Osteoporosis

Osteoporosis or “the porous bone” is a devastating disease that robs the victim of their bone mass. It is a progressive disease and irreversibly weakens the bones. Any movement, bump or any small injury can result in fractures. Fractures of the wrist, ankles and hip bones are very common.

Osteoporosis has been primarily considered a disease common among older women (>45 years) but men are by no means immune. It sets in women after menopause and in men after andropause when the bone protecting hormones (Estrogen in females and Testosterone in males) become deficient and the loss of bone mass initiates.

Risk Factors:

• Aging
• Being female;
• Low body weight;
• Low sex hormones/ menopause;
• Smoking/ alcohol consumption;
• Lack of exercise;
• Poor exposure to sunlight;
• Family history – family member with history of osteoporosis/ fragile fractures;
• Poor dietary history – deficiency of calcium, vit. D;
• Ethnicity – Hispanic women at highest risk

Symptoms of Osteoporosis:

• No signs until a bone breaks;
• Persistent, unexplained back pain;
• Spinal deformities;
• Recurrent fractures;
• Fractures from minimal trauma;
• Experiencing chronic medical trauma;
• Loss in height due to compressed and weakened vertebrae;

Diagnosis:

A full medical history, including signs, symptoms and family history should be taken. If osteoporosis is suspected a specialised x-ray to measure the bone density is usually recommended.
Bone density testing is usually undertaken using dual energy x-ray absorptiometry (DEXA). This is a specialised x-ray scanning technique that emits only very low levels of radiation (approximately 1% of the radiation required for a chest x-ray).
This precise and painless test takes only 5-10 minutes and requires the person to lie on a special table while the DEXA machine passes over them. The density of bone is measured at different locations (usually the lower spine and hip) and a formula is used to calculate the overall bone density. Individual bone density is graded by comparing it to the average bone density for a person of similar age, size and gender.
In some cases, bone density can also be measured using computerised tomography (CT scanning) or ultrasound scanning, though these methods tend to be less precise.

Treatment:

Treatment for osteoporosis will depend upon the results of bone density scans, age, gender, medical history and the severity of the condition. Treatment most commonly involves lifestyle changes and medications and aims to maximise bone density and reduce the risk of bone fracture.

LIFESTYLE CHANGES

Exercise:

If possible, regular weight bearing exercise (eg: walking, tennis, golf) should be maintained as it can help to reduce bone loss and stimulate new bone formation. To be of benefit, doctors recommend at least 30 minutes of exercise at least three times a week. Prior to beginning any new exercise it is important to consult a doctor to ensure that the proposed exercise is safe to undertake.

Diet:

As the body cannot make its own calcium, a diet high in calcium is necessary and helps to slow the rate of bone loss. Vitamin D is also essential as it enables calcium to be effectively absorbed by the body. Eating a balanced diet that includes calcium and vitamin D-rich foods is important in supplying the bones with the calcium required. Foods high in calcium include dairy products, dark green vegetables, beans, legumes, fish (especially sardines or salmon which are eaten with the bones), soybean products, cereals and nuts. It is recommended that at least 1000mg of calcium is taken in each day. Foods high in vitamin D include sardines, tuna, eggs and liver.

Smoking, alcohol and caffeine:

Smokers will be advised to stop smoking. Minimizing alcohol and caffeine intake (eg: tea, coffee, cola drinks) may also be recommended as caffeine interferes with the absorption of calcium.
Exposure to sunlight:
Regular but moderate exposure to sunlight helps to produce vitamin D in the body. Note, excess sun exposure poses other health risks. If adequate sun exposure is not present, oral supplements for Vit. D should be given.

Reducing the risk of fractures:

It is important to take extra care with movement and daily activities in order to minimise the risk of fractures. This can include using mobility aids if unsteady on the feet, removing objects or hazards that can lead to falls (eg: loose floor rugs), installing hand rails in areas such as entranceways and bathrooms, and using non-slip mats in the bath or shower. Padding to protect vulnerable parts of the body eg: the hips, can also help in the prevention of fractures.

MEDICATIONS

Calcium:

If dietary intake of calcium is insufficient, calcium supplements may be prescribed in order to increase the amount of calcium available in the body. A dosage of 1000mg per day in usually recommended.

Vitamin D:

As vitamin D is important for the effective absorption of calcium into the bones, vitamin D supplements such as calciferol are usually given in conjunction with calcium supplements. An activated form of vitamin D called calcitriol (Rocaltrol) has also been shown to be beneficial.

Bisphosphonates:

These non-hormonal medications can increase bone density by reducing the rate of bone loss. They have been shown to reduce the fracture rate in people with osteoporosis. These medications are usually given in an alternating cycle with calcium supplements.

HRT:

Hormone replacement therapy (HRT) medications that include oestrogen are sometimes recommended for women with osteoporosis. HRT has been shown to reduce bone loss and may increase bone density. While HRT has obvious benefits in the treatment and prevention of osteoporosis, recent research has indicated that there are risks with long term HRT use. It is therefore important that the patient and their practitioner discuss the benefits and risks of taking the medication.

Prevention

Prevention is better than treatment and evidence suggests that maximising bone density in early and middle life helps to reduce the risk of osteoporosis in later life. Steps that can be taken to help prevent osteoporosis include:

• Not smoking
• Limiting alcohol intake
• Undertaking regular weight bearing exercise
• Maintaining a healthy body weight
• Adequate intake of calcium and Vit.D through out life span
• Considering HRT for women during menopause

A healthy lifestyle, balanced diet and proper exercise are the key to the prevention of osteoporosis instead of waiting for fracture to happen and then start the treatment. Though older women are affected more as compared to men, precautions should be taken by both the sexes so as to lead a healthy and happy life.

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Atkins Diet... Revisited

Atkins Diet or the Ketogenic diet is one of the most popular weight reduction diets. Low carbohydrate, medium protein and a high fat diet are the fundamentals of this particular form of diet. The credit of popularizing the ketogenic diet for weight reduction goes to Dr. Robert Atkins in 1958. He used this diet to resolve his own overweight condition and was successful to a good extent. He then published several books regarding this diet, the first one being “Dr. Atkins' Diet Revolution in 1972 and the latest one being The New Atkins for a New You in 2010. This book covers a lot of new information which had not been previously covered including nutrient rich foods as Atkins diet has often been criticized of being nutrient deficient. The diet regime has been the most controversial one yet the most popular!!!

The scientific basis:

The Atkins diet finds its roots in basic human metabolism. We all are aware that we need energy not only to survive but also is energy required by the human body for carrying out all its vital functions. This energy that the human body uses is derived from the food we eat. The food that we eat is comprised of carbohydrates, proteins and fats which are energy producing and vitamins and mineral which do not provide any energy. So we keep our focus on Carbs, fats and proteins. Out of the three, fat provides the highest energy that is 9 Kcal/ gm; whereas proteins and carbs provide 4 Kcals/ gm. All these nutrients are then broken down to glucose through different metabolic pathways which then helps to release energy.

Of all the three energy providing nutrients, carbs are the first ones to be broken down to glucose to release energy. Also the storage form of carbs lasts for a day only. Fats are usually reserved for later use by the body or during long periods of starvation; proteins are used for muscle development.

The atkins diet is based on restricting the use of carbohydrates so that the fat reserves of the body are mobilized and converted to glucose to provide energy, thus resulting in weight loss. However the process is not all that simple as written and involves a number of hormonal interplay before fat being used as an energy source. Another theory that Atkins Diet is based on is the fact that the glucose, after being used for energy purposes and being stored in muscles and liver as glycogen, the remaining is converted to fat and stored in the body resulting in weight gain. So if fat is being used for energy giving purpose, it will help in weight reduction and will also prevent weight gain from excess carbs.

How it works:

As stated earlier, the Atkins diet is based on carbohydrate restriction. But not all kinds of carbs are restricted. Only the “net carbs”(digestible carbohydrate grams that affect blood sugar less fibre grams)which provide energy upon breakdown are restricted. Carbs in the form of fibre are allowed and can be consumed liberally as fibre is not digested by the human body and excreted as such.

Also the use of a high fat diet helps in retarding the digestion as high fat foods take time to be digested which helps in reducing the hunger sensation. In contrast, a high fibre and a low fat diet is easily digested resulting in increased hunger. Hunger suppression is one of the most common cause of dietary regime failures. However, studies claim that Atkins diet is easy to adhere to.

What to eat:

There are four phases of the dietary regime.

The Atkins diet starts with the Induction phase where the body has to be induced to switch over the energy source from carbs to fats. This procedure requires ketosis (breakdown of fat for energy) to be triggered. This is done by severe carbohydrate restriction for one week. During this period, the net carbohydrate intake is restricted to 20 gms. Foods of choice may be high protein foods like milk, eggs, meats, chicken, tofu which are generally low in carbs.

Use plenty of raw whole vegetables like cucumber, tomatoes, asparagus, spinach, pumpkin, cabbage, capsicum etc. so as to increase the bulk of the diet. Vegetables are generally high in fibre. Cheese is another preferred food. Though many cheeses are not very high in carbs, careful reading of the labels is required as some cheeses may be high in carbs. 3-4 ounces of cheese/ day is acceptable.

Then use liberal fats and oils. Olive oil/ peanut/ canola oil is the preferable choice; however small amounts of sunflower/ safflower/ soybean oil may be used. Choose for regular fat mayonnaise and salad dressings. Peanut butter may be a better choice than the regular butter. Cream may also be used.

Water is considered the best beverage for people following Atkins Diet. Its helpful in removing the extra ketones from the body which are produced as a result of fat metabolism. Also its a zero calorie drink. Decaffeinated coffee, herbal green teas may be used, however, with no sugar in it. Aerated drinks, cola and juice need to be strictly avoided. However, you can use sucralose (splenda) as an artificial sweetener, which will provide you with the sweetness but not the sugar.

Alcoholic drinks are not allowed during this phase.
Most of you will see the maximum weight loss during this period.

The second phase is the ongoing weight loss phase. The Ongoing Weight Loss (OWL) phase of Atkins consists of small, incremental increase in carbohydrate intake, but remaining at levels where weight loss occurs. The target daily carbohydrate intake increases each week by 5 net grams, a very low amount of carbohydrate. The main aim of this phase is to continue the on-going weight loss and has to be continued till the weight is with in 4.5 kg of the target weight.

During the first week of the OWL phase, the vegetables acceptable in the induction phase like asparagus, cauliflower or avocadoes. The next rung to be climbed is the inclusion of cheese, nuts and seeds. This may include peanuts, sesame seeds, almonds, walnuts, cashews etc. The rungs of the carb ladder suggested by The Atkins Diet is given below. However, you can choose from the rungs of the ladder and avoid some like alcohol, which is not necessary.

Increase acceptable vegetables

• Cheese
• Nuts and seeds
• Berries
• Alcohol
• Legumes
• Other fruits
• Starchy vegetables
• Whole grains

The third phase is the Pre-Maintenance Phase. Daily net carbohydrates intake is increased again this time by 10 grams each week from the latter groupings, and the key goal in this phase is to find the "Critical Carbohydrate Level for Maintenance". This is the maximum number of carbohydrates a dieter can eat each day without gaining weight. This may well be above the level of carbohydrates that induce ketosis on a testing stick. As a result, it is not necessary to maintain a positive ketosis test long term.

Dieters may be able to add some of the forbidden carbs back into their diet once a week. In this phase, according to the Atkin diet, one's body is beginning to lose the protection of ketosis as one prepares for the last phase which is Lifetime Maintenance.

Dieters are encouraged to continue to drink at least eight glasses of water per day and to increase their daily carbohydrate count by 10 grams each week as long as they continue to lose weight. The Atkins plan recommends that once dieters reach their goal weight and are able to maintain that level for a month or so, then they can increase their daily carb consumption by another 10 grams to see that is possible without gaining. If one gains weight at the level, the plan recommends that one drops back levels of carbohydrates in 10 grams increments. It may take several weeks to find one's individual tipping point.

The fourth and the last phase in the Maintenance Phase. This phase is intended to carry and continue the eating patterns that had been practices well during the previous phases. The favourite carbs can be consumed in small quantities but you will always have to check the quantity of carbs so as to maintain your weight.

Also you have the option of starting it all over again if you feel that you have started to gain weight again!!!!

Controversies:

The Atkins diet has always been surrounded by controversies. The medical circle for nearly three decades and presently argues the disadvantages of a high fat diet. But the promoters of The Atkins diet believe that this kind of a high fat and a low carb diet is better metabolically and provides protection against the metabolic syndrome. They also rule out the possible risk of heart diseases that may occur due to such a high fat consumption.

Also some people believe that such kind of diet is not easy adhere on to and people may loose command soon but the diet also seems to be very popular at the same time.

Nevertheless, whatever are the controversies and misconceptions regarding the Atkins diet, it is very popular and effective for short term weight loss. Long term results would depend on how seriously people are able to follow it and adhere to it.

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