Wednesday, September 29, 2010

Exercise for Bone Health

Exercise and lifestyle
by Dr. Susan E. Brown, PhD

Exercise and bone health — use them or lose them

I recently read a great quote by the Founding Director of the National Institute on Aging, Robert Butler, MD. He wrote, “If doctors could prescribe exercise in a pill form, it would be the single most widely prescribed drug in the world.” It’s interesting because almost all of us who are invested in our health already know that exercise is one of the most important factors in living a long and healthy life, but many of us are too busy to make time for it.

Exercising for your bones — simple ideas to get you started

Go dancing with a friend or partner.
Take a walk each night after dinner or try wearing a pedometer during the day to track how much you walk.
Ride your bike to friends’ houses, stores, and work.
Run up and down your stairs a few times a day.
Purchase or borrow a Nintendo Wii Fit program (includes dance parties, yoga, tennis games, boxing, and more).
Jump rope or simply hop on one leg, then the other — or on both.
Try the OsteoBall, Bosu Ball, or rubber flex bands (e.g., Thera-Band).
Rent or borrow a yoga, t’ai chi, or other exercise DVD, from the local library, a friend, or Netflix. (Several of the videos we recommend can be found in our store.)
Try bursting several times during your regular exercise routine.
Use an X-iser step machine for a few minutes a day. Use steppers, free weights, and other strength training devices at your local gym, or wear a weight vest or belt during your workout.
In my mission to explore and teach a natural, life-supporting approach to bone health maintenance and regeneration, nothing else I’ve found tells bone to build and rebuild itself quite like exercise. And with more exercise, you can not only improve the strength of your bones, but you can increase your overall health and longevity on all levels, just as Dr. Butler suggests.

If you’re serious about maintaining strong and healthy bones throughout your life — and despite the wide prevalence of osteoporosis and osteopenia, it is entirely possible — exercise should move up on your list of priorities. But what type of exercise is best for bones? You may have heard that certain forms of exercise are good for bone-building, while others, like swimming or biking, aren’t as helpful. Let’s take a closer look at exercise and help you determine what’s best for your bone — and your life.

If your bones could talk...

If your bones could talk, they would say, “Show me you really need me!” Though it feels and looks solid, living bone is dynamic tissue that is constantly altered in response to motion and movement. The more your bones are called upon to carry weight, the more your body puts its resources into building them to support that weight. Bone and muscle are part of the same unit, and as you build muscle, you build bone by default. Here’s why: muscles are attached to bones by tendons. When muscles contract, the tendons tug on your bones, stimulating them to grow. The stronger the muscle, the more powerful the stimulation on the bone.

The best news is that everyone, from a young athlete to an elderly person confined to a wheelchair, can build bone mass with a combination of exercise, an alkaline diet, and bone-healthy nutritional supplements. And there are many options out there for you to explore (see the box above). From hopping on one or both legs during the commercial breaks of your favorite TV show to biking back and forth to work, there’s a way for you to make exercise a part of your life, and once your bones are called upon, their mass will increase.

What and how much exercise helps build bone?

Mix it up!

Your bones respond best to unusual, unexpected bursts and varying combinations of forces, rather than routine workouts. Here are some ideas to help you achieve this:

Jump, skip or break into a jog when you wouldn’t normally.
Vary your weight-lifting repetitions, mixing heavier weights than you’re used to with lighter ones.
Include several bursts in your workout, where you increase your heart rate for a minute or so.
If you always use the treadmill, try dancing or yoga exercises every other work-out.
Try a whole body vibration platform if there’s one in your area
As I have written in my book, Better Bones, Better Body, regular lifelong exercise is best for bone, but it’s never too late to begin building bone density with exercise. Your age, gender, current bone mass, and training history are all factors that will influence your choice of exercise for bone health. (Curious about your bones? Take our Bone health profile.)

The optimal exercise routines for men’s and women’s bone health is unknown and subject to much debate. But we do know that different forms of exercise benefit bone mineralization and the mechanical properties of bone in different ways for men and women of different age groups.

The standard party line is that exercise that requires high forces or generates high impact on the body (such as gymnastics, dance, or weight-lifting) is necessary to improve bone density. Generally speaking, the greater the force or impact, the more bone-growth stimulation. Scientific evidence does suggest we most efficiently build bone mass with a combination of high-impact exercise (such as jumping) and weight-lifting (which can include push-ups, yogic arm balances, using a weighted vest, etc.).

But other properties of bone besides mass make it resilient, such as its water content and cross-sectional geometry. That’s why non-weight-bearing or resistance exercise such as swimming, biking, and isometric exercise (like using the OsteoBall®) also have value, in that they can increase your bones’ flexibility and compression strength. Resistance exercise also decreases your risk of falling and fractures by enhancing balance, coordination, and muscle strength.




One way to increase the forces of resistance on your bones is with Eastern forms of exercise such as yoga, t’ai chi, or qi gong, and other alternative systems such as Pilates. We’re just now beginning to understand that the benefits we gain from such mind–body disciplines extend much further than simply strength and flexibility.

Practices like yoga and t’ai chi can improve balance, coordination, and focus — not to mention providing a boost in confidence! As we age, many of us become less confident when moving about, and while it’s good to be careful, hesitancy can make us more likely to fall and possibly fracture. And whether you’ve been diagnosed with osteoporosis or osteopenia or not, falling puts you at risk of fracture.

Several recent scientific studies document the positive effects of yoga on bone health in women of all ages. Results showed increased bone density in the spine and hips as measured by DEXA scans, as well as reduced markers of bone turnover.

In addition to the physical effects, there’s often a psychological benefit to Eastern practices. This can help enhance our natural mind-body connection and calm the autonomic nervous system, lowering adrenaline and cortisol, our primary stress hormones. These actions ultimately help bone and whole-body health. As Dr. Paul Lam notes on his Tai Chi for Osteoporosis DVD, “Practicing Tai Chi strengthens from the inside out.” When beginning from our hearts and minds, we are capable of great things in the whole body.

If it seems overwhelming to join a class to learn exercises, you might try familiarizing yourself first with the concepts with a DVD like the ones we offer on our website or take a look at a YouTube video on-line. You may find you prefer practicing in the comfort of your own home, or that you’re ready to find a local class. What I like about attending a class is that most instructors lead the class to move in different ways each session, rather than sticking with the same routine. And variety is great for bone.

Exercise: one way to stem menopausal bone loss

While both men and women can develop osteoporosis, women are far more likely than men to experience bone loss, and the critical time in their lives for bone health is the menopause transition. For years we’ve been told that women can lose up to one-fifth of their bone mass during the menopause transition, and that estrogen is the crucial player. But there is actually much more to the story — waning estrogen doesn’t make it impossible to build bone in perimenopause and menopause. Women’s bodies maintain bone best when our hormones are balanced, not just when they’re present at certain premenopausal levels. It also helps to exercise, eat an alkalizing diet, and take a quality multivitamin designed for bone building, like the ones we offer in our Personal Program for Better Bones.

I always tell women, the bone you’ve got is good. Let’s keep it! Exercise is an excellent way to maintain the bone you already have during this crucial transition time, and more rigorous strength training can make a big difference to bone mineral density during the early postmenopausal years.

If you want to build bone during the menopause transition, it may take a more intensive exercise plan. In the case of early post menopausal women with osteopenia, some research indicates that the isolated effect of simply increasing habitual physical activity does little to increase muscle strength. But don’t be discouraged by that — it just tells us that women with a diagnosis of osteopenia or who are otherwise at higher risk need a more deliberate exercise program than simply increasing habitual physical activity.

Exercise for those with osteoporosis or osteopenia

Some exercise “don’ts” in osteoporosis

Some exercises aren’t recommended for those who have fractured or who have severe osteoporosis. Flexion exercises where you bend your spine significantly forward can increase the risk of vertebral fractures by putting excessive pressure on the vertebral bodies. Such exercises may include crunches where you round your back, touching your toes from a standing position, pulling your knees into your chest and lifting your chin and neck while on your back, or rounding your back over and downward while in a seated position. Extension exercises where you stretch up and flex backwards are generally safe for everyone.


Caption: Exercise “don’ts” for those with osteoporosis and osteoporotic fractures of the spine. Exercises that curve or bend the spine increase your chances of vertebral fracture.

It’s common for people diagnosed with osteoporosis or osteopenia to be a little afraid of exercise, because they are worried their bones might fracture with any unusual activity. Such caution is warranted in some situations, such as if your bone density is very low compared to other women your age, or if your body is in a very deconditioned state. But in the vast majority, this is not the case. Almost everyone can start with a program of walking, and most can safely undertake a significant bone-building exercise program with great success. But it’s important to work with your healthcare practitioner and take care not to put excessive stress on weakened bones.

Take a look at our Better Bones Exercise Plan to begin your process, and make sure you discuss your goals with your practitioner.

How to get results — a Better Bones approach

For most of us, almost any exercise — as long it’s regular and not so intensive it causes damage — is good bone exercise. Your bones are designed to naturally break down and rebuild themselves to support the demands you place on them. But truly amazing changes come about when all the body’s systems are working synergistically. Here are the three core elements of our integrative bone health approach:

Create an exercise plan. Because everyone is starting from a different place, we put together a guide to help you design Your Better Bones Exercise Plan in a way that fits your unique needs and lifestyle.

Eat a plant-based, alkalizing diet. Just by living and breathing, we create an internal acid load, and because our bones are the body’s great buffers, an overly acidifying diet leaches buffering minerals from the bones to alkalize the blood. In contrast, fruits and vegetables provide alkalizing mineral reserves to counterbalance acid-forming metabolic processes. (See our articles on acid-alkaline balance).

Boost your bone-building vitamins, minerals, essential fatty acids, and amino acids. Because even the healthiest diet doesn’t necessarily supply all that you need, I recommend taking high-quality nutritional supplements to ensure that you’re getting all 20 essential bone-building nutrients, such as vitamin D, vitamin K, calcium, potassium, and magnesium.

Combining these three elements — regular exercise, an alkalizing diet, and high-quality supplements — will make it much more likely for you to get the results you’re looking for. Adopting this approach can also give you a surprising bonus: improved energy and whole-body wellness, well into old age.

Exercise that replenishes you in every way

Tips for safe exercise

Exercise within your comfort zone.
Avoid movements that cause pain.
Maintain good posture and avoid rounding your back.
Be sure to warm up and stretch your muscles.
Work with a physical therapist if you have experienced an osteoporotic fracture.
As a mother and busy practitioner myself, I know how tough it can be to find the time and inspiration to exercise regularly. But it’s so important for your bones, and I promise, when you find something you love doing, it will become second nature.

Be creative, explore, and be willing to try something new or combine different forms of exercise. Avoid anything that feels like one more chore. When you exercise in a way that replenishes you it triggers the reward cascade in your brain — you’ll know it when you experience it!

There is so much out there. Fully embracing your exercise routine will not only help you to maintain and build new bone, but will enhance your outlook, longevity, and whole-body health.

Monday, September 13, 2010

Low Vitamin D Associatwd with Depression in Older Adulta

A new study in London investigated the association between vitamin D deficiency and depressive symptoms in a national community sample of older people. Vitamin D deficiency is common in older people with potential effects on mood.

Methods: Data were analyzed from 2070 participants aged 65 years who had participated in the 2005 Health Survey for England. Serum 25-hydroxy vitamin D (25(OH)D) levels and depressive symptoms (Geriatric Depression Scale) had been measured. Covariates included age, sex, social class, season of examination, and physical health status.

Results: Depressive symptoms were associated with clinical vitamin D deficiency (25(OH)D levels <10 ng/mL; present in 9.8%) independent of other covariates but not with broader deficiency states. This association was not modified by season of examination.

Conclusion: Vitamin D deficiency is associated with late-life depression in older adults.

Sunday, September 12, 2010

SAMe May Be Beneficial for Depression

Study Shows SAMe May Ease Depression

By TARA PARKER-POPE
A popular dietary supplement called SAMe may help depressed patients who don’t respond to prescription antidepressant treatment, a new study shows.

SAMe stands for S-adenosyl methionine, a naturally occurring molecule that is widely used in Europe for depression, arthritis and other ailments. It is found throughout the human body, with high concentrations in the liver, adrenal glands and brain.

The latest research, conducted by investigators at Harvard Medical School and Massachusetts General Hospital in Boston, is important not only because it suggests another treatment option for patients with depression, but because it also offers news clues into the physical pathways of depression that could ultimately lead to more effective treatments.

“There are many directions in research that this opens up,” said Dr. George I. Papakostas, director of treatment resistant depression studies at Mass General and the study’s lead author. “It provides clues to new treatments, and it provides clues to understanding what causes depression as well as what goes on biochemically when people get better from depression.”

The researchers studied the use of SAMe or a placebo in 73 adults with depression who were not responding to prescription antidepressant treatment. All of the study subjects continued to take the prescription antidepressant, but 39 of them were randomly assigned to receive SAMe for six weeks. The remaining 34 patients received a placebo in addition to their regular prescription treatment.

After six weeks of treatment, 36 percent of the patients taking a combination of SAMe and an antidepressant showed improvement, compared to just 18 percent of those taking the antidepressant and placebo. And about 26 percent of patients in the SAMe group experienced a complete remission of symptoms, compared to just 12 percent in the placebo group, according to a report published in The American Journal of Psychiatry.

The research offers hope to patients who haven’t been helped by traditional antidepressant treatment. Studies suggest that for more than half of depressed patients, antidepressants alone don’t eliminate symptoms. As a result, doctors are looking for additional treatments to help these patients, referred to as “nonresponders.”

Modern antidepressants essentially work by building up concentrations of neurotransmitters, which amplifies their effect on the brain. It’s not clear exactly how SAMe works to curb depression, but researchers have several theories. SAMe may influence the expression of genes involved in depression or alter the function of different receptors and structures that transport neurotransmitters in the brain. The molecule also may be directly involved in the creation of neurotransmitters.

“Most antidepressants we use are acting on neurotransmitters in the brain,” said Dr. J. Craig Nelson, professor of psychiatry at the University of California, San Francisco, and author of an editorial accompanying the study. “It may be that SAMe is facilitating the synthesis of the neurotransmitters that the drugs then act on. That’s probably the best hypothesis.”

Other studies have suggested that SAMe can relieve symptoms of depression. A 2002 analysis of depression trials conducted by the Agency for Health Care Research and Quality found that SAMe use resulted in clinically meaningful benefits to depressed patients compared to placebo, and that the supplement worked as well as tricyclic antidepressants, a category of prescription drugs.

In his editorial, Dr. Nelson notes that SAMe is typically not covered by insurance companies, and that although the cost is relatively low, it is still more than the drug co-payments required by most health plans. A monthly supply of the same brand of supplement studied would be about $143, the editorial notes.

Dr. Nelson, who was not involved in the Harvard study, said the results need to be replicated in a larger study, and that more information is needed on dosing, side effects and long-term treatment with SAMe, among other things. Dr. Papakostas agrees the study “needs replication” but said he is hopeful about the potential for future research.

“It’s a huge advancement in terms of expanding the types of medications we have to treat depression,” Dr. Papakostas said. “In the last 60 years of depression research, all the treatments have focused on similar mechanisms of action. This is one of the first few studies that suggests a different mechanism. It’s a medication that works differently than everything else.”

The study was funded by a grant from the National Institutes of Mental Health, but the SAMe pills and placebo pills were provided by the dietary supplement maker Pharmavite. Dr. Papkostas, Dr. Nelson and other researchers involved in the study all disclosed several financial relationships with makers of prescription antidepressants.

New Study Links Osteoporosis Drugs to Cancer

New Study Links Oral Bisphosphonates to Esophageal Cancer

A case-control study in BMJ finds that oral bisphosphonates are associated with increased risk for esophageal cancer, thus contradicting a recent JAMA study finding no such link.

In the current study, British researchers used a national database to identify nearly 16,000 adults diagnosed with esophageal, stomach, or colorectal cancer over a 10-year period, and matched them with some 78,000 controls without cancer. Prescriptions for bisphosphonates were then assessed for the 7.5 years before diagnosis.

Bisphosphonate prescriptions were associated with a 30% increase in risk for esophageal cancer, with the elevated risk largely limited to patients with 10 or more prescriptions. The drugs did not appear to increase risk for stomach or colorectal cancer.

The researchers, noting that the contradictory JAMA study used the same database, say the disparate result may be due, in part, to the longer follow-up and greater number of controls in the current study.

Saturday, September 4, 2010

Drinking Water Before Meals Can Lead to Weight Loss

Last week, scientists reported results of a three-month clinical trial, whose results confirm that drinking two eight-ounce glasses of water before meals leads to substantial weight loss. The weight-loss findings were presented at the 240th National Meeting of the American Chemical Society (ACS), and the study was funded by The Institute for Public Health and Water Research.

“We are presenting results of the first randomized controlled intervention trial demonstrating that increased water consumption is an effective weight loss strategy,” said senior author Brenda Davy, Ph.D., of Virginia Tech. Dr. Davy went on to say, “…we found that over the course of 12 weeks, dieters who drank water before meals, three times per day, lost about 5 pounds more than dieters who did not increase their water intake.” She pointed out that folklore and everyday experience long have suggested that water can help promote weight loss. But there has been surprisingly little scientific information on the topic.

Dr. Davy cited an earlier study by her group, which showed that middle aged and older people who drank two cups of water right before eating a meal consumed 75 to 90 fewer calories during it (Van Walleghen EL et al. 2007). The current study involved 48 adults aged 55-75 years, divided into two groups: One group drank 2 cups of water prior to their meals and the other did not. All of the subjects ate a low-calorie diet during the study. Over the course of 12 weeks, water drinkers lost about 15.5 pounds, while the non-water drinkers lost about 11 pounds.

As the authors concluded, “Thus, when combined with a hypocaloric [low calorie] diet, consuming 500 ml [16 ounces of] water prior to each main meal leads to greater weight loss than a hypocaloric diet alone in middle-aged and older adults.” (Dennis EA et al. 2010)

Davy said drinking ample water before a meal may work simply because people feel fuller and eat less calorie-containing food during the meal. Increased water consumption may also help people lose weight if they drink it in place of sweetened calorie-containing beverages, said Davy.

Sources
American Chemical Society (ACS). Clinical trial confirms effectiveness of simple appetite control method. August 23, 2010. Accessed at http://portal.acs.org/portal/acs/corg/content?_nfpb=true&_pageLabel=PP_ARTICLEMAIN&node_id=222&content_id=CNBP_025391
Davy BM, Dennis EA, Dengo AL, Wilson KL, Davy KP. Water consumption reduces energy intake at a breakfast meal in obese older adults. J Am Diet Assoc. 2008 Jul;108(7):1236-9.
Dennis EA, Dengo AL, Comber DL, Flack KD, Savla J, Davy KP, Davy BM. Water consumption increases weight loss during a hypocaloric diet intervention in middle-aged and older adults. Obesity (Silver Spring). 2010 Feb;18(2):300-7. Epub 2009 Aug 6.
Dennis EA, Flack KD, Davy BM. Beverage consumption and adult weight management: A review. Eat Behav. 2009 Dec;10(4):237-46. Epub 2009 Jul 16. Review.
Van Walleghen EL, Orr JS, Gentile CL, Davy BM. Pre-meal water consumption reduces meal energy intake in older but not younger subjects. Obesity (Silver Spring). 2007 Jan;15(1):93-9.