Category Archives: Physiology

Why I Believe in Colonoscopies

As a college junior, I got an ominous call from my mother one day. Dad had gone in for a routine colon screening and wound up with a cancer diagnosis. Mercifully, his malady was confined to a set of polyps that the gastroenterologist removed skillfully. Other than the inconvenience of more frequent screenings, he was expected to live a normal life. Mom informed me that as his progeny, I could expect to have this family history influence my diagnostic screenings.

Fast forward a few decades and a high school friend of mine wound up with colon cancer. Unlike my father, he had not gone in for any screenings until he experienced abdominal pain and bleeding. He was diagnosed with Stage IV colon cancer and died within a year and a half, leaving a wife and two young children. He was a great guy. I can begin to tell you how sad I felt about his predicament.

Colorectal cancer is a silent killer, yielding few (if any) symptoms in the early stage of the disease. It typically starts as small, benign clumps of cells (polyps) that turn malignant over time. As they grow, afflicted individuals may notice changes in their bowel habits, rectal bleeding, abdominal discomfort, weakness, fatigue, and/or weight loss. However, their symptoms may come on so gradually that they fail to pay the appropriate attention to them and take action.

The American Cancer Society estimates that 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer were diagnosed in 2022. Risk factors include age, genetic predisposition, family history, personal history of colorectal cancer or polyps, inflammatory intestinal condition, diet (low fiber, high fat), sedentary lifestyle, diabetes, obesity, smoking, and alcohol abuse. When caught early, 9 out of 10 folks can expect to survive at least 5 years. That’s why screening is so important!

Given my family history, I take colorectal screening seriously. I went in for my colonoscopy just last week. During this procedure, a gastroenterologist uses a long, flexible, tubular instrument to explore the length of the colon. It blows air into the colon to expand its field of vision and transmits images back to the doctor. If he or she detects abnormal tissue, it can be extracted and sent to a laboratory for analysis. An anesthesiologist sedates the patient during the procedure and monitors vital signs throughout. In my experience, the only discomfort occurred with the placement of the IV in my wrist and the injection of the sedative, both of which were transient.

Of course, one must empty one’s intestinal tract of all materials to give the doctor a clear look at the lining of the colon. That’s the “fun” part of the whole ordeal. My latest prep entailed:

  • Seven days without nuts, seeds, or whole grains in my diet
  • No dietary supplements for seven days (though prescription medications were AOK)
  • A clear liquid diet the day before my procedure
  • Use of SuTab tablets to induce diarrhea – 12 at 6:00pm the night before and 12 at 4:30 the day of my procedure consumed with a gaggle of water
  • Nothing by mouth after 6:30am

My pre-procedure evening wasn’t all that pleasant, and I didn’t get a whole lot of sleep. But the stuff worked exactly as they’d said it would. My check-in time was 9:30am for a 10:30am procedure; I was out of there by 11:30am. My darling husband provided transportation services as the sedative rendered me ill-equipped to operate machinery or make critical decisions.

Suffice it to say, I wouldn’t invest a whole blog post on the subject of colonoscopies if I didn’t believe in their ability to save lives. The CDC recommends that persons 45 and older get screened. If coloscopies aren’t advised, CT colonography, flexible sigmoidoscopy, and/or stool test might prove insightful. A frank discussion with a primary care provider can shed light on one’s individual circumstances. I dearly wish that my high school friend had availed himself of that.

Of course, cancer prevention should also be top of mind. The Mayo Clinic offers the following guidelines for lifestyle choices to reduce the risk of colorectal cancer:

  • Eat a high fiber diet with plenty of fruits, vegetables, and whole grains
  • Drink alcohol in moderation (if at all).
  • Don’t smoke.
  • Get at least 30 minutes of exercise daily.
  • Maintain a healthy weight.

Placebos, Nocebos, and Hypnosis

“A mind is fundamentally an anticipator, an expectation-generator.” – Daniel Dennett, AI pioneer

In 1978, a young couple faced a crisis of conscience. As practicing Christian Scientists, they believed in the power of faith healing and eschewed modern medicine, but their infant son was gravely ill. With his life in the balance, the mother considered taking him to the hospital. Her Christian Science healer reminded her of God’s love for the boy and encouraged her to hold fast to her faith. Moments later, the boy’s condition turned around.

That young lad (Erik Vance) heard the story of his miraculous salvation many, many times during his formative years in the Christian Science community. Faith healing was the only form of medicine that he knew, and he witnessed its beneficial effects time and again. Though he eventually fell away from the church, his fascination with the practice stayed with him. He became a science writer and traveled the world to understand the physiological underpinnings of this seemingly magical phenomenon. He captured his findings in Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.

As noted in prior posts, our minds are not computers rooted in logic and facts. They are survival machines geared toward keeping us alive as efficiently and effectively as possible. Expectation serves as a primal survival skill – i.e., anticipating what lies in the immediate future and mounting a swift reaction. Experience guides our expectations. When missing information, we fill in the gaps and move forward, sometimes outside of conscious awareness.

placebo, noceboExpectation plays a substantive role in the body’s capacity for healing. When ill or injured, most of us have been trained to trust in medical professionals to make us well. In the Western world, we visit clinics where caregivers in scrubs and/or white lab coats discuss our ailments and then prescribe drugs, shots, or procedures to make us well. But it turns out that for certain conditions, we can generate the same degree of healing with sham medications and procedures. Scientists refer to that phenomenon as the placebo effect. So, why does it work?

Our brains are adept at pattern recognition; it feeds our “expectation-generator.” Famed neuroscientist Ivan Pavlov explored this capacity in canines by ringing a bell every time he offered them food. Pretty soon, the dogs would salivate whenever they heard the bell. Humans also experience conditioned responses. In one experiment, test subjects were given an immunosuppressant drug in a sweet drink to lower their immune response. After a few iterations, their bodies produced the same reduction in immune response with out the drug even though participants were told in advance that their drinks contained no pharmaceuticals!

Our brains can induce a gaggle of physiological responses without prescription drugs. We’re walking pharmacies with the capacity to produce effective treatments for certain conditions – notably, pain, anxiety, depression, irritable bowel, addiction, nausea, insomnia, and Parkinson’s disease. But several factors influence this healing effect:

  • We need conditioning, a credible backstory, and appropriate environmental cues to engender a belief in the treatment. [Note: Placebo injections prove more effective than placebo pills because we believe that they are more powerful. Likewise, sham surgeries work better than sham pills.]
  • We need a favorable emotional response to our circumstances. Hope yields positive results; despair exaggerates suffering.
  • Social pressure can lessen symptoms or speed recovery – e.g., “If it works for millions of people, it’ll probably work for me.” In fact, the peer pressure placebo effect is twice as strong as an individual placebo response. It feeds into our primal need to go along with the herd.
  • Our genetic maps may make us more (or less) susceptible to placebo responses. As a case in point, folks with the met/met variation of COMT (which, among other things, sweeps up excess dopamine) are far more placebo sensitive than those with the val/val or val/met variations.

Unfortunately, a susceptible brain can make bad things occur without cause – a.k.a., the nocebo effect. One’s mental state can cause physiological suffering. It’s generally driven by fear and can be initiated with a few well-placed words – a report of a contagious disease, a belief that one’s misdeeds will engender cosmic revenge, a curse levied by a supernatural being. A wise person blocks all aggressive suggestions that could cause harm.

Hypnosis represents another form of suggestibility that can drive real physiological change. Its efficacy relies upon the skill of the hypnotist in painting a picture of the magical place that relaxes the participant and opens the door to suggestion, using appropriate pacing and tone of voice to sustain the “trance,” and implanting a credible story that sticks. Roughly 10% of the population responds strongly to hypnosis. Early evidence suggests these folks have naturally higher theta and alpha brain waves than their busy-minded beta and gamma brain-waved counterparts. The latter benefit from meditation to calm their “monkey minds.”

So, what should we make of all of this?

Vance asserts that expectation and suggestibility are a part of all forms of healing. As he says; “Everyone’s door to expectation has a different key, and everyone is suggestible in a slightly different way. But once the door is unlocked, we have amazing power to heal ourselves.” His guideposts for leveraging this capability:

  • Don’t endanger yourself. While some maladies may respond to self-healing, take advantage of modern medicine when you need it.
  • Don’t go broke. Be sensible and follow the evidence before emptying your wallet.
  • Don’t send any creature to extinction no matter how compelling the backstory. They have a right to live, and their sacrifice may do no material good.
  • Know thyself. “For most, suggestibility is a cocktail of genetics, personal beliefs, experience, and personality.” Figure out which pathways hold the most promise for you and be open to the power they hold

Gut Health

My journey of well-being has provided a glimpse into the inner working of my digestive track. I’ve shared my newfound knowledge in posts entitled Our Guts Have Minds of Their Own, The Marvelous Microbiome, and SIBO and Leaky Gut. I added to my intestinal intelligence through Wondrium’s Gut Health with Dr. Mary Pardee. This 26-lesson course covers the mechanics of digestion, strategies for maintaining a heathy gut, gut pathologies, and gut testing and treatment. While there was a fair amount of overlap with what I’d read previously, I managed to come away with a few new insights.

digestive systemIf you’re curious about your gut health, your daily constitution provides a pretty good indication on how things are going. A healthy poop should be soft, brown, S-shaped, and the length of the wrist crease to elbow crease. It might be tinged red, orange, or green based on foods eaten recently –  e.g., red beets, squash, dark leafy greens. It should not be particularly malodorous or greasy. And it should not be bloody. Dietary adjustments and fluid intake can cure a multitude of sins. Bloody stools should be brought to a doctor’s attention.

As covered in the post Drink Water, there’s all kinds of reasons why we should consume an adequate amount of fluid daily (though not to excess at any one time). Dr. Pardee suggests that we take in most of our water between meals. The liquid we drink at meal time can dilute our stomach acid and make it less effective for processing food and killing off bacteria. Older adults are particularly vulnerable in this regard as stomach acid drops as we age. It’s best to confine meal time beverage intake to a handful of sips just to keep things moist.

How we eat is as important as what we eat. Digestion begins with the sight and smell of food; they make our mouths water. Saliva moistens food upon entry into the oral cavity and also starts the process of breaking it down chemically. Of course, chewing represents the most effective form of breakdown. We should transform solid food into the consistency of baby food before swallowing. Big chunks of food are challenging for the stomach to process into a form acceptable by the small intestine.

Meals should benefit from focused attention. When we’re mindful of what we’re eating, we’re more likely to sense satiety and less likely to overeat. Mindful eating also helps us notice whether we’re actually hungry or eating for some other reason – e.g., boredom, stress. It also provides the means to really savor our food and be grateful for its nourishing presence.

Speaking of stress, it’s not a good idea to chow down when in the grips of a fight, flight, or freeze response. In this state, the body shuts down nonessential functions and directs its energy and blood supply to the muscles. It does not want mess around with digestion until the threat has passed. As such, stress eating really, really does not make sense!

Regular exercise supports strong motility along the digestive track. As we move, our food moves through our bodies. This movement prevents an overgrowth of bacteria in the gut and can avoid painful elimination. Dr. Pardee suggests that we aim for 10,000 steps per day. A good night’s sleep also supports motility by elevating cortisol first thing in the morning to a level that stimulates bowel movement. For those with chronic motility issues, fresh ginger, ginger capsules, and ginger tea (2-3 tea bags per cup steeped 10 minutes) may prove helpful.

As with other experts in the field, Dr. Pardee is big on a healthy eating to promote a healthy gut microbiome. Ideally, three-quarters of the plate for every meal includes a varied array of non-starchy vegetables. Daily fiber intake should trend upwards of 100 mg daily through natural sources. (The average American only consumes 15 mg of fiber!) A generous supply of herbs provides potent antioxidants (e.g., polyphenols) to quell systemic inflammation. Fermented foods help the gut garden thrive. And for good measure, eliminate dairy and go easy on nuts.

While probiotics have become a staple of the microbiome conscious, they don’t colonize the gut; they’re transient. They may help reduce anxiety, lower cortisol levels, or support pain management while working their way through the system, but they’re not a panacea for a gut that’s off kilter. Healthy eating, regular exercise, and good sleep habits are the gut’s best friends.

How Your Five Senses Can Help You Sleep

My last post covered all the things we should consider during the day to give us the best possible chance of getting restorative sleep at night. Now, it’s time to focus on our five senses and what they need to support a good night’s sleep.

According to sleep expert Dr. Michael Breus, our bedroom environment matters – big time – when it comes to sleep. First and foremost, make sure you have a really good mattress and pillow. If you’ve had yours for quite some time, it may be time for an upgrade. You may also have reached the end of life on the existing equipment if it has been exposed to dust, mites, sweat, and bodily fluids long enough to produce allergens. That kind of spending may not induce a great deal of enthusiasm, but remember: It’s where you spend a third of your life!

TOUCH: Buy high quality products that feel good on your skin. Use natural, breathable fibers – wool, cotton, down – not synthetic. Dr. Breus likes Egyptian cotton sheets, Pima cotton sheets, Modal fiber, and Lyocell at 200-400 thread count that fit the mattress. bedroomA removable pillow cover separate from the pillow case helps with pillow hygiene and potential allergens. Keep things moderately warm to cool; the ideal ambient room temperature for sleep is 65˚-70˚F. Lean toward the lower.

SIGHT: Ideally, bedrooms should be relatively dark (to boost melatonin) and feature a tranquil color scheme. Forty-watt, blue-light blocking bulbs work quite well. Dimmer switches support those who want the option of a bright light during the daytime. Red or amber night lights can provide illumination for nocturnal bathroom visits. Use a sleep mask if sensitive to light, but wash after each use to prevent eye infections. (I rotate through my collection of 10 inexpensive masks.)

SMELL: While our bodies like freshness, they can make the bedroom fragrance anything but fresh. Open windows at least weekly to circulate some fresh air – and fresh smells – into the boudoir. Regulate humidity, and circulate clean, filtered air when the windows are closed. If you like aromatherapy, try lavender or chamomile, but avoid minty scents.

SOUND: If you cohabitate with a sonorous bedfellow, try using ear plugs rated for a noise level of 32 dB or below. At the other extreme, if the room is too quiet, it may make the ears more sensitive. Try using a sound machine set to a low volume. And don’t settle for an old fashioned alarm clock with its jarring blast of sound. You can awaken to a pleasant sound, a light, or vibration and start your day in a happier frame of mind.

TASTE: Though eating is discouraged within 3 hours of bedtime, a sleep-supportive beverage could be just what the doctor ordered. Try making a cup of banana tea by immersing a whole banana in boiling water and discarding the pulp after brewing. It contains three ingredients that can help improve sleep: potassium, magnesium, and tryptophan. If that doesn’t strike your fancy, brew some guava leaf tea and add a teaspoon of raw honey. It tastes good and helps stabilize blood sugar until morning.

How To Prepare for A Good Night’s Sleep

sleeping man

For those of us who struggle with falling and staying asleep, sleep guru Dr. Michael Breus serves up a lot of good advice. This post shares a host of things we need to do during the day to make sure we’re ready for “lights out” at night.

Set a regular schedule for when you sleep and when you rise to support your body’s natural sleep-wake cycle (a.k.a., circadian rhythm). The adrenal gland works in tandem with the pineal gland to manage this biological rhythm. The adrenal gland produces cortisol which acts as a stimulant; the pineal gland produces melatonin, which makes us sleepy. They function best within a context of consistency.

Start the day with a morning routine to send your body a clear signal that it’s time to start the day. As you open your eyes, sit up straight and take in five deep, slow, deliberate breaths. Consider doing a few morning stretches to clear your head and get your body moving. Grab 15 minutes of sunlight within 30 minutes of awakening (or use a full-spectrum light source) and drink 16-20 ounces of water before your morning coffee or tea. (We lose about a liter of fluid while we sleep!) Put on some high energy music and feast on a high protein, low carbohydrate breakfast.

Get aerobic exercise, preferably in the morning. It gets the blood pumping, improves blood pressure, reduces stress and anxiety, and helps you fall and stay asleep at night. Fitness buffs also produce more growth hormone which improves cellular repair and boosts immune function. All of these benefits kick in over time. (Yep – you’ve got to work out consistently a minimum of 20-30 minutes per day!) Avoid evening workouts as they prove stimulating and do not allow for sufficient time for the elevated core body temperature to drop back down.

Go outside at midday to stop a premature surge in melatonin. It will help you stay alert during the afternoon while continuing to maintain your body’s sleep-wake rhythm. If tempted to nap, wait for 7 hours after waking and give yourself a 25-minute cat nap (light sleep) or a full 90-minute sleep cycle. However, if you struggle with insomnia, don’t nap! It’ll hurt your chances of falling asleep at bedtime.

Watch what you eat and drink in the afternoon and evening. Stop drinking caffeinated drinks by 2pm (although it’s best not to use caffeine at all). Eat sparingly at dinner and go easy on protein and spices to avoid indigestion. Our metabolism slows during sleep and doesn’t have the means to process a heavy meal. Include whole food plant based carbs to increase serotonin. No meals or snacks within 3 hours before bedtime.

Shut yourself off from alcohol at least 3 hours before bedtime and drink a full glass of water for each alcoholic beverage consumed. It takes roughly an hour to metabolize one alcoholic drink. In the United States, one such drink contains roughly 14 grams of pure alcohol, which is found in 12 ounces of regular beer (~5% alcohol), 5 ounces of wine (~12% alcohol), or 1.5 ounces of distilled spirits (~40% alcohol).

Create a bedtime routine to shut down your brain and help your body relax. There’s no one-size-fits-all formula; you’ll have to experiment to see what works for you. Dr. Breus offers the following suggestions:

  • Shortly after dinner, capture what you need to do tomorrow (or the next few days) and anything about which you might be concerned. Jot down a few ideas to address your worries, and then set all such thoughts aside. They’re on the list; you don’t need to think about them until tomorrow.
  • Take a hot bath 90 minutes before bedtime, leaving enough time for the body to cool down again. (Our body temperatures drop when we sleep!) Or, take a cool down shower 30 minutes before bed.
  • Turn off screen time at least 90 minutes before bedtime. The blue light that these devices emit shuts down melatonin. If that won’t work for you, use blue blocker glasses.
  • Create a “Power Down Hour” right before bed that consists of 30 minutes of mindless chores, 15 minutes of hygiene, and 15 minutes of calming activity (e.g., stretching, yoga, meditation, guided imagery).
  • Spend 30 minutes connecting with loved ones right before your power down hour… but don’t launch into any serious, upsetting, or tension-filled conversations.
  • If you enjoy reading a good old fashioned book right before bed, use an amber reading light. If you read on an iPad, Smartphone, or the like, use blue blocker glasses.
  • Write in a gratitude journal right before bed.

Renewed Focus on Sleep

restorative sleep

I envy people who consistently get a good night’s sleep. My dad was one of those folks. He felt he’d had a rough time getting to sleep if it took him 5 minutes to nod off. I can lie awake for hours waiting for Mr. Sandman to show up and bring me a dream. As I’ve recently gotten the message – again – about the importance of a good night’s sleep, I’m putting more effort into it. And I‘m also relying on expert advice from Dr. Michael Breus, author of Good Night: The Sleep Doctor’s 4-Week Program to Better Sleep and Better Health and host of Wondrium’s Sleep Better with Dr. Michael Breus.

Sleep consists of a five-stage cycle that takes 80-120 minutes and repeats 4-6 times per night. We need the experience of all five stages to be mentally and physically restored upon awakening to start a new day. They are:

  • Stage I: As we drift off to sleep, the brain’s electrical activity slows down as does our eye and jaw muscle movement.
  • Stage II: We get a light yet restful sleep during which our body temperature lowers and our muscles relax.
  • Stage III and IV: This deep, slow wave sleep allows for bodily restoration.
  • Stage V: Rapid Eye Movement or REM sleep supports the neural network’s processing and organization of memory. It’s the period during which our eyes twitch and we experience our most intensive dreaming.

Dr. Breus tells us that loss of a mere 90 minutes of good quality shut-eye can make us one-third less alert during the ensuing day. It also messes with our eating habits. Inadequate sleep boosts ghrelin (the hunger hormone), downregulates leptin (the satiety hormone), and stimulates consumption of fatty, sugary, starchy foods. In addition to the risk of weight (fat) gain, our ability to process glucose drops 30%, causing sugars to circulate in the blood. Yikes!

What are some of the common causes of a poor night’s sleep?

  • Inconsistent sleep habits may have us going to bed and awakening at different times every day, making it difficult for the body to regulate its 24-hour sleep-wake cycle (a.k.a. circadian rhythm).
  • We may be trying to sleep at times that are inconsistent with our chronotypes, i.e., our natural propensities to sleep at certain times during a 24-hour period. (As I can attest, night owls do not do well in a morning person world!)
  • The foods and beverages we consume may interfere with sleep.
  • Our bed partners may disrupt our nocturnal mojo.
  • We may be spending too much time in bed or napping to excess and find that we just aren’t sleepy when it’s time to go to bed.
  • We may have a bona fide sleep disorder that requires professional intervention.

In the next couple of posts, I’ll share some of Dr. Breus’ recommendations for improving sleep. These practices take a little time and effort to put in place, and their efficacy may vary from person to person. Some combination of them might work for folks like me. In the meantime, if you have one of those nights where you’re struggling to get to sleep, here are some things to try:

  • Practice mindfulness to steady the mind and alleviate distractions. Focus on the breath and return to it every time you sense the mind has wandered.
  • Listen to a bedtime story. It can draw your attention away from random thoughts and mental rabbit holes without providing the kind of stimulation that engages your attention. I resisted the idea when first presented to me, but it has proven quite effective. That being said, I usually fall asleep before I hear the end of the story and wonder what happened!
  • Breathe in for a count of 4 and hold for a count of 7 to fill the lungs with oxygen. Breathe out for a count of 8 to activate the parasympathetic nervous system. The latter helps calm the body.
  • Count back from 300 by 3s.
  • Keep a worry journal by your bedside. Worries may show up at night because you’re too busy during the day to pay attention to them. Jot them down, and then tell yourself that you’ll handle them in the morning.
  • Try not to stress out about not sleeping. Tell yourself it’s O.K. to simply relax and enjoy a restful moment.

A Deeper Dive on Osteoblasts and Osteoclasts

Earlier posts provided a brief introduction to Our Beautiful Bones as well as tips on How to Promote Healthy Bones. In short, a balanced system of remodeling maintains bone health. When osteoblast (bone building) and osteoclast (bone deconstruction) activity get out of synch, bones become more fragile and elevate the risk for fracture.

Dr. R. Keith McCormick, author of The Whole Body Approach to Osteoporosis, wrote a fascinating article that ties bone health to immune function.1 This high-level summary seeks to capture the main concepts for laypersons (as I understand them!) We’ll start by looking at the genesis of osteoclasts and osteoblasts.

Osteoclasts trace their origin to hematopoietic (blood-oriented) stem cells located in the bone marrow. These stem cells can differentiate into:

  • Red blood cells, which carry fresh oxygen all over the body
  • T Cells, which help the body mount an adaptive immune response
  • Dendritic cells, which are responsible for initiating the adaptive immune response
  • Macrophages, which engulf and digest cancer cells, pathogens, cellular debris, and other foreign/unhealthy substances
  • Osteoclasts, which secret acid phosphatase to dissolve bone crystal (hydroxyapatite)

hematopoietic stem cells

The presence of macrophage colony-stimulating factor (M-CSF) causes the hematopoietic stem cell to differentiate into myeloid progenitors. M-CSF may be released by osteoblasts (bone builders) in response to stimulation by the parathyroid; it may also be released when the body senses a need to combat inflammation. Osteoclasts come into being when RANKL attaches to the receptor activator of nuclear factor KB (RANK) on the myeloid progenitor.

Note that RANKL does not confine its activities to bone remodeling; it also plays a role in immune function. It can be expressed by Helper T Cells to activate B cells to secrete antibodies and macrophages, or activate cytotoxic T cells. It may also alert the immune system to lymph-born antigens.

Osteoblasts trace their origin to mesenchymal stem cells. These stem cells can differentiate into:

  • Adipocytes, which specialize in storing energy as fat
  • Cartilage cells, which form connective tissue found in the larynx and respiratory tract, the external ear, and in the articulating surfaces of joints
  • Osteoblasts, which leverage cytokines (cell signaling proteins) to instigate bone remodeling and subsequently deposit collagen and alkaline phosphatase into bone excavation sites for mineralization

mesenchymal stem cells

In healthy individuals, osteoblasts actuate just the right amount of messenger proteins (e.g., RANK-L) to dissolve bone in a manner consistent with the osteoblasts’ capacity for bone building. Osteoblasts also produce osteoprotegerin (OPG), a soluble decoy receptor that absorbs excess RANK-L and keeps it from activating too many osteoclasts.

The RANK/RANKL/OPG system of bone homeostasis receives substantive bone remodeling support from estrogen. Estrogen improves Vitamin D absorption in the gut (for improved availability of bone-building minerals) and stimulates the release of calcitonin (to make osteoclasts less active). Moreover, estrogen-receptor activation of osteoblasts stimulates release of the growth factors TGF-β and IGF-1, and OPG. This action limits M-CSF and RANKL (which reduces osteoclast formation) and increases osteoclast cellular death.

Individuals with reduced estrogen levels (notably post-menopausal women) and/or persistent activation of the immune system may lack the natural ability to limit RANKL engagement in osteoclast production. As noted previously, both the immune and bone remodeling systems use the same intercellular communications tools. Unfortunately, osteoclast precursors do not consider the source of the signals when acting upon them. When immune system activation boosts production of RANKL and cytokines, the healthy balance of osteoclast-osteoblast function tips in favor of bone breakdown and compromises bone strength, density, and microarchitecture. Therefore, reducing antigenic load, inflammation, and oxidative stress may prove as critical for sustaining bone health as estrogen.

Many of us are unaware of the ways in which we activate our immune systems. We may feel that our bones are not at risk because we don’t have inflamed tissues, viral infections, or other obvious signs of physical distress. And yet our lifestyles may induce immune responses that fly “under the radar.” For example:

  • Oxidative stress is stimulated by processed food, preservatives, food coloring, air pollution, toxins, and smoke inhalation.
  • A weak intestinal endothelial lining (a.k.a. “leaky gut”) may permit bacteria and dietary antigens to escape into the blood stream. Common factors that increase intestinal permeability include: alcohol, food allergies, gluten, NSAIDs (e.g., Advil, Motrin, ibuprofen), psychological stress, surgery/trauma, and unsaturated fats.
  • A high sugar diet may encourage bacterial and/or fungal overgrowth in the gastrointestinal track and oral cavity, such as the characteristic white-coated tongue associated with Candida albicans.
  • Chronic inflammation caused by long-term infection (e.g., periodontal disease), food allergies, autoimmune disorders, and the like evoke immune response.
  • Chronic stress amps up inflammation and weakens immune function.

Dietary and specific nutrient interventions can reduce inflammation and limit the potential impact of excess osteoclastic activity. Ask your doctor for recommendations, or read Dr. McCormick’s article.

 

1 R. Keith McCormick, DC, CCSP, Osteoporosis: Integrating Biomarkers and Other Diagnostic Correlates into the Management of Bone Fragility, Alternative Medicine Review, Volume 12, Number 2, 2007

How to Promote Healthy Bones

we can do this

As a woman of a certain age, my primary care physician (PCP) ordered a routine bone scan (DEXA test) to gain a baseline reading on bone density. Because the results proved concerning , I’m working on my bone health plan.

I contacted my naturopath and enrolled her participation in efforts to identify the root cause for my bone loss and develop a remediation strategy. While a low level of sex hormones is the most likely cause given my otherwise excellent health, we opted to run a comprehensive series of tests to rule out any other confounding factors. These insights will inform any requirements for medication or nutritional supplements.

Meanwhile, there are a host of lifestyle interventions that support healthy bones, all of which promote overall wellbeing.

First and foremost, eat a healthy diet with 5-9 servings daily of fresh, unprocessed, organic fruits and vegetables. Limit grains to 1-2 servings daily as they are acidic. Get your protein from plant-based sources, grass-fed meat, free range poultry, or wild caught fish… but don’t overdo it. Go easy on dairy and salt; limit consumption of sugar, processed foods, soft drinks, and alcohol. Consume limited amounts of healthy fats (e.g., omega-3 and omega-6) and eliminate unhealthy fats. Drink at least eight 8-ounce glasses of water daily.

Note: While I’ve followed these guidelines for years, I decided to install My Fitness Pal on my phone to track my daily intake. I’ve made some simple adjustments as a result and will continue to use the app.

Second, use nutritional supplements as needed to shore up any deficiencies in essential vitamins and minerals. My diet hits the mark on everything except Vitamin D. As a resident of the Pacific Northwest and member of a family with a history of skin cancer, I’m ill-advised to have my body manufacture this crucial element through unshielded exposure to the sun. Moreover, older adults do not absorb sun well enough to make an adequate supply. So, I’ll take a daily supplement to address this matter.

Third, practice good posture, move safely, and support lifts using leg instead of back muscles. For those with advanced osteoporosis, avoid bending or twisting the spine as those actions can cause microfractures. Use a pillow strategically to avoid twisting while sleeping. Use long-handled tools for gardening and housework.

Fourth, cultivate an active lifestyle within the parameters set by a knowledgeable physician. Stretching prevents injuries and improves agility. Weight-bearing exercises and activities of daily living may stimulate bone growth. Weight lifting builds muscles and bones. Studies have shown the latter to have the greatest impact on bone mineral density. Moreover, a strong body with a keen sense of balance reduces the risk of falling. That being said, exercise must become a regular part of daily living. Gains may reverse rather precipitously should one return to a sedentary lifestyle.

Note: While I’ve been relatively active throughout my life, I’ve decided to step it up. I’m exploring higher intensity aerobic exercise options and working with exercise bands at home for weight training. (The body doesn’t care how resistance is generated so long as it fatigues the muscles!) I’m using a desk riser to vary office work between sitting and standing. And, I’ll try to move about or exercise every hour or so. Every little bit counts!

Fifth, minimize stress. When the body stays on high alert, it shuts down its “building projects” in favor of initiating its fight or flight response. As I’ve detailed elsewhere, it’s not a healthy state of affairs and far from noble to simply “take it.” Look for all the large and small stressors in your life and make a considered effort to reduce them. Meditation and mindfulness may help. (It works for me!)

Sixth, don’t smoke. It creates a whole gamut of health-related risks. Bone health is just one more reason to quit.

Finally, stay positive. Establish goals directed toward improving your bone health. The greater your belief in the treatment protocol, the more likely you’ll stick to the plan and realize its benefits.

For more information, check out The Whole Body Approach to Osteoporosis: How to Improve Bone Strength and Fracture Risk by Dr. R. Keith McCormick.

Our Beautiful Bones

For twelve seasons, the crime procedural drama Bones traced the exploits of an FBI agent and his forensic anthropologist partner who helped solve cases by examining human remains – the bones. Viewers watched the team bring the bad guys to justice while also learning a bit about human anatomy. I’ve learned still more in a recent flurry of reading (see below).

human skeletonOur bones define our basic shape, protect our vital organs, and serve as the scaffolding on which all of our soft tissues hang. They house bone marrow in which our red blood cells, white blood cells, and platelets are produced. They also provide a storage repository for minerals essential for energy production and tissue growth. When our diets fall short on nutrients, our bodies take what they need from our bones. Unfortunately, a chronic nutritional shortfall puts our bones’ strength and stability at risk.

Bones consist of three concentric layers. The familiar skeleton from biology class or Halloween decorations reflects a densely-packed outer cortical sheath. A spongy cancellous (or trabecular) bone sits just inside its harder cousin and resembles a honeycomb. It provides support without added weight. The inner medullary cavity contains the marrow.

Our skeletal frame undergoes tremendous growth between infancy and adulthood. We achieve peak bone mass somewhere between age 20 and 30, yet bone remodeling remains a mainstay of our physiology for a lifetime. Osteoclasts break down and absorb old and weakened bone to make way for stronger material. Osteoblasts deposit collagen into these excavation sites for subsequent combination with lysine (an amino acid) and minerals (e.g., calcium, magnesium, phosphorous, potassium) to form new bone. Osteoclasts and osteoblasts need to work in lockstep to maintain healthy bones. Too little osteoclast activity can make for weakened bones and insufficient triggering to activate osteoblasts. Too little osteoblast activity causes bones to lose density.

Several vitamins and minerals contribute to bone development:

  • Vitamin A helps regulate osteoclast and osteoblast activity
  • Vitamins B6 and B9 keep homocysteine levels in check so as not to disrupt bone remodeling
  • Vitamin C plays a role in making collagen and serves as an antioxidant
  • Vitamin D increases calcium absorption in the intestines and stimulates the kidneys to reabsorb calcium from urine
  • Vitamin K – specifically menaquinones 4 and 7 (MK4 and MK&) – helps clear excess calcium from joints and arteries, protects bone sheath flexibility, and supports calcium deposit in the bone matrix
  • Calcium, magnesium, phosphorous, and trace minerals contribute to the hardening of bones
  • Silicon improves bone matrix quality and facilitates bone mineralization

Hormones also get in on the action:

  • Calcitonin (secreted by the thyroid gland) binds with osteoclasts and makes them less active so that osteoblasts can do their work
  • Parathyroid hormone (secreted by the parathyroid gland) promotes calcium absorption in the intestine and reduces loss through urine
  • Cortisol (secreted by the adrenal gland) assists bone growth in small amounts… and interferes in large amounts!
  • Growth hormone (secreted by the pituitary gland) increases muscle mass and strengthens bones
  • Thyroid hormones (secreted by the thyroid gland) control the rate of bone remodeling, although an excess may disproportionately increase bone resorption
  • Sex hormones (estrogen and testosterone) stimulate bone formation; estrogen also keeps osteoclasts in check

And, of course, we need well-functioning digestive and liver function to ensure that we extract nutrients effectively from our food. So, just as our bones support our whole body, a whole lot of physiological elements need to come together to support our bones.

When a weakened physiology disrupts the activity of the aforementioned vitamins, minerals, and/or hormones, bone breakdown can outpace bone regeneration and render bones weak and porous. Physicians refer to the initial stage of disease as osteopenia and the advanced stage osteoporosis. More women than men are diagnosed with the disease due to the precipitous loss of estrogen during menopause. According to the International Osteoporosis Foundation, one in three women and one in five men worldwide over age 50 will sustain a fracture due to osteoporosis in their lifetimes.

Age is an obvious risk factor for bone loss given a general weakening in physiological function. Other risk factors include:

  • Chronic nutritional deficiency that fails to satisfy the body’s need for essential vitamins and minerals
  • Chronic low level acidosis which causes the body to leach calcium from the bones to maintain its slightly alkaline blood
  • Poor digestive function which inhibits the absorption of nutrients from foods – e.g., Celiac disease, dysfunctional microbiome, leaky gut, low hydrochloric acid
  • Chronic inflammation caused by long-term infection, food allergies, autoimmune disorders, and the like which elevates osteoclast activity
  • Excess cortisol caused by unrelenting stress which suppresses bone growth
  • Oxidative stress caused by poor diet, gastrointestinal disorders, hormonal imbalance, toxicity, stress, aging
  • An inactive lifestyle that provides little incentive for the body’s construction team to build bone and muscle
  • Use of certain prescription medications (e.g., glucocorticoids) that interfere with serum calcium and bone formation

Most of us do not pay much attention to our bones unless and until we sustain a fracture. Among older adults, such occasions may result in painful recuperation, loss of function, decreased quality of life, and even morbidity. A consultation with one’s physician complemented by a diagnostic bone scan can assess risk. No matter our age, a healthy lifestyle that is sensitive to skeletal health can help us preserve its function for many years to come.

References:

  • Bart L. Clarke, MD, Medical Editor, Mayo Clinic Guide to Preventing and Treating Osteoporosis: keeping your bones healthy and strong to reduce your risk of fracture, ©2014
  • Joy M. Alexander, PhD and Karla A. Knight, RN, 100 Questions & Answers About Osteoporosis and Osteopenia, Second Edition, ©2011
  • Felicia Cosman, MD, What Your Doctor May Not Tell You About Osteoporosis: Help Prevent – and Even Reverse – The Disease That Burdens Millions of Women, ©2003

Women’s Health

During a peak period in parent care, I checked in with my primary care physician for an annual physical. I reported symptoms of fatigue, brain fog, dry skin, joint aches, cold intolerance, and low heart rate – all classic signs of hypothyroidism. My doctor told me that I was depressed and suggested that I go on antidepressants. I explained that I did not feel anxious or depressed. He said, “If it walks like a duck and squawks like a duck, it’s a duck.” I passed on his advice and opted to see a naturopath instead. A simple blood test pointed to a thyroid problem. With the right medication, all of the symptoms went away.

stethoscopeUnfortunately, my experience is all too common. Studies reveal a gender-biased medical system that treats women as invisible, ignores their legitimate concerns, and belittles them. In a 2001 study (“The Girl Who Cried Pain”), men and women presented the same symptoms to their care providers. The men generally received pain-relief medication, while the women were directed toward sedatives. The presumption is that women are too emotional to report symptoms accurately. This dismissive attitude is especially troublesome given the prevailing hormonal epidemic. According to Dr. Aviva Romm, MD:

  • 85% of women experience troublesome premenstrual symptoms
  • At least 75% have painful or heavy periods
  • Up to 20% of women experience chronic pelvic pain
  • 10% of women have endometriosis, and half of all women aged 60+ will have had a hysterectomy
  • Between 5-10% of women have polycystic ovary syndrome (PCOS)
  • An estimated 30 million women have hypothyroidism

What has happened in the last 70+ years to have gotten our hormones so out of kilter? It turns out that our inner and outer ecosystems are no longer health promoting. We’re dealing with poor nutrition, elevated stress, substandard quantity and quality of sleep, poor digestion, a dysfunctional microbiome, toxic exposure and accumulation, excess use of over-the-counter and prescription medication, inflammation, and oxidative stress. That’s quite a lot! Mercifully,  Dr. Romm tells us that our sorry state of affairs can be reversed. We do not have to put up with unpleasant health outcomes!

In Hormone Intelligence: The Complete Guide to Calming Hormone Chaos and Restoring Your Body’s Natural Blueprint for Well-Being, Dr. Romm shares everything you might ever want to know about women’s health along with a 6-week detailed program for getting things back on a natural and balanced track. It includes:

  • A discussion on healthy eating along with detailed advice on what to eat and what to avoid for hormone health
  • An exploration of stress and its impact on hormone health along with a prescription for de-stressing your life
  • A fascinating look at the body’s natural rhythms and how to get the body’s master “clock” and peripheral “clocks” to synch up
  • A detailed discussion of the gut-hormone connection that covers topics about which I’ve posted earlier – i.e., the body’s enteric system and microbiome (Who knew that the small and large intestines would be so crucial for optimal health?)
  • A prescription for detoxifying our bodies
  • Strategies for revitalizing cellular repair

The book is so jammed-packed with great information that I’d advise female readers to keep a copy of it on their bookshelves (or Kindle) for reference. It will equip them to have a more engaged dialog with their primary care providers. To that end, Dr. Romm offers the following tips to get the best medical care:

  1. Work with a woman. Studies show that they listen more, interrupt less, and make fewer mistakes.
  2. Remember, you’re the boss. You do not have to accept your doctor’s recommendations or treatment. You are entitled to get second opinions.
  3. Trust yourself. If something is “off,” don’t let yourself be shamed out of getting help to resolve it.
  4. Be your own advocate. (Dr. Romm’s book will help you gear up for that role.)
  5. Bring an advocate who can support you during your consultation – especially a forthright and/or knowledgeable one.
  6. Know when it’s time to get another doctor. If your care provider is disrespectful, condescending, distracted, or unskilled in a therapeutic modality that interests you, find someone with whom you can forge an effective partnership.