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June 2004

Organic Foods and the USDA
Osteoporosis Protection
Lifestyle and Osteoporosis
Dietary Supplements for Osteoporosis
Ask Dr. J: Fish Oil Supplement Safety
References
In the Health News
Diet and Disease
Recipe of the Month: Veggie Kebabs for the Grill

Organic Foods and the USDA

Dear Friends,

The USDA (United States Department of Agriculture) has never been a strong supporter of organic agriculture or organic foods in general. Their original attempt to allow irradiated foods, sewage sludge, and genetically modified foods to be included in their organic definition was overwhelmingly opposed by the organic food industry and large numbers of consumers. As a result, they dropped those regulations.

Later, they denied that organic foods were any better than conventionally grown products, and even issued warnings about the dangers of organic foods! They have been resting since then, but now they seem poised to once again make it harder for consumers to know that whether what they are eating is organic, or whether non-food products claiming to be organic really are.

The USDA announced an enforcement directive of April 23, 2004, including the following statement: “when practices provided for in paragraphs (a) through (d) are insufficient to prevent or control crop pests, weeds, and diseases, the producer may use synthetic substances listed in § 205.601 of the National List.”

This suggests to me that regulations of pesticides are not as strict as they should be. According to the Organic Consumers Association, non-agricultural products such as fish, body care products, pet foods, fertilizer, and clothing, may be labelled “organic” with little to no regulation or assurance of authentic organic ingredients. In addition, the regulation situation is confusing, because it appears that if both the producer of supposedly organic foods and the certifier do not know the ingredients of the pesticides, they can certify the food as organic.

This is part of a widespread problem of choosing healthy foods–awareness is not enough if we can’t trust the labeling of the foods to be accurate. As much as I encourage organic gardening and growing as much of your food as possible, it is almost inevitably only a small part of the food intake for most people. Being able to choose organic foods in the marketplace is essential if you want to take the best care of your own and your family’s nutrition.

Public demand is fueling the fast-growing increase in organic production and distribution, which may be seen as threatening to large-scale conventional farms and the enormous food processing industry. They would like nothing better than to be able to call their products organic to “catch the wave” of this industry without having to be strict about the quality of their foods. The only way to maintain real organic foods is to pressure the USDA to adopt high standards. I suggest joining the Organic Consumers Association at www.organicconcumers.org, and The Campaign to Label Genetically Modified Foods (www.thecampaign.org), as well as www.saveorganicfood.org.

Osteoporosis Protection

Everyone who is concerned about their health is aware of the need to prevent osteoporosis, or age-related deterioration of bone structure leading to a higher risk of fractures. Osteoporosis has been in the news lately, because of recent studies showing that dietary supplements are likely to help prevent the decline of bone density and reduce the incidence of fractures.

Bones are dense with a collagen and non-collagen protein matrix and mineral deposits, mainly calcium phosphate. Bone is a living and growing tissue, and gains some of its strength from constant remodeling and repair of micro-fractures that occur regularly from normal wear and tear. Cells that are responsible for the remodeling are of two types, osteoblasts that form bone, and osteoclasts that break down bone to release calcium. The balance of osteoblast and osteoclast activity influences bone density.

Strong bone formation is a slow process (remodeling bone takes many months), and it requires a number of nutrients (vitamins C and D, calcium, phosphorus, magnesium, and possibly manganese, copper, and others), proper hormonal balance, and weight-bearing exercise. Vitamin C is essential for the production of collagen, contributing to the basic bone matrix. Hormones involved in establishing and maintaining bone density include growth hormone, parathyroid hormone, adrenal hormones, testosterone, estrogens, progesterone, and thyroid hormone.

Women have a lower bone density than men, and their loss of bone after thirty years old accelerates with the menopausal decline in estrogen levels. Men’s bone density also declines with age, but osteoporosis occurs later because of their higher peak bone density. After the age of 80, both men and women are at great risk of fractures from weakened bones. Adequate dietary calcium is not the only influence on bone calcium, although it is important.

Lifestyle and Osteoporosis

Some diet and lifestyle factors lead to calcium loss in the urine. For example, caffeine, salt, phosphorus, and sugar in the diet can lead to excessive excretion of calcium (phosphorus and sugar are main ingredients in soft drinks, associated with increased osteoporosis). Smoking and excessive alcohol intake are also associated with increasing osteoporosis risk.

High dietary protein may also cause calcium to be excreted, but it also may increase absorption from food, leading to mixed results in scientific studies, although the evidence suggests that excessive meat consumption is also a risk factor.

Weight-bearing exercise stimulates bone formation and remodeling. Impact causes some strain on the bone, and this in turn leads to increased activity of the bone-forming cells. In one study of 126 post-menopausal women, strength training to build muscle mass significantly increased hip bone density over two years.

Supplements and Osteoporosis

Vitamin D is essential for the absorption of calcium from the intestinal tract leading to increased calcium deposition in the collagen matrix. It is produced by the action of UV from sunlight on cholesterol in the skin (it is really a steroid hormone called cholecalciferol, not a true vitamin). It is also present in a few foods.

Vitamin D is one of the few nutrients that may be toxic in high doses, but it is likely that most elderly people are not getting enough because of lack of sun exposure and declining production in the skin with age. Recommendations for vitamin D range from 200 to 800 IU daily.

Recent studies show that a risk factor for heart disease, high serum homocysteine, is also related to increased risk of osteoporosis, and that vitamin supplements can reduce that risk. Dutch researchers studied 2400 subjects over 55 years old, for three to six years, concluding that those with the highest homocysteine had about double the risk of fractures as those in the lowest range.

Homocysteine may interfere with collagen cross linking, decreasing bone strength. The second study in the New England Journal of Medicine examined 2000 men and women, aged 59 to 91, over 12 to 15 years. They also found a direct relationship of homocysteine with the incidence of fractures, with the highest level of homocysteine associated with two to three times as many fractures as the lowest levels.

Dietary supplements of vitamin B6 (100 to 200 mg), folic acid (1000 to 5000 mcg), and vitamin B12 (1000 mcg) all help to reduce the level of homocysteine in the blood. These are simple, safe supplements that also lower the risk of heart disease. However, these are not the only beneficial supplements for bone density.

Ipriflavone is a modified flavonoid derived from soy, and it both inhibits bone breakdown and enhances calcium deposition in bone. The usual dose of ipriflavone is 600 mg daily. A number of studies show that over a one year period, ipriflavone increases bone density while placebo subjects see a decline. All subjects also received 1000 mg of calcium in several of the studies.

Soy isoflavones (genistein and daidzein) have some phytoestrogenic effects and help bone density. A study of menopausal women taking 40 gms of soy protein daily (90 mg of isoflavones) showed reduced bone loss. Soy isoflavones are abundant in tofu, soymilk, and tempeh (but I do not recommend TVP, a highly processed texturized vegetable protein).

Testosterone, estrogen, and progesterone stimulate bone formation, as does growth hormone. With the current risks associated with Premarin and Provera (Prem Pro), I only recommend bio-identical hormone treatment. If blood test markers of growth hormone indicate a low level, which is very common as people age, it may well be worthwhile to have injection treatment with human growth hormone (oral supplements are generally ineffective).

Magnesium, vitamin K, and omega-3 oils from fish are all of potential benefit in preventing osteoporosis. A comprehensive program of diet, exercise, dietary supplements, and appropriate hormonal therapies is likely to provide the most benefit in preventing and reversing this disease.

Ask Dr. J: Fish Oil Supplement Safety

Q. I have read about the contamination of farm-raised fish. Is there also a problem with contamination of fish oil supplements?
—RG, via email

A. A wide range of fish oil products are available in the health market, as a source of omega-3 oils. These oils have many health benefits, especially for people who have limited conversion of alpha-linolenic acid to the EPA and DHA that are the most active components of fish oil. The conversion is more limited in the elderly and in children, and these oils are important for brain function, lipid control, protection from heart and blood vessel disorders, controlling inflammation, and treating depression, as well as many other health problems.

ConsumerLabs, an independent testing company, found that of the 20 commercial fish oil supplements that they tested, none were contaminated with mercury, probably due to the species of fish that were used as the oil source. Other contaminants are unlikely to be a problem because of the distillation and purification processes used to extract the oils.

However, ConsumerLabs tested 20 brands and found that six contained only 50-80 percent of the amount of omega-3 oil that was claimed on the label. (More recent testing indicates that manufacturers are paying attention to these results and improving their products.) Be sure to buy your fish oil supplements from reliable companies with about 30 percent omega-3 oil (combined EPA and DHA).

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References

USDA and Organic Foods:

Organic Consumers Association, Action Alert, Bush Administration moving to allow corporate takeover of organics! May 5, 2004; www.organicconsumers.org

Compliance and enforcement directive NOP C&E #04.01 www.ams.usda.gov/nop/Compliance/pesticidesCompliance.pdf

Osteoporosis:

Kerr D, et al., Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. J Bone Miner Res. 2001 Jan;16(1):175-81.

Wyshak G, Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med 2000 Jun;154(6):610-3.

van Meurs JB, et al., Homocysteine levels and the risk of osteoporotic fracture. N Engl J Med. 2004 May 13;350(20):2033-41.

McLean RR, et al., Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med. 2004 May 13;350(20):2042-9.

Holick MF, Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004 Mar;79(3):362-71.

Kovacs AB, Efficacy of ipriflavone in the prevention and treatment of postmenopausal osteoporosis. Agents Actions 1994 Mar;41(1-2):86-7.

Agnusdei D, et al., Effects of ipriflavone on bone mass and calcium metabolism in postmenopausal osteoporosis. Bone Miner 1992 Oct;19 Suppl 1:S43-8.

Scheiber MD, et al., Dietary inclusion of whole soy foods results in significant reductions in clinical risk factors for osteoporosis and cardiovascular disease.... Menopause 2001 Sep-Oct;8(5):384-92.

Fish Oil Supplement Safety:

Science Daily, 2004-03-17 Fish Oil Supplements May Contain Flame Retardants.

Product Review: Omega-3 Fatty Acids (EPA and DHA) from Fish/Marine Oils, www.consumerlab.com/results/omega3.asp

Tod Cooperman (ConsumerLabs.com representative), Lecture presentation at the American College for Advancement in Medicine Scientific Meeting, May 22, 2004

In The Health News

Dietary selenium appears to protect against the development of advanced prostate cancer. Results from the Physicians Health Study at Harvard shows that men with the highest blood levels of selenium had a 50 to 60 percent reduction in advanced prostate cancer. They compared 586 men with prostate cancer to 577 control subjects. ((Li H, et al., A prospective study of plasma selenium levels and prostate cancer risk. J Natl Cancer Inst. 2004 May 5;96(9):696-703.) This confirms earlier studies. Selenium is found in nuts, whole grains, brewers yeast, and seafood, and it is common in high quality multivitamins.

After a heart attack, depression and loneliness often trigger a recurrence, but this risk is greatly reduced in people who exercise. Researchers studied over 2000 subjects, and among those who were socially isolated or depressed, heart attack recurrence was double the rate in those who were sedentary compared to those who exercised. In addition, their depression was relieved by exercise. (Blumenthal JA, et al., Exercise, depression, and mortality after myocardial infarction in the ENRICHD trial. Med Sci Sports Exerc. 2004 May;36(5):746-55.)

Diet and Disease

A typical fast-food breakfast at McDonalds (and probably similar chains) induces an inflammatory response that could explain why such foods are associated with an increased risk of heart disease. Researchers measured oxygen free radicals and inflammatory markers such as CRP, after a 900 calorie meal of egg and sausage McMuffins, and hash browns. The CRP and free radical markers all increased. Aljada A, et al., Increase in intranuclear nuclear factor kappaB and decrease in inhibitor kappaB in mononuclear cells after a mixed meal... Am J Clin Nutr. 2004 Apr;79(4):682-90.

Recipe of the Month: Veggie Kebabs for the Grill

Cookouts do not have to include meat or be rich in saturated fat to be delicious. On a skewer, alternate chunks of red and green peppers, cherry tomatoes, onion quarters, tofu cubes, eggplant (small cubes cook faster), zucchini and summer squash chunks, and crimini or other mushrooms. Marinate these (the longer the better), before skewering, in a mixture of water, soy sauce, balsamic vinegar or lemon juice, olive oil, crushed garlic, dried or crushed fresh ginger, fresh basil, thyme, and ground pepper. Put them on the grill until slightly soft (10-20 minutes), turning several times. You can cover this with a variety of sauces for serving. Make a tangy, thick and creamy Thai-type sauce with peanut or almond butter, coconut milk, crushed garlic, ground cumin and coriander, chili pepper, and lemon juice. Pour the sauce over the veggies and serve on brown rice.

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CONSULTATIONS:

From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.


Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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