A Growing Problem

One of my keen areas of interest is bone health or more specifically the thin bone disease known as osteoporosis.

It is an area of consistent research interest and the influence of diet, nutrition and vitamins is gaining a lot of press. We have come a long way from the idea that bone strength is all about calcium but the message is slow to leak through to the conventional medical community and general public alike. Personally, I feel that many people view bone as a hard, inert and brittle substance similar to the skeleton that use to hang in the corner of the school biology lab. In reality, living bone is a very different. Our skeleton is a highly active metabolic tissue and undergoes a regular process of renewal known as ‘bone turnover’. This process changes with age and is influences by many lifestyle factors.

I was lucky enough to be asked to contribute to an article written by Kate Miller on the subject of bone and joint health; thanks to Natural Product News, you can read the final article here A Growing Problem. By Kate Miller, Natural Product News July/August 2016.

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Did you need that buzz and burn just to feel well… before you got fibromyalgia?

Marcusby Holistic Osteopath, Marcus Webb

Over the years of working with fibromyalgia (FM) sufferers and writing about FM stress always bobs up as a key associated factor closely followed by the inevitable cause and effect argument that tends to ensue with no one really coming out any the wiser! Naturally, suffering from a disabling, medically unexplained and often untreatable condition brings inherent stresses of its own with it, but there is some compelling data suggesting that a pre-FM state of being may exist in many sufferers that is stress sensitive and may possibly form the basis of their system breakdown that ultimately leads on to the clinical picture we know as FM.

It is not uncommon for me to hear how a FM suffer is finding it so hard to get use to a reduced level of activity after being “so busy” or “driven” in work or sports. Many FM sufferers can recall how well they use to multi-task juggling work, family life and the gym without a second thought and how they needed that ‘burn’ at the gym to feel energised and on top of life and if they missed their routine fix of exercise how flat they felt, and this was before they developed FM. The interesting thing with all these stories if just how similar they are; active, driven often very successful individuals now living lives they could never imagine; lives of pain, fatigue, loss of motivation and in many cases social isolation. Naturally, depression and stress are more than likely to develop in such circumstances but what is even more intriguing is the idea that a pre-FM state existed that actually required all the stimuli of multi-tasking, the work-buzz and the physical burn of the gym just to keep that person feeling normal. The key tipping point is when it all stopped… that’s when the system crashed and burned.

Within the FM community, how many times do we hear the story of how well everything was going before that ‘virus’ hit and confined the person to bed for some time or that ‘injury’ took the person out of circulation for a good while as it healed. Alternatively, someone’s entire life and routine could be blown out of the water by a bereavement or redundancy at work. A virus, an injury, loss/bereavement, redundancy… there are all very common triggers for FM but are they actually to blame or were they simply the catalyst that broke the behaviours that simply kept the person going? Data to support this theory does exist and revolves around exercise-based research. We now know that within a group of healthy individuals who are exposed to regular exercise some develop widespread musculoskeletal pain, fatigue and mood disturbances (the same or very similar profile to that of FM) after a brief period of the exercise withdrawal while some don’t. Even more profound was the fact that the symptomatic individuals, who appeared to suffer so badly following the withdrawal of their exercise, also displayed other typical features of FM such as altered autonomic function, reduced immune (especially NK-cell) responsiveness and other bodily reactions typical of hypothalamic-pituitary axis (HPA) dysfunction. In essence, they appeared to develop all or many of the clinical features of FM!

The authors of the study suggested that, in some, there exists a pre-existing hypo-functioning stress system that requires regular stimulus just to remain normally stimulated. This mechanism follows the principles of what is known as ‘allostasis’, in which the body seeks to maintain balance, and may explain why so many FM sufferers report living very active, stimulating and to onlookers stressful lives prior to developing FM. It appears that while they were unknowingly self-medicating with stimulus from all angles they were doing so simply to feel normal; it was the only way they could kick their hypo-functioning stress systems into life. However, with this theory comes further questions such as why do some people have hypo-functioning stress system to start with? The possible answers to this part of the puzzle may lie in the long accepted association between early life stress and a dysfunctional stress regulating systems. It is known that early life stress is strongly linked to the development of FM with the pivotal trigger being an over or under active stress regulating system; it is known that early life stress can trigger one or the other. In the case of an under active stress regulating system, having a life full of stimulus and arousal not only distracts from us from dwelling on negative life events it also stimulates the body and maintains a normal level of being. Anything that interferes with this will tip the body into a negative spiral both emotionally and physically as the full effects of the underactive HPA system kicks in. With prolonged removal from life events and routines that enhance arousal a chronic state of low HPA activity becomes the normal and the clinical picture of chronic fatigue syndrome with FM (CFS/FM) becomes established.

While this will not offer a universal explanation to the development of CFS/FM it does put forward a provocative argument for many cases and should assist in managing stress or a system that needs a bit of stress to feel normal. May be this helps to explain why some CFS/FM sufferers do so well on natural agents such as TriAdren (a special blend of standardised adrenal supporting ingredients; ginseng liquorice root and vitamin C) while others feel such a benefit from agents designed to calm an over active HPA system such as Zen-Time with Lactium. In the case of the low functioning HPA system enhancement with graded exercise and carefully balanced adrenal stimulants such as those in TriAdren help to give the lift this subset of CFS/FM sufferers need while the central nervous system calming effects of the Lactium ingredient contained in the Zen-Time formula eases the agitation and stress related symptoms that typify an over active HPA system. Either way, managing CFS/FM is an ever evolving science and art but the basic science that underpins the simple act of withdrawing exercise and observing the effects on healthy individuals has open many new angles for further study.

Learn more about TriAdren at www.supersupps.com

Learn more about Zen-Time with Lactium (and take the FREE online stress test) at www.zen-time.co.uk

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Gluten sensitivity and fibromyalgia… is there really a link?

Marcusby Holistic Osteopath, Marcus Webb

By the time you read this little article I am sure you will have heard about a study linking gluten sensitivity with fibromyalgia and reporting on how ‘remarkable clinical improvement can be achieved with a gluten-free diet in patients with fibromyalgia (FM) even if coeliac disease has been ruled out’. The conclusion also goes on to say that ‘non-coeliac gluten sensitivity may be an underlying treatable cause in FM syndrome’.

However, the plot thickens; in all 20 of the FM subjects studied biopsies of their intestine revealed a pathological change known as intraepithelial lymphocytosis, a finding the authors use to help support their hypothesis that gluten sensitivity is a causal agent and underlies FM. This cause and effect relationship that this latest study hints at does sound convincing especially when we keep in mind that intraepithelial lymphocytosis has been associated with gluten sensitivity in the past but should we be jumping to such a definitive conclusion; what about those FM patients who don’t have intraepithelial lymphocytosis, were they removed from the study because they did not respond to a gluten-free diet? Don’t get me wrong, I am not trying to discredit or down play the study or the potential benefits of a gluten free diet in cases of FM but I am aware that many FM sufferers may read this and feel that they have to follow a gluten-free diet in order to get better but before going on it may be good to lay out a little additional information about intraepithelial lymphocytosis.

Within the tissue of the gut known as (epithelial tissue) special white blood cells known as lymphocytes reside waiting like guard on duty to be triggered into life by an invading army. In the case of the gut this is would normally be a bacterial infection. In around 3% of routine biopsies increased levels of lymphocytes can be observed (ie. intraepithelial lymphocytosis) and between 9-40% of cases celiac disease has eventually been diagnosed. In some cases intraepithelial lymphocytosis occurs in other multi-system disorders such as Hashimoto’s thyroiditis, Graves’s disease, rheumatoid arthritis, psoriasis, multiple sclerosis, Systemic lupus erythematosus, ankylosing spondylitis and autoimmune enteropathy. The other cases tend to be viewed as a non-specific finding related to other health issues such as bacterial overgrowth (SEBO), inflammatory damage secondary to non-steroidal anti-inflammatory drug use or other chronic inflammatory bowel disease. In other words, the presence of intraepithelial lymphocytosis is not diagnostic of gluten sensitivity but in the absence of other causes gluten sensitivity could be a possibility since it has been reported to account for around 10% of the cases of intraepithelial lymphocytosis but it should be kept in mind that hypersensitivity to other non-gluten components of food may also trigger this tissue change. Interestingly, a good number of the 20 subjects had co-existing health problems that have also been linked with the bowel tissue chances characteristic of intraepithelial lymphocytosis such as psoriasis (in 2 cases), hypothyroidism (in 3 cases), inflammarory/irritable bowel (in 5 cases) and gastric reflux (in 10 cases) which is a problem that commonly receives PPI drug therapy. As a drug class, PPI’s are also known to trigger intraepithelial lymphocytosis. However you critique this study as much as you want but what you can’t ignore is the outcome; for many, great relief of their chronic and disabling symptoms using a drug-free approach.

For many FM sufferers having a condition that is resistant to conventional therapies places them in a real corner when it comes to treatment and management options. From my experiences working with FM/CFS sufferers we tend to do what works or what works for that person! Science tends to take its time in catching up with the clinical observations but while it is catching up in many cases there is no real harm in exploring options that appear to have some evidence to support their use such as a trial of a gluten-free diet. From the results of the current study the gluten-free diet was followed for 16 months on average but in one case (a FM sufferer for 20 years) improvement in pain, fatigue and gut symptoms were felt after just 5 months and in another case (a sufferer for 10 years) complete remission of FM and improvements in gut and migraine was also observed after just 5 months. In some cases significant improvements and a return to normal life activities and work were seen after more prolonged (over 30 months) exposure to the gluten-free diet. However you look at it, cutting the gluten has made a dramatic difference to many sufferers in this small study.

If you feel that a gluten free approach is something you fancy trying its not a diet to be taken on lightly… so many foods contain gluten! Despite this, I would advise that you seriously consider going gluten free if your FM is of long standing and you have exhausted all other approaches. Keep in mind that you may have to stick to it for many months before you feel any tangible benefits but again, for what its worth, I can support the observations that many ill-defined inflammatory and pain related conditions simply improve with the elimination of gluten.

To help get you started you should avoid Barley, bulgar wheat, couscous, durum wheat, rye, semolina, spelt, wheat, all biscuits, breads, cakes, chapattis, crackers, muffins, pastries, pizza bases, muesli, wheat based breakfast cereals and anything made from wheat, rye or barley flour. By no stretch of the imagination is this a complete gluten free diet but it’s a start and something you can instigate today. Sitting down with an experienced nutritionist or naturopath should be your next step so you can get a more complete understanding of the complete gluten free diet and what it involves. In the early days of a gluten free diet I tend to recommend the use of a special dietary enzyme supplement based in a blend of plant derived gluten splitting enzymes. In addition to the cellulose digesting enzyme known as cellulase the key ingredient in Gluten Relief is Dipeptidyl Peptidase IV (or DPP-IV for short). DPP-IV is a type of protein splitting enzyme, known as a protease, and has been shown to break down the wheat protein gluten and milk protein casein. This combines with alpha-galactosidase to aid in the digestion of long chain sugars found in beans, broccoli, cabbage, sprouts etc… Using an enzyme preparation such as Gluten Relief (by the Canadian manufacturer Natural Factors) does not replace in anyway a gluten free diet but when you are unsure or are out and about with limited choices it may help to ‘defuse’ a potential gluten containing meal.

Link to study: Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. 

Link to Gluten Relief product

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Spice up your life to cool down inflammation

There has been quite a lot of press interest in the adverse effects of certain anti-inflammatory drugs and their potential to trigger a host of unwanted side effects including heart attacks. It’s no secret that most anti-inflammatory medications can play havoc with your stomach and gut but the news that taking these drugs could cause heart complications was quite a shock to those who have come to rely on these drugs to get them through the day. Interestingly, research over the years into the spice turmeric has revealed some encouraging results when used to treat pain and inflammation. Turmeric is composed of a complex mixture of organic compounds the principle one being curcumin. Although easily confused with the spice cumin, curcumin is completely unrelated and a unique compound to the spice turmeric. It belongs to a group of compounds called curcuminoids that are responsible for the typical yellow colour of turmeric. Anyone who has seen natural turumic root in the supermarket may notice a similarity to another culinary spice, ginger root. However, this is no coincidence because turmeric and ginger both belong to the same botanical family; Zingiberaceae. Both of these spices accumulate pharmacologically important compounds within the root tissue. In the case of turmeric the compounds are known as curcuminoids where as in ginger the compounds are called gingerols. The key fact that interests us is the ability of these compound to effectively reduce inflammation and pain while sparing other tissues the hazardous side effects commonly associated with anti-inflammatory medications. This may sound a bit to good to be true but to understand how turmeric, or more specifically the curcumoid known as curcumin, achieves this we will have to discuss the inflammatory process and a bit of biochemistry!

Inflammation – the basics.

When ever we injure ourselves the body has to mend the damage. To do this, chemicals need to be released that enhance blood supply, neutralise any invading bad bacteria and stimulate the local immune reaction. Over this early (acute) phase inflammation is accompanied by pain, swelling and some heat. In the majority of cases this process is self-limiting and once the injury has been mended all the levels settle to normal along with all the related symptoms. However, this is not always the case especially if there is an ongoing irritant present such as arthritis, joint damage or autoimmune disease. In these cases the inflammation becomes chronic and the sufferer experiences daily pain and disability. Anti-inflammatory drugs can offer great relief but often at a price and their safe long term use has become questionable.

Inflammation – the chemistry

The cascade of events that eventually causes inflammation kicks off within cell membranes. A specific fatty acid, known as arachidonic acid (AA), is released from it’s bound state within the cell membrane by an enzyme (phospholipase-A2). Two key players in the inflammation story, COX and LOX, then act upon the now freed AA. The COX enzyme comes in two forms, COX1 and COX 2. When AA interacts with COX1 it produces a mixture of compounds (prostaglandins; PG’s) that protect the stomach and maintain the ability of the blood to clot. When AA interacts with COX2 in produces PG’s that signal pain and enhance inflammation. The LOX enzyme converts AA into another powerful group of inflammatory compounds known as leukortrines. Drugs that block the COX and LOX enzymes are known as anti-inflammatory drugs for this reason; they block the inflammatory cascade. However, by blocking the COX1 enzyme these drugs also block the stomach and gut protective PG’s and cause thinning and blood vessel leaks as they also block the PG’s that maintain blood clotting. As a result, specific drugs were developed that selectively block the COX2 enzyme but leave the COX1 alone. In theory, this sounded great but in reality the drugs did leave the COX1 enzyme alone in the majority of tissues except the COX1 found within the cells that line the blood vessels. These cells are called endothelial cells and the COX1 enzyme within these cells produces a special compound known as prostacyclin, which in turn maintains the smooth flowing of the blood within the blood vessels. By blocking the action of endothelial COX1 and the production of prostacyclin blood becomes stickier and prone to clotting, which explained the increased heart attack risk associated with drugs that have COX2 inhibitor action.

Inflammation – the natural answer

Research into the anti-inflammatory actions of curcumin has revealed that curcumin is a safe and effective inhibitor of COX2 and of the LOX enzyme that is responsible for the generation of the powerful inflammatory actions of leukortrines. What’s more, curcumin has also been shown to block the initial release of AA from the cell membrane. By doing this curcumin may have an effective preventative action as well as a powerful anti-inflammatory effect when used on a regular basis. To date, there have been no indication or suggestion that curcumin inhibits the endothelial COX1.

One factor that goes against curcumin is it’s poor absorption from the digestive tract. To get around this problem manufacturers have produced a highly bio-available extract; Theracurmin. This innovative ingredient uses a microscopic particle (100 times smaller than regular curcumin powder) size to enhance the curcumin absorption from the gut. Studies using Theracurmin have shown that the microscopic curcumin particles are absorbed up to and reach concentrations 300 times higher than regular powders.

How to take curcumin supplements

Theracurmin is simple and easy to use; take 1-2 capsules daily around a meal time. Because of the lack of available information, those who are pregnant or breast feeding or taking warfarin should only use curcumin based products after taking medical advise.

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50% improvement in pain-related questions by the end of the study (60 days)

NEM paper

A new study was conducted at six different clinical sites throughout Germany to evaluate the efficacy and tolerability of NEM® for the relief of the pain and discomfort associated with osteoarthritis of the knee and/or hip.

NEM® is a natural source of collagen, chondroitin, and hyaluronic acid, each of which is known to support joint health. Much of the benefit with NEM® is thought to be the result of its nutrients boosting the production of critical joint molecules.

Forty-four patients were treated with a daily dosage of 500 mg of NEM®. Clinic visits were scheduled for subjects at study initiation and at 60 days following the onset of treatment. Statistical analysis revealed that supplementation with NEM® produced a significant pain relieving effect within 10 days. On average, nearly 1/4th of the subjects experienced a 30% improvement in pain-related questions within 10 days and almost 20% of the study population experienced a 50% improvement in pain-related questions by the end of the study (60 days). Significant improvement for stiffness was noted at 30 and 60 days after treatment.

An indication of the pain relieving effect of NEM was a drop in analgesic use. For the 30 days prior to study commencement, patients consumed on average 7 doses of acetaminophen. Analgesic use had dropped considerably to 2.43 doses per 30 days after 30 days of supplementation with NEM®.

No side effects were noted with NEM®.

Product link: NEM® capsules

Study link: NEM Brand Eggshell Membrane Effective in the Treatment of Pain Associated with Knee and Hip Osteoarthritis: Results from a Six Center, Open Label German Clinical Study. 2014

Naturopathic Physician, Dr Michael Murray comments on osteoarthritis: What is osteoarthritis?

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Vitamin B12 – the story continues

Marcus Webb

Observations and comments by Marcus Webb

Vitamin B12 has always been associated with fighting fatigue and supporting nerve function. However, this complex vitamin with many biological functions that new research indicates extend beyond simple physical wellbeing.  

Vitamin B12 has an established key role is the normal functioning of the brain and nervous system as well as for the formation of healthy blood cells and is involved in the metabolism of every cell in the body. For such an essential nutrient it may come as a surprise that the human body is unable to produce its own B12 and is completely reliant on dietary sources. While some may quote authorities who state that our bowel bugs generate some vitamin B12 it has been shown that this tiny trickle is not absorbed from the colon and serves as no real nutritional source. We vitamin B12, albeit in small amounts, but we have to get it from our diet. Some key dietary sources are describe later on but in essence there is no reliable non-animal source of vitamin B12 making it very difficult for strict vegetarians or vegans to obtain significant amounts.

Interestingly, vitamin B12 was initially discovered due to its relationship with the condition pernicious anaemia. This is an autoimmune disease whereby the cells in the stomach responsible for secreting intrinsic factor (IF), which is crucial for the absorption of B12, are destroyed.

Taking vitamin B12

Vitamin B12 is often used to treat nerve pain. In most cases, the reported benefit of B12 is related to the injected form of B12 in people suffering from nerve pains in relation to diabetic neuropathy or shingles pain.

There have been some news stories relating to poor B12 absorption in people taking gastric acid blocking drugs. These drugs take effect on the same cells within the stomach that produce IF. In regular users, regular tablets or capsules of B12 will not help much because the absorption of B12 has become impaired as a consequence of the drug action. This is where the suckable/chewable tablets (B12 Infusion tablets from Enzymatic Therapy) come into their own. Vitamin B12 can be effectively absorbed across the delicate membranes of the mouth in sufficient amounts to readdress any deficiency without the need for injection therapy in most cases. For those with true pernicious anaemia who need regular injections of B12 every 3 months a top-up using the B12 Infusion tablets in the month leading up to the next injection can offer a great ‘lift’ for those who notice a general low energy phase before their next injection. So long as the B12 is in the biologically active form known as methylcobalamin and in a chewable/suckable form dosing up on one tablet per day for a month or so could make all the difference to fatigue or ‘brain fog’. Even if you have not been using the acid-blocking drugs, it may be worth trying a course of sublingual B12 for a month especially if you are over 50 years old or follow a strict vegetarian or vegan lifestyle.

Chronic Fatigue Syndrome, Fibromyalgia and Vitamin B12

Scientific studies into the causes of fibromyalgia (FM) and chronic fatigue syndrome (CFS) are always interesting, especially when they appear to support what we notice in the clinic. In the case of vitamin B12 many FM/CFS sufferers report improved energy and overall well-being following a course of high-dose B12 supplementation over 4-6 weeks. Lending some scientific evidence to this anecdotal observation, a study carried out in Sweden back in 1997 gave support to the use of B12 in FM/CFS cases when it was shown that the fluids surrounding the brain and spinal cord (the cerebrospinal fluid of CSF) was significantly lower in vitamin B12 than expected. Having such a low CSF B12 level was closely associated with increased levels of a metabolite known as homocysteine. This in turn was linked to profound symptoms of fatigue. The study concluded that these findings were probably contributing to the FM/CFS in their study group. Sadly, since then, little work has been performed in this area of vitamin B12 research but a team from Kings College did provide preliminary evidence of reduced functional B vitamin status in CFS patients. It’s not often practical to perform routine blood testing for B-vitamin status in cases of FM/CFS let alone sampling of the CSF, but in the holistic management of this complex spectrum of disorders, a trial of vitamin B12 or a good vitamin B complex often yields impressive results and is well worth considering.

Product link: BioActive B12 infusion 1000mcg vitamin B12 in the sublingual methylcobalamin form

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Don’t miss the window

Our skeleton starts off life as a delicate membrane-like template late in the second month of pregnancy but soon after the third month a primitive skeleton can be easily seen. Our bones form relatively early on because they are a key factor needed in the healthy growth and development of the growing baby. We tend to forget just how important a skeleton is but without it there would be nowhere for our muscles to attach and our vital internal organs would be extremely vulnerable to damage.

Throughout pregnancy, Mums-to-be are told to eat well and to get plenty of bone forming nutrients such as calcium. This advise extends to breast and bottle feeding and well into the weaning months and early years for good reason; the skeleton of a growing child is highly active and demands a plentiful supply or raw materials. However, there appear to be a gap somewhere between the early to mid teens and late 30’s where the focus of attention is taken away from skeletal health as other health priorities take the lime light and centre stage. For a growing number of people in this age bracket, weight management becomes an issue along with the trend for very restrictive diets in an attempt to drop the excessive weight. It’s not uncommon for levels of physical activity drop off especially in the school leaver population who either choose to avoid sports altogether or are forced into a more restrictive lifestyle that is so common in the digital workplace. Combine this with an increasing tendency to rely on processed and convenience foods and a lack of basic food, cooking and nutritional knowledge in many people and its quite easy to see how and why the early teen through to late 30’s are potentially hazardous to long term health. If we remain focused on the skeletal system, this phase of life is especially important considering that 90% of a girls skeletal mass is acquired by the age 18 and in boys by the age of 20. However, our bones keep developing reaching their lifetime peek mass by the age of 30 in both sexes. After this the skeleton remains quite stable until, in the case of women, the menopause starts when there can be a significant loss of bone mass. Men tend to loose bone mass slowly around the same phase of life but because of their greater skeletal size the effects are less noticeable in most cases. So, there appears to be window that can swing open for an opportunity to optimise skeletal health or slam shut, placing the maturing bone in jeopardy. Its rather like paying into a long term savers account or pension, you should have some reserves for later in life but it does mean you have to contribute early on and for many years to come with no real obvious outward signs of any benefit but in general you will be better off for the efforts.

The bare bones of skeletal nutrition We all know that calcium is important for bone health but it has been rather over played in the past. Our diets abound with calcium and the mature skeleton stores 99% of the bodies calcium reserves. In fact, our blood calcium levels are kept within such tight parameters that any fluctuation above or below the normal is considered a key sign of an underlying hormone disease rather than anything to do with dietary excess or deficiency. In saying that, calcium is still a vital bone mineral and one that is needed on a daily basis to maintain health. Despite many people having a problem in regards to sensitivity to allergy, milk and dairy products still provide a reliable and cost effective source of dietary calcium and protein. There have been some concerns raised about the intake of milk and an increased risk of thin bone disease but these claims have not been substantiated. In brief, the anti-milk theory suggests that the protein and phosphate naturally found in milk and dairy products make them ‘acid-producing’foods causing a shift in the bodies acid (pH) levels and triggering an accelerated loss of calcium from the bones and body; this process is not supported by any scientific evidence. Moreover, studies have confirmed that a higher phosphate intake was actually associated with decreased urine calcium and increased calcium retention. The theory then goes on to link this process with observations of thin bone related fractures in people from countries that consume a lot of milk and dairy foods; this is a case where correlation and causality can be misleading. Studies involving populations living and working in urban and rural environments yield quite different outcomes probably more related to their physical activity levels rather than to their milk and dairy food intake. While some people may find dairy foods a problem for those who do not a sensible level of intake would not appear to have any real detrimental effect on bone health and for some groups of people could be an important source of readily available protein and minerals. Check the tables below and see if you are getting enough calcium from your food (Table 1) compared to the recommended daily intake levels based on Western European, American and Canadian figures (Table 2).

Table 1: Calcium in common foods (apporoxamate)
Food Serving size Calcium (mg)
Milk, whole 236 ml 278
Milk, semi-skimmed 236 ml 283
Milk, skimmed 236 ml 288
Goats milk 236 ml 236
Yoghurt, low fat, plain 150 g 243
Yoghurt, low fat, fruit 150 g 210
Yoghurt, Greek style, fruit 150 g 189
Cheese, cheddar 40 g 296
Cheese, cottage 112 g 142
Tofu, soya bean, steamed 100 g 510
Soya drink 236 ml 31
Soya drink, calcium enriched 236 ml 210
Broccoli, cooked 112 g 45
Curley kale, cooked 112 g 168
Apricots, raw 160 g (1 fruit) 117
Orange 160 g (1 fruit) 75
Figs, ready to eat 220 g (4 fruits) 506
Almonds 26 g (12 whole) 62
Brazil nuts 20 g (6 whole) 34
Sardines, canned in oil 100 g (4 fish) 500
Pilchards, canned in tomato sauce 110 g (2 fish) 275
Whitebait, fried 80 g 688
Bread, white sliced 30 g (1 slice) 53
Bread, wholemeal, sliced 30 g (1 slice) 32
Pasta, plain, cooked 230 g 85
Rice, white, basmati, boiled 180 g 32
Table 2: Recommended daily intake of dietary calcium
Age Calcium (mg/day)
0-6 months 300-400
7-12 months 400
1-3 years 500
4-6 years 600
7-9 years 700
10-18 years 1300
Women
90 years to menopause 1000
Post menopause 1300
During pregnancy (1st trimester) 1200
Lactation 1000
Men
19-65 years 1000
65 + years 1300

As you can see from Table 1, getting adequate dietary calcium is not difficult but you need to know what too eat! A strict vegetarian who also avoids dairy foods will find it much harder to meet the minimum requirements for calcium without consuming specialist foods such as Tofu or taking a calcium supplement. Equally, someone following a strict weight loss may also fall short especially if they choose to follow the diet over a long term basis rather than modify their intake level across a balanced diet. Calcium is important but it is by no stretch of the imagination is it the key nutrient. What needs to be kept in mind is the fact that bone is a living tissue, its not simply a hard calcified mass. If it was it would be very prone to fracture because there would not be any flexibility or ‘give’in the skeleton when we jumped or ran. Proteins give bone its flexibility as well as a framework onto which the minerals (calcium, magnesium, phosphorous) can be deposited. A diet low in dietary protein is also detrimental to bone health. Fad diets that restrict proteins and poor general eating habits can that rely heavily on processed foods and carbohydrates starve the body of the essential protein building blocks of life known as amino acids. Key proteins from meat, fish, and eggs generally form the corner stone to human protein intake in Europe. In essence, there is nothing wrong with animal protein but there is no need to over consume from this food group since there are many great vegetable protein sources as well. Vegetarians and those seeking to rely less on animal proteins need to choose carefully but can increase their vegetable protein intake easily by eating more lentils, kidney beans and broad beans as well as soya, tofu, grain, nuts and seeds. By increasing the intake of vegetable proteins you will also be increasing the levels of other key bone nutrients including magnesium, zinc, B-vitamins (such as folic acid) and vitamin A generating beta carotene especially if you regularly eat the coloured vegetables such as orange, yellow and red peppers.   Absorb it or loose it In order to benefit from the calcium in your diet or from your supplement adequate levels of vitamin D are required. Over the past few years vitamin D has become a hot-topic in the press where it has been associated with many health problems ranging from MS through to certain types of cancers and even depression and psoriasis when levels are grossly deficient. The situation involving vitamin D and it’s involvement in such a variety of health problems is complex, poorly understood and undoubtedly linked to genetic susceptibility but when it comes to bone health the cause and effect relationship is very well understood and established. Vitamin D is not an easy vitamin to get in Northern European countries simply because of the lack of intense sunlight (more specifically the ultraviolet-B rays) needed to stimulate its production within the skin. Here we hit another controversy, by recommending sun exposure are we now putting people at risk of skin cancer? The simple answer is no! Just remember that sun exposure is healthy, sun burn is not. Getting 15-20 minutes of sun light per day, best between 10am and 2pm when the sun is at its peek, is all that is needed to boost natural vitamin D levels. For those of us at work stuck inside, shift workers or people confined to inside living some vitamin D can be obtained from a few foods (for example; salmon, mackerel, tuna, sardines, egg and liver) but to get enough you will need to eat quite a lot of it and on a very regular basis to meet the requirements for health let alone optimal health and there is no real vegetarian food option that delivers any vitamin D. In regards to vitamin D the only real option is a supplement especially over the winter periods. Intake recommendations for vitamin D vary greatly but supplements should be in the vitamin D3 form and need to be between 400iu (10mcg) to 1000iu (25mcg) in strength per day unless you have had a vitamin D blood test and need to significantly boost your levels under supervision. If you can’t get a blood test from your own GP we can always arrange this for you but the private lab will carry a lab fee of around £60 per test for a calcium and vitamin D test. You can take your own blood sample at home (a finger prick) and posted off to the lab for analysis. Another vital vitamin for bone health is vitamin K. This is required for the formation of specific bone proteins that actively help to build and strengthen the framework needed a healthy skeleton. Vitamin K is obtained from dark green leafy vegetables such as kale, cabbage and spinach as well as from lettuce. There are more specialist foods made from fermented soybeans that deliver high amounts of vitamin K. A good bone supplement should supply vitamin K but this needs to be avoided in anyone taking anticoagulant medication such as warfarin. Those on warfarin should not increase their vitamin K containing foods form the same reason.

Special situations The window for optimising bone health can be significantly helped by diet and lifestyle choices but there are a few occasions when other health issues can complicate things. People with certain digestive problems that adversely affect nutrient absorption, such a Coeliac disease and some inflammatory bowel problems, need special individualised attention and advise. This may also extend to the long term use of steroid based medications because of its adverse impact on bone health.

Dietary supplements While we have placed great emphasis on food, diet and what can be achieved through lifestyle adjustment, the use of a specific dietary supplement aimed at optimising bone specific nutrition may be appropriate in many cases. The bone specific supplement Calci-D-min delivers a highly absorbable plant calcium known as Aquamin (derived from red algae) that’s easy on the stomach and quickly absorbed and assimilated by the body. Aquamin also delivers magnesium and 74 other naturally occurring trace elements contained in the red algae. The Calci-D-min supplement has been formulated to supply effective levels of vitamin D3, K1 and K2 along with boron selenium and zinc. Depending on the diet, as food supplement two to four capsules are recommended taken with food. Because of the vitamin K ingredient, Calci-D-min is not recommended for anyone taking the anticoagulant drug warfarin. The product is 100% vegetarian and fully approved by the Vegetarian Society.

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