骨质疏松症 GU ZHÍ SHUSONG ZHENG - OSTEOPOROSIS

Osteoporosis is a reversible disease. It is estimated that 50 percent of women between the ages of 45 and 75 in the United States are affected by osteoporosis to some degree, with 16 percent of those experiencing serious bone deterioration that could lead to injuries and fractures. The most common injuries associated with osteoporotic bone fragility are compression fractures of the vertebrae, often unnoticed because they are microfractures, and fractures of the hip from falls, that often are debilitating and difficult to heal.

For years doctors have recommended dietary calcium as the best way to ward off osteoporosis, but many studies cast doubt on this idea. A 2003 Harvard study looked at diet and hip fractures among 72,337 older women for 18 years and concluded that ‘Neither milk nor a high-calcium diet appears to reduce fracture risk.’ A more recent Harvard study, this one from 2007, analyzed seven trials that followed a total of 170,991 women for several years and found no association between total calcium intake and hip fracture risk. 

Other studies in recent years show that women are 4 times as likely to experience vertebral fractures with aging, which often go undiagnosed. Spinal vertebral microfractures often cause syndromes of nerve root pathology, chronically inflamed spinal tissues, and irritation or impingement of the nerves going to various organs. Inexplicable symptoms, such as difficulty controlling urination could be related to chronic microfractures of the lumbosacral vertebrae.

Since osteoporosis is a gradual and systemic disorder, signifying a problem with hormonal regulation and metabolic dysfunction that it is potentially related to other health issues, all women should understand and learn how to routinely fend off against it. A comprehensive and holistic approach to therapy is needed to prevent and treat osteopenia and osteoporosis, and the specialty of Traditional Chinese Medicine provides an array of therapies that will help achieve this goal.

A research study published in the January 18, 2012 New England Journal of Medicine provided accurate statistics of how slowly osteoporosis develops. This study of the progression of osteoporosis after age 65 showed that current guidelines of bone density tests every two years, did not reflect accurate information about the real risks and slow progression of the disease, but in the meantime women are prescribed osteoporosis drugs when the first signs of osteoporosis, or osteopenia, were detected.

New recommendations would call for a baseline test at age 65 with a follow up in 15 years for most women. The study author, Margaret Gourley, of the University of North Carolina at Chapel Hill, stated: “There is a strong belief that the more we test, the more we are helping patients. This is a good example of why that does not hold up at all.” While current testing and use of problematic pharmaceutical bisphosphonate drugs have not been proven successful to address slowly progressing osteopenia and osteoporosis, a holistic regimen over time has. This study also started the process of determining which subset of women were at increased risk, identifying health problems that could be corrected to prevent the progression of true osteoporosis.

Current drug therapies that try to block valuable calcium molecules from leaving the bone matrix come with considerable risks related to the many dysfunctions associated with an altered calcium metabolism. Many experts believe that unnecessary tests lead to many false positives and prescription of harsh drug regimens that create greater patient risk than protection, according to this researcher, Margaret Gourlay. She stated that all osteoporosis drug therapy should be based on the speed of progression of the disease, comparing a baseline test to current bone density results, not a supposed normal bone density, which may vary considerably between individuals and with age, depending on body size, weight, and variations in the bone structure.

In 2012, the American Board of Internal Medicine Foundation enlisted 17 medical specialty organizations to discourage proven overuse of medications, unproductive tests, and treatments by changing professional testing and treatment guidelines. It was determined that these unnecessary procedures that currently waste at least $700 billion per year in the United States and create an enormous financial and health burden on patients, should be avoided. The American Academy of Family Practice Physicians was one of the first professional specialty organizations to respond and recommended that bone density screening for women younger than 65, or men younger than 70, be discouraged for those with no significant risk factors for osteoporosis.

While there is finally more sensible advice concerning diet and exercise, there is still little medical guidance to avoid problematic prescription drugs, such as acid-inhibiting drugs for heartburn and gastric reflux, some antidepressants, and corticosteroids, commonly used to treat asthma, allergy and skin problems, and most importantly, there is still almost no advice to utilize Complementary and Integrative Medicine such as Traditional Chinese Medicine.

To truly prevent the onset of osteoporosis and resulting bone fractures, a holistic course of therapy should be initiated as the problem starts to slowly develop. Traditional Chinese Medicine can provide such a comprehensive strategy and individualized course of therapy, utilizing acupuncture and individualized prolonged course of herbal and nutrient medicine, prescribed in a step-by-step goal-oriented manner. While Chinese medicine treats chronic and acute disorders, it is an excellent preventive medicine. The first tenet of Chinese medicine is prevention.

The key to preventing osteoporosis is to maintain the blood at a slightly alkaline pH level.

A diet of milk and dairy, meat, poultry, fish, grain, and high-glycemic foods or refined carbohydrates makes blood more acidic, because protein is composed of amino acids. When blood becomes more acidic, the body tries to balance it through the process of homeostasis or Yin & Yang balance by adding alkaline material the only way it can ─leeching some of the calcium compounds stored in the bones. Thus, eventually, osteoporosis results.

It takes three servings of fruits and vegetables ─which are alkaline─ to neutralize the acid of just one serving of animal protein the size of a deck of cards; and two servings of fruits and vegetables to neutralize the acid in one serving of grain. If it is not possible to do this for every meal, a one-day a-week complete vegan diet is an acceptable alternative. Consuming dairy foods does add back calcium, but calcium from animal sources like dairy is highly acidic so the body needs to take back calcium from the bones to make the pH level slightly more alkaline, so this becomes a vicious circle.

Understanding of a common and potential health problem like osteoporosis, is an important first step in preventing or reversing the osteoporotic disease mechanisms that is interrelated to other health problems and could go unnoticed for some time before it becomes disabling. Osteoporosis is an insidious disorder for it is a slowly developing condition, and the body needs a very regulated calcium supply to maintain healthy function, this important molecule comes from the bones when the blood becomes too acidic. Osteoporosis is a complex pathology of bone degeneration and fragility that occurs with aging and poor diet, but it is caused by a variety of common health imbalances and can be both reversed and prevented.

What is almost always overlooked in the physiological mechanisms of osteoporosis is the proper regulation of bone formation, with collagen fiber alignment, healthy ground substance, and calcium hydroxyapatite together forming strong bones. The organic matter in bones has the same composition as tendons and ligaments, and constantly remodels, and thus a variety of factors must be considered to keep healthy bone maintenance and remodeling. Among these factors is blood circulation. Bones depend upon blood circulation, healthy blood vessels, and healthy blood cells, and bone cells not receiving adequate circulation and blood nutrients, die.

Osteoporosis, besides being a disease is also a symptom that reveals other pathologies, and is intimately tied to hormonal deficiency and imbalance, acidity imbalance, and other metabolic concerns that a patient may want to correct on the quest to healthy longevity. Osteoporosis is like the tip of an iceberg. What is obvious to the eye is only a small part of the whole threat. A diagnosis with osteoporosis is a sign that there are a variety of unhealthy metabolic and hormonal dysfunctions that need to be addressed, and that if untreated will deny one a healthy and productive life in aging.

Osteoporosis may occur secondary to other diseases or as a side effect, resulting from medication use that has been largely overlooked by the medical community, especially since it occurs slowly and with an insidious onset in almost all cases, and medical doctors are hesitant to discourage use of the medications. Long term use of many common types of pharmaceuticals may cause or contribute to osteopenia and osteoporosis.

Experts agree that a high percentage, if not a majority of cases of secondary osteoporosis occurs due to use of corticosteroid medications, or glucocorticoids. Glucocorticoids are a class of steroid hormones that are synthesized in the adrenal cortex, that affect every cell in the body, have broad effects related to the various types of cell receptors and interactions with other hormones, and play a central role in regulation of glucose metabolism along with insulin, which is another steroid hormone.

The most common type of glucocorticoid is cortisol, which is highly regulated and released in a diurnal pattern. Glucocorticoid medications are now found in combination with other drugs and appear in a wide variety of medications, even many without the need of prescription. Corticosteroids are taken via asthma inhalers, in skin creams, in many types of oral medications, and in injections. The most common types of glucocorticoid medication are prednisone, methylprednisolone, hydrocortisone, and beclomethasone.

Other common medications that may cause or contribute to osteopenia and osteoporosis include SSRI antidepressants, diuretics, antibiotics, anti-seizure medications (e.g. phenytoin), lithium antidepressant, and the birth control drug Depro-Provera, which comes with such a warning by Canadian health authorities. Chronic use of antacids or drugs that inhibit gastric acid production may also cause or contribute to osteopenia and osteoporosis. Medical conditions that may cause secondary osteoporosis include liver impairment, malabsorption diseases such as celiac disease, chronic obstructive pulmonary disease (COPD), anorexia nervosa, bulimia, multiple sclerosis, chronic kidney failure, and rheumatoid arthritis.

Overlooked and underdiagnosed health problems such as hyperparathyroidism and thyroid dysfunction, and diabetes/metabolic syndrome, may also cause secondary osteoporosis, as well as subclinical adrenal stress syndromes with transitory hypercortisolism. Thalassemia (a form of anemia), leukemia (often chronic), and bone and bone marrow cancers, are linked to osteoporosis, and use of barbiturates, excessive alcohol consumption, cigarette smoking, and environmental aluminum toxicity are linked as well. Experts in public health emphasize that secondary osteoporosis must be treated differently than primary osteoporosis, not only addressing the disease mechanisms, but treating underlying causes and eliminating drugs that many be causing or contributing to the disease when possible.

TYPES OF OSTEOPOROSIS AND VARIOUS CAUSES

In osteoporosis there are 2 main mechanisms involved: decrease in bone building or remodeling rate, called osteoblastic activity, and increase in bone breakdown, called osteoclastic activity. Since these are highly regulated in the body, they usually occur together, and the rate of osteoblasty is less than the rate of osteoclasty, thus osteoporosis ensues.

4 main types of osteoporotic syndromes 1) deficiency of estrogens accelerating loss of bone calcium, 2) chronic acidity in the body stimulating excess need for calcium buffer and accelerating loss of bone calcium, 3) dietary deficiency of calcium and what we call Vitamin D3, which is actually a prohormone, which may create an increase parathyroid hormone response, accelerating loss of bone calcium, and 4) hyperparathyroidism, an often ignored hormonal problem at a subclinical level, that is often accompanied by subclinical hypothyroidism, adrenal insufficiency, and general hormonal struggle.

Hyperparathyroidism leads to excess stimulation of osteoclastic activity, or breakdown of bone that exceeds rebuilding rate. For a great many aging patients, the chronic use of various pharmaceuticals that inhibit absorption of nutrients such as calcium or create hormonal imbalances related to bone maintenance are the primary cause.

A HOLISTIC COURSE OF THERAPY IN OSTEOPOROSIS PREVENTION AND CURE

Each patient presents a unique individual set of health concerns that must be addressed to achieve a successful therapeutic approach. A knowledgeable professional that utilizes a package of therapies, such as herbal medicine, nutrient medicine, dietary advice, and acupuncture, provides a customized and practical protocol. Diet and exercise are perhaps the most important part of the treatment protocol, and light weight-bearing exercise on a daily basis, sufficient chlorophyll-rich green vegetables in the diet, and healthy fats are the basis for a proper regimen.

With TCM care, the use of bioidentical hormonal creams, especially progesterone stimulation and pregnenolone is the most important therapeutic consideration, but should be used minimally, with the goal of quickly restoring natural innate production of steroid hormones, not replacement. A symbiotic array of therapeutic tools, with short, intermittent courses of acupuncture stimulation, and a persistent step-by-step approach with herbal and nutrient medicine that is individualized, is very important to achieve the best outcomes.

Herbal Formulas: various companies formulate standard professional herbal formulas utilizing a combination of herbs that stimulate hormonal health, provide key nutrients, invigorate circulation, and warm the tissues by promoting a healthier metabolism. Research has found a variety of Chinese herbal chemicals that directly increase bone deposition, regulate bone calcium resorption, and inhibit mechanisms that contribute to osteoporosis, and formulations are based on a wide variety of research findings.

Herbal formulas to stimulate improved kidney and liver function are also routinely prescribed, and as we see below in links to scientific studies, many of these herbs are proven scientifically to aid in osteoporosis therapy. Some of the herbal chemicals useful in the stimulation of improved bone health are best captured in alcohol and glycerite extracts. Phytoestrogen flavonoids from the Chinese herb Drynaria fortunei GU SUI BU have been found to be most potent in this regard, and a tincture of GU SUI BU, European Olive Leaf, and GOTU KOLA may exert a significant benefit in both bone formation and tissue maintenance.

Strontium supplements: strontium is a mineral that is very similar to calcium and has been found to easily deposit into bones for this reason, acting like calcium to strengthen the bone matrix, but unlike calcium, the body does not easily resorb the strontium from the bone. Strontium has been used in medicine to treat osteoporosis since 1884, and recent studies at the Mayo Clinic and McGill University show significant increase in bone formation and symptom improvement. Other beneficial effects of strontium include improved neurotransmitter release and nerve function. Supplementation should continue for a year for full benefit.

Cholecalciferol D3: although originally called a vitamin, we now know that D3 is a prohormone, or hormone precursor. Cholecalciferol is the form of D3 that the body uses to produce the D3 hormone that helps regulate bone deposition and resorption of calcium. Recent research has found that the body uses D3 to aid many cellular functions, and double-blinded placebo trials have proven that cholecalciferol decreases insulin resistance, indirectly aiding hormonal health in ways that will help the body to better keep bone maintenance.

Much of the population is deficient in circulating D3, which is normally produced via a process where healthy cholesterol is transformed to cholecalciferol in the skin via exposure to midday sunlight, and then processed in the liver, and finally in the kidney. A healthy diet, with healthy fats and oils, exposure to 10 minutes of midday direct sun on the skin at least a few times a week, and healthy liver and kidney function are the best ways to maintain D3 levels.

Supplementation should utilize a high dose of quality cholecalciferol (4000 to 5000 IU) to be effective, and a simple blood stick metabolite test can be performed to measure active levels in the body. Poor quality Vitamin D supplement is of little use. Food sources from both meats and vegetables/grains provide some nutritional resource. Since this nutrient is essential to bone maintenance, it would be best to observe all of these protocols. Supplementation should continue for at least 6 months to restore levels if one suffers from a significant deficiency.

Essential mineral supplement formulas: while the goal is to get the body to deposit more calcium hydroxyapatite into the bones than it removes, an increase of various essential minerals listed below are necessary to accomplish this goal. Intake of some minerals inhibit absorption of others, and lack of some minerals decrease absorption of other minerals. High quality professional products are sometimes costlier but provide value. Look for the GMP (Good manufacturing practice) insignia on the products before buying.

MAGNESIUM: Though calcium gets all the credit when it comes to bone health, magnesium is equally important. Magnesium is a constituent of bone and is essential for several biochemical reactions involved in bone building. A diet low in magnesium, the norm for the standard American diet, and relatively high in calcium actually contributes to osteoporosis. While blood levels of magnesium are often normal, this is misleading. An accurate test is red blood cell magnesium, which is often low in cases of depression and fatigue. Overconsumption of processed foods is usually the culprit in magnesium deficiency. This nutrient is found in organically grown vegetables, whole grains, sea vegetables and meats such as turkey. Daily magnesium supplementation at a dose of 400 to 800 mg per day, depending upon the quality of diet is highly recommended.

MANGANESE: This nutrient should be supplemented in the form of manganese picolinate. The recommended dose is 15 mg per day.

CALCIUM: Calcium needs vitamins C to synthesize in the body. Take 1,000 to 1,500 mg per day in the form of aspartate, citrate, or lactate. Despite widespread promotion of the antacid Tums as a way to obtain needed calcium, better supplements are available. Although the calcium carbonate found in Tums has been shown to increase bone density, it also exerts an alkalizing effect on stomach acid, thereby inhibiting calcium absorption and increasing the risk of kidney stones.

BORON: Boron is a trace element found in fruits, nuts and vegetables. It has been found to reduce urinary calcium loss and to increase serum levels of 17-beta estradiol ─the most biologically active estrogen; both of these effects help bone health. The minimum daily dose of boron needed is 2 mg daily and is easily met with a diet rich in fruits, nuts and vegetables; supplements can be taken up to 12 mg per day.

Collagen supplement and antioxidants: since collagen is a key component of bone and contributes to the health formation of new bone matrix and calcium deposition, taking a collagen extract may be essential to rebuilding healthy bone when bone density is poor. A complete therapeutic regimen, involving acupuncture, weight bearing exercise, hormonal stimulation and balancing, and correction of related health problems, should be utilized, and when progress is able to be made biochemically, inclusion of a collagen and antioxidant supplement could be essential for progress in creating new health bone.

Western herbs to aid in the prevention and treatment of osteoporosis include red clover, valerian, alfalfa, fenugreek, echinacea, goldenseal, black walnut, saw palmetto, devil’s claw, hawthorn, uva-ursi, elderberry, white willow bark, feverfew, butterbur, lemongrass, barberry, Oregon grape, sarsaparilla, comfrey, black cohosh, club moss, and more. Herbal intake in a variety of forms is helpful, and a professional herbalist can regularly prescribe herbs that will not only treat specific problems but help with general health and prevent osteoporosis.

Food therapy is essential in the holistic protocol. Calcium and magnesium are the backbone of chlorophyll, the green in fresh green vegetables. Lots of dark green leafy vegetables are highly recommended, such as collards and mustard greens.

SPECIFIC WAYS TO PROTECT THE BONES

DIET: Bones are dynamic organs that thrive in a mineral-rich environment. Eating lots of refined foods, is likely to promote weak bones and poor teeth. Low-acid diets are necessary to support the health of the entire body.

EXERCISE: Two 40-minute sessions per week of weight training have been shown to increase bone density as much as estrogen, according to research by Miriam Nelson, PhD., Director of the Center for Physical Activity and Nutrition at Tufts University. Dr. Nelson reports that higher-impact activities (including vertical jumping and stair climbing), when done safely, can also help build bone. She recommends a comprehensive exercise program that includes weight-bearing aerobic exercise, strength training, vertical jumping (when appropriate and for women under 50), balance exercises and stretching. Walking, bicycling and climbing all keep bones well mineralized by placing vertical vectors of force on them. Proper alignment of the skeleton is also crucial for maintaining healthy bones and hips throughout life. Pilates and yoga are excellent for alignment.

REDUCE PHOSPHATE CONSUMPTION: Phosphate consumption directly interferes with calcium absorption. Eliminate cola and root beer drinks, which have a high phosphate content.

SMOKING AND ALCOHOL CONSUMPTION: Since smokers, along with those who consume two or more alcoholic drinks daily, are at the highest risk for osteoporosis, they must refrain from smoking and limit alcohol intake to improve their chances of good health and bone quality.

CAFFEINE: Caffeine increases the rate at which calcium is lost in the urine. Daily intake should be limited to no more than the equivalent of the amount of caffeine found in one to two cups of coffee. Power drinks are the absolute opposite to good health in relation to the function of all systems of the body and are specially detrimental to bone health, kidney function and cardiovascular system.

DECREASE STRESS HORMONES: If depressed or under chronic stress, get help, but to avoid pharmaceuticals make an appointment with a licensed acupuncturist and herbalist. Depression increases the risk for osteoporosis. The stress hormone known as cortisol is higher in depressed or chronically stressed individuals, and over time, this hormone results in bone and skin breakdown.

VITAMIN D3: According to Michael Holick, M.D., PhD, Chief of Endocrinology, Metabolism and Nutrition at Boston University School of Medicine, blood levels less than 20 ng/ml can greatly increase risk of osteoporosis, while the lowest average blood concentration for vitamin D that demonstrates fracture reductions is equivalent to 30 ng/ml. Consuming adequate levels of vitamin D is associated with lower risk of hip fractures in postmenopausal women, according to research from Brigham and Women’s Hospital and Harvard Medical School. Optimally, take 5000 IU, but at least 2,000 IU of vitamin D daily.

BETA-CAROTENE: Take 25,000 units per day (15 mg). Beta-carotene is converted into vitamin A in the body. Vitamin A promotes a healthy intestinal epithelium, which is important for optimal absorption of nutrients, and it also promotes strong joints. It is found in abundance in yellow and orange vegetables such as acorn squash and carrots and also in dark green leafy vegetables.

PROGESTERONE: Progesterone’s role in bone metabolism is well documented but frequently overlooked. I recommend one-quarter to one-half teaspoon of two percent cream daily on the skin.

VITAMIN C: This nutrient assists in collagen synthesis and repair in bones and skin. The recommended dose is 2,000 mg per day. The work of Dr. Linus Pauling suggests that optimal vitamin C intake should be much higher than we have been taught. An orange provides only 60 mg per day, but Dr. Pauling’s evidence is quite convincing that vitamin C is beneficial and has no side effects at levels around 2,000 to 5,000 mg per day, and sometimes more. What the body does not need it expels in the urine, and when too much is taken it results in loose stools. At that point, one should stop for a couple of days and resume consumption lowering the dose to half of what caused the loose stools.

VITAMIN K: This vitamin can be safely taken in high doses not only to improve the strength of bone, but to significantly reduce the incidence of fractures, without increasing bone density or reducing bone breakdown. Vitamin K does not increase bone density, yet it significantly reduces the risk of a fracture.

Even though it helps prevent fractures, there is no increase in risk of blood clot forming by taking high dose of K, unless the patient is on Coumadin. Which most people are not.

High doses of K – 5 mg per day for four years has been studied without any increased risk of clotting or toxicity.

CHINESE HERBS

Gu Zhi Shu Song Wan, in Chinese literally “Osteoporosis Tablets,” for it is formulated to support healthy bone function. This formula may help increase bone strength and stop bone loss commonly seen in women after menopause, and men of old age.

FORMULA COMPOSITION

BU GU ZHI Fructus Psoraleae Corylifoliae

GU SUI BU Rhizoma Drynariae

DU ZHONG Cortex Eucommiae Ulmoidis

XU DUAN Radix Dipsaci Asperi

TU SI ZI Semen Cuscutae Chinensis

SHU DI HUANG Radix Rehmanniae Preparata

BAI SHAO Radix Paeoniae Lactiflorae

DAN SHEN Radix Salviae Miltiorrhizae

MU LI Concha Ostreae

LONG GU Os Draconis

BU GU ZHI: tonifies the kidney, strengthens Yang, and preserves Jing. In studies of osteoporosis animal models, BU GU ZI extracts increase serum calcium levels and decrease urinary calcium excretion, reduce bone loss and lead to the gain in bone mineral density. A compound isolated from BU GU ZI is further found to inhibit the formation of osteoclasts, the cells that resorb the bone matrix.

GU SUI BU: nourishes the kidney and is well known for its property in promoting healing bones after injury. In studies of osteoporosis animal models, GU SUI BU extract can significantly increase bone mineral density and promote bone-forming osteoblast differentiation and mineralization.  

DU ZHONG: is a popular tonic for both liver and kidney. It strengthens the bones and tendons and is commonly used for lower back and joint pain. Extracts prepared from DU ZHONG have been shown to prevent bone loss from postmenopausal animals.

XU DUAN: tonifies both the liver and the kidneys and strengthens the bones. Its extracts are also found to promote bone formation in experimental animals.

TU SI ZI: invigorates the kidney and nourishes the liver and bone marrow. Cuscuta seed extracts are shown to promote differentiation and mineralization of human osteoblast cells.

SHU DI HUANG: nourishes Yin and tonifies the blood.

BAI SHAO: nourishes the blood, harmonizes the liver and relieves pain.

DAN SHEN: promotes blood circulation and removes blood stasis. In animal models DAN SHEN extracts are able to prevent bone loss caused by ovary removal.

MU LI: nourishes Yin and calms the liver. It is a rich source of calcium, phosphate, and zinc and supplements the calcium needed in bone formation. Oyster powders can enhance proliferation and differentiation of osteoblast cells in cultured cells and thus prevent bone loss.

LONG GU: has properties similar to Mu Li.

EAT YOUR WHEATIES! 

 

LONGEVITY

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-Above Article Written by Dr. Osorio, Gloria DAOM, L.Ac. 2012.