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topics in women’s health

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Bone Health

HOW HEALTHY BONES GROW

We need strong bones to keep active and fit beyond our eighties but there is much confusion about how to keep our bones strong and how to treat bone loss.

Bone health has become a multibillion-dollar industry and drugs, which improve bone densities, can be dangerous, despite what celebrities are paid to tell you in commercials. Reports are beginning to surface about bone death from the very drugs promising to keep you upright in your old age (see my March 2008 blog). There are many natural ways to improve your bones but first you need to understand how bones grow as you age. That’s right, your bones never stop growing.

Bones are constantly breaking down and rebuilding. Bone breakdown (resorption) is a normal, vital part of bone health and without it you cannot make new strong, shock-absorbing bone. If you don’t make new bone your bones will become brittle and more likely to break. It’s all about balance—bone loss, balanced with new bone formation. All of this bone breaking and rebuilding is controlled by many different hormones.

When you are young and hormonally peaking, your bone formation outpaces bone loss. You reach your peak bone mass between the ages of 20 and 30, your prime childbearing years. After this, things reverse. In your mid to late 30’s bone loss begins to outpace bone formation. During the 2 to 3 years before and after menopause, bone loss is higher than at any other time in a woman’s life. Most women lose 3% to 5% of their bone mass during this time. After this, bone loss slows back down to the normal rate of 1% to 1.5%. That’s why it’s important to know your bone density before menopause hits.

After menopause, the amount you lose isn’t different from the amount you used to lose when you were young. But the really big, important difference is that AS YOU AGE YOU MAKE LESS NEW BONE. Why? There are many reasons: poor diet, poor digestion, low or imbalanced hormones, deficient minerals, deficient vitamins, less activity, less aerobic exercise, less protein, excess processed foods, over-dieting, extreme diets (long term vegan and poorly monitored vegetarian diets), and even over-exercising. All the reasons your body ages and slowly deteriorates help to explain why you may not make enough bone as you grow older.

It is very important that in your mid to late 30’s you do all that you can to support bone building. This may be especially hard to do if you are breast feeding or pregnant in your late 30’s and early 40’s. Now I am not saying don’t have babies later in life—but take special care to ensure that your diet, digestion, food choices, hormones, and supplements optimally support bone building. Or you may find yourself unable to enjoy running in the sand with your grandchildren.

HOW TO BUILD BONES NATURALLY AS YOU AGE

When I consider bone building with my patients I discuss 5 topics: Hormones, Vitamins, Minerals, Digestion/Diet, and Exercise. All 5 are important.

1) Hormones

All studies have shown that using hormone support (estrogen and progesterone) prevents bone fractures and improves bone density. Added bonus: in doing this you will look and feel better, and reduce your risks of heart disease and dementia (if you use hormones wisely).

Estrogen prevents bone breakdown, and four hormones, (progesterone, testosterone, DHEA, and Growth Hormone), build new bone. Measure these hormones and maintain their levels in the mid or upper middle ranges of normal. I describe how to do this safely in my book.

In addition to these hormones, Parathyroid Hormone, (PTH), is important to regulate bone growth. It is now available for the treatment of osteoporosis, administered with an injection pen, and marketed under the name, Forteo. I recommend this for women who have severe bone loss, which is not improving despite supporting the 5 areas discussed here.

Calcitonin is another hormone that supports bone growth (marketed as a nasal spray, Miacalcin or Fortical). Unfortunately this has not been as effective as PTH in improving bone strength, although some studies have shown it to be helpful in reducing pain associated with severe osteoporosis.

2) Vitamins

Vitamin K ensures that calcium “sticks” to bone. I think of vitamin K as the glue that helps hold bone together. Without vitamin K bones are prone to breaking. In addition, vitamin K helps to control where your calcium goes. Without enough vitamin K you tend to lose calcium or calcium “sticks” to your arteries, and not your bones. Studies have shown that women who are deficient in vitamin K were more prone to calcification (hardening) of their large arteries and bone loss.

Vitamin K is fat soluble—that means that it is absorbed with fat. It requires a digestive enzyme (lipase) and bile salts to be absorbed. For this reason always take vitamin K with food. Women who have their gallbladder removed may be at higher risk of vitamin K deficiency.

There are many forms of vitamin K:

Vitamin D is needed to absorb calcium and it helps to regulate PTH (parathyroid hormone) levels. All women should know their vitamin D level (25 OH D level) and maintain it above 30 nmol/L (ideally 50 nmol/L).

Sunlight for 15 minutes per day is a great way to maintain levels, but most women need to supplement because of limited sunlight. Seasons, geographic latitude, time of day, cloud cover, smog, and sunscreen affect UV ray exposure and vitamin D synthesis. For example, sunlight exposure from November through February in Boston is insufficient to produce enough vitamin D. Even weak sunscreens (SPF=8) block your ability to make vitamin D.

Caffeine also limits your absorption of vitamin D. A study showed that elderly postmenopausal women who consumed more than 300 milligrams of caffeine per day (18 oz, or less than a Venti Starbuck’s) lost more bone in the spine than women who consumed less.

The best form of Vitamin D is cholecalciferol, D3 (preferred to ergocalciferol D2). Always take vitamin D with food to improve absorption. If you are taking it and your level is not improving consider taking a pancreatic enzyme, (with lipase), with your meals (see my blog on Digestion and Bone Health).

Vitamin B6 has been shown to help bones grow stronger (and by the way, progesterone works optimally when B6 levels are optimal). Vitamin B6 deficiency is rampant in women. Why? Oral estrogens and birth control pills lower it and many additives in processed foods (food dyes, pesticides and plant growth regulators) prevent it from working normally inside us.

Vitamin C deficiency, or scurvy, is known to cause weak bones. Vitamin C helps to make bones and it increases absorption of calcium. In a world with growing pollution, (particularly heavy metals), we are all more prone to vitamin C deficiency.

3) Minerals

Magnesium is the most common mineral deficiency that I see in my patients and studies have shown that if it is low, bones are more prone to break. You lose magnesium with excessive sweating and stress, so it is often low in perimenopause and menopause. Also, you may be prone to low magnesium if you suffer from chronic yeast infections.

Magnesium activates vitamin D and helps to build cartilage. You need 300 mg/day, more if your RBC (red blood cell) magnesium level is below 4.8 mg/dL. Best forms are glycinate, taurate, and aspartate (citrate is good if you are prone to constipation, it will cause your stool to be looser). Good food sources are kelp (the best food source), whole grains (wheat bran and wheat germ), tofu, legumes, seeds and nuts.

Calcium needs to be balanced with phosphorous (2:1), so the more phosphorous you eat, the higher your need for calcium. Protein and soda raises your phosphorous, so don’t go over board with either of these. To improve your bones you will need 1200-1500 mg of calcium each day.

The best forms are: Calcium citrate, malate, gluconate, lactate, ascorbate, or hydroxy apatite, (not carbonate which is the hardest form to absorb and requires normal stomach acid-lacking in most people over the age of 50, or on reflux medications). Most people think dairy is the best food source but many foods have even higher amounts. In addition to cheeses, good food sources are: kelp, kale, turnip greens, dulse, collard greens and almonds. Many women take TUMS for a calcium supplement. This doesn’t make sense since you need acid to absorb calcium.

Boron prevents calcium wasting, is needed for vitamin D to work, and it improves estrogen and testosterone levels. You need 2 to 3 mg/day. Good food sources are fruits and vegetables. Unfortunately many soils are boron deficient and it is thought that many Americans are boron deficient, despite eating these foods regularly.

Zinc enhances the actions of vitamin D. Most American diets are low in zinc. It is best taken in the Zinc picolinate form,15 to 30 mg/day. The absolute best food source is oysters, but other good sources are: shellfish, pumpkin seeds, and ginger root. It is in many legumes, nuts and seeds but zinc is not easily absorbed from these foods (it binds to fiber compounds in plants).

Manganese is needed to make collagen (the protein framework for bone). You need 15 to 20 mg/day. Good food sources are nuts (especially pecans, almonds, and brazil nuts), whole grains (especially barley, rye, whole wheat, split peas and buckwheat), dried fruits, and green leafy vegetables.

Copper prevents bone breakdown. You need 1 to 2 mg/day. Beware however, that too much can lower your zinc and vice versa. Good food sources are shellfish (particularly oysters), and legumes.

Strontium is normally found in bone. It acts similarly to calcium, and studies have shown that it can improve bone density and prevent dental caries. Now, don’t be confusing natural strontium with strontium-90, produced during nuclear testing in the 1960’s. Natural forms of strontium (strontium gluconate, citrate and carbonate) have been used safely for decades to draw calcium into bone and promote bone formation.

Because strontium is so similar to calcium it will compete with calcium. For this reason, always take it away from calcium and don’t take too much or it could lower your calcium in your bones.

Doses vary depending on the type of strontium used. I typically prescribe strontium citrate (one of the best absorbed forms), 250-700 mg/day, taken on an empty stomach, (2 hours after any meal and at least 4 hours away from any calcium or other minerals).

Silicon promotes bone growth by decreasing bone-destroying cells (osteoclasts) and increasing bone-promoting cells (osteoblasts). It is one of the most abundant elements on earth, (second only to oxygen) but, it’s not easily absorbed. Most people need 20 to 40 mg/day. Good food sources are: unrefined grains, such as brown rice and oatmeal.

4) “Gut” Stuff: Diet and Enzymes

Bone is largely protein (cartilage). So building bone requires a diet with protein and a good digestion to absorb protein and the nutrients mentioned above.

You need a diet with adequate protein (but not excessive protein) and plenty of fruits, vegetables, and whole grains to provide the vitamins and minerals mentioned above. In addition omega 3 fats (olive, fish and nut oils) are important.

You can take all the vitamins, minerals and protein in the world, but they won’t do you any good, if you can’t absorb them. Stomach acid (Hydrochloric acid, HCl) and digestive enzymes (protease) are needed to digest and absorb proteins and calcium. Lipase and bile acids are needed to absorb vitamins D and K. So if you have had your gallbladder out or you have digestive problems consider using a bile acid and/or digestive supplements.

Your stools will tell how well your digestion is working. Let me get a little descriptive here. Your bowel movements should be formed, in a tube, and hold together, without falling apart when flushed. They shouldn’t be pelleted or hard to pass and you shouldn’t have excess gas, or rectal itching. Many people put up with such symptoms but they are usually signs of poor digestion. If your bone loss is not improving, have your digestion evaluated. If you don’t want to be tested or can’t, simply use a good pancreatic enzyme that contains lipase and protease and be sure to take it with your meals and supplements.

5) Weight Training and Exercise

Many studies have shown that strength training improves bone mass, density, and strength as well as reducing falls, and improving your mood, and general outlook on life. Exercise stimulates your body to make new bone. Just as training builds bigger and stronger muscles, bones becomes more dense and stronger when there is regular resistance and demands made upon it.

Weight training exercise is as important as any hormone or vitamin. You need to do it at least 2 to 3 times each week. Lifting weights is great but other examples of effective weight-bearing exercises are: jumping rope, baseball, basketball, soccer, tennis, aerobics, dancing, and walking. (Although swimming is good exercise, it is not a weight-bearing activity—but I still recommend it.)

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Breast Pain

Painful breasts are so common that it is considered “normal”, but it’s not. It is a sign that your hormones are out of balance. Breast pain is preventable and should not be ignored. Though there is no proven link to breast pain and breast cancer, breast pain is a sign that your breast health is not ideal.

Here is a list of common causes (described in detail in my book, The Natural Hormone Makeover):

Things that help alleviate breast pain:

  1. Avoid caffeine in any form. If you have to have it, drink green tea. The antioxidants in it help the liver to metabolize the caffeine. There are also chemicals in green tea that promote hormonal health. (Avoid dairy products, and alcohol, too.)
  2. Yoga, exercise and stretching all help symptoms of PMS, especially breast pain, as lymph flow is improved. Exercise helps to balance your hormones.
  3. Lipotropic complex is an inexpensive herbal blend of herbs and liver nutrients that help your body breakdown estrogen to alleviate breast pain (see Liver health).
  4. Evening Primrose Oil is an Omega 6 (GLA) oil that is especially good for balancing women’s hormones. Use 2000 to 3000 mg daily. I generally recommend using it with vitamin E (800 units/day). This combination also helps to reduce hot flashes.
  5. Beta-Sitosterol, is a plant sterol that can help estrogen breakdown. Foods high in sterols include nuts, wheat germ, and sesame seeds. For breast pain you need high levels, 600-800 mg/day.
  6. Chinese Herbal Blends have been used for centuries to improve hormone metabolism and relieve breast pain and PMS.
  7. Acupuncture is great for PMS symptoms and breast pain.

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Excess Hormones

Symptoms of Excess Estrogen:

Symptoms of Excess Progesterone:

Symptoms of Excess Testosterone:

Symptoms of Excess Adrenal Hormones:

Cortisol:

DHEA:

Aldosterone:

Pregnenolone:

Thyroid Hormone:

Melatonin:

Growth Hormone:

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Low Adrenal Hormones

Symptoms of Low DHEA:

Symptoms of Low Cortisol:

Symptoms of Low Pregnenolone:

Symptoms of Low Aldosterone:

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Low Growth Hormone

Symptoms of Low Growth Hormone:

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Low Melatonin

Symptoms of Low Melatonin:

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Low Sex Hormones

Symptoms of Low Estrogen:

Symptoms of Low Progesterone:

Symptoms of Low Testosterone:

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Low Thyroid Hormones

Symptoms of Low Thyroid Hormones:

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PMS

PMS is very treatable. I like the Chinese take on PMS. It is “stuck liver energy” or Qi (pronounced “chee”). The liver is where our hormones get broken down. Understand the liver and you will understand how to feel good. According to Chinese Medicine, anything that helps the liver improves PMS and anything that is bad for the liver worsens it. So, alcohol, dairy, and caffeine are not good for PMS. Herbs that help the liver, like milk thistle, the herbal combination lipotropic complex, and Chinese blends that move the liver help PMS very well.

I treat PMS with liver herbs—either Chinese blends or lipotropic complex. Take these herbs 2-3 times each day for the entire month, and as you improve, use them only from the midcycle onward. In addition, stop caffeine (except green tea—which does not stagnate the liver much), alcohol, and dairy. Okay, maybe you can’t stop. Occasional use is fine—but avoiding them really will help.

Chinese medicine also connects emotions to our organs. Guess what emotion is associated with our liver? The Chinese call it “smoldering anger.” I love that they distinguish between various forms of anger. We women are prone to the smoldering type (men on the other hand are prone to the explosive type). So, in addition to herbs and diet, look at what you hate about your life and try to change it. If you can’t or won’t, try the Chinese herbal formulas, “End Witchiness” (for irritability) or “End Monthly Blues” (for depressive symptoms). They work well and I think all women should have a bottle of these on hand.

In addition, I divide PMS into 2 parts: young PMS, and older PMS.

Young PMS affects women under 35. Most have OK levels of progesterone. So PMS in their case is usually due to stuck liver. Sometime there is stress so that their ovulation is off and they may not produce enough progesterone. Sometimes there is a thyroid issue so that progesterone is not being made or not working well. But, because most young PMS is a liver issue, it improves with liver herbs, improved diet (less dairy, alcohol, and caffeine) and regular exercise (which is another way to improve liver “flow” according to Chinese sages). So if you are under 35, take herbs, lay low on caffeine and dairy, and exercise.

Older PMS affects women over 35. They are most likely in need of better progesterone and estrogen balance. You can have your doctor measure a progesterone level when it is peaking, on days 19 to 21 in your cycle. Your level should be greater than 6ng/ml (your level needs to around 11 to get pregnant). If progesterone is low, ask to use bioidentical natural progesterone (on days 15 to 25) or you can try using Vitex, an herb that improves progesterone levels.

If you are having PMS 24/7, before and after your cycle, you are probably low in progesterone and estradiol. So check an estradiol level—it should be greater than 60 pcg/ml. If progesterone and/or estradiol are low, support them with bioidentical hormones. Use Estradiol on days 1 to 25 and add in progesterone on days 15 to 25.

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