Sadly on some diabetes forums , some posters, mainly men, think that as they have no signs of osteoporosis now, they’re not at risk. The very idea has become a joke Some of them may not be at high risk but unfortunately their comments may well be read by those most definitely at risk.
Osteroporosis means porous bones. Your bones lose internal strength through demineralisation. Inside they become like a honeycomb with gradually less and less strength. Even slight falls or bangs can result in a fracture, Spinal bones become squashed or compressed because of their reduced strength.resulting in curvature of the spine and loss of height.
I don’t find it funny when I see my mother . She suffers from a combination of osteoporosis and osteoarthritis. She’s tiny, fragile, she no longer looks like my mother. She has lost about 10 inches in height through the disintegration of her spine. In daily life it is the arthritis that causes the pain but it is the osteoporosis that has sapped her confidence and destroys her quality of life. She lives in fear, she’s scared to move, afraid of a hip fracture. She’s right to be, her mother died following a hip fracture as do the incredible number of 1150 people a month in the UK.
Many people are at risk even without considering their diabetes. Conditions such as celiac disease , hyperthyroid or a mismatched dose of thyroxine for hypothoid, a genetic history, an early menopause are just some of the risk factors. All women have a 50% chance of some degree of it in old age; the risk for men is less at about 10%. Most won’t know they’ve got it until they start to lose height, or suffer their first break. Saying,’ well I’ve been on this diet for 6 months and don’t see any sighs of osteoporosis is meaningless.’
What’s this got to do with diabetes?
Diabetes however may be an additional risk factor In the case of diabetic women a study found women with Type 1 were 12 times more likely to have had a fracture compared to women without diabetes. Studies have found long term bone loss in type 1 so it does seem that people with Type 1 are at risk of osteoporosis
The studies are less clear for type 2 If you are male and have been overweight, you may have some protection as the extra weight may have strengthened your bones in the same way as weight bearing exercise . Men as a whole are less likely to develop it as they tend to have bigger frames
However, the Iowa study found that women with type 2 on oral medications, or insulin had an increased risk of fractures. A meta analysis in the BMJ covering both diabetic men and women , type 1 and 2 also showed an increased risk of fracture for both genders, but why is unclear. It could be because of diabetic retinopathy, peripheral neuropathy, and cerebral stroke or hypoglycemia, increasing the risk of falling.
http://care.diabetesjournals.org/content/24/7/1192.full
http://aje.oxfordjournals.org/cgi/content/full/166/5/495#BIB42
If you are at risk you can do something about it?
1) The best thing is to work on prevention whilst young by building up strong healthy bones. It is in childhood that most bone development takes place but peak bone density may not be reached until 30. So what you do in your teens and early twenties is important. If you build stronger bones in the first place they are less likely to become osteoporotic.
2) Even if you’re older you can do something. Bone loss is gradual, the same factors that build healthy bones also protect against loss.
Factors that may help increase bone strength
Exercise:
weight bearing exercise like walking, running , dancing, even walking from the shops carrying the shopping . This seems to be really important. Good for bones, for heart and for blood glucose contro.For bones exercise such as cycling and swimming are less good as they are non weightbearing.
Calcium
Women between the ages of twenty to forty typically require a recommended daily allowance (RDA) of 1000 mg/day in the UK, as age increases so does the recommended dose of calcium required. For women over 40 years of age, who are not taking hormone replacement therapy the recommended calcium dose is 1200 mg/day in the UK . For Women 40 and above who take hormone replacement therapy the recommended daily allowance of calcium is slightly lower at 1000 mg/day. The recommended calcium daily allowance for women over sixty is 1200 mg/day. 20% of women don’t have nearly enough in their diet.
Good sources of calcium are dairy products such as milk, cheese and yoghurt. Calcium is also found in canned fish with bones, such as sardines. Other sources of calcium include green leafy vegetables (such as broccoli and cabbage, but not spinach), soya beans and tofu
So eat your dairy and your greens!
Vitamin D get outside in the sun during the summer months (but sensibly. The Cancer research organisation says that the amount needed to synthesize vit D is less than the amount needed to cause sunburn. A British study by the Health research forum recommends that people in the UK should put on sun-cream only after they have been in the sun for five to ten minutes, in order to allow vitamin D to be made in the skin)
Good food sources are oily fish and eggs.
Protein :
People need sufficient protein to establish strong bones and studies have shown that low protein diets in older people are associated with fractures.
Factors that may cause increased bone demineralisation (bone loss)
(the controversial bit)
Smoking (thats not controversial)
High protein diets
Some high protein diets have been shown to cause people to excrete more calcium than normal through their urine. Over a prolonged period of time, this may increase a person's risk of osteoporosis. However, it might depend upon the actual diet. (how much protein, what type and what other things are eaten)
There was a recent study where subjects ate a reduced- calorie, high protein diet which included 3 dairy servings. The results showed increased urinary calcium excretion but at same time provided improved calcium intake and attenuated bone loss. This continued both during the 4 month weight loss phase and the following 8 months of 'weight maintenance' The principle researcher said 'The combination and/or interaction of dietary protein, calcium from dairy, and the additional vitamin D that fortifies dairy products appears to protect bone health during weight loss. NB Fresh milk is not fortified with vit d in the UK
(Thorpe)
People at risk who adopt this diet need to investigate very carefully there is a plethora of contrary information. Some high protein diets have very little calcium intake. (but I think it's the same message as above..... Eat your dairy and greens!
Ketogenic diets
These are also very controversial and may be high protein as above or normal protein and high fat.
Children on ketogenic diets for epilepsy (high fat, adequate protein and low carb) even though carefully supervised have had problems with bone demineralisation. A six year study at John Hopkins university showed of 28 patients, 6 experienced fractures( Groesbeck) .Morbidly Obese children on a similar diet wee also found to have experienced bone loss.( Willi)
Personally I'm not a dietitian or a doctor but I'd be very wary of putting a child with diabetes on this type of diet without expert advice . I'd also be very careful if I were a young person in my teens or twenties and still to reach peak bone mass.
In older adults there very little evidence available , certainly no long term evidence. and whats available is equivocal. A 3 month study of the effect on bone turnover and a low carb diet found no difference (Carter). However a 6 month one led by Westman found there wa an increase in urinary excretion of calcium and uric acid, possibly resulting from ketosis, proteinuria, or weight loss. (Yancy et al)
A paper by SA Bilsborough and TC Crowe discusses the possible problems (p401). It’s worth reading if you’re considering this type of diet.
Low-carbohydrate diets: what are the potential short and long-term health implications?
Shane A Bilsborough and Timothy C Crowe
(available in full but PDF doesn't seem to link why??)
References:
Matthew P. Thorpe et al, A Diet High in Protein, Dairy, and Calcium Attenuates Bone Loss over Twelve Months of Weight Loss and Maintenance Relative to a Conventional High-Carbohydrate Diet in Adults1–3, Nutr. 138:1096-1100, June 2008
DK Groesbeck, RM Bluml, EH Kossoff Long-term use of the ketogenic diet in the treatment of epilepsy. Developmental Medicine and Child Neurology, 2006 - Cambridge Univ Press
Steven M. Willi*, et al The Effects of a High-protein, Low-fat, Ketogenic Diet on Adolescents With Morbid Obesity: Body Composition, Blood Chemistries, and Sleep abnrmalities Pediatrics: 1998, pp. 61-67
Eric C. Westman et al: Effect of 6-Month Adherence to a Very Low
Carbohydrate Diet Program The American journal of medicine, 2002
J. D. Carter The effect of a low-carbohydrate diet on bone turnover
Osteoporosis International. Sept 2006
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