Vitamin K2, but Not Vitamin K1, is Helpful for Bone Density

The importance of vitamin K in the prevention and treatment of osteopenia/osteoporosis has just been discounted in a WebMD review ("Vitamin K: No Help for Bone Density") of research published Oct. 14, 2008, in PLoS Medicine (Cheung A, et al.) In the study, Canadian researchers, not surprisingly, found that taking 5 mg per day of vitamin K1 does not protect postmenopausal women from age-related declines in bone density.

What is surprising is that the researchers, despite noting that vitamin K is a family of compounds, and that vitamin K2 is the form which is an approved treatment for osteoporosis in Japan, chose to use vitamin K1 in their clinical trial.

It is well known that vitamin K1 (phylloquinone) is involved in blood coagulation. It is also well documented that vitamin K2 (menaquinone) is the essential cofactor for the carboxylation (activation) of the (gamma-carboxyglutamic acid) Gla-containing proteins involved in calcium regulation.

Numerous peer-reviewed studies have shown that vitamin K2 - given either as the synthetic form MK-4 (a short-chain version called menatetrenone) at a dosage of 45 mg/day, or as the natural form, MK-7 (a long-chain menaquinone derived from natto) at a dosage of 45 mcg/day - is a highly effective activator of osteocalcin, the Gla-containing protein integral to calcium deposition in bone. This body of research conclusively demonstrates that vitamin K2 not only lessens fracture incidence and improves bone density but also, via the carboxylation of another Gla protein (matrix Gla protein), inhibits arterial calcification.

Finally, even though they did not use the right form of vitamin K, looking at the research more closely shows that in the treatment group fractures were down - only 9 women getting vitamin K1 vs. 20 getting placebo had fractures (which is why we want higher bone density!). In addition, surrogate markers of bone production were up and the trends were toward higher density at several points during the intervention.

Why Cheung et al. did not use the optimal form of vitamin K remains a mystery, as does the lack of critical analysis and incomplete conclusion provided by the review. Hopefully, the outcome of this misleading publication will not be an increased incidence of osteopenia/osteoporosis in women at risk of these conditions who are dissuaded from supplementing with vitamin K2.

References:

Cheung A, Tile L, Lee Y, et al. Vitamin K Supplementation in Postmenopausal Women with Osteopenia (ECKO Trial): A Randomized Controlled Trial, PLOS Medicine, Oct. 14, 2008; Vol 5: p. e196.

Pizzorno L, Pizzorno J. Vitamin K: Beyond Coagulation to uses in Bone, Vascular, and Anti-Cancer Metabolism. IMCJ, Apr/May 2008, Vol 7:No. 2, p.24-30.

Related Topics:

• Men: New Guidelines for Osteoporosis Tests
• 15 Osteoporosis Questions to Ask Your Doctor

Strong Bones for Life - Naturally (Part 2)

Your Bones, Your Choice

Of course, even old decrepit bone is better than no bone, the situation seen in osteoporosis, which results when osteoclasts' demolition work greatly outpaces osteoblasts' new construction. Fortunately, this unbalanced situation, which can develop if the body becomes chronically pro-inflammatory and/or lacks a good supply of all the materials needed to build new bone, can be prevented and treated without drugs.

Here's what you need to build strong bones for life, naturally.

Calcium
Daily calcium needs:

• Women 19-50: 1,000 mg


• Women 51+: 1,200 mg


• Postmenopausal women not taking HRT: 1,500 (if on HRT, 1,200 mg daily; if you are taking HRT, it should be bio-identical bi-est and progesterone compounded specifically for you after you have had your hormone levels - all three estrogen fractions and progesterone - checked, not Premarin and Provera! If your physician is not aware of this, switch physicians.)

Remember, you get calcium from both food and supplements, so keep a food diary for a week or two to estimate your typical calcium intake and then take enough supplemental calcium to reach the above amounts.

If you regularly eat dairy products (from cows, sheep, or goats), soyfoods with added calcium, sesame seeds, and greens such as spinach, collard greens, Swiss chard, or broccoli, you are likely getting about 600 mg calcium from food each day.

Choosing a Calcium Supplement
You will see different forms of calcium in supplements. Choose either chelated calcium or hydroxyapatite (#3 or #4 below). Here's why:

1. Naturally-derived calcium: may appear on labels as bone meal, oyster shell, limestone, or dolomite (clay). Avoid these supplements since naturally derived calcium may contain significant amounts of lead.


2. Calcium carbonate: the most commonly used form and the least expensive, but not nearly as well absorbed as chelated calcium. If taking calcium carbonate, take with meals when your stomach will be secreting hydrochloric acid to digest the food as it will also help you break down and absorb calcium carbonate.


3. Chelated calcium: will appear on the label as calcium-citrate, calcium-malate, calcium-gluconate or calcium-aspartate. In these chelated forms, the calcium is bound to an organic acid (citrate, malate, gluconate) or amino acid (aspartate), which improves its absorption. Chelated forms of calcium are more expensive than calcium carbonate, but build more bone for the buck, so are worth it.


4. Hydroxyapatite: sometimes appears as MCHC (microcrystalline hydroxyapaptite). The most expensive form of calcium, hydroxyapatite, is a complex crystalline compound that contains calcium linked with phosphorus in a pre-formed building block of the bone mineral matrix. MCHC contains hyrdoxyapatite plus bone-derived growth factors and all the trace minerals that comprise healthy bone. If you are at high risk of osteoporosis or have osteopenia, you should be taking MCHC.

Vitamin D
Vitamin D is essential for calcium's absorption both from the intestines and into bone.

You want vitamin D3, the natural form. The fully activated form of the vitamin in the body is titled 1,25-dihydroxycholecalciferol as know as "calcitriol".

Some supplements (especially the less expensive ones) contain synthesized D2 (called ergocalciferol). Current research shows this is not as biologically effective as the natural D3. (Houghton L, Vieth R. The case against ergocalciferol (vitamin D2) as a vitamin supplement. Am J Clin Nutr. 2006 Oct;84(4):694-7).

Anyone living in northern latitudes (e.g., the Pacific Northwest or New England) is at high risk for vitamin D deficiency and should have her or his blood levels of 25(OH)D3 checked. 25(OH)D3 is the major circulating form of vitamin D in the blood and the best barometer of vitamin D status. Be sure this is the vitamin D test your doctor orders for you; many labs/doctors test D2.

Adequate blood levels of vitamin D to provide for bone health (as well as protecting against colon and breast cancer, multiple sclerosis, inflammatory bowel disease, depression - and a host of other ailments) begin at 75 nmol/L of 25OH-D3. Blood levels of vitamin D between 90 and 100 nmol/L are optimal.

The amount of vitamin D you need will depend on the results of your blood test. A daily intake for all adults of >/=1000 IU vitamin D is needed to bring vitamin D concentrations up to 75 nmol/L in at least 50% of the population. If you live in northern latitudes or live in the south but get little sun exposure or wear sunscreen, you can start taking 1,000 IU of D3 daily right away. However, you may need 2,000 or even 5,000 IU of D3 daily for 6-8 months to restore adequate levels of this critical nutrient.

We are currently involved in a corporate wellness program in Canada. We found that 82% of the employees have low levels of vitamin D in their blood.

Magnesium
If your blood test reveals that you are significantly vitamin D-deficient (we've seen vitamin D levels around 30 nmol in many patients and levels as low as 13 nmol in several), and your physician recommends you take more than 2,000 IU/day for an extended period of time, you will also need to supplement with magnesium citrate, 500 mg, twice daily.

Calcium and magnesium counterbalance one another in numerous cellular activities. If you are taking high levels of vitamin D, you will be absorbing significantly more calcium and will need to ensure your magnesium levels are sufficient to maintain this balance.

This is very important: symptoms of magnesium deficiency include migraines and tension headaches, muscle weakness, leg cramps, restless legs, elevated blood pressure, transient ischemic attacks, and heart arrhythmia.

Vitamin K
Vitamin K, specifically vitamin K2 or menaquinone, activates a group of proteins (the Gla-proteins), which are responsible for where calcium gets delivered in the body. Vitamin K2 ensures that the calcium you consume (and which will be getting into your circulation in higher amounts now that you are taking vitamin D) is deposited where you want it—in your bones, and not where you don't—in your blood vessels and other soft tissues.

When your vitamin K2 levels are adequate, two of the Gla-proteins that are activated are: (1) osteocalcin, the protein responsible for anchoring calcium within bone, and (2) matrix Gla-protein, which prevents calcium from depositing in the heart, arteries, breast and kidneys.

Both vitamin K1 (phylloquinone) and vitamin K2 (menaquinone) are available as supplements. Vitamin K1 is primarily involved in helping your blood clot normally, although our bodies are able to convert a small amount of K1 into K2.

For bone health, K2 (menaquinone), particularly natural menaquinone derived from natto, which may be labeled MK-7 (menaquinone-7) is the most potent form. You may also see K2 as menatretrenone; this is MK-4, a synthetic version that must be taken in much higher doses because its half-life in the body is quite a bit shorter.

If you are taking MK-7, a daily dose of 45 mcg is sufficient. If taking MK-4, take 5 mg daily.

Best food sources of vitamin K (K1) include kale, spinach, Swiss chard, broccoli, Brussels sprouts, parsley and romaine lettuce. Natto, from soy, is an excellent source of K2, but is not easily available in the U.S., nor would the taste appeal to most Americans.

Boron
Boron protects against calcium loss by helping to maximize the activity of both estrogen and vitamin D in bone.

The drop in estrogen levels that occurs during menopause triggers an increase in the production of a pro-inflammatory mediator called interleukin-6, which stimulates the production and activity of osteoclasts. Boron is needed for the conversion of estrogen to its most potent form, 17-beta-estradiol, which allows the body to make the most use of its remaining estrogen.

Boron is also involved in the reaction in the kidneys in which vitamin D is converted to its most active bone-building form, (1,25-(OH)2D3)—a compound that is even 10 times more potent than D3.

In one study of postmenopausal women, supplementation with 3 mg/day of boron reduced urinary calcium excretion by 44%!

Best food sources of boron are apples, pears and grapes. Leafy greens, legumes and nuts can also be good sources of this mineral; however, since the boron content of fruits and vegetables depends upon that provided by the soil in which they were grown, which can vary dramatically, boron supplementation with 3 mg/day is recommended.

Omega-3s
Inflammation-related activation of osteoclasts plays a key role in osteoporosis. Not only do the omega-3 fatty acids lessen the production of pro-inflammatory cytokines that activate osteoclasts acids, these fats also stimulate the activity of osteoblasts. In contrast, the pro-inflammatory omega-6 fats so abundant in the typical American diet stimulate osteoclasts. (Fernandes G, Lawrence R, Sun D. Protective role of n-3 lipids and soy protein in osteoporosis. Prostaglandins Leukot Essent Fatty Acids. 2003 Jun;68(6):361-72; Heaney RP, Carey R, Harkness L. Roles of vitamin D, n-3 polyunsaturated fatty acid, and soy isoflavones in bone health. J Am Diet Assoc. 2005 Nov;105(11):1700-2; Watkins BA, Li Y, Lippman HE, Feng S. Modulatory effect of omega-3 polyunsaturated fatty acids on osteoblast function and bone metabolism. Prostaglandins Leukot Essent Fatty Acids. 2003 Jun;68(6):387-98.)

Experts suggest the optimal ratio of omega 6:omega 3 fatty acids is 4:1 or even 2:1. The standard American diet delivers a ratio somewhere between 10 and 20:1.

In a recent study, subjects consumed each of three diets for a period of 6 weeks. The first, a typical American diet, delivered a 9.6:1 ratio of omega 6:omega 3 fats. The second and third diets provided ratios of 3.5:1 and 1.6:1 omega 6 to omega 3 fats, respectively. Walnuts, a rich source of both omega 6 and the omega 3 fats, were the primary sources of omega-3s in the second diet; a little more than one ounce (37 grams) of walnuts and ½ ounce (15 grams) of walnuts were included in each day's meals in the form of walnut granola, walnut butter, walnut pesto or plain walnuts as a snack. The third diet contained about 20 grams (2/3 ounce) per day of flaxseed oil, a highly concentrated source of the omega 3 fat, alpha linolenic acid.

Indicators of bone loss called N-telopeptides (NTx, which are produced when osteoclasts break down bone collagen, were measured and found to be significantly lowered by the diets containing a lower ratio of omega 6 to omega 3 fats. The second diet, in which the ratio of omega 6: omega 3 was 3.5:1 reduced NTx 11.5%, while the third diet dropped NTx levels by 15.3%.

The researchers also measured levels of a pro-inflammatory cytokine called TNF-a (tumor necrosis factor alpha), which increases osteoclast production and activity. As the ratio of omega 6: omega 3 dropped, levels of TNF-a also dropped substantially. (Griel AE, Kris-Etherton PM, Hilpert KF, et al. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007 Jan 16;6:2.)

In other research, a few weekly servings of salmon (14 ounces per week), has been shown to raise omega 3 levels more effectively than taking a daily fish oil supplement while also lowering blood levels of a number of pro-inflammatory chemicals including TNF-a. Researchers think omega-3s may be better absorbed from fish because fish contains these fats in the form of triglycerides, while the omega-3s in almost all refined fish oils are in the ethyl ester form. Once absorbed, omega-3s are converted by the body from their triglyceride to ester forms as needed. (Elvevoll EO, Barstad H, Breimo ES, Brox J, Eilertsen KE, Lund T, Olsen JO, Osterud B. Enhanced incorporation of n-3 fatty acids from fish compared with fish oils. Lipids. 2006 Dec;41(12):1109-14.)

Your Bones, Your Choice
You only have one body. Doesn't supporting its inherent drive to maintain strong, healthy bones by supplying the natural compounds it uses in normal bone remodeling make better sense than giving it a drug that poisons your osteoclasts and puts you at risk for abnormal heart rhythms and jaw bone death? Your bones, your choice.

~Joseph Pizzorno, ND and Lara Pizzorno, MDiv, MA, LMT

Part 1: Bisphosphonate Drugs

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• Osteoporosis Diet Dangers: Foods to Avoid
• Exercises to Help Osteoporosis

Strong Bones for Life - Naturally (Part 1)

Bisphosphonate Drugs

It's true, as Sally Fields emphasizes in her TV ads for Boniva, that you have only one body; it's not true that Boniva and the other bisphosphonate drugs commonly prescribed to prevent osteoporosis offer the best way to take care of it!

Although prescribed to 30 million Americans each year, the bisphosphonates (e.g., Fosamax, Boniva, Actonel), have now been linked to serious potential complications.

A recent FDA alert warned physicians that all bisphosphonate drugs may cause "severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain...[that] may occur within days, months or years" after starting the medication, and in some patients, may not resolve even after discontinuing the drug.

Even more frightening are recent studies conclusively linking bisphosphonate use with jaw osteonecrosis or bone death. Osteonecrosis occurs when bone damaged as a result of poor blood flow or trauma is not removed and replaced with new bone. Initial symptoms include numbness, heaviness, swelling, pain and infection in the jaw, and progress to loosening of the teeth, decay and death of the jaw bone. Bisphosphonates accumulate in bones, particularly in the jawbone, and inhibit the bone's natural ability to repair everyday damage.

A Cochrane Review noted that age = or > 60 years, female sex and previous invasive dental treatment were the most common characteristics of patients taking bisphosphonates who developed osteonocrosis. (Pazianas M, Miller P, Blumentals WA, et al. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007 Aug;29(8):1548-58.) Considering that the target population for bisphosphonate drug use is postmenopausal women, and many women now 60 or older have had some kind of invasive dental procedure in their lifetime, these risk traits for osteonecrosis with bisphosphonate use are far too common for comfort; so common that concerned dentists are highly reluctant to perform any type of dental surgery on women taking these drugs.

In one of the most recent studies, published in the Journal of Oral Maxillofacial Surgery in April 2008, researchers at the University of Southern California's School of Dentistry found a direct correlation between the development of microbial biofilms (bacterial colonies that cause chronic infections) in affected bone and the use of bisphosphonates. (Sedghizadeh PP, Kumar SK, Gorur A, et al. Identification of microbial biofilms in osteonecrosis of the jaws secondary to bisphosphonate therapy. J Oral Maxillofac Surg. 2008 Apr;66(4):767-75.)

Just how many people now have osteonecrosis of the jaw caused by bisphosphonates? Incidence of osteonecrosis among cancer patients, who are given an intravenous and more potent variety of these drugs (e.g., Zometa and Aredia), is estimated at between 1% and 10%. Among those with osteopenia/osteoporosis taking the lower-dose pill forms (Fosamax, Actonel, Boniva), no one knows for sure. Studies to provide firm answers are just beginning, but it has been established that invasive dental procedures, such as tooth extractions or root canals, greatly increase risk of osteonecrosis in women taking bisphosphonates. As for treatments, cutting away the dead bone just worsens the situation, so antibiotic rinses are used, but frequently fail to remedy the condition. And since bisphosphonates remain in bones for years, no one knows how long the risk of osteonecrosis remains, even if the drug is no longer being taken. (Kolata G. Drug for Bones is Newly Linked to Jaw Disease, New York Times, June 2, 2006)

Recent studies have also reported bisphosphonate use as a risk factor for atrial fibrillation (abnormal heart rhythm) in women. One study estimates that 3% of atrial fibrillation cases might have been due to bisphosphonate (specifically, alendronate) use. (Heckbert SR et al.) Physicians are warned that bisphosphonate use needs to be closely monitored in certain populations at high risk of serious adverse effects from atrial fibrillation (such as patients with heart failure, coronary artery disease, or diabetes). In other words, those at risk for serious side effects from bisphosphonates also include anyone with heart disease or diabetes, a significant percentage of the U.S. population. (Heckbert SR, LiG, Cummings SR, et al. Arch Intern Med. 2008 Apr 28;168(8):826-31; Cummings SR, Schwartz AV, Black DM. N Engl J Med. 2007 May 3;356(18):1895-6.)

Not surprisingly, hundreds of lawsuits have now been filed against the manufacturers of biophosphonate drugs, and a class action suit appears likely.

Manufacturers of Bisphosphonates

• Fosamax - Merck & Company
• Boniva - Roche and GlaxoSmithKline, popularized by Sally Field commercials
• Actonel - Proctor & Gamble Pharmaceuticals, Sanofi Pharmaceuticals
• Skelid - Sanofi Pharmaceuticals
• Didronel - Proctor & Gamble Pharmaceuticals
• Reclast and Zometa - Novartis Pharmaceuticals

How Bisphosphonates Work

Even if the bisphosphonates did not put you at risk for severe musculoskeletal pain, the loss of your jaw, or abnormal heart rhythms, these drugs would still not be your best choice for strong healthy bones. Why? Because all they do is suppress bone turnover and remodeling.

Our bones, unless inhibited by bisphosphonates, are constantly rebuilding themselves throughout our lives. Cells called osteoclasts break down old or damaged bone, signaling other cells called osteoblasts to replace it with strong new bone. Bisphosphonates kill osteoclasts. Bone density goes up on these drugs, but the bone they leave in place is worn out tissue your body would normally clear out and replace with strong new bone.

This is why bisphosphonates put people at risk for osteonecrosis (jaw bone death). Because these drugs suppress osteoclastic activity, damaged bone is left in place rather than resorbed, so the amount of damaged old tissue accumulates until it reaches a level when any trauma or insult will result in extremely poor healing, the exposure of necrotic bone to the oral environment, development of pain, and increased risk of microbial infection, which is precisely what is seen in bisphosphonate-associated cases of osteonecrosis of the jaw.

Next: Part 2 - Your Bones, Your Choice

~Joseph Pizzorno, ND and Lara Pizzorno, MDiv, MA, LMT

Related Topics:

• WebMD Video: Jaw Osteonecrosis
• Quiz: How Much Do You Know About Bones?

Pharmaceutical-Flavored Water?

Our water supply has a drug problem.

Will your next refreshing glass of water actually be a drug cocktail? A just-released 5-month AP investigation indicates this is more than likely. Albeit in miniscule amounts, drugs-- including antibiotics, anticonvulsants, mood stabilizers and sex hormones--were present in the drinking water supplies of 24 metropolitan areas, including southern California, northern New Jersey, Detroit, Washington D.C., Philadelphia, PA, and Louisville, KY.

Although you're unlikely to notice any immediate effects (to reach a therapeutic dose of any of the drugs detected, you'd need to swallow 120 Olympic size pools of water), long term chronic exposure to this pharmaceutical cocktail may not be safe.

"These are chemicals that are designed to have very specific effects at very low concentrations. That's what pharmaceuticals do," notes John Sumpter, Distinguished Professor of Ecotoxicology at Brunel University, London.

Sumpter, who pioneered the field now known as endocrine disruption, was one of the first to show that effluents from sewage treatment contain estrogenic hormones, including estradiol, the main component of the contraceptive pill. His work lead to the surprising (at the time) conclusion that human drugs were getting into rivers and causing intersexuality in fish.

Fish may be more sensitive than humans (after all they breathe water), but do we want to just wait to see if humans are affected?

"We know we are being exposed to other people's drugs through our drinking water, and that can't be good," says Dr. David Carpenter, a professor at the Environmental Health and Toxicology Division, School of Public Health at the University of Albany in New York.

And while prescription drugs are subjected to clinical trials to evaluate their safety in humans, it behooves us to realize that even those that are passed with a supposedly clean bill of health cheat, in real life terms, to get it.

Drugs are evaluated as single agents, typically over a period of months. In real life-and now in our water supply-drugs are not artificially constrained to one at a time, and the exposure is often not for a few months. In the case of our water, it's for a lifetime.

Pharmaceuticals not only frequently produce significant undesirable side effects when given one at a time-properly prescribed and administered drugs are the 4th leading cause of death in the U.S.-they also interact with other drugs, and the results of these interactions have not been evaluated.

How do the drugs get in our water?

The drugs we take are not completely metabolized into harmless compounds, but pass out of our bodies in urine and feces. And even the drugs we don't take end up in the water supply: more than half of us flush unused and expired meds down the toilet.

Plus, we're not the only ones using drugs. Cattle are given steroids to bulk up, and pets are being medicated for everything from arthritis, cancer, and heart disease to diabetes, allergies, dementia and that Western lifestyle affliction, obesity, to the tune of $5.2 billion over the past five years. The most recent data shows Americans increased their spending on animal meds nearly 10% in 2006. (Animal Health Institute: http://www.ahi.org/index.asp)

What's a consumer to do?

Lessen the load on the ecosystem:

• Dispose of unused or unwanted medications at take-back sites or ask your doctor, nearby hospital or pharmacist to take back unused and expired drugs. Do NOT flush unused meds down the toilet or toss them in the trash. Check the www.earth911.org database or contact your local household and hazardous waste office to find out a drug-take-back program nearby.


• Purchase drugs in small amounts; they'll cost you less and you won't end up with leftovers.


• Work with a health care provider to develop health and wellness strategies you can commit to; you'll feel better, enjoy life more, and reduce your need for medications.


• When medication is necessary, ask your doctor or pharmacist for one with the least environmental impact.

Check out the Teleosis Institute, an organization that is working to provide programs to get pharmaceutical (and personal care product) waste out of the environment in California. If you don't live in California, you'll still find lots of good information and resources there, and you might also tell your elected officials to have a look.

Lessen the load on your body:

In addition to lessening your need for drugs by taking steps to become healthier, you can improve the quality of the water you drink by:

• Filtering your water. For information on the various types of filters, check the National Resources Defense Council website: (http://www.nrdc.org/water/drinking/gfilters.asp)
  


• Putting your filtered water in a reusable glass or stainless steel pitcher or bottle. Plastic bottles contain compounds, such as bisphenol A (BPA) and polyethylene terephthalate (PET), that have been shown to migrate into the beverages they contain. BPA A has been shown to be both estrogenic and neurotoxic. PET plastics used for water bottles leach antimony, a regulated contaminant with both acute and chronic health dangers. ( Le HH, Carlson EM, Chua JP, Belcher SM. Bisphenol A is released from polycarbonate drinking bottles and mimics the neurotoxic actions of estrogen in developing cerebellar neurons. Toxicol Lett. 2008 Jan 30;176(2):149-56. Westerhoff P, Prapaipong P, Shock E, Hillaireau A. Antimony leaching from polyethylene terephthalate (PET) plastic used for bottled drinking water.
  
  Water Res. 2008 Feb;42(3):551-6. Shotyk W, Krachler M.
  
  Contamination of bottled waters with antimony leaching from polyethylene terephthalate (PET) increases upon storage. Environ Sci Technol. 2007 Mar 1;41(5):1560-3. PMID: 17396641.

These 3 websites had the best summaries of the effects of the various filters we could find. Only reverse osmosis specifies that drugs are removed, and these filters remove needed minerals-which we need.

• Heart Spring
  


• Pure Water Systems
  


• Garden Club of America
  

TYPES OF FILTERS

Carbon filters remove many organic chemicals and chlorine and radon. Carbon filters should be of good quality and maintained properly. Because bacteria can grow on some filters, it is imperative that carbon filters be changed frequently.

Reverse osmosis units remove most toxic minerals and organic chemicals but generally do not remove radon or chlorine. They should be used with carbon filters. Reverse osmosis units are slow and should only be used for drinking water at a spigot. The purified water becomes aggressive and can corrode the pipes of the delivery system. These pipes and faucets should not be made of lead or lead components.

Distillation removes pollutants by boiling water and cooling the steam so it condenses back into water. Distillation is slow and expensive and distilled water is poorly buffered. Therefore, distilled water can be highly aggressive and should be stored in glass or other inert containers.

Water softeners remove calcium and magnesium from “hard” water and make it clean better. However, calcium and magnesium are considered human nutrients.

The healthiest water is free of pollutants but contains beneficial minerals like calcium and magnesium.

by Lara Pizzorno

Related Topics:

• Feel Your Best With Water
• The Facts About Bottled Water

Technorati Tags: drugs, drinking water, contaminants, contamination, water

Are You Getting Enough Iodine?

Iodine intake has been decreasing in the U.S. since the early 70s as a result of changes in Americans' food and dietary habits, and because, as recently published research shows, iodized salt may contain far less than the amount of iodine listed on the label.

Milk, and therefore dairy products, used to be a decent source of this important trace mineral, but their iodine content has greatly decreased due to changes in cattle feed and a phase out of iodine dairy sanitizers. The average iodine content of U.S. whole cow's milk has plummeted from 184 mcg/L) in 1978 to 19 mcg/L in 1989-90.

Sea vegetables, such as kelp, dulse, hijiki, and nori, remain an excellent source of iodine (a mere 1/4 cup supplies 415mcg), but are not frequent American fare, and unless certified organic, may contain heavy metals.

This leaves iodized salt as the major source of dietary iodine for the U.S. population. Unfortunately, relying on salt for our iodine may not be effective for a number of reasons.

Americans have been told to limit salt intake and are taking the advice to heart. Because excessive sodium intake can increase hypertension risks, many agencies now recommend reducing salt intake. A 1995 report found 58% of men and 68% of women reported never using salt, using "lite" salt, or rarely using ordinary table salt. More recently, the American Medical Association has suggested that the FDA remove salt from the "Generally Recognized as Safe" list. (Interagency Board for Nutrition Monitoring and Related Research. Third Report on Nutrition Monitoring in the United States. Executive Summary; 1995; Page ES-10; http://www.cdc.gov/nchs/data/misc/tronm.pdf.)

Even those of us not actively limiting our salt intake may not be getting much iodine along with our sodium.

A study published in the January 2008 issue of Environmental Science and Technology, Dasgupta P, Liu Y, et al. indicates iodized salt is not likely to contain the amount of iodine it's supposed to, and even if it did, virtually all of the salt actually used in prepared foods in the U.S. is not iodized.

According to product labels, all U.S. iodized salt contains 45 mcg of iodine per gram, but when the University of Texas researchers analyzed 88 samples of iodized table salt from 40 states, 53% of samples contained less. Iodine values in freshly opened, top-of-the can samples averaged 44.1 mcg/kg, but actual values ranged from as little as 12.7 to 129 mcg/kg. And the amount of iodine within each can was not homogenous but varied as much as 3.3 times among the 5 samples taken at different depths from the same container. Iodine was also found to decrease greatly during high humidity storage, although light or heat had little effect. (Dasgupta P, Liu Y, Dyke J. Iodine nutrition: iodine content of iodized salt in the United States. Environ. Sci. Technol., 42 (4), 1315-1323, 2008.)

In sum, if you're using iodized salt, you have no idea how much iodine it is actually providing, and the longer you've had that container of salt, the more likely it's iodine content has decreased.

In addition, in the U.S., the use of iodized salt is not mandatory either in restaurants or food processing. Americans are eating out a lot and even when eating at home, often rely on prepared processed foods. So, although the prepared food we're buying may be highly salted, with very few exceptions, the salt used by restaurants and fast-food outlets is non-iodized salt, and so is the salt used by food processors, who say they fear the possibility that iodized salt might change the flavor of their products.

This concern turns out to be unsupported by fact. In 2006, UNICEF invited delegates from the Republic of Moldova to Switzerland, where all salt for both human and animal consumption must be iodized, to convince them to use iodized salt in food production. Iodine deficiency is common in Moldova where, every year, approximately 27,000 newborn babies suffer from brain damage as a result—a tragedy that using iodized salt in processed foods can eliminate. Delegates visited food factories where they found that the addition of iodine to Swiss bread, baked goods, and world-renowned cheeses causes no change in the taste or consistency of these foods. (Summary here.)

Switzerland used to have high levels of iodine deficiency. In 1806, when Napoleon ordered the Prefect of the Swiss Canton of Valais to conduct a survey for military service recruitment, out of 70,000 inhabitants, 4,000 were diagnosed with cretinism. Later, researchers discovered that cretinism, along with goiter (swelling of the thyroid gland in the neck) and, more importantly, mental retardation, were direct effects of iodine deficiency.

Iodine is necessary for the body's production of thyroid hormones, which, in addition to regulating metabolic rate, direct brain development, so iodine is critical in the fetus (the brain is formed during the 1st trimester of pregnancy), infants and children (brain development continues through adolescence). Lack of sufficient iodine is the leading cause of preventable mental retardation in the world. Even a mild iodine deficit in pregnant women, infants, and children, can lower intelligence by 10-15 IQ points, lessening an individual's mental abilities throughout life.

Switzerland introduced iodized salt in 1922, and since 1960, has eliminated iodine deficiency through universal salt iodization--providing iodine through all salt for human (including table salt and salt used for industrial food production) and animal consumption. Both the visible signs, like cretinism and goiter, as well as the more important hidden effects of iodine deficiency on brain development and IQ, have completely disappeared in Switzerland.

A vastly different situation currently exists in the US. Public-health studies over the past 30 years indicate that iodine levels in the U.S. population, particularly in women of childbearing age, are too low. Urinary iodine (the standard means of evaluating iodine levels in the body) has plummeted by almost 50% in adults, and the frequency of moderate iodine deficiency (urinary iodine excretion of less the 50 mcg per liter) in pregnant women has jumped from 1% to 7%. To underscore how low this is, the WHO defines iodine deficiency as a urinary iodine excretion of anything less than 100 mcg per liter, and estimates that, world-wide, approximately 2 billion people, including 285 million school-age children, are iodine-deficient.

In a recent editorial in the New England Journal of Medicine entitled "Iodine Nutrition - More is Better," thyroidologist Robert Utiger of Harvard Medical School urges that the recommended daily intake of iodine be increased to 300 to 400 mcg, a dosage he feels can best be met through a universal salt iodization program similar to Switzerland's. (Utiger RD, N Engl J Med. 2006 Jun 29;354(26):2819-21, PMID: 16807421)

Utiger's suggested RDA is significantly higher than current U.S. recommendations (see Table: Recommended values of iodine intake in the U.S.), but he argues that the most recent data shows the small easily correctable risks of possible excess iodine consumption are far outweighed by the substantial irremediable risks of iodine deficiency, which is widespread. (Teng W, Shan Z, Teng X, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med 2006;354:2783-93.)

"The best way to address this issue is to at least assure that iodized salt contains the amount of iodine it should, ideally to raise the iodine content of salt, and get the food processors to use iodized salt," says Utiger.



What can you do now to ensure an adequate intake of iodine?

• Check your multiple vitamin and mineral supplement to be certain it provides at least 150 mcg per day. If you are pregnant, trying to become pregnant or breast-feeding, your pre-natal supplements should deliver at least 290 mcg per day.
• Use iodized salt when cooking at home and carry a small container in your purse or briefcase for use in restaurants.
• Experiment with sea vegetables. Many can be found in the form of flakes or powder as well as strips or sheets.
• Nori-used in sushi rolls is also available in seasoned snack-size strips, great for crumbling over soups or salads.
• Kelp-light brown to dark green strips, can often be found in flake form.
• Dulse-a reddish-brown seaweed that is soft and chewy in texture, can be found ground fine for use as a salt substitute.
• Kombu-add a strip to beans while cooking; it will help prevent gas and add flavor.
• Wakame-used to make Japanese miso soup.
• Arame-a lacy sea vegetable with a sweeter, milder taste, adds salty flavor to soups or stews.
• Hijiki-looks like strands of wiry, black pasta, a great addition, in small amounts (it's quite flavorful), to carrot salad. Soak hijiki and mix with shredded carrots, chopped pickled ginger, sesame seeds and oil, a little finely sliced scallion, and a dash of tamari.

One important caveat: Purchase only certified organic sea vegetables to ensure they are free of contamination. Sea vegetables have a high affinity for heavy metals, and if grown in polluted waters, can soak up not only healthful minerals, but also contaminants such as arsenic, lead, cadmium or mercury.

(van Netten C, Hoption Cann SA, Morley DR, van Netten JP. Elemental and radioactive analysis of commercially available seaweed. Sci Total Environ. 2000 Jun 8;255(1-3):169-75. PMID: 10898404)

Related Topics:

• The 10 Best Foods You Aren't Eating
• Food Pyramid Guide - Does Your Diet Measure Up?

Technorati Tags: iodine, food, diet, health, thyroid

Eat Red for Valentine's Day

Our first-ever National "Eat Red Week," (February 4-10) just ended, encouraging Americans to discover the heart-healthy power of red fruits and vegetables. Cherries (especially tart cherries), red grapes, tomatoes, red chili peppers-all these plant Valentines are loaded with phytonutrients our hearts, arteries and veins just love.

• Tart cherries. Tart cherries get their deep red color from disease-fighting phenols called anthocyanins. Michigan State researchers found that tart cherries contain the highest concentrations of anthocyanins 1 and 2, which help block the cyclooxygenase enzymes (COX-1 and COX-2) that are also the target of common pain meds like aspirin, ibuprofen, and acetaminophen.⁽¹⁾
  
  Tart cherries contain 30-40 milligrams of anthocyanins 1 and 2 in every 100 grams (3 ounces) of fruit. (Blueberries lack anthocyanins 1 and 2, but keep eating them; they're packed with lots of other good things!) Tart cherries outstrip sweet cherries in the anthocyanin/phenol department, delivering more than twice as many per 100 grams (92-47 milligrams in sweet cherries vs. 312 milligrams in tart ones).
  
  Tart cherries also score way high on a lab test called the Oxygen Radical Absorbance Capacity (ORAC), which measures how many free radicals a food can neutralize. (Damage done to cells, tissues and organs by free radicals is a key factor not only in cardiovascular disease, but also in virtually every chronic, degenerative disease, not to mention, aging.)
  
  A person needs to consume 3,000 to 5,000 ORAC units each day for blood levels to maintain a good antioxidant defense system, nutrition researchers estimate. Just slightly more than 3 ounces (100 grams) of tart cherry juice concentrate delivers 12,800 ORAC units. A single ounce supplies 3,622 ORAC units. A quarter cup of dried tart cherries weighs in at 3,060 on the ORAC scale, and a half cup of frozen tart cherries supplies, on average, 1,362 ORAC units. ⁽²⁾
  
  Other research recently published in the American Journal of Clinical Nutrition revealed that tart cherries rank 14 in the top 50 foods for highest antioxidant content per serving size – surpassing well-known antioxidant stars like red wine, dark chocolate and orange juice.⁽³⁾



• Red grapes."How do I love thee? Let me count a few of the ways I protect your heart..."
  
  Resveratrol, a flavonoid found in the skin of red and purple grapes (and therefore in red, but not white wine), improves blood flow by stimulating the production and/or release of nitric oxide (NO), a molecule made in the lining of blood vessels (the endothelium) that signals the surrounding muscle to relax, dilating the blood vessel and increasing blood flow.⁽⁴⁾
  
  Resveratrol also inhibits angiotensin II, a hormone secreted in response to high blood pressure and heart failure. Angiotensin II can damage the heart because it tells cardiac fibroblasts, the family of heart muscle cells responsible for secreting collagen, to proliferate. The resulting production of excessive amounts of collagen causes the heart muscle to stiffen, reducing its ability to pump blood efficiently. ⁽⁵⁾
  
  Pterostilbene, another antioxidant in grapes, activates PPAR-alpha. The PPARs are a family of receptors on our cells that mediate their absorption of compounds for use in energy production. PPAR-alpha is crucial for the metabolism of lipids, including cholesterol. ⁽⁶⁾



• Tomatoes. A number of recent studies have found that women with the highest intake of lycopene-rich tomato-based foods have a significantly reduced risk of heart disease. In the most recent, a 4.8 year prospective case-control trial involving almost 40,000 middle-aged and elderly women in the Women's Health Study, as the women's blood levels of lycopene went up, risk for cardiovascular disease dropped-- lots.
  
  The women were stratified into four groups, according to their dietary lycopene intake. After excluding those with angina, women whose plasma lycopene levels were in the three highest groups were found to have a 50% reduced risk of cardiovascular disease compared to those with the lowest blood levels of lycopene. ⁽⁷⁾



• Red chili peppers. Firing up your tastebuds with chili peppers can help protect the cholesterol in your blood from oxidation - a first step in the process that leads to atherosclerosis. In a randomized, crossover study involving 27 healthy subjects (14 women, 13 men), eating freshly chopped chili greatly increased cholesterol's resistance to free radical injury.
  
  Subjects were randomly divided into 2 groups. For 4 weeks, half the subjects ate a freshly chopped chili blend (30 grams/day, about 1 ounce), consisting of 55% cayenne, while the other half consumed a bland diet (no chili and other spices were kept to a minimum). After 4 weeks, the groups switched diet for another 4 weeks. Blood samples were taken at the beginning of the study and after each diet.
  
  After the chili-diet, the amount of free radical damage to cholesterol was significantly lower in both men and women than after the bland diet. In addition, after eating the chili-spiced diet, women had a longer lag time before any damage to cholesterol was seen compared to the lag time seen after eating the bland diet. In men, the chili-diet also lowered resting heart rate and increased the amount of blood reaching the heart. ⁸

This year, send your heart a Valentine: eat red!

Related Topics:

• Can Food Get You in the Mood?
• WebMD Video: Chocolate: Why We Crave It

Studies Cited:
⁽¹⁾ (Seeram NP, Momin RA, et al. Cyclooxygenase inhibitory and antioxidant cyanidin glycosides in cherries and berries. Phytomedicine. 2001 Sep;8(5):362-9.)
⁽²⁾ (Wu X, Beecher GR, Holden JM, Haytowitz DB, Gebhardt SE, Prior RL. Lipophilic and hydrophilic antioxidant capacities of common foods in the United States. Journal of Agriculture and Food Chemistry. 2004;52:4026-4037.)
⁽³⁾ ( Halvorsen BL, Carlsen MH, Phillips KM, Bohn SK, Holte K, Jacobs DR, Blomhoff R. Content of redox-active compounds in foods consumed in the United States. American Journal of Clinical Nutrition. 2006;84:95-135.)
⁽⁴⁾ (Lu KT, Chiou RY, Chen LG, Chen MH, Tseng WT, Hsieh HT, Yang YL. Neuroprotective effects of resveratrol on cerebral ischemia-induced neuron loss mediated by free radical scavenging and cerebral blood flow elevation. J Agric Food Chem. 2006 Apr 19;54(8):3126-31.)
⁽⁵⁾ (Olson ER, Naugle JE, Zhang X, Bomser JA, Meszaros JG. Inhibition of cardiac fibroblast proliferation and myofibroblast differentiation by resveratrol. Am J Physiol Heart Circ Physiol. 2005 Mar;288(3):H1131-8.)
⁽⁶⁾ (Rimando AM, Nagmani R, et al. Pterostilbene, a new agonist for the peroxisome proliferator-activated receptor alpha-isoform, lowers plasma lipoproteins and cholesterol in hypercholesterolemic hamsters. J Agric Food Chem. 2005 May 4;53(9):3403-7.)
⁽⁷⁾ (Sesso HD, Buring JE, et al. Plasma lycopene, other carotenoids, and retinol and the risk of cardiovascular disease in women. Am J Clin Nutr. 2004 Jan;79(1):47-53.)
⁽⁸⁾ (Ahuja KD, Ball MJ, Effects of daily ingestion of chilli on serum lipoprotein oxidation in adult men and women. Br J Nutr. 2006 Aug;96(2):239-42.)

Technorati Tags: food, red, valentinesday, chilipeppers, tomato, tartcherries, eatred

Natural Medicine is Based on Science, Too!

Newsweek Gratuitously Targets CAM

I strongly agree with Jerry Adler in his editorial in this week's Newsweek Magazine that we should make health care decisions based on evidence. In fact, my whole career in the past 35 years has been to advance science-based natural medicine. Science does not belong to any one profession; it is a way of looking at the world to achieve reproducible results and maximize efficacy and safety. Unfortunately, Mr. Alder appears to have an anti-CAM rather than a pro-science agenda.

While he gleefully (and appropriately) gives examples of CAM (complementary and alternative medicine) therapy failures and unsubstantiated and outlandish claims, he ignores equally egregious examples of prescription drug failures, adverse drug reactions and intentional fraud found in conventional medicine. Why does he conveniently ignore the several articles the past year in the medical journals he so trusts that have documented numerous examples of research faked to make drug intervention trials look better and conscious efforts by pharmaceutical companies to avoid reporting adverse events?

Only a single example, the Vioxx tragedy, is estimated to have caused as many as 100,000 excess deaths. This single, properly prescribed and supposedly well-researched drug has, in my opinion, caused far more serious harm by several orders of magnitude than all CAM errors, contaminated or misadvertised products, and adverse events combined. As Mr. Alder so conveniently ignores, several state attorney generals have now sued Merck for intentional consumer fraud. And they are winning.

I don't want to appear to justify CAM failures by pointing out conventional medicine failures - neither is acceptable. As I tell my students and include in my many lectures; "We do research not to prove what we do works, but rather to get better." I am a "true believer" in the natural medicine approach to health. However, that does not mean that everything we believe is correct or that every therapy is safe and effective. The only way to know is to do objective research.

Happily, there are now hundreds of thousands of good quality studies published in peer reviewed journals evaluating CAM therapies. While most show efficacy and safety, some do not. Knowing the difference is how we get better. I could give so many examples. Let's look at just a few recent studies:

• A study of 42 healthy volunteers found that green tea phytonutrients increase activity of the enzymes that detoxify carcinogens.
• A placebo-controlled study of 297 children found that giving them drinks containing FDA-approved food colors resulted in hyperactive behavior.
• A study of 29 postmenopausal women who had suffered from at least 14 hot flushes each week experienced a 50% reduction in symptoms after consuming 1.4 ounces of crushed flax seeds per day.
• A study of 29,361 men found that those who ate more than a serving of either broccoli or cauliflower each week almost halved their risk of developing advanced-stage prostate cancer.
• A study of 889 patients found that drinking cranberry juice significantly boosts eradication of Helicobacter pylori (the bacterium responsible for ulcers and many digestive complaints) in women receiving triple therapy with the antibiotics omeprazole, amoxicillin and clarithromycin (OAC).
• A prospective study of 5,611 adults 60 years or older found that those who most closely followed a Mediterranean style diet decreased their overall mortality rate by 50% after 6 years.

The list is endless.

Mr. Adler's diatribe does a disservice to the over one hundred thousand CAM researchers and clinicians conscientiously studying this medicine and providing health care and the approximately half the population of the US who seek health care from state-licensed CAM professionals and use CAM products.

In this blog, we will continue our commitment to providing our understanding of the best research available. This means considering both negative and positive results.


References
Chow HH, Hakim IA, Vining DR, et al. Modulation of human glutathione s-transferases by polyphenon e intervention. Cancer Epidemiol Biomarkers Prev. 2007 Aug;16(8):1662-6.

McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007 Sep 5; [Epub ahead of print]

Pruthi S, Thompson SL, Novotny PJ, Barton DL, Kottschade LA, Tan AD, Sloan JA, Loprinzi CL. Pilot evaluation of flaxseed for the management of hot flashes. J Soc Integr Oncol. 2007 Summer;5(3):106-12

Kirsh VA, Peters U, Mayne ST, Subar AF, Chatterjee N, Johnson CC, Hayes RB; Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Prospective study of fruit and vegetable intake and risk of prostate cancer: J Natl Cancer Inst. 2007 Aug 1;99(15):1200-9. Epub 2007 Jul 24.

Masala G, Ceroti M, Pala V, et al. A dietary pattern rich in olive oil and raw vegetables is associated with lower mortality in Italian elderly subjects. Br J Nutr. 2007 Aug;98(2):406-15. Epub 2007 Apr 3.

Related Topics:

• Be Smart About Integrative Medicine
• Understanding Alternative Medicine

Technorati Tags: CAM, complementary and alternative medicine, integrative medicine, health and wellness