Participants: Eric Shadle, Don Mackintosh
Series Code: HFAL
Program Code: HFAL000114
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00:51 Hello and welcome to "Health for a Lifetime"
00:53 I'm your host Don Mackintosh 00:55 and today we're going to be talking about 00:56 women's health issues. 00:58 One of the big concerns with women is osteoporosis, 01:01 and talking with us today about this important subject 01:04 is Dr. Eric Shadle and we're glad you're with us doctor. 01:08 You practice obstetrics and gynecology which means 01:11 you deal with women and women's health issues all day every day. 01:15 That's right, that's right. 01:16 This issue of osteoporosis, is it a big problem? 01:20 Is it a big concern for women? 01:21 It's a very big problem. 01:23 It's a problem that affects very many women every year. 01:31 It affects men too but much more commonly in women. 01:35 What exactly is osteoporosis? 01:39 Well the easy answer is that it is bone thinning. 01:42 The bone starts becoming thinner and thinner. 01:46 We lose bone mass with age. 01:49 And so we actually find at age 35 01:53 that we have the peak bone mass that we're going to have 01:58 in our entire lives and after that, on average at least, 02:01 we start losing some bone mass. 02:04 So if we could look inside the bone and we were going to look 02:06 at it and see exactly what was happening, 02:09 you know, what kind of things would we be seeing? 02:13 Well, the bone that is normally mineralized, 02:20 and here we have a graphic showing the bone volume 02:25 tissue and that's an example 02:28 of what bone is supposed to look like. 02:30 I think we have another graphic that will show us 02:33 how the bone is thinner and that is what osteoporosis is. 02:40 This would be an example, we see with prednisone, 02:43 that is a medication that is a steroid that actually will 02:49 cause bone thinning. 02:52 The architecture of the bone is changed so that there are 02:56 fewer bony spicules. 02:58 You see in this picture there that there are these dark lines 03:03 that are kind of going up and down, 03:06 and then the ones that are going horizontally across the screen, 03:11 there's not too many of those, 03:13 and they are kind of breaking off. 03:14 And I think there is one more graphic that will show that 03:18 even more - that there are big holes in what we'd call 03:24 these horizontal struts and that makes the bone very weak. 03:28 Just like in skyscrapers, you have the external structure, 03:33 and then you have these struts which are actually 03:37 floors can act as a strut across horizontally 03:43 that gives the structure much more strength, 03:47 and the same is with our bones. 03:48 So if we lose those horizontal struts, 03:50 then the bone fractures much more easily, 03:53 and that's really the problem with osteoporosis. 03:56 So the significance of the problem you said is great, 03:59 but what really happens when you have osteoporosis; 04:02 what kind of things happen? 04:03 Well, the big problem is fractures. 04:08 It's estimated that 1.3 million people have 04:12 osteoporotic fractures in this country each year, 04:16 and it's due to the low bone density. 04:19 Half of these fractures are vertebral, 04:22 that is the vertebrae in your back. 04:26 One-quarter of them are in the hip, 04:28 and 1/4 are Colles - that's in your wrist; 04:32 as you fall, you put your wrist out or your hand out, 04:36 and you can break your wrist. 04:37 And the estimated cost for this 04:40 is 13.8 billion dollars, it was in 1995, 04:44 and certainly it's more than that currently. 04:47 Wow, so this is a huge problem. 04:49 All kinds of people have that. 04:51 You said here as we were talking that... 04:54 people that survive to age 90, they really have a 04:59 significant increase in their risk. 05:01 That's right - we look at women to the age of 90, 05:06 33% of them have had an osteoporotic fracture 05:10 and 17% of men. 05:11 So, like I said, it's not just in women, 05:14 but it's certainly much more prevalent in women. 05:17 Now you've said that what happens in osteoporosis is 05:21 those horizontal lines or the vertical... 05:24 ...The horizontal lines - sorry. 05:26 The vertical lines... 05:28 The horizontal lines are kind of ... they're leaving, 05:30 and everything kind of crumbles down. 05:32 But what are the underlying causes of osteoporosis? 05:36 What causes those horizontal lines to take a vacation? 05:40 Well you know, we're told that 05:43 osteoporosis is a calcium deficiency disease... 05:46 That's what we're told by the 05:48 traditional medical establishment, 05:50 and that's what we think of with osteoporosis is calcium, 05:56 but actually there are several risk factors that have been 06:00 identified... Some of them include: 06:04 Gender - female gender as we've talked about. 06:09 Another is previous fracture; if you've had a fracture before 06:12 you're more likely to have another one - 06:14 that would make sense. 06:15 Tobacco use is another independent risk factor. 06:20 So women as well as men who smoke - will increase their risk 06:25 of osteoporosis. 06:26 Sedentary lifestyle - just not getting up. 06:30 Not bearing weight or not doing anything like that. 06:32 Alcohol, caffeine and low estrogen levels - all those 06:39 you know, will cause osteoporosis as well. 06:42 In addition to that, we have inflammatory bowel disease 06:45 like Crohn's disease. 06:47 There's type 2 diabetes which is the adult-onset diabetes 06:53 which is 95% of diabetics actually have type 2 diabetes, 06:58 and then there is prior hyperthyroidism if you've 07:01 had or have hyperthyroid. 07:04 Dementia - probably simply because you fall easier. 07:08 Because you get confused, you don't know where you're at. 07:12 Family history - if your mother, your father had osteoporosis 07:17 and fractures. Advanced age. 07:19 And there are certain types of medications that can cause that. 07:23 So these are risk factors, they're not causing it. 07:26 That's right - these are risk factors, 07:28 and these are factors that the traditional medical community 07:31 focus in on. 07:34 In addition to the fact that calcium deficiency is the main 07:40 underlying idea behind all of these factors actually 07:46 in traditional medical. 07:47 Maybe you're going to talk about these more, 07:48 but let me ask a question about 07:50 a couple of them if you don't mind... Sure 07:51 How is smoking or tobacco use related to osteoporosis? 07:55 Smoking - it probably increases calcium excretion, 08:01 is probably how that works. 08:03 It's kind of like a diuretic... 08:04 It's like a diuretic - the nicotine. 08:08 So that's probably the main... 08:09 And then the inflammatory bowel disease - 08:11 Does this mean they don't absorb the things 08:14 they need to have strong bones? That's most likely, right 08:17 Okay, now you said that that's the common list, 08:21 but you also told me that there is one that just doesn't 08:23 get the kind of press it needs 08:24 to get that's a real big risk factor. 08:26 That's right and many physicians don't even realize this 08:30 or haven't studied this... 08:33 And that is a high protein diet. 08:36 A high protein diet, I find, is actually the main 08:41 underlying cause for so much osteoporosis in this country. 08:45 In fact, there had been multiple epidemiologic studies 08:48 that indicate the high protein diet as the primary cause 08:52 for the osteoporosis. 08:54 So, usually you hear people say, 08:56 "Well, you need to get your protein" 08:57 That's right, that's right, we're very concerned about 09:00 that in this country. 09:01 That's right - where's your protein? That's right 09:03 But you're saying - you need to get rid of your protein. 09:06 Yes, we get WAY too much. 09:07 In this country, we consume well over 100 grams of protein a day, 09:11 and studies have shown that... actually those societies, 09:18 those countries that have the highest rates of 09:21 osteoporotic fractures, actually are those countries 09:25 that consume the most protein, 09:26 especially the most dairy and animal proteins - 09:29 Because after all, if we're going to get over 100 grams 09:33 of protein a day, it's generally from 09:36 concentrated protein sources such as milk, 09:39 such as cheese and meats. 09:42 All those different things that are really high in protein. 09:46 Are there certain types of proteins that cause more 09:49 osteoporosis than others? 09:50 Yes, that's an interesting question because we find that 09:55 animal protein actually causes more calcium excretion 09:59 from the body than does vegetable protein... 10:04 That's right - plant protein. 10:06 So the type of protein that we get is also very important 10:09 in addition to the fact of just getting too much protein. 10:13 I might say something - You know, this program 10:15 is seen around the world in SOME countries, 10:17 in some places people are suffering from 10:20 diseases that come as a result of a deficiency, 10:24 of not enough of this or that, 10:26 starvation, all those different things... 10:28 We're talking primarily about a concern that's a 10:30 Western disease, am I right about that? That's right 10:33 Osteoporosis is definitely a Western disease. 10:35 So if someone is watching today in a place where they don't 10:37 have hardly anything to eat at all, 10:40 they can't be saying, "Well, I don't want to eat that 10:42 because it has too much protein. " That's right 10:45 That's a good point - I'm mainly addressing 10:50 the Western diseases that we see in Scandinavia, 10:54 throughout Europe and North America where 11:00 we've really exported our high fat diet and high protein diet. 11:04 Wherever you seen the golden arches, 11:06 probably there's a problem. That's right 11:08 Actually diagnosing osteoporosis, 11:12 how do you really make that diagnosis? 11:14 Do you take someone's bones out and look at them 11:15 or how do you do that? 11:17 Well that would be one way to do it, 11:18 but most patients really disagree with that. 11:21 I imagine they do. 11:23 So what we've decided to do, rather than go in 11:27 and take their bones out, or even go in an take a biopsy 11:29 of their bone which would be very painful, 11:32 and expensive and difficult to do, 11:34 what we do is an x-ray study. 11:37 It's called densitometry, bone densitometry, 11:41 or just a bone density study, 11:43 and we can actually measure the amount of bone that is there 11:49 But we mainly look at the vertebral bodies in the 11:52 lower back and in the hip. 11:54 Those are the main ones, but we can also look 11:57 in the arm bones there. 12:00 The other thing we can look at is bone markers 12:06 that we find in the urine. 12:08 There are some tests that we can look at that 12:10 actually measures the metabolism of bone... 12:13 And so, if these are really high, we know we may be 12:16 losing bone and so that would be a good predictor that 12:21 we might be on the road towards osteoporosis. 12:23 All those things, looking at the urine, 12:24 those kind of tests... 12:26 What - I don't know, what would that be like, creatinine? 12:29 Creatinine clearance we sometimes look at in the urine - 12:32 There are actually links, the pyridine links 12:36 is actually what we'd be looking at in the urine. 12:38 And most laboratories really aren't keyed into that 12:43 or physicians and what you need to do is find a physician 12:46 who would be keyed into that and there are certain labs 12:49 that can be used across this country to measure that. 12:52 So let's say I have osteoporosis or my wife has it, 12:54 or my grandmother has it, or my aunt has it, 12:56 or my uncle has it, especially we're talking 12:58 about women's health and we know that's an issue... 13:01 What's the treatment? 13:02 What should we be looking for or pointing at the world? 13:06 What kind of treatment are they going to be offered? 13:08 What kind of treatment should they have? Yes 13:10 Well the standard fare in this country for treating 13:15 osteoporosis is estrogen therapy. 13:20 Bisphosphonates which are certain medications that 13:24 we can talk about in a few minutes here. 13:26 "Designer" estrogens - what I call designer estrogens 13:30 it would be like Evista/raloxifene 13:32 which is a medication that binds on certain 13:37 estrogen receptors but not on others, 13:39 and calcium and calcitonin.. 13:43 And so that's the standard treatment, 13:45 and we're looking at - you see there, 13:48 we're really looking at medications, pills is how we 13:52 primarily treat osteoporosis in this country... 13:57 And we treat it and the first treatment really that we 14:02 talk about, with women, is estrogen and calcium. 14:07 Those 2 things, because we see it as a 14:10 calcium deficiency disease. 14:12 You think, and the milk industry and different things, 14:14 they certainly promote that too, don't they? Absolutely! 14:16 They promote that very ardently that we need our protein, 14:22 and we need to take milk and 14:24 dairy products to get our calcium. 14:25 And then also, increasing weightbearing, 14:27 they talk about that too, probably. Sure, yes 14:30 So, again, maybe your concern is that this not 14:34 broad enough for focus. That's true 14:37 It certainly wouldn't have any problem with us 14:40 talking about making sure we get enough calcium, 14:43 though we probably don't need as much 14:46 calcium as we think if we're eating correctly. 14:49 That is... getting 50 grams or less of protein a day. 14:54 and 40 or 50 grams of protein should be fine, 14:57 and in fact, that's what the World Health Organization 15:00 recommends for daily consumption. 15:03 So what are the things that they're not focusing on 15:05 that we should be focusing on? 15:06 That the traditional medical... 15:11 Well the main one, as I've said, would be the lifestyle issues 15:17 of getting the right type of protein and not too much protein 15:21 but also, we certainly need to be looking at 15:24 caffeine, alcohol, tobacco... 15:26 These are also lifestyle issues 15:28 that definitely contribute to osteoporosis as well. 15:32 We could, what I call, age-proof our homes. 15:36 As we get older, we can fall easier, 15:40 and we don't want to fall because now our bones are 15:43 thinner and we could have a fracture... 15:45 And so just doing things like taking the throw rugs 15:48 out of the house so that you're not going to trip 15:51 over that and some things like that are 15:54 some easy things that we can do. 15:56 So in other words, we can talk about the building blocks 15:59 that help take away our bone mass and not ingest those 16:03 like caffeine and whatnot. 16:05 What about coffee or caffeine or those kind of things, 16:07 what really happens, why is it that we're losing 16:11 bone mass if we drink those kind of things? 16:13 Probably all the, including protein, 16:17 one of the mechanisms that is linked to osteoporosis 16:22 is because it is taking calcium out of the body... 16:27 And so with coffee - with the caffeine that we have in there, 16:32 it acts as a diuretic and it takes calcium out of our bone. 16:38 Interestingly enough, you look at coffee and you want to know 16:43 what is the... I mean that's a fluid, it's all water, right? 16:46 That's what it looks like. 16:47 Yes, that's what it looks like, but actually the net water 16:51 intake to our bodies is only about 1/2 to 2/3 of every cup 16:58 that we drink because the rest of it is going out 17:01 in the urine because it acts as a diuretic... 17:05 As opposed to if you just drink plain water, 17:07 then 100% of that is a net increase of water in our body. 17:11 And so that's how coffee or any caffeinated beverage will 17:17 increase the amount of calcium that we lose in the urine. 17:23 Protein - that's one of its mechanisms too, 17:26 as a diuretic, because one of the breakdown products 17:31 of protein is urea nitrogen and that acts as a diuretic. 17:37 Not to mention the fact that protein, if you get too much, 17:42 protein is amino acid, right? 17:45 So you have all these amino acids, 17:47 those are obviously acid; the body is alkaline, 17:50 and to normalize that, alkalinize the body, 17:54 we buffer that with calcium, and it's the most ready source 18:00 that our body has. 18:01 We're talking with Dr. Eric Shadle 18:04 We've been talking about osteoporosis. 18:07 We've been talking about what commonly is done, 18:09 why it occurs and what commonly is done to treat it. 18:12 When we come back, we're going to look at some other treatment, 18:15 some things that you could do; maybe you know you have 18:17 osteoporosis or someone that does. 18:19 We hope you join us when we come back. 18:27 Have you found yourself wishing that 18:29 you could shed a few pounds? 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20:03 Although there are still studies going on, 20:05 we're not ready to say we made a decision here 20:08 on this program but it seems like it doesn't 20:10 have that big a role, but with osteoporosis, 20:14 is estrogen replacement therapy or estrogen therapy, 20:17 is that something we should be looking at? 20:19 It certainly has been shown in many retrospective studies. 20:24 In fact, it is confirmed in EVERY retrospective study 20:27 that has ever been done to prevent bone loss. 20:31 So it would prevent osteoporosis and has actually been shown 20:35 in studies to decrease fracture risk... 20:38 So estrogen is something that we need to look at when 20:41 we're talking about osteoporosis. 20:43 And retroactive studies, that means look back 20:47 to people that didn't have it versus those that... 20:50 Right... you don't have a good control group; 20:53 you don't have a prospective study where you're 20:55 going to say - "Okay, I'm going to take a group of 20:58 women on estrogen and a group off of estrogen, 21:02 and control for every other factor in their lives, 21:05 and then look 5 years later or 10 years later. 21:08 Yeah, it's a difficult thing to do, 21:10 so what they do is look back. 21:11 There are problems with those types of studies 21:13 but it is impressive that every 21:15 one of the studies say the same thing. 21:17 So, most authorities really feel that estrogen does help 21:21 to prevent osteoporosis. 21:23 But I guess the question really is... 21:25 Who would need to take the estrogen, 21:29 and that's a harder question... 21:35 And I do think there are women that would benefit from 21:38 taking estrogen, especially women who are unwilling 21:42 to make some lifestyle changes. 21:45 Some simple lifestyle changes to decrease the amount of 21:47 protein intake that they would 21:51 consume in a day is one of the big things. 21:54 So if you are not willing to make some lifestyle changes, 21:58 you need to be thinking about maybe estrogen therapy 22:00 and talking to someone like you, 22:01 but you do have some time to figure it out. That's right 22:03 There IS time because it is a slowly progressive disease 22:08 and you shouldn't feel pressured to make a decision today. 22:15 Some people talk about what's called - 22:17 "naturally occurring progesterone" 22:19 and that treatment for osteoporosis. 22:22 What do you think about that? That's right 22:23 Well synthetic progesterone, those progesterones that 22:27 is made in the laboratory that most pharmaceutical companies 22:30 have patents on, definitely does NOT prevent osteoporosis 22:35 but the natural occurring progesterone in a 22:39 transdermal cream - some studies have indicated 22:43 that it may help to prevent osteoporosis. 22:47 However, most of the good studies from peer reviewed 22:51 journals in obstetrics and gynecology, for example, 22:56 do not confirm that natural progesterone will prevent 23:01 osteoporosis. 23:02 So the jury is definitely out on that one. 23:05 So we can't say for sure whether or not on that, 23:09 but it may not help, but it probably won't hurt... 23:14 Would that be safe to say? I think that's safe 23:16 What about diet and the prevention of osteoporosis? 23:20 What's the role that that plays? 23:22 Well as I noted earlier, I believe that diet is the most 23:27 important single factor in the development of osteoporosis. 23:30 It's just no question that our high protein diets cause us 23:37 to lose bone mass. 23:39 You know, for every glass of milk you consume, 23:41 there's a net loss of more than 30 mg of calcium from the body. 23:45 Wait a minute! Milk is supposed to be the thing that helps this, 23:48 and you're saying you LOSE calcium when you drink milk. 23:52 For every glass of milk and these are multiple 23:55 studies that have shown that. 23:56 In fact, one of the most recent studies comes out of 23:58 the University of Wisconsin in Madison, the dairy state, 24:02 and that study has not seen the light of day too much, 24:06 but it's definitely there, it's been done... 24:08 And we find that you just cannot take enough calcium 24:13 if you're consuming too much protein, 24:16 especially concentrated protein such as in milk. 24:20 Wow, so when they say drink milk and all those commercials 24:24 That's right - it does the body good - it says. 24:27 Boy, you're bones are thinning as you drink it, 24:30 especially if you're a lady. 24:31 Yes, because first of all, the calcium that's in milk, 24:35 you only absorb about 1/3 of it, 24:39 as opposed to most plant sources where you absorb 2/3 or more. 24:45 And secondly, it's a big protein concentration, 24:50 and you lose calcium because of that. 24:54 So what are some food sources then, 24:55 if milk is not the best, what are the food things, 24:58 what are the things we should be eating? 25:00 Well the easy way to say that would be green leafy vegetables, 25:04 but there are some that are better than others. 25:07 Actually, spinach is very high in calcium, 25:09 but the oxalic acid in it prevents its absorption 25:16 or as much as in other vegetables. 25:18 The #1 source is what is a weed; 25:23 in most places it's called "lamb's quarters" 25:26 It's actually a green leafy vegetable. 25:28 Carob flower, interestingly enough, also is very high 25:31 in calcium. 25:33 Carob flower - the plant source of carob. Right 25:36 And just eating a diet that is high in vegetables, 25:43 with a variety of color and a variety of types of vegetables, 25:48 we're going to be just fine with calcium. 25:51 So grain, soy, figs, hazelnuts, sesame seeds - all that stuff 25:55 you have listed here, and kale, 25:57 those are all good things. 25:58 Just take whatever is on that... 26:01 That's right - if it's a green leafy vegetable, 26:05 eat it and enjoy it. 26:07 One other thing before we close this... 26:09 You know this is a fascinating talk on osteoporosis, 26:11 because it's completely different than what you 26:12 hear on the media, but one thing you've said 26:14 is that when we talk about calcium sources, 26:17 or protein sources, so many times these are rat studies 26:21 that are done and they say that that tells us we need 26:23 a bunch of protein, but what you're telling me is that - 26:25 Yes, interestingly enough, the studies that were done 26:30 to tell us how much protein we need were done on rats. 26:33 And if you look at different mammals and the amount of 26:38 protein in the mother's milk of that species, 26:41 you find that the protein amount, 26:46 the concentration of protein in each species' milk is 26:48 related to the doubling size of birth weight; 26:53 how long it takes to double birth weight. 26:55 So, for example, a rat is born and 4-1/2 days later, 27:00 it doubles its birth weight. 27:01 And so it has 11.8 gm/dl of protein in a rat's milk. 27:08 Whereas if we would just take something like a goat, 27:11 it takes 19 days to double its birth weight, 27:15 and it only had 4.1 gm/dl 27:17 And then you take a human which takes a 120 days... 27:21 to double its birth weight, you only have 1.2 gm/dl 27:26 So I think God is giving us the formula right in milk 27:31 in our own species' milk about how much protein we need... 27:36 as it relates to osteoporosis. 27:38 We've been talking with Dr. Eric Shadle 27:40 We've been talking about osteoporosis... 27:42 AGAIN, we come to a conclusion God's way is the best way, 27:45 eating what He has produced and He has provided 27:48 can certainly help us with our bone health. 27:51 We hope that you have enjoyed this program and as a result 27:54 you'll have Health that Lasts for a Lifetime! |
Revised 2014-12-17