lifelong bone health

LIFELONG BONE HEALTH

DAILY HABITS AND STRATEGIES

DREW SCHULTZ

a workplace wellness report

LIFELONG BONE HEALTH-‐ DAILY HABITS AND STRATEGIES

©Copyright 2015 Live Well Longer, LLC. All Rights Reserved.

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Drew Schultz is a personal trainer who has been working with individuals in the Triangle for fourteen years. He is a top personal trainer with O2 Fitness. Drew is a co-‐author with Brian Tracy of the best-‐selling "Against the Grain”, a business leadership book on entrepreneurship. He is also a corporate wellness presenter. Osteoporosis: Lifestyle and Prevention Osteoporotic fractures are more common than heart attack, stroke, and all forms of female specific cancers combined. Even though we often associate osteoporosis with mainly the senior segment of our population, the stage can be set earlier in life for the quality of bone density later in life. This report will shed light on some critical factors often overlooked, particularly in the areas of diet and workplace posture. The best way to combat this disease is to form lifelong bone-‐health promoting habit patterns now, no matter your age. If you are already a senior citizen, then start RIGHT NOW! The skeleton and daily considerations The skeleton remodels itself every decade. There is always a turnover of tissue in the body (why we need protein in the diet, which we will discuss in detail in the diet section). After age 25, the body’s cells lose hydration and elasticity. As such, we become stiffer and more easily molded to our environment and postural position we assume throughout the day. As the skeleton remodels itself, it becomes almost molded to our habitual postural position. As many of us are seated so long throughout the day, our skeletal system is not stressed appropriately. There is 1.4 times our bodyweight placed on the lumbar spine when we are seated. This repeated, habitual stress contributes to skeletal health problems as the years go by. Compounding the issue is the “hunched over” postural position, or kyphosis that is now being seen even in the “millennial” generation due to texting. Being hunched over the desk on the computer much of the day can be seen in some individuals’ posture no matter what they might be doing.

Does this look healthy? Unfortunately, many of us fit into this mold, and it reinforces poor posture that will amplify osteoporotic problems in the future.



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What can we do to fight Osteoporosis? Each individual will have a different way of responding to efforts to stimulate bone density. Sometimes there are biological reasons that are beyond our control that call for medical intervention. This is particularly the case as the human body ages, and especially so for post-‐menopausal women. Estrogen production plays a critical role in bone tissue formation. What we can do is focus on two areas-‐ diet and exercise. It seems to always go back to these two when it comes to our health.

Bone Density Dietary Strategies

Oftentimes, dairy products and the mineral calcium come to mind when we think of foods necessary for bone health. There are several components of nutrition to keep in mind when eating for bone health. Protein. All of the tissues of the human body are made up of protein. Muscle, internal organs, skin, saliva-‐ and bone are made up of protein. When we consume protein-‐rich foods such as dairy, eggs, meat, fish, or foul-‐ or from plant sources such as nuts and legumes-‐ the body breaks down this dietary protein into amino acids. These aminos are then reconstituted into the specific proteins necessary for specific tissues.

Peer-‐reviewed journal data have shown in recent years that protein intake is associated with bone density (1-‐5). If an individual is taking calcium and vitamin D supplements, there is no guarantee that there will be an increase in bone density. Focusing on calcium and vitamin D is not enough. When there is adequate protein intake, along with the necessary micronutrients (vitamins and minerals), then there is a greater chance of success when it comes to doing everything we can to fight bone loss. Furthermore, when there is a presence of protein in the digestive tract along with calcium, there is a greater absorption of calcium-‐ particularly in a low calcium diet (6,7).



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Many people are unsure of their protein intake. In terms of what the human body can make use of, women can break down and assimilate 20-‐25 grams of protein per meal; men, 25-‐30 grams. Protein can be broken down in about two hours. If someone is consuming three to five meals a day with these amounts, they are consuming enough protein. One ounce of meat, fowl, or fish contains a little over 5 grams of protein. Four ounces of meat, fowl, or fish contains about 23 grams of protein-‐ an ideally sized portion. Some people may be used to eating more than this per sitting, which ends up either excreted or converted to energy-‐ often in the form of extra body fat. Understanding what amounts of protein are realistically used by the body will not only help ensure enough building blocks for bone and other tissues, but also keep total caloric intake in check. If you are still hungry after adjusting your protein portion, this provides the perfect opportunity for emphasizing vegetable portions-‐ particularly the foods that contain the necessary micronutrients for bone health. Leafy Greens. There is a pervasive notion that there is a shortage of vitamin D. If we spend more than a few minutes outside in an effort to have the sunlight stimulate its production in the body, we’re scared of getting skin cancer. Its so easy-‐ green vegetables, especially leafy greens, contain all of the micronutrients-‐ the vitamins and minerals that you need for building bones. Vitamin D, calcium, phosphorous, zinc, magnesium, potassium-‐ are all found in leafy greens-‐ spinach, kale, collards, and Swiss chard, for example. The nutrients all work together synergistically; rather than just focusing on one or two nutrients and thinking, “I’ll just take a calcium pill and I’ll be covered”, we have all of the nutrients we need for bone health already provided. Leafy greens can be easily consumed several times a day. In the morning, an omelette or eggs in the pan with a handful of leafy greens takes less than ten minutes. As the leaves are heated, they wilt so that more can be consumed at one time. To avoid concerns about heat damaging any nutrients (minerals are virtually indestructible), I put them in just before or as I’m turning the heat off, and I stir them in with the other items in the pan on the stovetop. This gently wilts the leaves without utterly shriveling them up. Leafy greens can be added to any of your favorite foods, be it cooked or raw. A meal cooked in a pan in under thirty minutes can be large enough to divide into several portions. This enables you to take the food with you to work in plastic containers, overcoming the challenges of both getting the right nutrients and eating on the run.



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Salads with mixed greens, a protein source such as chicken and/or even a cheese (goat cheese or Gorgonzola/Cambozola go great with mixed greens), and other items to taste such as peppers, onions, olives, artichokes, and nuts make for a delicious, nutrient-‐dense bone-‐building meal. Whatever the case, a fat should be included, as fat in the presence of vegetables and fruit is necessary for maximizing nutrient absorption. This is why vitamin D is known as a fat-‐soluble vitamin; it is dissolved and transported in fat. Cheese, nuts, or olive oil would provide the dietary fat component of the mixed greens salad. In addition to green vegetables, other readily accessible sources of vitamin D include mushrooms, pork, and seafood, particularly shellfish and fatty fish (naturally fatty-‐ not fried). Eggs also contain vitamin D (about 4% of the recommended daily value per egg).

The catalyst for renewed bone density Loss of bone (osteopenia) is correlated with loss of muscle mass (sarcopenia). Indeed, both are issues that face us after age fifty, but especially after age sixty. Osteopenia is the precursor to osteoporosis. By establishing bone-‐health promoting habit patterns as soon as possible, these two conditions can be minimized, halted, and in some cases reversed. I have personally worked with many individuals over fifty and sixty years of age who have not only stopped muscle loss but actually increased lean mass and

A slow cooker is also a way to remove the obstacle of “I don’t have enough time.” This example includes two vitamin D rich foods, a pork loin with kale (also a great source of calcium and other bone-‐building nutrients), as well as low-‐glycemic, fiber rich quinoa.



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strength-‐ in many cases doubling their strength. With the tandem path that bone and muscle follow in their development or regression, it behooves us to think in terms of training the musculoskeletal system, rather than just training for bone health or training for muscle/strength. It is the very act of loading the musculoskeletal system with appropriate exercise that is the catalyst for renewed bone density.

Resistance Training. Exercise, especially resistance training when you are using your bodyweight, free weights or machines help increase bone density. This is accomplished in two ways. First, gravity pulling down as force is applied causes an increase in density from direct pressure or impact. This influences the internal structure of the bones known as trabecular bone. In the diagram, you’ll see it has a spongy appearance and it runs in cross-‐sectional sheets.

As the years go by and our entire skeletal system is remodeled every decade, the spongy pores become more irregular and the walls are thinner. When an elderly person falls and breaks their hip, it can be that their hip actually breaks first under the weight of their own body, and then they fall. So, just as we want to train our muscles three-‐dimensionally, we also want to make sure we’re training the skeletal system three-‐dimensionally. The second way resistance training helps with bone density is the tendon attachment of the muscle to the bone pulls on the bone and increases stress in a good way directly on the bone. A good resistance training workout will stress this area just enough above and beyond what we would typically experience in daily activity. After this type of stimulus, the body makes an adaptation. It almost as though the body says “There may be more

This retired professional performs a TRX workout, which utilizes your own bodyweight with Kevlar straps secured to an overhead anchor. The closer you are to the anchor, the more the resistance; further from the anchor, less resistance.

Image courtesy medguidance.com.



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of this to come; let’s make the muscles and bone stronger and lay down new tissue in case we have to deal with this again in the near future.” The near future would be several days. Between one to two weeks of absence from a given activity results in regression, be it strength, balance, or flexibility. Getting in the habit of strength training three times a week will ensure that you are doing everything you can physically to promote lean mass-‐ muscle and bone. Weight-‐bearing cardiovascular activity is also a productive form of exercise for promoting bone density. Running, tennis, and even walking are movement-‐oriented activities that cause force to be transmitted through the skeletal system. If lower body joint issues preclude an individual from any of these activities, then non-‐weight bearing activities such as stationary cardio machines, cycling, and swimming can be substituted for the benefit of cardiovascular training. Aqua aerobics with foam dumbbells in the water provide muscular resistance in planes of motion different from free weights in the usual setting, since the body is surrounded by water in 360 degrees and you have to fight against it no matter how you move.

What do balance and flexibility have to do with Osteoporosis? Balance and flexibility are the two most overlooked components of fitness. While these activities may seem slower paced and in some cases tedious, think of them as investments. Not only do they keep you safer, they enhance your performance in your resistance training. According to the Centers for Disease Control, one-‐third of adults aged sixty-‐five and older experience a fall each year. Less than half will speak with their doctor about it. Falling is the leading cause of death for seniors, as well as the most common cause of nonfatal and traumatic injuries for this population. Twenty to thirty percent of fall victims incur moderate to severe injury.

In this action shot, these ladies perform a Kinesis workout, which utilizes cable pulley resistance in 360 degrees of motion-‐ just like real life. Also as in real life, they are working on balance and flexibility training, which we will examine next as it relates to osteoporosis.



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One result of a fall, even if no physical injury occurred, is the fear of falling. Ironically, this can increase an individual’s risk of falling, as this fear becomes disabling. The person may limit their activities, leading to reduced mobility and loss of physical fitness. Considering the loss of flexibility and lean body mass we earlier discussed, the problem becomes greatly compounded. The phrase “Use it or loose it” becomes all too real in terms of balance, flexibility, lean mass, spatial awareness, and general health/quality of life. The more flexible you are, the better you can move through a productive range of motion for a given exercise. The better you can move through an exercise, the more influence you have on the musculoskeletal system-‐ and ultimately, bone density. The better balance you have, the safer you are both in and out of the fitness club. The better balance you have, the more you can load different sides of the body, rather than the body being used to the same weight distribution or movement patterns. The more movement patterns you have, the higher your quality of mobility-‐ which translates to higher quality of life. Smart resistance training, personalized for your needs and taking into account any injuries or limitations you might have, is a stimulus for bone density in conjunction with proper diet that focuses on leafy green vegetables and protein. Its not enough just to supplement with the right nutrients; there has to be a stimulus for the bones to regenerate, just as resistance training is a stimulus for the muscles. By focusing on proper diet and fitness-‐ including resistance training, balance, and flexibility-‐ we can reduce the impact of osteoporosis and greatly increase our quality of life. If you would like to learn more about these topics and tailor a program specific to you or your organization, contact Drew at [email protected], or 919-‐805-‐0520.



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1. Darling, AL; Millward, DJ; Torgerson, DJ; Hewitt, CE; Lanham-‐New SA. Dietary Protein and Bone Health: a Systematic Review and Meta-‐Analysis. American Journal of Clinical Nutrition. Dec 2009. 90 (6): 1674-‐92. DOI: 10.3945/ajcn.2009.27799. Epub 4 Nov 2009. 2. Dawson-‐Hughes, B. Interaction of Dietary Calcium and Protein in Bone Health in Humans. The Journal of Nutrition. 1 March 2003. 133 (3): 8525-‐45. 3. Hannan, MT; Tucker, KL; Dawson-‐Hughes, B; Cupples, LA; Felson, DT; Kiel, DP. Effect of Dietary Protein on Bone Loss in Elderly Men and Women: the Framingham Osteoporosis Study. Journal of Bone and Mineral Research. Dec 2000. 15 (12): 2504-‐12. 4. Sahni, S; Broe, KE; Tucker, KL; McLean, RR; Kiel, DP; Cupples, LA; Hannan MT. Association of Total Protein Intake With Bone Mineral Density and Bone Loss in Men and Women from the Framingham Offspring Study. Public Health Nutrition. Nov 2014. 17 (11): 2570-‐6. DOI: 10.1017/S1368980013002875. Epub 29 Oct 2013. 5. Sahni, S; Cupples, LA; McLean, RR; Tucker, KL; Broe, KE; Kiel, DP; Hannan MT. Protective Effect of High Protein and Calcium Intake on the Risk of Hip Fracture in the Framingham Offspring Cohort. Journal of Bone and Mineral Research. Dec 2010. 25 (12): 2770-‐6. DOI: 10.1002/jbmr.194. Epub 26 Jul 2010. 6. Hunt, JR; Johnson, LK; Fariba Roughhead, ZK. Dietary Protein and Calcium Interact to Influence Calcium Retention: a Controlled Feeding Study. American Journal of Clinical Nutrition. May 2009. 89 (5): 1357-‐65. DOI: 10.3945/ajcn.2008.27238. Epub 11 Mar 2009. 7. Kerstetter, JE; O’Brien, KO; Insogna, KL. Low Protein Intake: the Impact on Calcium and Bone Homeostasis in Humans. The Journal of Nutrition. Mar 2003. 133 (3): 855S-‐61S.

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