Make No Bones About It

A new class of drugs appears to be on the way to biting the dust. Bisphosphonates are prescribed to strengthen bone tissue. Chemically, they are made up of two groups of phosphates (phosphorus combined with oxygen) linked to carbon with two side chains. Fosamax and Actonel, perhaps the best known ones, are taken orally to prevent or treat osteoporosis. Other bisphosphonates, like Areida and Zometa, are given intravenously, usually for cancer patients and those suffering from a chronic bone disorder called Paget’s disease, to aggressively treat bone deterioration.

While we might imagine bone as a very solid, enduring structure, it is actually constantly in a state of flux: it is regenerated with new cells while old one are removed. Osteoclasts are a type of bone cell that perform this latter task and bisphosphonates work by blocking their function.

I first became aware of problems with this class of drugs a number of years ago after reading that they are similar in makeup to the chemicals used to scrub sinks and tubs, and that they are not well tolerated nor absorbed by the digestive system. Even more to the point, their true efficacy was called into question because while the result of destroying osteoclasts undoubtedly makes bones denser, the increased density was not translating into increased strength, but causing increased brittleness and increased susceptibility to breakage.

Now it appears that suspicions about the toxicity of bisphosphonates are beginning to be born out. Their use has now been shown to be associated with a condition known as ‘osteonecrosis’, which is the death of healthy bone tissue, in the jawbone. The majority of cases have been observed in cancer patients who were treated with higher doses of the drug, but some cases are reported in cases of people under oral treatment.

To make matters worse, this side effect itself is not easily treated. A recent NY Times article sited the case of a 53-year-old woman who, after being on oral bisphosphonates for 18 months, developed the condition after a tooth extraction. The extraction site did not heal, and “pieces of bone from her jaw kept splintering and coming out.” Subsequent dental surgery to cut and fill the bone tissue did not work. She continues to have painful sores and is not able to use that part of her mouth. (Drug for Bones Is Newly Linked to Jaw Disease, By GINA KOLATA, NY Times, June 2, 2006)

The prevalence of these side effects and the extent of the problem are still not fully understood. But I suspect that we are now just becoming aware of the tip of iceberg. So, as in the case of other allopathic drugs proven to have unexpected and unwelcome side effects, people are stopping treatment and searching for other options.

So, what are the other options to maintain healthy, strong bones? Fortunately, there are any number of things one can do to be proactive.

One of the primary factors is the amount of exercise. Research published by the International Osteoporosis Foundation last year indicated that compared to women who sit for less than 6 hours daily, women who sit for 9 hours or more are 50% more likely to have hip fractures. Similarly, active young girls have up to 40% more bone mass than sedentary.

Evidence shows that exercise which is weight bearing or high impact (meaning both feet leave the ground simultaneously like running, jumping jacks or jump rope) is as or even more important than appropriate nutrition in preventing osteoporosis. Thus the IOF’s maxim: “move it or lose it.”

This is not to say that nutrition can be ignored. Both specific nutrients and the overall balance of the diet play important roles in the health of our bones. In addition, certain demineralizing foods or substances are best eliminated.

Most everyone is aware of the need for sufficient calcium. The problem is that there is a bewildering variety of calcium salts – calcium carbonate, citrate, lactate and gluconate, to mention a few – that are sold as supplements and there are varying claims as to how well they are absorbed.

An increased amount of calcium without adequate magnesium poses various health risks, so it is important to take both together. Traditionally the ratio of calcium to magnesium is 2:1, although some nutritionists advocate a 1:1 ration. (Americans on average have an unhealthy 3.5:1 ratio.)

In addition to magnesium, potassium and Vitamin K also increase the absorption of calcium. Vitamin K appears to serve an especially important role in strengthening bones by activating certain proteins that hold onto and direct the flow of calcium Without adequate amounts of K, these proteins lose the capacity to control the calcium and it can stray out of the bone matrix into the bloodstream.

Vitamin K is found in dark green leafy vegetables as well as fermented foods. One of the best sources is a traditional Japanese food made from fermented soybeans. Known as ‘natto’, it has a rather a pungent odor to go along with a strong flavor and a sticky, stringy appearance. (It one of those foods, like blue cheese, for which one has to cultivate a taste). Interestingly, this is the same food from which nattokinase is derived. Nattokinase is an enzyme widely used as a nutritional supplement to clean the blood vessels and improve circulation.


In addition to adequate intake of calcium, taken along with appropriate amounts of magnesium, and Vitamin K there are a number of other considerations to keep in mind.

For instance, it is conjectured that the prevalence of osteoporosis is not merely the result of deficiencies of particular vitamins, minerals or other nutritional substances, but also the consequence of a systemic imbalance in pH, which is the measure of acidity and alkalinity. An optimal range for the pH of human blood is around 7.36 to 7.44, that is to say, slightly alkaline. (Above 7 is alkaline, below it is acidic.)

Being outside this range can trigger various pathological conditions, so the body has a self-regulatory mechanism to achieve an optimal pH. For a number of reasons – diet being one of the primary ones, acidic conditions are much more prevalent in people today. Addressing this imbalance can successfully treat many common ailments, such as acid reflux, gout and some forms of arthritis. This explains why, for instance, the old Vermont nature cure of apple cider vinegar is such a potent remedy. Though acidic itself, it acts as a systemic alkanizing agent when ingested.

Without the assistance of external remedies, one of responses the body has to an acid environment is to use calcium drawn from the bones as a buffer in an attempt to restore a healthy pH. The obvious consequence of this is insufficient calcium in the bone matrix – and the obvious solution is to maintain an appropriate pH, not taking more calcium.

In fact, the most highly touted sources of dietary calcium, cow cheese and milk, are somewhat acidic. So, while they certainly do supply calcium, they might also be part of the problem. But probably more than dairy, the over-consumption of sugar, alcohol, processed foods, heavy carbohydrates like potatoes, pasta, and most grains as well as too much animal protein (beef and lobster are amongst the most acidic) is responsible for most acidic conditions. It should be mentioned that the following are also all acidifying: many refined oils (olive oil, coconut oil and ghee are exceptions in that are slightly alkaline), fried foods, distilled vinegar (in contrast to raw, expelled apple cider vinegar), tobacco, artificial sweeteners like aspartame and saccharine, caffeine and drugs (especially steroids and antibiotics.

While it is not necessary to totally eliminate acidic foods, to rectify an acidic condition it is important to eat a predominantly alkaline diet (approximately 75%). This means abundant amounts of fruits and vegetables. Seeds, unbleached sea salt and sea vegetables can also be staples of an alkaline diet. In contrast to most beans, lentils are strongly alkaline as are the fermented soy products tamari and miso.

It is important to remember that the pH of a particular food is not the same as the effect it has on the body. Good examples are lemon, grapefruit and apple cider vinegar, all of which are clearly acidic but have an alkaline effect on the body. This phenomenon is also probably the reason that there is not universal agreement on the alkaline/acid effect of a number of foods. For instance, I have seen some sources categorize carrots as acidifying while others classify them as alkalinizing. The same goes for yogurt, cottage cheese and even tomatoes.

Another very crucial factor is appropriate amounts of essential fatty acids. It is not only a matter of adequate amounts of EFAs, just as critical is the ratio between the two most important polyunsaturated fatty acids, Omega-3 and Omega-6. An imbalance has been linked with lowered bone density, as well as other chronic illnesses such as cancer, heart disease, arthritis, and diabetes.

While there is some difference of opinion about the idea ratio of Omega-3 to –6, it should be somewhere from 1:1 to 1:3. But it is estimated to be in the neighborhood of 1:15 for the average American. Probably the biggest factor creating this imbalance is increased consumption over the last century of Omega-6 rich vegetable oils such as those derived from corn, safflower, sunflower, canola, soybean and sesame. Other factors include eating processed grains where the germ has been removed such as white flour and whiter rice as well as consumption of meats from grain fed – as opposed to grass grazing – animals.

This imbalance can be addressed by reducing the consumption of vegetable oils and introducing sources of Omega-3 rich foods such as cold-water fish or oils made from them, flaxseed and grass fed beef, lamb, free-range chicken and their eggs. (Olive oil is rich in Omega-9 EFAS and does not disturb the Omega-3 to –6 ratio.)

One more key strategy to prevent osteoporosis is to get adequate amounts of Vitamin D. It is essential source for a steroid hormone called calcitriol, which maintains adequate levels of calcium. Deficiencies are associated not only with weak bones but also with chronic diseases ranging form cancer, heart disease, diabetes, to gum disease and depression.

What is important to realize about Vitamin D is that the best – and only natural - way to get it is through sunshine. Although found in fortified milk and available in nutritional supplements, attaining adequate amounts orally can be toxic. Although it is somewhat politically incorrect to suggest in this day and age of environmental degradation, getting adequate sun is still crucial for our health.