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Organic Foods and the USDA
Osteoporosis Protection
Lifestyle and Osteoporosis
Dietary Supplements for Osteoporosis
Ask Dr. J: Fish Oil Supplement Safety
References
In the Health News
Diet and Disease
Recipe of the Month: Veggie Kebabs for the Grill
Dear Friends,
The USDA (United States Department of Agriculture) has never
been a strong supporter of organic agriculture or organic
foods in general. Their original attempt to allow irradiated
foods, sewage sludge, and genetically modified foods to be
included in their organic definition was overwhelmingly opposed
by the organic food industry and large numbers of consumers.
As a result, they dropped those regulations.
Later, they denied that organic foods were any better than
conventionally grown products, and even issued warnings about
the dangers of organic foods! They have been resting since
then, but now they seem poised to once again make it harder
for consumers to know that whether what they are eating is
organic, or whether non-food products claiming to be organic
really are.
The USDA announced an enforcement directive of April 23,
2004, including the following statement: “when practices
provided for in paragraphs (a) through (d) are insufficient
to prevent or control crop pests, weeds, and diseases, the
producer may use synthetic substances listed in § 205.601
of the National List.”
This suggests to me that regulations of pesticides are not
as strict as they should be. According to the Organic Consumers
Association, non-agricultural products such as fish, body
care products, pet foods, fertilizer, and clothing, may be
labelled “organic” with little to no regulation
or assurance of authentic organic ingredients. In addition,
the regulation situation is confusing, because it appears
that if both the producer of supposedly organic foods and
the certifier do not know the ingredients of the pesticides,
they can certify the food as organic.
This is part of a widespread problem of choosing healthy
foods–awareness is not enough if we can’t trust
the labeling of the foods to be accurate. As much as I encourage
organic gardening and growing as much of your food as possible,
it is almost inevitably only a small part of the food intake
for most people. Being able to choose organic foods in the
marketplace is essential if you want to take the best care
of your own and your family’s nutrition.
Public demand is fueling the fast-growing increase in organic
production and distribution, which may be seen as threatening
to large-scale conventional farms and the enormous food processing
industry. They would like nothing better than to be able to
call their products organic to “catch the wave”
of this industry without having to be strict about the quality
of their foods. The only way to maintain real organic foods
is to pressure the USDA to adopt high standards. I suggest
joining the Organic Consumers Association at www.organicconcumers.org,
and The Campaign to Label Genetically Modified Foods (www.thecampaign.org),
as well as www.saveorganicfood.org.
Everyone who is concerned about their health is aware of
the need to prevent osteoporosis, or age-related deterioration
of bone structure leading to a higher risk of fractures. Osteoporosis
has been in the news lately, because of recent studies showing
that dietary supplements are likely to help prevent the decline
of bone density and reduce the incidence of fractures.
Bones are dense with a collagen and non-collagen protein
matrix and mineral deposits, mainly calcium phosphate. Bone
is a living and growing tissue, and gains some of its strength
from constant remodeling and repair of micro-fractures that
occur regularly from normal wear and tear. Cells that are
responsible for the remodeling are of two types, osteoblasts
that form bone, and osteoclasts that break down bone to release
calcium. The balance of osteoblast and osteoclast activity
influences bone density.
Strong bone formation is a slow process (remodeling bone
takes many months), and it requires a number of nutrients
(vitamins C and D, calcium, phosphorus, magnesium, and possibly
manganese, copper, and others), proper hormonal balance, and
weight-bearing exercise. Vitamin C is essential for the production
of collagen, contributing to the basic bone matrix. Hormones
involved in establishing and maintaining bone density include
growth hormone, parathyroid hormone, adrenal hormones, testosterone,
estrogens, progesterone, and thyroid hormone.
Women have a lower bone density than men, and their loss
of bone after thirty years old accelerates with the menopausal
decline in estrogen levels. Men’s bone density also
declines with age, but osteoporosis occurs later because of
their higher peak bone density. After the age of 80, both
men and women are at great risk of fractures from weakened
bones. Adequate dietary calcium is not the only influence
on bone calcium, although it is important.
Some diet and lifestyle factors lead to calcium loss in the
urine. For example, caffeine, salt, phosphorus, and sugar
in the diet can lead to excessive excretion of calcium (phosphorus
and sugar are main ingredients in soft drinks, associated
with increased osteoporosis). Smoking and excessive alcohol
intake are also associated with increasing osteoporosis risk.
High dietary protein may also cause calcium to be excreted,
but it also may increase absorption from food, leading to
mixed results in scientific studies, although the evidence
suggests that excessive meat consumption is also a risk factor.
Weight-bearing exercise stimulates bone formation and remodeling.
Impact causes some strain on the bone, and this in turn leads
to increased activity of the bone-forming cells. In one study
of 126 post-menopausal women, strength training to build muscle
mass significantly increased hip bone density over two years.
Vitamin D is essential for the absorption of calcium from
the intestinal tract leading to increased calcium deposition
in the collagen matrix. It is produced by the action of UV
from sunlight on cholesterol in the skin (it is really a steroid
hormone called cholecalciferol, not a true vitamin). It is
also present in a few foods.
Vitamin D is one of the few nutrients that may be toxic in
high doses, but it is likely that most elderly people are
not getting enough because of lack of sun exposure and declining
production in the skin with age. Recommendations for vitamin
D range from 200 to 800 IU daily.
Recent studies show that a risk factor for heart disease,
high serum homocysteine, is also related to increased risk
of osteoporosis, and that vitamin supplements can reduce that
risk. Dutch researchers studied 2400 subjects over 55 years
old, for three to six years, concluding that those with the
highest homocysteine had about double the risk of fractures
as those in the lowest range.
Homocysteine may interfere with collagen cross linking, decreasing
bone strength. The second study in the New England Journal
of Medicine examined 2000 men and women, aged 59 to 91, over
12 to 15 years. They also found a direct relationship of homocysteine
with the incidence of fractures, with the highest level of
homocysteine associated with two to three times as many fractures
as the lowest levels.
Dietary supplements of vitamin B6 (100 to 200 mg), folic
acid (1000 to 5000 mcg), and vitamin B12 (1000 mcg) all help
to reduce the level of homocysteine in the blood. These are
simple, safe supplements that also lower the risk of heart
disease. However, these are not the only beneficial supplements
for bone density.
Ipriflavone is a modified flavonoid derived from soy, and
it both inhibits bone breakdown and enhances calcium deposition
in bone. The usual dose of ipriflavone is 600 mg daily. A
number of studies show that over a one year period, ipriflavone
increases bone density while placebo subjects see a decline.
All subjects also received 1000 mg of calcium in several of
the studies.
Soy isoflavones (genistein and daidzein) have some phytoestrogenic
effects and help bone density. A study of menopausal women
taking 40 gms of soy protein daily (90 mg of isoflavones)
showed reduced bone loss. Soy isoflavones are abundant in
tofu, soymilk, and tempeh (but I do not recommend TVP, a highly
processed texturized vegetable protein).
Testosterone, estrogen, and progesterone stimulate bone formation,
as does growth hormone. With the current risks associated
with Premarin and Provera (Prem Pro), I only recommend bio-identical
hormone treatment. If blood test markers of growth hormone
indicate a low level, which is very common as people age,
it may well be worthwhile to have injection treatment with
human growth hormone (oral supplements are generally ineffective).
Magnesium, vitamin K, and omega-3 oils from fish are all
of potential benefit in preventing osteoporosis. A comprehensive
program of diet, exercise, dietary supplements, and appropriate
hormonal therapies is likely to provide the most benefit in
preventing and reversing this disease.
Q. I have read about the contamination of
farm-raised fish. Is there also a problem with contamination
of fish oil supplements?
—RG, via email
A. A wide range of fish oil products are available in the
health market, as a source of omega-3 oils. These oils have
many health benefits, especially for people who have limited
conversion of alpha-linolenic acid to the EPA and DHA that
are the most active components of fish oil. The conversion
is more limited in the elderly and in children, and these
oils are important for brain function, lipid control, protection
from heart and blood vessel disorders, controlling inflammation,
and treating depression, as well as many other health problems.
ConsumerLabs, an independent testing company, found that
of the 20 commercial fish oil supplements that they tested,
none were contaminated with mercury, probably due to the species
of fish that were used as the oil source. Other contaminants
are unlikely to be a problem because of the distillation and
purification processes used to extract the oils.
However, ConsumerLabs tested 20 brands and found that six
contained only 50-80 percent of the amount of omega-3 oil
that was claimed on the label. (More recent testing indicates
that manufacturers are paying attention to these results and
improving their products.) Be sure to buy your fish oil supplements
from reliable companies with about 30 percent omega-3 oil
(combined EPA and DHA).
Organic Consumers Association, Action Alert,
Bush Administration moving to allow corporate takeover of
organics! May 5, 2004; www.organicconsumers.org
Compliance and enforcement directive NOP
C&E #04.01 www.ams.usda.gov/nop/Compliance/pesticidesCompliance.pdf
Kerr D, et al., Resistance training over
2 years increases bone mass in calcium-replete postmenopausal
women. J Bone Miner Res. 2001 Jan;16(1):175-81.
Wyshak G, Teenaged girls, carbonated beverage
consumption, and bone fractures. Arch Pediatr Adolesc Med
2000 Jun;154(6):610-3.
van Meurs JB, et al., Homocysteine levels
and the risk of osteoporotic fracture. N Engl J Med. 2004
May 13;350(20):2033-41.
McLean RR, et al., Homocysteine as a predictive
factor for hip fracture in older persons. N Engl J Med. 2004
May 13;350(20):2042-9.
Holick MF, Vitamin D: importance in the
prevention of cancers, type 1 diabetes, heart disease, and
osteoporosis. Am J Clin Nutr. 2004 Mar;79(3):362-71.
Kovacs AB, Efficacy of ipriflavone in the
prevention and treatment of postmenopausal osteoporosis. Agents
Actions 1994 Mar;41(1-2):86-7.
Agnusdei D, et al., Effects of ipriflavone
on bone mass and calcium metabolism in postmenopausal osteoporosis.
Bone Miner 1992 Oct;19 Suppl 1:S43-8.
Scheiber MD, et al., Dietary inclusion
of whole soy foods results in significant reductions in clinical
risk factors for osteoporosis and cardiovascular disease....
Menopause 2001 Sep-Oct;8(5):384-92.
Science Daily, 2004-03-17 Fish Oil Supplements
May Contain Flame Retardants.
Product Review: Omega-3 Fatty Acids (EPA
and DHA) from Fish/Marine Oils, www.consumerlab.com/results/omega3.asp
Tod Cooperman (ConsumerLabs.com representative),
Lecture presentation at the American College for Advancement
in Medicine Scientific Meeting, May 22, 2004
Dietary selenium appears to protect against the development
of advanced prostate cancer. Results from the Physicians Health
Study at Harvard shows that men with the highest blood levels
of selenium had a 50 to 60 percent reduction in advanced prostate
cancer. They compared 586 men with prostate cancer to 577
control subjects. ((Li H, et al., A prospective study of plasma
selenium levels and prostate cancer risk. J Natl Cancer Inst.
2004 May 5;96(9):696-703.) This confirms earlier studies.
Selenium is found in nuts, whole grains, brewers yeast, and
seafood, and it is common in high quality multivitamins.
After a heart attack, depression and loneliness often trigger
a recurrence, but this risk is greatly reduced in people who
exercise. Researchers studied over 2000 subjects, and among
those who were socially isolated or depressed, heart attack
recurrence was double the rate in those who were sedentary
compared to those who exercised. In addition, their depression
was relieved by exercise. (Blumenthal JA, et al., Exercise,
depression, and mortality after myocardial infarction in the
ENRICHD trial. Med Sci Sports Exerc. 2004 May;36(5):746-55.)
A typical fast-food breakfast at McDonalds (and probably
similar chains) induces an inflammatory response that could
explain why such foods are associated with an increased risk
of heart disease. Researchers measured oxygen free radicals
and inflammatory markers such as CRP, after a 900 calorie
meal of egg and sausage McMuffins, and hash browns. The CRP
and free radical markers all increased. Aljada A, et al.,
Increase in intranuclear nuclear factor kappaB and decrease
in inhibitor kappaB in mononuclear cells after a mixed meal...
Am J Clin Nutr. 2004 Apr;79(4):682-90.
Cookouts do not have to include meat or be rich in saturated
fat to be delicious. On a skewer, alternate chunks of red
and green peppers, cherry tomatoes, onion quarters, tofu cubes,
eggplant (small cubes cook faster), zucchini and summer squash
chunks, and crimini or other mushrooms. Marinate these (the
longer the better), before skewering, in a mixture of water,
soy sauce, balsamic vinegar or lemon juice, olive oil, crushed
garlic, dried or crushed fresh ginger, fresh basil, thyme,
and ground pepper. Put them on the grill until slightly soft
(10-20 minutes), turning several times. You can cover this
with a variety of sauces for serving. Make a tangy, thick
and creamy Thai-type sauce with peanut or almond butter, coconut
milk, crushed garlic, ground cumin and coriander, chili pepper,
and lemon juice. Pour the sauce over the veggies and serve
on brown rice.
drjanson@drjanson.com
November
through May: 386-409-7747
June
through October: 603-878-2256
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