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Disasters and Prevention
Strontium for Bones
Total Bone Health
Complex Work and Dementia
Ask Dr. J: Insomnia
References
In The Health News
Diet and Disease
Recipe of the Month: Tomato Basil Soup
Dear Friends,
The disasters in the Gulf of Mexico are grim reminders of
the devastating power of natural phenomena. They also offer
important lessons on the value of preparation and preventive
maintenance compared to the enormous cost of repair and restoration.
The flood prevention systems in Holland and the Thames barriers
in England reflect an enormous investment and a commitment
to protecting their communities. The same kind of personal
investment in health care would also yield enormous dividends.
Every time someone improves a health habit, they take a step
in the direction of preventive maintenance. Eliminating sugar
from the diet, reducing processed foods, white flour, and
food additives, eliminating meat consumption, eating more
fruits, vegetables, and fibers, getting regular exercise,
controlling stress, taking dietary supplements, and participating
in aesthetic activities, all go a long way to shoring up the
defenses against chronic, degenerative, lethal diseases. These
changes also help reduce the incidence of daily health problems
that may not be lethal but reduce the quality of life, such
as arthritis, indigestion, allergies, headaches, skin disorders,
and more.
Unlike the preparations that might have been done in the
Gulf, these health habit changes are not associated with enormous
costs. In fact, if someone eliminates much of the junky, processed
foods that are so commonly consumed, the changes might be
free (just eliminating coffee and doughnuts, candy, ice cream,
and sodas, for examples, can save enough money to pay for
your athletic shoes, health club membership, all of your supplements—and
maybe doctors’ visits to boot!) This does not mean eliminating
the pleasures of life. I tell my patients that I do not believe
in sacrificing pleasure for health, because people generally
will not do that, and they do not have to, because healthy
foods can be just as pleasurable as the customary consumption
in developed countries.
While the devastation in the Gulf region is a catastrophic
tragedy associated with enormous suffering, equal tragedies
occur every day with the thousands of premature and preventable
deaths that result from the unhealthy lifestyle choices that
we have the power to change. This is not to make light of
this disaster, or of the others around the world that cause
the sudden and unexpected loss of lives, homes, and livelihoods.
These affect us all, and call forth an outpouring of compassion.
However, it is perhaps even more tragic that the thousands
of lifestyle-related, preventable deaths are not at all unexpected.
We can easily predict them by observing the way people choose
to live, whether it is due to lack of awareness, advertising,
social pressures, or lack of caring. I am encouraged whenever
I see people making positive changes, and I believe that the
message is getting across that prevention makes a real difference.
Strontium is a mineral that is considered to be non-essential
in the human diet. It occurs in food in small amounts depending
on the soil content of the mineral. In the 1950s and 1960s,
atmospheric nuclear testing released a large amount of radioactive
strontium-90, contaminating the environment, and posing risks
because it can act like calcium and deposit in bones and teeth.
Non-radioactive strontium is quite safe even in very large
doses.
Because non-radioactive strontium also deposits in bones
and behaves like calcium, it can enhance bone density and
resistance to osteoporotic fractures, but only when taken
in doses that are significantly higher than the amout found
naturally in the diet. As early as the 1950s, studies of strontium
salts (such as lactate and gluconate) showed benefits to bones.
Recent studies have confirmed that strontium helps with both
prevention and reversal of osteoporosis, maintaining bone
density and restoring it in people who already have some bone
thinning.
In an article in 2001, strontium was reported to benefit
bones in two ways, reducing the resorption of bone by osteoclasts
(literally “bone-eating” cells) and by increasing
formation of bone by osteoblasts (“bone-forming”
cells). It was noted that it was effective in both normal
animals and in those that already had bone loss.
In 2002, 160 early post-menopausal women were given either
a placebo, or 125, 500, or 1000 mg of strontium ranelate (containing
340 mg of elemental strontium per gram) for two years. They
measured spinal and hip bone density and biochemical markers
of bone turnover. Women on the highest dose had an overall
increase in bone density of 2.4 percent relative to placebo.
(In early post-menopausal women you would expect some bone
loss over two years.)
Some confusion surrounds the correct source and dose of strontium
for treating osteoporosis. A pharmaceutical company has patented
a particular synthetic salt (ranelate) although other salts
have been studied in the past, and are just as good as sources
of strontium. The dose that the studies list is reported as
up to two grams, but the actual elemental strontium is much
less, because the ranelate salt makes up the bulk of the weight.
The elemental strontium in these studies is 340 mg per gram,
which is easily available from other sources, such as citrate,
gluconate, or lactate, and no evidence suggests that the ranelate
itself is important.
In a 2002 report, 353 menopausal women were given 170, 340,
or 680 mg of elemental strontium (as ranelate) for two years.
These subjects had already had at least one vertebral fracture
due to osteoporosis. At the highest dose, mean bone density
increased by three percent per year, and abnormal vertebral
deformities were cut in half. Markers of bone resorption were
significantly reduced with this dose, and bone formation indicators
were increased.
In a larger study reported in 2004, 1649 postmenopausal women
with osteoporosis and at least one vertebral fracture were
given a placebo or 680 mg of elemental strontium for three
years. Within the first year, the risk of new fractures was
cut in half, and at the end of three years the overall risk
reduction was 41 percent. All subjects received calcium and
vitamin D before and during the study, and at the end of three
years, the strontium group had a 14.4 percent increase in
vertebral bone mineral density and an 8 percent increase in
femoral neck bone density.
In a study of 5091 postmenopausal women treated with the
same dose for five years, all measures of bone density and
fracture rate improved. Risk reduction was 36 percent in the
high risk group and 45 percent in the lower risk group.
I recommend 680 mg of elemental strontium as citrate for
the best absorption and fewest pills. It should all be taken
at bedtime, separate from any calcium or food, as strontium
may interfere with calcium absorption. However, strontium
is not the only requirement for healthy bones. In most studies,
subjects are also given calcium and vitamin D (I recommend
1000 IU or more).
In addition, it helps to have a low-sugar, moderate-protein
diet, regular weight-bearing exercise, and supplements of
magnesium, manganese, boron, ipriflavone, vitamins C and K,
and possibly bio-identical hormones, such as progesterone,
testosterone, and estrogens. This is a comprenensive approach
to maintaining and restoring bone health.
In a new study of 10,079 Swedish twins, researchers correlated
the risk of developing dementia with the complexity of the
work setting. Those people in more complex work situations,
as measured by interaction with data, people, and things had
a lower risk of developing Alzheimer’s disease than
their twin controls. It appeared that complex interactions
with people was the most significant protective activity.
Those people with more challenging interactions were over
20 percent less likely to have Alzheimer’s than their
twin counterparts with less challenging work settings. Other
forms of dementia were also reduced but not as much. Previous
studies have indicated that mental activity, such as reading,
playing board games, playing music, and dancing are associated
with a decreased dementia risk.
In addition, you can help protect brain function with high
doses of antioxidants such as vitamin E and coenzyme Q10.
It is also valuable to take supplements of alpha lipoic acid,
acetyl L-carnitine, phosphatidyl serine, ginkgo biloba, vitamin
C, turmeric extract (curcumin), flavonoids, and fish oil along
with a diet rich in fruits, vegetables, and soy isoflavones.
Q. What are the best supplements for promoting
depth of sleep and preventing middle of the night awakening
for oldsters?
—SCR, via Email
Sleep disorders are very common, especially in the middle-aged
and elderly. They can result from anxiety, stress, depression
and other emotional problems, sedentary lifestyles, blood
sugar disorders, obesity, jet lag, caffeine and alcohol consumption,
many drugs, hormone imbalances, life and family situations,
and many other causes. Insomnia can be difficulty falling
asleep or waking in the middle of the night and not being
able to go back to sleep.
Occasional sleep loss is not a serious problem, but chronic
insomnia is associated with many health disorders. These include
fatigue, depression, accidents, poor work performance, decreased
alertness, mental confusion, heart disease, inflammation,
lowered immunity, and more.
Lifestyle changes are very helpful in promoting restful sleep.
Make sure your bedroom is peaceful, the mattress is comfortable,
and block out all light. Get regular vigorous exercise during
which you work up a sweat, but do this at least an hour or
two before bedtime. Practice relaxation techniques, such as
breathing exercises, yoga, meditation, or visualization. Eliminate
caffeine, alcohol, sugar, and junk from your diet, and avoid
any foods to which you might be allergic.
Melatonin, the pineal hormone that adjusts the biological
clock is helpful in doses of 1-3 mg, 60-90 minutes before
bed. Timed release melatonin might be better if you wake in
the middle of the night. Supplements of 5-hydroxy tryptophan
(a serotonin precursor, 50-200 mg), can help sleep. The herb
valerian (200-600 mg of standardized extract) reduces anxiety
and insomnia, as can other herbs, such as passion flower and
hops. Timed release niacin (250-500 mg twice per day) works
well to promote sleep. Magnesium (500 mg) is also a relaxant.
Some combination of all these approaches should work.
Marie PJ, et al., Mechanisms of action
and therapeutic potential of strontium in bone. Calcif Tissue
Int. 2001 Sep;69(3):121-9.
Reginster JY, et al., Prevention of early
postmenopausal bone loss by strontium ranelate: the randomized,
two-year, double-masked, dose-ranging, placebo-controlled
PREVOS trial. Osteoporos Int. 2002 Dec;13(12):925-31.
Meunier PJ, et al., Strontium ranelate:
dose-dependent effects in established postmenopausal vertebral
osteoporosis...J Clin Endocrinol Metab. 2002 May;87(5):2060-6.
Meunier PJ, et al.,The effects of strontium
ranelate on the risk of vertebral fracture in women with postmenopausal
osteoporosis. N Engl J Med. 2004 Jan 29;350(5):459-68.
Reginster JY, et al., Strontium ranelate
reduces the risk of nonvertebral fractures in postmenopausal
women with osteoporosis:... J Clin Endocrinol Metab. 2005
May;90(5):2816-22.
Schaafsma A, et al., Delay of natural bone
loss by higher intakes of specific minerals and vitamins.
Crit Rev Food Sci Nutr. 2001 May;41(4):225-49.
Sairanen S, et al., Bone mass and markers
of bone and calcium metabolism in postmenopausal women treated
with 1,25-dihydroxyvitamin D... Calcif Tissue Int. 2000 Aug;67(2):122-7.
Katsuyama H, et al., [Influence of nutrients
intake on bone turnover markers] Clin Calcium. 2005 Sep;15(9):1529-34.
Macdonald HM, et al., Nutritional associations
with bone loss during the menopausal transition evidence of
a beneficial effect of calcium, alcohol, and fruit and vegetable
nutrients and of a detrimental effect of fatty acids... Am
J Clin Nutr. 2004 Jan;79(1):155-65.
Andel R, et al., Complexity of work and
risk of Alzheimer’s disease: a population-based study
of Swedish twins. J Gerontol B Psychol Sci Soc Sci. 2005 Sep;60(5):P251-8.
Verghese J, et al., Leisure activities
and the risk of dementia in the elderly. N Engl J Med. 2003
Jun 19;348(25):2508-16.
Grant MD, Brody JA, Musical experience
and dementia. Hypothesis. Aging Clin Exp Res. 2004 Oct;16(5):403-5.
Antioxidant supplements can reduce the damage from strokes.
In a controlled study, 48 stroke patients received either
800 IU of vitamin E and 500 mg of vitamin C starting within
12 hours of the stroke, or no treatment. They were measured
at baseline for antioxidant capacity, malondialdehyde level
(MDA, a measure of oxidative damage), and CRP (a marker of
inflammation). At days 7 and 14, the supplemented group had
a reduction in both indicators. (Ullegaddi R, et al., Antioxidant
supplementation enhances antioxidant capacity and mitigates
oxidative damage following acute ischaemic stroke. Eur J Clin
Nutr. 2005 Aug 10; [Epub ahead of print].) At 90 days after
the stroke, the treatment group still had lower inflammation
as indicated by the CRP level.
Obese people have higher rates of heart disease and strokes,
and they have higher levels of C-reactive protein (CRP, the
inflammatory marker). New research shows that fat cells actually
produce CRP, which might be part of the explanation for the
increased risk. Fat cells also produce substances that increase
insulin resistance. (Calabro P, et al., Release of C-reactive
protein in response to inflammatory cytokines by human adipocytes:
linking obesity to vascular inflammation. J Am Coll Cardiol.
2005 Sep 20;46(6):1112-3; reported in Reuters, September 17,
2005.)
A vegetarian diet for 14 weeks in 32 of 64 postmenopausal
women led to a significant weight loss of 13 pounds compared
to an 8.3-pound loss in the 32 on the control diet. The vegetarian
diet led to a higher metabolic rate and better insulin sensitivity,
indicating better ability to maintain a normal blood sugar.
Insulin sensitivity is associated with decreased risk of heart
disease. (Barnard ND, The effects of a low-fat, plant-based
dietary intervention on body weight, metabolism, and insulin
sensitivity. Am J Med. 2005 Sep;118(9):991-7.
It is still tomato season, and this mostly-tomato soup is
delicious. Sauté chopped onions and garlic in olive
oil. Grill firm tomato halves (or you can buy organic, fire-roasted
tomatoes from Muir Glen). Combine the tomatoes and onion mixture
in a soup pot, and add a large handful of finely chopped fresh
basil and freshly ground pepper (and some cayenne if you prefer
a spicy soup). Simmer for a short time to allow the flavors
to blend (you can add a small amount of sea salt or soy sauce,
or a small amount of fresh lemon). Put the entire mixture
in a food processor and blend briefly until smooth. You can
vary the dish by adding some fresh, chopped spinach, and you
can put in some raw diced cucumber just before serving. You
can serve this hot or cold, with or without a spoonful of
low-fat yogurt and a side of whole wheat toast.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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