Posts Tagged ‘Nutrition’
Why do some patients, who are already on good osteoporosis preventing or treating medications, still have a falling Bone Mineral Density? Are the medications not working? Not as well as they should! Why? Even the best medications cannot work without enough CALCIUM intake and absorption.
If you want to improve your bones you must ABSORB enough calcium. This can be a bit tricky. You need the right kind of calcium, taken in food or with food, and spread out over 3 meals or snacks. “Calcium” is Calcium Carbonate which requires lots of acid to dissolve. This often is a problem if you take antacids, have heartburn or GERD, have digestive issues like lactose sensitivity, celiac or IBS, or are just “too old”, which begins at 50.
Calcium in foods is easy to absorb. Calcium Citrate tablets or Tricalcium Phosphate Gummies require 2 tablets or gummies to total the 400 or 500 or 600 mg on the label. Adora Chocolates are 500 mg each. We recommend taking in 1200-1500 mg calcium daily. That means 400-500mg at each of 3 meals.
DXA does not show bones. DXA shows calcium. Calcium stiffens and strengthens bones. You cannot have good BMD or good bones without enough calcium! Take control of your bone health with adequate calcium in diet and supplements.
Next time a listing of Calcium in Foods
Jay Ginther, MD
I was asked about treatments for Fibromyalgia. Pain clinics have injections and pharmaceuticals that often help, but not always enough. I approach from a different angle.
Fibromyalgia is a collection of many different maladies that are magnifying each other. They are very difficult to untangle. Treating all aspects of the pain is the key to success.
I have actually “cured” fibromyalgia only 4 times, but usually I can decrease the pain enough that other measures will work better than before.
The key is understanding that pain often is nerves misbehaving, magnifying the intensity of unpleasant stimuli. This is neuropathy or neuralgia. These conditions are made much worse by nutritional deficits.
B1, B6, B12 and Folate are key nutrients for nerve function. Controlling diabetes is also important. Low calcium, potassium or magnesium cause cramping and pain. These should ALL be checked.
Vitamin D is often overlooked as essential for nerve function. Low vitamin D will cause depression, malaise, nerve malfunction and increased pain. I aim for a vitamin D level of 70 ng/ml – higher than needed for bone health, but completely safe. If your level is very low you may need megadoses, well above 5000 IU daily.
Take Control Naturally with Vitamin D3, as well as B1, B6, B12, Folate, Calcium, Potassium and Magnesium.
Jay Ginther, MD
Once again we have been treated to statisticians mushing together multiple disparate previous studies to “prove” that calcium alone, or vitamin D alone, or both together in one of many different combinations will not prevent fractures. All mushed together in a carefully selected meta-analysis, you can prove anything depending on which studies are included.
More important, asking if adding a specific dose of calcium, or vitamin D, or both, will prevent fractures, misses the entire point. Most studies did not properly account for the nutrients in each day’s diet in individual test subjects – or in individual control subjects, many of whom also consumed the nutrients being studied.
And how can you ethically ask a patient to limit their diet in a way you believe will put them at risk for fractures? You have to settle for encouraging patients who are inadvertently short on some nutrients to improve their diet. But then they do not fracture and you cannot prove that they would have if only you had withheld the information!
We help individuals improve their bone health. One size does not fit all. We do a Complete Bone Health Evaluation. Then we adjust nutrition and lifestyle as needed for that individual. In about half of women and three-quarters of men, this is enough.
Jay Ginther, MD
Clinical Osteoporosis 2017, NOF and ISCD joint meeting had a different emphasis this year. Fracture Risk, rather than Bone Mineral Density (BMD) is now the key metric. Several speakers emphasizd the importance of VFA in making the diagnosis of Clinical Osteoporosis. This is something I have presented in poster exhibits 2015, 2016 and 2017. I am now mainstream!
“Treat to Target” was the big new message this year. We should set a target of decreased Fracture Risk for each patient and alter treatment until we reach it. This has been routine for years in diabetes, hypertension, cholesterol, etc. This is recognition that Osteoporosis is a chronic disease that we can control, but never cure, just like many others.
Take Control Naturally is the necessary first step, as I have outlined over the last few months. This is often sufficient for prevention and in mild disease.
Advanced Osteoporosis, especially after fragility fractures, or vertebral compression fractures seen on VFA, is usually beyond nutrition and exercise only. This will usually require medications to significantly reduce fracture risk.
The huge change is the recommendation to use an Anabolic medication first, to markedly reduce fracture risk, when BMD is very low or multiple fractures have already occured. Then follow up with an Antiresorptive to maintain a low fracture risk. Traditionally Medicare and other insurances have demanded we try Antiresorptives first to maintain bone as it is, even when multiple fractures have proven the bone to NOT be good enough at curent BMD.
We are entering a new age of Fracture Prevention!!
Jay Ginther, MD