Millions of dollars are spent every year on prescriptions help relieve pain and stiffness associated with arthritis. Are there more natural supplements or alternative treatments that can be equally as effective? Do these natural approaches actually help in alleviating symptoms and is it worth the cost or effort? Continue reading
The Other Silent Killer
What is Osteoporosis and who is at risk? Osteoporosis is a disease of the skeletal system characterized by low bone mass and deterioration of the bone tissue.
While the symptoms of the disease seldom become debilitating until the latter stages of life, its propagation may begin much earlier.
According to statistics from the National Osteoporosis Foundation, 52 million Americans have low bone density or osteoporosis. 50% of women and 25% of men will break a bone after age 50 due to osteoporosis. By 2020, half of Americans over 50 are expected to have low bone density or osteoporosis. A woman’s risk of breaking a hip is equal to her risk of developing breast, uterine and ovarian cancer combined.
Proactive Prevention of Osteoporosis
Bone density peaks around age 30 and subsequently declines. Adolescents and young adults should regularly participate in weight bearing activities in order to build up a “bone density reserve.”
The American College of Sports Medicine, ACSM, recommends physical activities that generate relatively high-intensity loading forces to augment bone mineral accrual in children and adolescents. Evidence suggests exercise-induced gains in bone mass in children are maintained into adulthood, suggesting that physical activity habits during childhood may have long-lasting benefits on bone health.
Treatment is Paramount
While Osteoporosis is preventable, it is not curable. The only option is treatment. Treatment of established osteoporosis is cost-effective irrespective of age (Kanis, et al, 2005). Studies have shown that bone mineral density in postmenopausal women can be maintained or increased with therapeutic exercise.
Basic Bone Anatomy
Bones are made from collagen, calcium-phosphate complexes, and bone cells. Bone tissue is living, and is constantly being remodeled. The underlying cause of osteoporosis is an imbalance between bone resorption and bone formation. Excessive bone resorption, inadequate formation of new bone during remodeling, and inadequate peak bone mass are all mechanisms by which osteoporosis develops. Aging results in bone being lost more rapidly than it is formed.
Weight-bearing and Loading Exercise for Bone Health
Weight bearing activities like walking, jogging, dancing, stair climbing and hiking allow the force of gravity to act through the skeleton. Through this application of force, mechanisms that stimulate bone density are activated in response to the mechanical loading. The training principle of progressive overload is fundamental to the effective treatment of osteoporosis.
Strength Training for Bone Health
Impact loading exercises are superior to traditional weight-bearing activities for maintaining bone health. Impact loading exercise simply means any exercise that requires you to support your own body weight, including walking, aerobics or weightlifting. Resistance training can be defined as the act of repeated voluntary muscle contractions against a resistance greater than what is normally experienced in daily life. Training of this kind is known to increase strength through changes in both the muscular and nervous systems. In one study, resistance training had more of an effect on bone strength in the hip and lower spine than walking alone (Harvard Men’s Health Watch, 2013). Nine months to a year of regular exercise should be afforded before appreciable increases in bone mass are detected. Proper form and technique are important. Volume, frequency, duration and other training variables should be specific to the condition of the individual. For individuals with diagnosed osteoporosis, the ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription (Pescatello, et al, 2014) suggests the following guidelines for physical activity and resistance training aimed to prevent falls:
- One to three sets with five to eight repetitions of four to six weight-bearing, lower-body strength exercises using body weight as resistance
- Activities performed two to three days/week
- Additional resistance may be applied gradually and conservatively
(up to 10 lbs.) with weighted vest
- Therapy bands & rubber tubing may be used to facilitate
- Avoid impact exercise, spinal flexion against resistance, spinal
extension, high compressive forces on the spine, quick trunk rotation
Aerobic training is also important to the overall efficiency of the system, and in maintaining bone mass. Aerobic exercises are a system of physical conditioning, such as running, walking, swimming, or calisthenics strenuously performed so as to cause a significant temporary increase in respiration and heart rate. Activities that engage larger muscles like walking, cycling, swimming, and water walking are recommended for overall health, however claims that aerobic exercise can build bone density are false. According to ACSM, “Although aerobic exercises are beneficial and important for overall fitness, they don’t specifically help build bone density”.
While non-impact exercises may not directly support bone mass, they still offer immense indirect benefits in the treatment of osteoporosis. Balance exercises (e.g. Tai Chi, aquatic exercises) heighten proprioception and reduce the risk of falling, which is the leading cause of lost independence among the elderly. Postural exercises improve posture and help support the spine. Functional exercises improve the ability to perform activities of daily living, increasing quality of life and maintaining independence. Individuals who practice Tai Chi have 47% less falls and only 25% of the hip fractures of those who do not (Province, et al, 1995). Tai Chi can be beneficial for stunting bone loss in weight-bearing bones in early postmenopausal women (Chan, et al, 2004).
Dietary Approaches to Fighting Osteoporosis
Calcium and Vitamin D – Two of the most important nutrients in fighting osteoporosis are calcium and vitamin D. Calcium is an important component of the bone matrix, while vitamin D assists in its absorption. Supplementation with vitamin D has improved lower extremity muscle performance and reduced risk of falling in several high-quality double blind randomized control trials (Bischoff-Ferrari, et al, 2009). The Food and Nutrition Board of the Institute of Medicine of the
National Academies, National Institute of Health, Office of Dietary Supplements recommends the following intake levels for post-menopausal women:
- Calcium: 1200 milligrams/day
- Vitamin D: 10 micrograms/day (400 International Units/day) from ages 51 to 70 (Increase to 15 micrograms/day [600 International Units/day] after age 70)
Protein – Aging may compromise the body’s ability to process protein efficiency. Older adults should be vigilant in their consumption of protein in order to avoid protein malnutrition. In one study with elderly men and women, higher dietary protein intake was associated with a lower rate of age-related bone loss (Hannan, et. al, 2000).
American College of Sports Medicine
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. Br Med J 339:b3692.
Chan, K; Qin, L; Lau, M; Woo, J; Au, S; Choy, W; Lee, K; Lee, S. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil 2004;85:717–22.
Daltroy, L. H., Larson MG, Eaton HM, et al. Discrepancies between self-reported and observed physical function in the elderly: the influence of response shift and other factors. Soc Sci Med. 1999;48(11):1549–61. Medline:10400256.
Hannan MT, Tucker KL, Dawson-Hughes B, et al. (2000) Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 15:2504.
Hartard M, Haber P, Ilieva D, et al. (1996) Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia. Am J Phys Med Rehabil 75:21.
Kanis JA, Borgstrom F, Zethraeus N, et al. (2005) Intervention thresholds for osteoporosis in the UK. Bone 36:22
Kemmler W, Lauber D, Weineck J, et al. (2004) Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Arch Intern Med 164:1084.
Kerr, D., Ackland, T., Maslen, B., Morton, A. and Prince, R. (2001), Resistance Training over 2 Years Increases Bone Mass in Calcium-Replete Postmenopausal Women. J Bone Miner Res, 16: 175–181. doi: 10.1359/jbmr.2001.16.1.175
Palombaro, K. M., Black, J. D., Buchbinder, R., & Jette, D. U. (2013). Effectiveness of Exercise for Managing Osteoporosis in Women Postmenopause. Physical Therapy, 93(8), 1021-1025. doi:10.2522/ptj.20110476
Pescatello L, Arena R, Riebe D, Thompson PD, ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, American College of Sports Medicine, 9th ed., 2014, Philadelphia : Wolters Kluwer/Lippincott Williams & Wilkins Health
Preisinger E, Alacamlioglu Y, Pils K, et al. (1995) Therapeutic exercise in the prevention of bone loss. A controlled trial with women after menopause. Am J Phys Med Rehabil 74:120.
Province MA, Hadley EC, Hornbrook MC, et al. (1995) The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA 273:1341.
Raisz, L. (2005). “Pathogenesis of osteoporosis: concepts, conflicts, and prospects”. J Clin Invest 115(12): 3318–25
Strength Training is Better for Bones. (2013). Harvard Men’s Health Watch, 2013 Jul;17(12):8.
This article is written by Kevin McMahan, a Health and Wellness Educator for the Monterey Bay Holistic Alliance. Kevin has had a lifelong interest in health and wellness. After graduating from Carmel High School he went on to get an associates degree in social sciences from Monterey Peninsula College, and a bachelors in kinesiology from California State University Monterey Bay. He is a certified personal trainer through the American College of Sports Medicine. “Your health is your wealth”, is something that he always likes to say. The Monterey Bay Holistic Alliance is a registered 501 (c) 3 nonprofit health and wellness education organization. For more information about the Monterey Bay Holistic Alliance contact us or visit our website at www.montereybayholistic.com.
Disclaimer: The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)3 organization and does not endorse any particular products or practices. We exist as an educational organization dedicated to providing free access to health education resources, products and services. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. The statements about organizations, practitioners, methods of treatment, and products listed on this website are not meant to diagnose, treat, cure, or prevent any disease. This information is intended for educational purposes only. The MBHA strongly recommends that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition.
What does Vitamin D have to do with muscle development and functionality? Can taking vitamin D supplements help improve muscle strength? Recent research shows that vitamin D can be effective in improving muscle strength and reducing muscle fatigue.
HOW DOES THE BODY RECEIVE AND USE VITAMIN D? Vitamin D is a fat-soluble vitamin. It is produced in the body using the energy we receive from sunlight, and also found in some foods such as milk, salmon or cod liver oil and other fish, and vitamin-fortified foods, such as cereals. Vitamin D and calcium are important for good bone health and vitamin D helps the body absorb calcium and protect older adults from osteoporosis. Muscles need vitamin D in order to move and nerves need it to carry messages between the brain and every part of the body, and vitamin D helps our immune system fight off invading bacteria and viruses.
WHAT IS VITAMIN D DEFICIENCY? A diagnosis of vitamin D deficiency is rapidly on the rise and becoming a significant public health problem world-wide. Fatigue is frequently found to be the cause of vitamin D deficiency. The mitochondria within the cells, take fats and sugars and make them into energy. When the mitochondria are not working properly, people have symptoms of fatigue. Vitamin D deficiency is a well-recognized cause of fatigue and myopathy (a muscular disease resulting in muscular weakness). Bones can become thin, brittle, or misshapen without sufficient vitamin D. Vitamin D can prevent rickets in children and osteomalacia in adults. In the 1930’s milk was fortified with vitamin D making rickets almost unheard of in the United States, although it is still occurs occasionally. It is difficult to get enough vitamin D from food and therefore sunlight is the primary source. This means that elderly people who are home-bound, those who spend most of their days working inside, or women or men who wear long robes and cover their heads for religious reasons, will most likely not receive enough vitamin D and will need supplementation. Dark-skinned and obese people, those whose wear sun-block, and those who have tinted windows are also at risk of not getting enough vitamin D. Doctors are discovering that patients with somewhat elusive or undiagnosed symptoms of fatigue and muscle weakness are suffering from a vitamin D deficiency.
WHAT RESEARCH HAS BEEN CONDUCTED?
Several research studies have been conducted on vitamin D. Bischoff-Ferrari (2009) and other researchers investigated vitamin D and its effects on preventing falls among older individuals. They concluded, “Supplemental vitamin D in a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19% and to a similar degree as active forms of vitamin D. Doses of supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.”
Holick and Chen (2008) conclude that, “Vitamin D deficiency is now recognized as a pandemic.” They state that “A circulating level of 25-hydroxyvitamin D of >75 nmol/L, or 30 ng/mL, is required to maximize vitamin D’s beneficial effects for health. In the absence of adequate sun exposure, at least 800-1000 IU vitamin D3/d may be needed to achieve this in children and adults.” Vieth R, Bischoff-Ferrari and others (2007) in a study on dietary and lifestyle predictors with British adults, found an “urgent need” to recommend an efficient dose of vitamin D.
The Agency for Healthcare Research and Quality (2010) summarized 165 primary articles and 11 systematic reviews that incorporated over 200 additional primary articles, in “Vitamin D and Calcium: Systematic Review of Health Outcomes.” They concluded that “The majority of the findings concerning vitamin D, calcium, or a combination of both nutrients on the different health outcomes were inconsistent. Synthesizing a dose-response relation between intake of either vitamin D, calcium, or both nutrients and health outcomes in this heterogeneous body of literature proved challenging.”
Dr. Anna Dorothea Hoeck, MD (2009), estimates that over a billion people worldwide are vitamin D deficient or insufficient and that there appears to be a correlation between vitamin D deficiency and chronic fatigue syndrome or multi-system syndromes. She states that “Severe vitamin D deficiency with levels below 10 ng/ml (25 nm ol/L) causes severe fatigue and personality changes, depression-like symptoms, chronic sleep disorder, multiple intolerances,obvious immune dysfunctions and in the long time, multi-system symptoms and multi-system diseases”
Dr. Zahid Naeem (2010), MBBS, MCPS, DPH, FCPS, Professor, states that “Vitamin D deficiency is a global health problem. With all the medical advances of the century, vitamin D deficiency is still epidemic. Over a billion people worldwide are vitamin D deficient or insufficient. Yet no international health organization or governmental body has declared a health emergency to warn the public about the urgent need of achieving sufficient vitamin D blood levels.”
A recent research study was presented at the Society for Endocrinology annual conference in Harrogate, UK., and supported by the British Society of Paediatric Endocrinology and Diabetes (BSPED). Dr Akash Sinha (2013), research team leader, and researchers from Newcastle University Endocrinology, GNCH, Institute of Genetic Medicine, investigated the effects of cholecalciferol therapy (vitamin D3) on skeletal mitochondrial oxidative function in symptomatic, vitamin D deficient individuals. The researchers studied the phosphocreatine (a compound of phosphoric acid and creatine found in vertebrate muscle) recovery time in patients with vitamin D deficiency. Twelve patients were used in the study. They each were diagnosed with severe vitamin D deficiency before and after treatment with vitamin D. A non-invasive magnetic resonance scan (MRI) called phosphorus-31 magnetic resonance spectroscopy was used to measure phosphocreatine movement in response to exercise in the calf muscles of all 12 patients. Serum assays were performed before and after cholecalciferol therapy to document serum 25OHD and bone profiles. Ten to twelve (10-12) weeks after treatment, the researchers found phosphocreatine recovery significantly improved. After receiving vitamin D supplementation, all patients reported improvement in fatigue symptoms. According to Dr Akash Sinha research team leader,
“This is the first time a link has been shown between vitamin D status and muscle aerobic function.”
“Patients with vitamin D deficiency often experience symptoms of muscle fatigue. Our findings in a small group of patients with very low vitamin D levels show that muscle efficiency significantly improves when vitamin D status is improved.”
Vitamin D deficiency is becoming a world-wide problem. This may be due to our technological advances and cultural changes with more people choosing to spend long hours working and relaxing indoors. Researchers conclude that vitamin D deficiency may be the cause of multiple physical ailments with symptoms of muscle fatigue, atrophy and bone loss. Vitamin D is not easily found in many foods, therefore many researchers and health professionals are determining that it may be necessary or urgent for people to alter their lifestyle to receive adequate doses of vitamin D from sunshine or from supplementation. The recent study by Akash and others (2013) showed significant improvement in muscle efficiency after increasing vitamin D supplementation with patients who were vitamin D deficient. This was ground-breaking documentation. More research, like this is needed with more subject to determine how and why this is happening and if people who are not vitamin D deficient can also benefit from using vitamin D.
Akash SA, Hollingsworth K, Ball S, and Cheetham T, Improving the vitamin D status of vitamin D deficient adults is associated with improved mitochondrial oxidative function in skeletal muscle Endocrine Abstracts (2013) 31 OC1.6, DOI:10.1530/endoabs.31.OC1.6
Bandeira F, Gris L. Vitamin D deficiency a global perspective. Arq Bras Endocrinol Metab. 2006;50/4:640–646.
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009;339:b3692.
Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, et al. Vitamin D and calcium: a systematic review of health outcomes. Evidence Report/Technology Assessment No. 183 prepared by the Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I. AHRQ
Cranney A, Horsely T, O’Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garrity C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and Safety of Vitamin D in Relation to Bone Health Evidence Report/Technology Assessment No. 158. (Prepared by Ottawa Evidence-based Practice Center under Contract No. 290-02-0021). AHRQ Publication No. 07-E013, Rockville, MD: Agency for Healthcare Research and Quality. August 2007.
Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr 2003;78:912-9.
Hoeck AD, MD, Vitamin D deficiency results in chronic fatigue and multi-system symptoms
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Naeem Z, Vitamin D Deficiency- An Ignored Epidemic, Int J Health Sci (Qassim). Jan 2010; 4(1): V–VI.
Vitamin D: Fact Sheet for Health Professionals, Office of Dietary Supplements, National Institutes of Health, U.S. Department of Health and Human Services
Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, et al. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 2007;85:649-50.
Vitamin D and Calcium: Structured Abstract. May 2010. Agency for Healthcare Research and Quality, Rockville, MD.
This article is written by Jean Voice Dart, M.S. Special Education from Illinois State University. Jean is a published author and has written hundreds of health articles as well as hosting a local television program, “Making Miracles Happen.” She is a Registered Music Therapist, Sound Therapist, and Master Level Energetic Teacher, and is the Executive Director, founder and Health and Wellness Educator of the Monterey Bay Holistic Alliance. The Monterey Bay Holistic Alliance is a registered 501 (c) 3 nonprofit health and wellness education organization. For more information about the Monterey Bay Holistic Alliance contact us or visit our website at www.montereybayholistic.com.