Treating My Osteopenia

osteopeniaGrowing old. What a nuisance. Wrinkles, gray hair, enlargement of the suborbicularis oculi fat pads – a.k.a. eye bags big enough to pack a picnic lunch. And now bones returning to dust right inside of me.

This tirade stems from the results of my Dual X-ray (DXA) bone densitometry test. In the past eleven years, my osteopenia has gotten worse (surely, it’s a measurement error!) to greatly increasing my risk of hip and spine fractures as I age. (But I love to ice skate – talk about falls!)

No surprise as I have so many risks: older, white, small-boned female, lowish BMI (cosmetically slim), never took estrogen, bisphosphonates (Actonel) did nothing, used to smoke, loves wine (modestly reduces calcium absorption) and coffee (modestly increases calcium excretion).

My diet is balanced enough, albeit lowish in protein because I don’t eat much meat and eggs and, like most others, I don’t meet my personal requirements for calcium and vitamin D: 1,200 milligrams of calcium – some say 1,500 – and 600 i.u. of vitamin D– some say 800) per day. And what about boron, vitamin K, phosphorous, and other key nutrients for bone health? I’ll comment only if you ask.

I do eat yogurt faithfully and, sometimes, milk in cereal. I eat my dark leafy greens and nuts and, sometimes, fish with bones; however, calcium from plants is not well-absorbed (oxalates and phytates interfere with absorption), I rarely drink a glass of milk or eat cheese, and I never have calcium-fortified orange juice or breakfast bars. (Personal preference: yuck!) According to the lab, I’m not vitamin D deficient (vitamin D is needed for calcium absorption), but I’m sure I don’t eat enough fatty fish, liver, cod liver oil, egg yolks, radiated mushrooms, or fortified milk – most yogurt is not fortified  – and I don’t get enough strong sun. But I’m not about to eat more because, as a short older women, I practically can’t eat without gaining weight. (Young ones, wait and see.)

And so, I have to take supplemental calcium and vitamin D. I take Nature Made adult gummies Calcium with Vitamin D3 four a day at doses of 500 mg or less between meals to increase absorption. (Add another 150 calories.) These suplements are acceptable because, frankly, they taste like candy. Each gummie contains 250 milligrams of calcium and 350 i.u. of vitamin D, which should keep me within the Tolerable Upper Intake Level (UL) for  gender and age. The calcium is tricalcium phosphate, a well absorbed source, and vitamin D3 (vs. D2), the best form. Still, research tells me not to expect much.

Weight-bearing exercise also helps to build bone. I walk a lot, jump on the mini-trampoline a bit and do Pilates consistently. But that doesn’t cut it. Now, I have to take up running or jumping up onto and down from a box at least 15 inches high to generate enough force to help build bone. (See the New York Times, Why High-Impact Exercise Is Good for Your Bones.) Since 15 inches is more than a quarter of my height, jumping on the box won’t work, and if I liked to run, I’d have done it by now, but like the supplements, it’s therapeutic. What a nuisance.

Your thoughts: Have you had a bone densitometry test? What did it reveal? Do you take calcium supplements?

Beware of the Ground Turkey Trots

ground-turkey-406x250“Don’t buy the ground turkey,” I said to my nonagenarian aunt at the supermarket. She is just too frail and too old to take that risk.

Consumer Reports’ recently investigated 257 samples of raw ground turkey meat from major supermarkets in the United States. They tested for five bacteria (enterococcus, E. coli, salmonella, staphylococcus aureus, and campylobacter) that may cause severe foodborne illness and be fatal in some cases. Consumer Reports’ found that 90 percent of the samples tested had  one or more of the five bacteria.  But what’s worse is that nearly 80 percent of the Enterococcus bacteria were resistant to three or more classes of antibiotics, as were more than half of the E. coli and 67 percent of the Salmonella strains. Who can forget the Salmonella Heidelberg outbreak of 2011? One person died, 37 were hospitalized and 136 people were officially sickened – from ground turkey. The CDC said the outbreak might have sickened 4,000 more people.

Consumer Reports’ recommends buying ground turkey labeled “no antibiotics” or “organic” because turkeys “raised without antibiotics” contain fewer antibiotic-resistant bacteria – they still harbor bacteria, but they are less likely to be superbugs. Still, just to be safe, IMHO the very young, very old and frail, pregnant, and sick should avoid ground turkey and the risk of getting the turkey trots.

Your thoughts, Do you eat ground turkey meat?

We Need to Talk About Pizza

Pizza sliceFist bump

Today, I’m on a mission to simplify the challenge of reducing sodium intake in America. I am inspired by the Heart Association’s (AHA) sodium awareness campaign, the Sodium Swap Challenge, launched this week. AHA wants us to know about the “Salty Six” – bread and rolls, cold cuts and cured meat, pizza, poultry, soup, and sandwiches – common foods that are loaded with sodium – and then they ask us to cut back at the rate of two foods per week to change our acquired taste for salt in 21 days.

Kudos to AHA for a noble effort. Excess salt is associated with high blood pressure, a modifiable risk factor for stroke. And because sodium holds onto excess fluid, it can make us puffy and bloated. (Stop right there!) On average, Americans eat 3,400 milligrams of sodium a day; however, the dietary guidelines recommend less than 2,300 mg and only 1,500 mg if you are 51 or older, have a cardiovascular condition, or are African-American.

First I Look at the Pizza

Back to simplification. Bread sales are down, as are canned soup sales, but the pizza market is growing. Cheese consumption has quadrupled since the 1950s. That’s because it’s on the pizza. The average American eats 10 pizza pies – 23 pounds of pizza – a year; 94 percent of us eat pizza (at least) once a month; 41 percent eat pizza (at least) once a week. Kids ages 3 to 11 prefer pizza over all other foods.

Pizza is the go-to food for busy people. People who wouldn’t dream of dinner at McDonald’s think nothing of ordering a pizza or two. Do they know that a Big Mac with medium fries has 1310 milligrams of sodium, while the same weight of pepperoni pizza has 3249 milligrams?!! One pizza meal has enough sodium (and saturated fat) for two days.

Pizza is an amalgam of bread, cured meat (36% of pizzas are pepperoni), cheese, and tomato sauce, four top sodium foods from the Centers for Disease Control’s Top Sources of Sodium in the Diet, a better list.  To simplify sodium reduction, pizza-eating families and singles should look to pizza.

I’m glad we talked.

Your thoughts: Do you know anyone who eats too much pizza?

Adult Gummie Vitamins Save the Day

Have you noticed the explosion of gummy vitamins?  Every brand seems to make them now. I am most familiar with Nature Made, a company dedicated to demanding safety and quality standards. They introduced me to their new lines of supplements – Adult Gummies, Full Strength Minis, and VitaMelts – but today I am recommending the adult gummies because they saved the day – twice.

Case One
My 92 year old aunt needs vitamins. Her weight matches her age. This is Aunt Jean, not Aunt Pauline, who was helped a bit when Sugar-free Peeps Saved the Day. Aunt Jean cannot eat much because she has achalasia, a condition that affects the ability of her esophagus to move food toward the stomach, and so she has difficulty swallowing solids. She has had surgery and medications, but this is the best she can do. She clearly doesn’t eat enough, but I’m just the friendly visitor, not the Boost® police. Plus, she is picky, picky, picky. Her longevity is definitely not related to eating a balanced diet.
Aunt:      “Should I take these vitamins? Do they smell bad? They’re big”.
Me:         “You smell the minerals and, yes, those vitamins are too big. I recommend a multivitamin-mineral supplement that smells and tastes like candy. You can chew it.”
Aunt:      “I want that those.”
Me:         (Note to self: Picky eaters always like candy. Also, Nature Made describes their gummies as, “…mouth-watering, real fruit flavors like peach, mango and orange that taste like real fruit, not candy.”  I guess they had to say that.)

Case Two
My 29 year old daughter, Liza, has perfect health and a wonderful diet. (See A Whole Lotta Grain Goin’ On.) But – Liza is a preschool teacher surrounded by kids with colds. Back at school, week-one, she already has a cold. (Don’t give it to me!)  Perhaps a multivitamin-mineral supplement would help, if not for the nutrients, then for the affirmative action of taking it. Caveat: Liza does not swallow vitamin pills.
Me:         “Here, take this bottle of Nature Made Adult Gummies. I got it as a gift.”
Liza:       (90 days later and cold-free) I finished that bottle of vitamins. Do you have more?
Me:         “I don’t, but you can buy them in any drug store. Here is a coupon for $2 off.”

Conclusion:   Adult Gummies saved the day – twice.  As for me, I take Nature Made Full Strength Mini Multi for Her 50+. I have no problem swallowing little pills.

Your thoughts: Do you take a daily multivitamin-mineral supplement?

Too Much Garam Masala

A scary thing happened the other day. Liza, my daughter, had a bad reaction to something at an Indian restaurant in Curry Hill in New York City. I found the food we were eating to be much too spicy, but when I looked up to see the fear on Liza’s face, I knew something was terribly wrong. “I feel funny. My heart is pounding. I can’t breathe,” she said. The rapid heartbeat, chest discomfort, breathing difficulty, burning, and tingles all came in waves. Liza was having an allergic reaction. Within an hour, the discomfort and the daze were completely gone, but I blamed the episode on that over-the-top spicy garam masala.

A typical Indian garam masala spice blend recipe has black and white peppercorns, cloves, cinnamon, black and white cumin seeds, and cardamom pods. This particular blend was full of chili and other spices too. As it turns out, cloves, cinnamon, cardamom, and nutmeg are medicinal herbs that can cause an allergic reaction. Clove oil and other aromatic spices contain eugenol, which has caused anaphylactic shock. Reputable sources like the Physicians’ Desktop Reference and the University of Maryland Center for Integrative Medicine confirm it.

Liza recovered completely, but a lesson was learned: herbs and spices are more than scent and flavor; they are pharmaceutical substances with therapeutic properties. Paracelsus, the Renaissance physician, said it best: “The dose makes the poison.”

You thoughts: Have you had an allergic reaction to food? Do tell….

Do You Know (How to) Squat?

My readers and friends know that I take great care of my hips. My hips have been sensitive since the Aughts, when I worked for corporations in the cube. Ergo consults…a footrest, nothing helped.

Now, I still sit to work at home, but I use an ergonomically designed knee chair and I stand as much as possible. (I am standing with my laptop on the counter as I write.)  I swear by hip exercises as well, but the one movement that helps my hips most is the squat. The squat stretches the five hip adductors going from the pelvis to the thigh bone and from the pelvis to the knee. It helps the quadriceps, hamstrings and glutes too. I squat on my knee chair and on the floor.

Westerners Don’t Know Squat

I believe westerners are neglecting a basic self-care activity by failing to routinely squat. In the Far East, India, Middle East, and Africa, squatting takes the place of sitting. Asians squat with their heels on the ground and knees aligned with the direction of their toes, but most Americans can’t place their feet on flat ground because their Achilles tendons have been shortened by wearing shoes and sitting in chairs. Their quads are weak, their hips don’t extend, and they fall over backwards when they squat.

How to Do the “Asian Squat”

To squat like an Asian, it’s important to first build up your Achilles tendons with foot and ankle exercises. And then, start by squatting with your back against a wall to prevent falling backwards. Keep your feet wide apart, align your knees over your feet, lower yourself slowly, rest your arms on your knees, and don’t sit down on the dirty ground! Next, practice squatting away from the wall with your back hunched over your knees. Now practice again and again until squatting is perfunctory.

Daniel Hsia, young filmmaker extraordinaire and bro of my pal, Sue Hsia Lew, made this video, “How to do the Asian Squat,” back in 2002. In my mind, Daniel’s spoof is a great public health intervention. Enjoy!

Your thoughts: Can you do the Asian Squat?

Also about hip exercises:
30 Days on the Rebound(er): Jumping on the Mini-trampoline

Jumping on the Mini-trampoline, 30 Days Later

Blackberries Are Here!

Here up north, the Farmer’s Markets are filled with blackberries this week. I sing their praises because, for thousands of years, humans have used blackberries for medicine and food.

Stills: Say, can I have some of your purple berries?
Crosby: Yes, I’ve been eating them for six or seven weeks now, haven’t got sick once.
Stills: Probably keep us both alive.

A Blackberry Tale*

During the Civil War more deaths were caused by disease than by wounds, and of disease deaths, about half were caused by intestinal disorders, mainly diarrhea, dysentery and  typhoid fever. In fact, 995 of 1,000 Union soldiers contracted dysentery. The cure for dysentery was blackberry tea because blackberries are a powerful astringent that limits bodily secretions, and more than one cease fire was called for the purpose of picking blackberries. Confederate and Union soldiers stopped to pick blackberries together, often from the same bush at the same time, only to start fighting again when the dysentery was cured.

Blackberry Nutrition

Of all the berries, blackberries are the most nutritious. They contain the most ellagic acid, a phenolic compound with anti-carcinogen, anti-viral and anti-bacterial properties. They are loaded with gallic acid, rutin, and anthocyanins (blue pigments) as well, all powerful antioxidants that help to protect human cells against oxidative damage. Besides fighting cancer cells, they control circulatory disorders, enhance night vision, and have too many additional therapeutic roles to mention. Blackberries are loaded with fiber, vitamin C, manganese, copper, and omega-3 fatty acid-like molecules. And all of that for only 60 calories per cup, a true high “nutrient density” food.

Here are some ways to enjoy blackberries:
Blackberry Spinach Salad (All Recipes.)
Blackberry Mint Iced Tea (Driscoll’s)
Old Bachelor’s Jam and  Old Bachelor’s Jam and Blackberry Tart (Martha Stewart)

Your thoughts: Do you have a blackberry recipe to share with my readers? Thanks!

*Flora and Fauna of the Civil War: An Environmental Reference Guide by Kelby Ouchley

Hepatitis C and All of We

Line up baby boomers – all 78 million of you – it’s time to test for hepatitis C. That’s what the Centers for Disease Control and Prevention (CDC) propose. We all need to get a blood test. Hepatitis is an inflammation of the liver that may progress to liver cancer or cirrhosis. Hepatitis C, the most common type in the United States, is spread when blood from a person infected with the virus enters the body of someone who is not infected. Around 15%–25% of infected people clear the virus without any treatment, but the remaining 75%–85% develop a chronic infection that may be silent for years. Most infected people don’t feel sick – while their livers are slowly being damaged.

Historically, the CDC has recommended testing people known to be at high risk.  They include current and past users of injection drugs, recipients of blood transfusions and organ transplants before 1990 when screening blood donations became widespread, and healthcare workers exposed to blood. Much less commonly, the hepatitis C virus is spread by sharing razors, toothbrushes, and other personal care items that may come in contact with blood. Having sex with someone infected with hepatitis C is somewhat risky too, especially when exposed to multiple sex partners who have sexually transmitted diseases. Sex, drugs and rock and roll. Bummer.

I, for one, I wish the CDC would stop scaring me. Doctors test for the hepatitis C antibody (also called HCAb or anti-HCV) to tell if you’ve been infected. The test is very sensitive, which means false positives, more testing, and more being scared. All when only 3 percent of asymptomatic boomers actually test positive. As a responsible health blogger, I probably shouldn’t say this, but I am always skeptical of guidelines that push asymptomatic individuals en masse towards prescriptions. I just wonder who is being best served. The CDC’s draft recommendations are available for public comment until June 8, 2012.

Your thoughts: Are you worried about having hepatitis C?

Addendum:  August 16, 2012
It’s official: The U.S. Centers for Disease Control and Prevention (CDC) is now recommending that all U.S. baby boomers get a one-time test for hepatitis C virus (HCV) infection, according to final screening guidelines released by the public health agency.  Read more.

How Sugar-free Peeps Saved the Day

Aunt Jean: “You have to call your Aunt Pauline. They told her to eat white bread. What’s going on? She doesn’t know what to eat. ”

Mary: “Her kidneys are failing and so she can’t have much potassium. Brown breads have a little more potassium. I’ll visit.”

You would think we dietitians always preach the conventional paradigm of healthy eating, but that is not the case. When the body’s major organ systems fail, we modify our advice.  For example, my Aunt Pauline’s kidneys are on the fritz. She can’t remove excess potassium, so the level builds up. Too much can cause an irregular heartbeat and even sudden death. And so, Aunt Pauline was prescribed a low potassium diet, also low in sodium for swelling, without excessive protein for the kidneys again, with her blood glucose levels in mind for diabetes, well controlled on pills.

Aunt Pauline had two low-potassium diet sheets listing what to and what not to eat. Both sheets were a little different and, on my laptop, another sheet from the National Kidney Foundation was a little different still. The lists agreed upon the very high and very low potassium foods, but the middle range was questionable. Cooked cabbage? Maybe yes, maybe no. The same was true for whole wheat bread. Believe me, I know what it’s like to make those lists. The results depend on the makeup of the committee and the time of day.

For breakfast, according to the lists, Pauline could choose oatmeal, puffed rice, a bagel, or white toast. Oatmeal is fine, but every day? What about other cereals? The paper didn’t say. That’s when we had to look at the real numbers and make decisions case-by-case. The rule: be wary of foods with more than 250 mg of potassium per serving. Puffed rice, 6 mg of potassium, 1 mg of sodium (“too bland”); raisin bran, 357 mg of potassium (not an option); yada-yada, try this and that, and then bingo! Rice Krispies, 30 mg of potassium, 190 mg of sodium. That will do. And food-by-food, we went down the list. How much, how often, what’s it worth to you? It’s the only way to get buy-in to the diet therapy.

And, to keep life sweet, we make room for indulgences, also a personal thing.
Mary: “Check it out: Marshmallows have zero potassium and 6 mg of sodium; I’ve seen sugar-free marshmallows made with sugar alcohols. You could make Rice Krispies Treats.”
Aunt Pauline: “Really? I would like that…But what I’d really like is Peeps.”
Mary: “I’ve seen sugar-free Peeps made with sugar alcohols. You can have those too.”
Aunt Pauline: “This diet isn’t so bad after all.”

Sugar-free Peeps save the day, junk food that they are.

Your thoughts: Do you know someone who is confused by his/her medical diet?

Vitamin D3 and Me

I finally found a vitamin D3 supplement that I am willing to take for my presumed deficiency. I say presumed because I haven’t actually had my 25-Hydroxyvitamin D serum levels tested. I’m skipping that step because the values haven’t been standardized and, besides, I’d have to self-pay.

But, why wouldn’t I have low vitamin D levels? The most recent National Health and Nutrition Examination Survey (NHANES) estimated that 25% to 57% of adults have insufficient levels of vitamin D. Other studies set the number as high as 70% for some segments of the population.

Vitamin D is made when the sun’s ultraviolet B (UVB) rays hit the skin. There are many reasons why I wouldn’t get enough. I work indoors (UVB rays don’t penetrate glass), live in the northern latitude, often wear sunscreen, and I’m getting older. Those factors push me towards the brittle bones that are conclusively related to a lack of vitamin D. Less conclusive are the links to cancers, heart disease, autoimmune conditions, and, it seems, to whatever else ails you including colds and flu and forgetfulness.

The RDA for vitamin D is set at 600 International Units (IUs) per day from food. That amount meets the needs of 98% of healthy people. But Americans don’t eat nearly enough vitamin D. According to NHANES, average intake is 204 to 288 IU/day for males, and for females, the range is 144 to 276 IU/day. Vitamin D is found in only a few foods: oily fish and cod liver oil are the most important sources, followed by egg yolks, liver, and mushrooms. And while 3-ounces of cooked salmon supplies 477 IUs, one egg has only 40. Milk has been fortified with vitamin D since the 1930s, but 16 ounces supplies a little more than half of the RDA. Some brands of orange juice, yogurt, cheese, margarine, and breakfast cereals are also fortified. Scroll down to see the vitamin D content of selected foods.

I’m Covered

I thought I should take some vitamin D, but I couldn’t stomach another pill. I take a multivitamin, a prescription med, two fish oil capsules, a curcumin capsule, and a calcium tablet sometimes. But then the folks from Nature Made invited me to look at a few of their products, and I accepted the offer because they are big on scientific research and purity, and because we met at 250 Greenwich Street, the new World Trade Center Tower 7. I’m a sucker for a skyscraper with a fantastic view.

Nature Made’s vitamin D3 (the active form) comes in a grape-flavored chewable tablet that tastes like a sweet tart. Each tablet supplies 1,000 IUs, the daily amount commonly advised. The leading vitamin D scholar, Dr. Michael Holick, recommends taking up to 2,000 IU per day (4,000 IUs is the Tolerable Upper Limit.)  And so now, if I get about 250 IUs from milk, 500 IUs in my multivitamin, and 1,000 IUs in one sweet-tart. I am covered.

 Your thoughts: How do you manage to get enough vitamin D?