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