contains 80% T4/20% T3. People who take Armour thyroid usually feel better for a short period of time because they were deficient in T3 but, after a period of time, the Armour thyroid will cause a T4-T3 imbalance at tissue level and a variety of undesired symptoms can then develop over time. One can get a better balance by giving some T4 with the Armour.

Some doctors are reluctant to prescribe (and some women reluctant to take) thyroid hormones in the belief that this will somehow increase the risk of osteoporosis. . I personally do not believe that there is good evidence for this, although my guess would be that excessive thyroid hormone does contribute to bone loss. Since there is no benefit in going above the normal physiologic levels of thyroid hormone, following the TSH result and clinically monitoring the patient will prevent overdose and resultant adverse effects.

Every organ system in the body is affected to some degree by treatment with thyroid hormone. I believe that the proper treatment of hypothyroidism with physiologic amount ofT4 and TI is critical in managing many complex medical problems at mid-life. If treatment is carefully monitored, there are no adverse effects. Management of hypothyroidism with T4 and TI is significantly more complicated than the standard 100% T4 therapy that has been used for the past 30 years or so. TI dosage must be monitored and altered precisely for optimum effect and this must be done by the use of compounded T3 time-release capsules. These are almost always made in units of 1OO capsules for practical reasons. Patients are initially seen every three months in order to adjust the dosage for the next prescription of T3. Another practice that will eventually become standard in this field is the adjustment of thyroid dosage for seasonal change, i.e., higher dosage in the colder weather and reduced dosage in the warmer weather.

Once dosage has been adjusted over 3 to 5 3-month visits and everything appears stable, visits are done at 6-7 month intervals. Patients must be ready to keep their appointments and take the medication exactly as directed. At the present time, there are many patients on a waiting list so that patients who drop out of the treatment plan fall back to the end of the list. Patients who have difficulty with the practices outlined above should stay with their current therapy.

By Power-Surge guest:
Kenneth Blanchard, M.D

Read the transcript of Dr. Kenneth Blanchard (coming soon!)

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