Vitamin D: Beneficial or Bogus?

“Vitamin-D Deficiency Makes Bones Age Prematurely”

 “Vitamin D won’t help you avoid bone fractures and taking too much is not safe”

 “Calcium and vitamin D: the backbones of bone health”

“Vitamin D supplements might not actually prevent osteoporosis”
Are you as confused as I am?

Vitamin D has long been associated with better bone health and reducing the risk of fractures in people with osteoporosis.  However, recent studies suggest that vitamin D supplementation neither improves bone mineral density nor prevents fractures in adults.

  • In 2014, a review and meta-analysis of 31 studies found that vitamin D alone is unlikely to be effective in preventing hip fracture
  • In 2017, an analysis of 33 randomized clinical trials, also found vitamin D supplementation was not associated with a lower risk of fractures among adults living independently 
  • Once again in 2018, after reviewing 81 studies, researchers found very little evidence that vitamin D supplementation had a benefit on bone density
All these studies came to the same conclusion:

The widespread supplementation of vitamin D for the prevention of osteoporosis and reducing fractures seems unwarranted and should not be advised.
 
So with this new information indicating that vitamin D supplementation is inappropriate, should we or shouldn’t we be taking vitamin D to boost our bone health?

Why our bones need vitamin D
  • Vitamin D is necessary for the absorption of calcium and phosphorus from the intestine.  In this way, vitamin D allows these nutrients to be better absorbed from the food we eat.  Not only is calcium essential for our bones, but it is also critical for every cell in our body.  It enables our blood to clot, our muscles to contract, and our heart to beat.  Phosphorous is just as important as calcium in supporting bone formation and maintenance.
  • Vitamin D helps to regulate parathyroid hormone. Elevated parathyroid hormone levels cause increased bone turnover and bone loss.
  • Vitamin D controls osteoblast function, the cells that build bone, and stimulates bone mineralization of osteoblasts
  • Vitamin D may improve lean body and muscle strength. Lean body has a positive influence on bone mineral density. 
  • Vitamin D aids in immune regulation.  Osteoporosis is often considered to be an inflammatory condition and vitamin D may squelch pro-inflammatory proteins that interfere with normal bone metabolism.
  • Among several other ways vitamin D supports overall health, emerging research has linked low levels of vitamin D to insulin resistance and diabetes.  People with diabetes have an increased risk of developing osteoporosis.    

These recent studies on vitamin D and bone health primarily reflected healthy adult populations and not necessarily those with vitamin D deficiency.  40% of the US population is deficient in vitamin D. The authors of these recent studies admit that the results may have been quite different if done on individuals with vitamin D deficiency.

What constitutes deficiency?

It depends on who you listen to!  Vitamin D is tested in the blood by looking at 25-hydroxy-vitamin D (25(OH)D) and is measured in ng/mL (nanograms per milliliter)

  • The institute of Medicine suggests that vitamin D levels under 20 ng/mL is considered a vitamin D deficiency
  • The Endocrine Society considers vitamin D levels below 30 ng/mL to be deficient and recommends vitamin D levels between 40 and 60 ng/mL for both children and adults
  • The Vitamin D Council suggests vitamin D levels aren’t sufficient until you reach 40 ng/mL

According to the Vitamin D Council, 40-50 ng/mL is the level of vitamin D humans evolved with living traditional outdoor lifestyles.  At these levels, vitamin D works efficiently to control the level of parathyroid hormone and calcium in the body.

The controversy on what is an optimal level of vitamin D continues, with articles and statements supporting all of the above guidelines.

Do YOUR bones need Vitamin D?

If we go by the recent research, the benefits of vitamin D supplementation on bone may be limited to people deficient in vitamin D.  However once bone loss has occurred, it is very hard to re-gain….so why would we ever want to risk becoming deficient in vitamin D? 
 
Additionally, bone health is not solely dependent on vitamin D and calcium.  Your bones need a constant supply of over 20 nutrients to remain strong and healthy.  Even if your vitamin D levels are sufficient, and you are adequately absorbing calcium, if you don’t have enough of the important synergistic nutrients to drive calcium into the bone and aid in mineralization, your bones will not benefit.

Perhaps one reason why these studies suggest that vitamin D is not beneficial is because the study participants lacked the other essential bone building nutrients needed to work in conjunction with vitamin D.
 
If you look toward our ancestry and nature, the primary way we got vitamin D was through sunshine, not food or supplementation.  In fact, very few foods contain vitamin D.
However, with our indoor lifestyles, concerns about skin cancers and use of sunscreens, and a decrease in all nutrient absorption as we age, most adults are at risk of becoming vitamin D deficient.

So don’t dump the D!

Without question, if you have or are concerned about osteoporosis, you should get your vitamin D status tested and supplement accordingly. The Vitamin D Council provides an excellent guide to proper supplementation based on your test results.
You can check out this valuable resource here.

Vitamin D may not be the magic bullet for improving bone density or curing your osteoporosis, but sufficient intake along with a diet that supplies a full complement of bone building vitamins and minerals can help to keep our bones strong and healthy for life!

Call me today for a free 15 min consult to find out if my BONES Method for assessing and addressing bone health is right for you.   703-738-4230 

 

References:
  1. Apaydin, M., Can, A. G., Kizilgul, M., Beysel, S., Kan, S., Caliskan, M., . . . Cakal, E. (2018). The effects of single high-dose or daily low-dosage oral colecalciferol treatment on vitamin D levels and muscle strength in postmenopausal women. BMC Endocrine Disorders,18(1). doi:10.1186/s12902-018-0277-8
  2. Avenell, A., Mak, J. C., & Oconnell, D. (2014). Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd000227.pub4
  3. Effects of vitamin D supplementation on musculoskeletal … (n.d.). Retrieved from https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30265-1/fulltext
  4. Forrest, K. Y., & Stuhldreher, W. L. (2011). Prevalence and correlates of vitamin D deficiency in US adults. Nutrition Research,31(1), 48-54. doi:10.1016/j.nutres.2010.12.001
  5. Huber, L. C. (2018). Faculty of 1000 evaluation for Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. F1000 – Post-publication Peer Review of the Biomedical Literature. doi:10.3410/f.732369946.793542051
  6. Johannes P. T. M. Van Leeuwen, Driel, M. V., & Pols, H. A. (2004). Control of Osteoblast Function and Bone Extracellular Matrix Mineralization by Vitamin D. The Skeleton,307-332. doi:10.1007/978-1-59259-736-9_21
  7. Newman, T. (2018, May 13). Could vitamin D help to fight diabetes? Retrieved from https://www.medicalnewstoday.com/articles/321787.php
  8. Symonds, M. (2018). Faculty of 1000 evaluation for Effects of vitamin D supplementation on musculoskeletal health: A systematic review, meta-analysis, and trial sequential analysis. F1000 – Post-publication Peer Review of the Biomedical Literature. doi:10.3410/f.734168764.793551458itamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men
Holistic Pain Relief: Laura Di Franco’s Ultimate Guide to Healing Therapies, Modalities and Practices

Holistic Pain Relief: Laura Di Franco’s Ultimate Guide to Healing Therapies, Modalities and Practices

 

This week I would like to share with you an AWESOME blog post written by my friend and colleague Laura Di Franco.  In Laura’s Guide to Healing Therapies, Modalities and Practices you will find a a wealth of knowledge on holistic healing, not only to address pain, but all conditions of human life.  My nutritional expertise is highlighted in Laura’s posting in the Integrative Nutrition section.

I first met Laura while we were working together as physical therapists in Mclean, Virginia in the early 2000’s.  At a time when most physical therapists were still HUMming away (in the PT world HUM stands for hot packs, ultrasound and massage), Laura was branching out into holistic physical therapy and I into Integrative Medicine and Nutrition. Through our different journeys, we both came to the same conclusion:

To truly heal, you need to get to the root cause of the problem, not simply cover it up with a band-aid type approach.

If you have been following me for a while, you know that I don’t believe in treating osteoporosis by simply recommending calcium and vitamin D supplements and a daily 30 minute walk.  Osteoporosis isn’t the result of a deficiency in supplements, but a combination of factors.

 

Fighting osteoporosis requires:

  • Real, whole foods that package nutrients in a way recognized by the body
  • A well functioning digestive tract that allows you to digest and assimilate nutrients
  • A lifestyle approach that gives you the capacity to meet the demands of life’s stressors
  • An exercise program that builds lean muscle tissue while also focusing on balance and posture
  • A targeted supplement program to meet your specific nutrient demands

When it comes to healing the body, just not the symptom, you need to take a holistic approach that addresses every aspect of your well-being…mind, body, soul and spirit.  

Please check out Laura’s blog post.  If you have experienced healing results from a therapy not mentioned, be sure to leave her a comment so she can share it. 

“When someone finds a therapy, practice or modality that changes their life, we heal the world!”  Laura Di Franco

Give me a call to learn about my holistic approach to building strong, healthy bones!  703-738-4230 or email me at susan@nurturedbones.com

Round Up in Your Bones?

Round Up in Your Bones?

By now you have heard that the weed killer Roundup is showing up in dozens of popular breakfast cereals and snack bars.  According to independent testing commissioned by the Environmental Working Group, the chemical glyphosate was found in 43 of the 45 conventional oat products they tested. Glyphosate is the active ingredient in Roundup, the world’s most widely used herbicide in the farming and landscape industries.  Although the Environmental Protection Agency does not consider glyphosate to be a human carcinogen, in 2015, the World Health Organization’s cancer agency declared that glyphosate is a probable human carcinogen. Recent studies have also proposed that glyphosate could impact other aspects of our health as well which leads me to ask “Does it affect our bones?”
 
What exactly is Glyphosate?

Glyphosate is a non-selective herbicide, meaning it will kill most plants. These herbicides are applied in large amounts to crops 2-3 times per season to remove weeds and then prior to harvesting to dry out the grain in a process called ‘desiccation.’  Glyphosate based herbicides are designed to specifically inhibit an enzymatic pathway unique to plants that interferes with protein synthesis and growth. Because this pathway only exists in plants and bacteria, not humans or animals, Roundup is assumed not to be harmful for people.  However, glyphosate is increasingly accumulating in people’s bodies. This is because the chemical remains in leaves, grains or fruit and can’t be removed by washing, nor is it broken down by cooking.  So if you are eating conventionally produced vegetables, fruits, corn, soy, potatoes or grains, you are ingesting glyphosate.  It can also enter the body by direct absorption through the skin or by drinking water contaminated with glyphosate. Glyphosate when combined with the additional ingredients in Roundup and other herbicides, make it even more toxic than glyphosate alone.
 
 How can glyphosate affect your bones?
 
Although there are no studies linking glyphosate and bone loss or osteoporosis, there are several potential ways this chemical can negatively impact your bone health.

 
 
5 ways Roundup in your food may damage your bones:
 
1.  Accumulates in your Bones
Several studies have detected glyphosate in the intestine, liver, muscle, spleen and kidney tissue of animals and one study found glyphosate in the bone. Glyphosate is known to make a strong bond with calcium, so it would make sense that it would end up in the bone. Whether it’s presence damages the bone is unknown.

2.  Creates Dysbiosis and Leaky Gut

Because it kills bacteria as well as plants, glyphosate has an antibiotic effect and can interfere with the health of your gut microbiota.  Emerging research indicates that a healthy gut microbiota can positively influence bone mass. 
3.  Increases Oxidative Stress
Oxidative stress, or the production of free radicals, inhibits new bone formation, accelerates bone turnover which leads to bone loss.
 
4.  Interferes with Vitamin D production
Glyphosate is known to inhibit cytochrome P450 enzymes in the liver which is necessary to create the active form of vitamin D which is necessary to aid in calcium absorption.
5. Nutrient Deficiency 
Glyphosate binds with vital bone building nutrients such as calcium, magnesium, iron, manganese, zinc, and boron in the soil, preventing plants from taking them up.  This affects the nutrient value of the food we eat to build our bones
 
 
5 ways to Avoid and Protect yourself from Glyphosate:

1.  Eat organic ingredients and products to reduce your exposure to all herbicides.

2.  Avoid all Genetically Modified Foods (GMO).  Most GMO crops are developed to be ‘Roundup Ready’, meaning that the plant won’t die when exposed to glyphosate.

3.  Get plenty of probiotics in your diet through eating fermented foods such as Kefir, yogurt, fermented vegetables, sauerkraut, Kimchi, Kombucha, miso.  You can also take a daily probiotic supplement.

4.  Load up on anti-oxidant rich foods such as blueberries, dark chocolate, pecans, artichokes, kidney beans, and green tea.

5.  Support liver detoxification.  Foods like garlic, citrus fruits, cruciferous vegetables, walnuts, beets, green tea all support the liver’s natural ability to expel toxins from the body.

Although there is no direct evidence that glyphosates induce bone loss, there is plenty of reason to be concerned about this chemical accumulating not only in our plants, but our soil, our water and our bodies.  
 
If you are interested, there is a test that can accurately assess the burden of glyphosate exposure in the body.  Respond to this email or give me a call to find out more.  703-738-4230

Get a Grip on your Bones

Get a Grip on your Bones

Upon rising with the sun barely peeking up over the horizon, I cautiously (because I don’t want to trip over my dog!) make my way to the bedroom door. I grip the doorknob, rotate it, and open the door. Making my way to the kitchen, I again twist open the dead bolt, turn the doorknob, and release the hound for her morning relief.  I pick up the kettle and, holding it tight, fill it with water and carry it to the stove.  Grabbing a can from the panty, and using one smooth but forceful motion, peel off the lid and spoon the contents into the dog’s bowl.  After, preparing tea, I sit down at my computer caressing the warm mug in my hands and breath in the aroma that signals the start of my day.  

Within the first few minutes of my day, I rely on the grip strength of my hands to perform just about every action.  Although it is easy to take the strength of your hands for granted, your raw grip strength is actually a predictor of overall health, and even osteoporosis. 
 
Why grip strength matters

Your grip strength not only measures the functional capacity of your hand, but has been shown to be related to cardiovascular function, mobility, amount of muscle mass and bone mineral density.  Stronger grip strength reflects more muscle mass which is associated with increased activity and better health.
 
Studies have been popping up for years linking grip strength to osteoporosis.  As recently as this past February, a study consisting of 120 postmenopausal women found that decreased grip strength was correlated with reduced bone mineral density of the spine and hip and was a strong risk factor for osteoporosis. 
 
Hand grip strength may also be associated with cardiovascular function and disease.  One researcher found that better hand grip strength was associated with having a healthier heart structure and function.  Another found that the weaker your grip strength, the greater the risk of having a heart attack or stroke.  In fact, grip strength can be a stronger predictor of cardiovascular mortality than systolic blood pressure!

Improved cognitive functioning, including memory, reaction time, and reasoning, has also been linked to a stronger hand grip.
 
Lastly, the stronger your grip the better mobility and balance reducing the risk of falling and breaking a bone.
 
How good is your grip strength? 

Can you lift a pot off the stove, carry grocery bags in from the car, loosen the lid of a jar?  If you struggle with these activities, that could be a sign that you need to takes steps to make activity and exercise a priority in your life.  Remember, grip strength is a predictor of overall body health and well-being.  It is important to understand that it is not the actual strength of your forearm and hand muscles that is significant, it is what your grip strength reflects about the strength and coordination of the muscles throughout your body.
 
Doing exercises to strengthen the muscles in your wrists and hands can certainly help, especially if you have osteoporosis in your forearm, but just improving grip strength isn’t the answer.  You need to engage in exercises and activities to improve skeletal muscle strength and health.  The more movement you do, whether it is structured exercise or functional work like house chores, gardening, carrying grocery bags, the more you strengthen your muscles head to toe, along with the bones that lie beneath them. 
 
Physical strength and fitness is one of the strongest predictor of individual’s future health.
 
**Grip strength, though a predictor of strength in the general population, doesn’t carry the same predictors in those with pain or deformity in the hands secondary to arthritis or rheumatoid disease.

If you are local to Northern Virginia, give me a call and we can schedule a time to test your grip strength!

703-738-4230
 

Diabetes and Your Bones

Diabetes and Your Bones

 

November is national diabetes awareness month.  Sadly, over 30 million people across the US are afflicted with diabetes.  Having high blood sugar can result in many serious health complications such as cardiovascular disease, nerve damage, kidney damage, eye damage, hearing loss, and Alzheimer’s disease.  And if that isn’t enough to worry about, diabetics are also at greater risk for developing osteoporosis.  Luckily, a lot of the same holistic approaches used to prevent and manage diabetes can also effectively preserve bone health.
 
There are two types of diabetes and each affect our bones differently. 
 
Type 1 diabetes is an autoimmune disease where the body’s immune system attacks and destroys the insulin-producing cells of the pancreas. This results in the inability to produce insulin.  Insulin, however, is important for building bone density because it stimulates osteoblasts, the cells that make new bone.  Insulin is also important in building lean muscle tissue. It stimulates the cellular pathway in muscle that enhances muscle growth.  And I can’t stress enough that lean muscle tissue is highly correlated with better bone health.  
 
Although insulin therapy allows better control of blood glucose, there continues to be greater incidence of osteoporosis and fractures in type 1 diabetics than the normal population.
 
People with type 2 diabetes actually have the opposite problem than those with type 1 diabetes.  In a type 2 diabetic, the pancreas still produces insulin, but the body is unable to use it effectively. This results in sugar accumulation in the bloodstream, called hyperglycemia.  It was previously thought that the weight gain that typically occurs in those with type 2 diabetes would benefit the bones and help increase bone mineral density.  However, recent studies indicate that hyperglycemia actually causes disruptions in bone metabolism by inhibiting the osteoblasts and creates abnormalities of bone collagen as well.   
 
Type 2 diabetes often co-exists with increased body fat.  Studies have shown that women with high body fat have bones that are up to 9% weaker than those with normal body fat.  While it’s not known exactly why excess fat is bad for bone health, animal studies have found that obese rats produce more fat cells than bone cells in bone marrow, which may explain the weakening.
 
The effects of insulin resistance on muscle also influences bone health. When the muscles are resistant to insulin, glucose cannot get into the muscles cells and help to build and maintain muscle mass.  Conversely, good muscle mass is needed for improving insulin resistance.  You muscles are one of the major insulin sensitive tissues in the body, so the more muscle mass you have, the more glucose you can move into your muscles in response to insulin.
Once again, the more lean skeletal muscle tissue, the better your bone health is going to be.
 
Common to both type 1 and type 2 diabetes is poor blood sugar control leading to excessive glucose in the bloodstream.  Human studies have linked high circulating blood sugar with chronic inflammation.  Chronic inflammation is one of main reason why people with diabetes are at an increased risk for heart attacks, strokes, kidney problems, and neuropathies.  Inflammation has also been seen to stimulate osteoclasts (cells that breakdown bone) and inhibit osteoblastic function.   Many studies have confirmed that higher levels of inflammatory markers (such as C-reactive Protein) are associated with increased fracture risk.
 
The good news is that many of the same things that I stress to help keep your bones strong and healthy can help diabetics better manage blood sugar control and inflammation.  And although there is no cure for diabetes, remission is possible in many cases of type 2 diabetes.  Focusing on nutrition, exercise and lifestyle changes can help normalize blood sugar levels, improve the body’s response to insulin and squelch the fire of inflammation.
 

9 Tips for Managing Diabetes and Maintaining Bone Health

 

1.  Get good with the glycemic index (GI): The measurement of how much carbohydrate-containing foods raise you blood sugar after you eat them.  Replace foods high on the GI with those with a lower GI.  Click here for more on the GI.  
 
2. Learn the value of non-starchy vegetables:  Dark leafy greens, asparagus, broccoli, Brussel sprouts low are all low on the GI, low in calories, high in fiber as well as a rich source of vitamin K and other bone building nutrients making them a perfect food for controlling blood sugars and building bones.  

3.  Eat fruits in moderation:  Blueberries are an excellent choice of fruit because not only do they have a low GI, the are high in antioxidants and also have anti-inflammatory properties.

4.  Dump sweetened dairy: Consume diary in the form of unsweetened Greek yogurt with is rich in healthy probiotics along with providing calcium and protein. 

 5.  Savor wild salmon:  Fatty fish contain omega-3 fatty acids, vitamin D and selenium which all support your bones and your body by providing anti-oxidant and anti-inflammatory effects. 
 
6.  Nothing wrong with snacking on nuts and seeds:  Rich vitamins, minerals, fiber, and walnuts and seeds such as chia and flax, provide omega-3 fatty acids.
 
7.  Learn to love Lentils:  Not only do they provide vitamins, minerals, fiber and protein that helps to control blood sugar, your bones love lentils!  
 
8 .  Add Aerobic exercise:  Not only does exercise help to immediately lower blood sugar, but these effects can last for 24 to 72 hours afterwards.  The goal of exercise for the diabetic should be 30 minutes of daily aerobic exercise, like walking or biking.  Impact exercise such as power walking, jogging, hiking, court sports are best for building bone.

9.  Rev up the resistance training: For every 10% increase in skeletal muscle mass, there is an 11% reduction in insulin resistance. We know that improving muscle mass also equates to an improvement in bone quality.

References:

1. What People With Diabetes Need to Know About Osteoporosis. (n.d.). Retrieved from https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/diabetes
2. Torres-Costoso, A., Pozuelo-Carrascosa, D. P., Álvarez-Bueno, C., Ferri-Morales, A., Ibarra, J. M., Notario-Pacheco, B., & Martínez-Vizcaíno, V. (2017). Insulin and bone health in young adults: The mediator role of lean mass. Plos One,12(3). doi:10.1371/journal.pone.0173874
3. Fukushima, Y., Kurose, S., Shinno, H., Thu, H. C., Takao, N., Tsutsumi, H., & Kimura, Y. (2016). Importance of Lean Muscle Maintenance to Improve Insulin Resistance by Body Weight Reduction in Female Patients with Obesity. Diabetes & Metabolism Journal,40(2), 147. doi:10.4093/dmj.2016.40.2.147
4. Kanazawa, I., & Sugimoto, T. (2017). Diabetes and Osteoporosis. Diabetes and Aging-related Complications,127-139. doi:10.1007/978-981-10-4376-5_10