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?

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?

Readers React to Antioxidant Article

Warning: This information cannot be generalized….

Silly me! Why was I afraid of being misquoted by the health media last week? The article of concern, The Truth About Antioxidants in Men’s Health, did justice to the Cochrane Review and to me. The writer clearly made the point that individual antioxidants supplements (beta-carotene and vitamins A, E and C) were not found to work in a major scientific review, and might actually be harmful.

It must be difficult for health writers to communicate complex scientific information, but writers are only as good as their sources, and so I feel responsible to provide accurate quotes. But, in this case, I should have been concerned about the audience who, as it turns out, didn’t want to hear it. Imagine my surprise when I read the comments:

“No, you’re wrong. There have been studies done that show no toxic effects of Vitamin A at doses greater than 100,000 IU.  Vitamin E is safe and non-toxic….”

“Really Men’s HEALTH!! Shame on you and get the facts straight please. If you are not an idiot, one knows it is not only the quality of the supplement but the insight to supplement where it is needed on an individual basis.”

“This article is ridiculous. It makes me wonder how many other articles are CRAP on this website as well as the periodical? TO ANYONE READING THIS…Visit the Linus Pauling Institute online. Also, look up the Gerson Therapy.”

“To discredit vitamin supplements like in this article is a joke.  Deficiency is the problem in this country – vitamins aren’t (even supplements). Beta-Carotene doesn’t show any side effects in high doses. Vitamin E is safe and non-toxic.”

Alrighty then! Let’s hope those readers (and there were more) are the vocal minority. Skepticism is healthy, but there is a difference between opinion and fact. And while we’re at it, public health recommendations are not based on personal experience. And, finally, don’t shoot the messenger, especially when the messenger is me!

Your thoughts:  Is health information in the popular press worth reading? What’s a ‘nutrition expert’ to do?

Individual Antioxidants Aren’t Worth Taking

Mary, Mary, quite contrary,
Where does your information go?

I am frequently interviewed by health writers. I entered their circles at my last job. Getting my name out is good for driving traffic to my website. I like to read about topics in nutrition and answer questions, but the content of the final article can be a surprise. Let’s see what happens to yesterday’s interview. Check back here for the final version in a few days.

And so, yesterday, I commented on the Cochrane Review of Antioxidant Supplements for Prevention of Mortality in Healthy Participants and Patients with Various Diseases – all 258 pages. The review is of all primary and secondary prevention randomized clinical trials to assess the beneficial and harmful effects the popular anti-oxidant supplements, beta carotene, vitamin A, vitamin C, vitamin E and selenium, verses placebo and no intervention. Antioxidants are compounds in plant foods that neutralize the byproducts of normal biochemical reactions. Those processes create unstable molecules (‘free radicals’) that, if left unchecked, can damage cells and, presumably, create disease.

Cut to the Chase

The review concluded that none of the supplements helped, and beta-carotene, vitamin E and vitamin A are potentially harmful. That didn’t surprise me because antioxidant research is in its infancy, and those popular supplements are only five of literally thousands and thousands of nutrients and phytochemicals (nutrients that are neither vitamins nor minerals) with antioxidant action. For instance, beta-carotene is one of more than 600 known carotenoids. Furthermore, some compounds have anti-oxidant activity in the lab but not in the body.

But the writer wanted to know if there is ever a particular situation in which an individual should consider taking one of the supplements in the review paper.  Err, no, the review said that taking individual antioxidants doesn’t work and is sometimes harmful. I recommend those antioxidants only as part of a multi-vitamin-mineral supplement with a full compliment of nutrients. I take such a supplement that does not exceed 100% of the DRI and goes nowhere near the tolerable upper intake level (UL) for any nutrient. And, yes, individuals should take a supplement at times when ‘oxidative stress’ is high. I’m thinking about extreme physical stress (e.g. training for an endurance event, working long hours in manual labor, inability to escape insufferable weather), or extreme emotional stress (e.g. painful divorce, incarceration, being fired), or during convalescence from an illness, accident or surgery, or when their usual diet is just plain crap. Those folks need a complete supplement, not a module, because nutrients work in synergy.

And so, my final answer is to eat a wholesome diet and skip the individual antioxidant supplements. Now, I’m waiting to see what actually shakes down.

Your thoughts, do you that nutritional supplements?

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?