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.
