bisphosphonate problems?

[Hopeful]

I have followed some of the threads over the years on bisphophonates and their side effects.

Tex, I saw in one of your posts that this class of drug may be a culprit in developing or worsening MC - is that correct? A friend was recently diagnosed with LC and thinks she can trace it back to an infusion of Reclast 18 months ago.

I have tried both Fosamax and Reclast and they both make me nervous. My latest bone scan shows a worsening of my osteoporosis (hip) and I'm currently suffering from a stress fracture of the knee (femur), so my docs are encouraging me to take these drugs again.

I am a pretty faithful user of Vit. D (5,000/day), very active in the sunshine 5 months of the year, and try to get enough load bearing exercise, but I'm kinda scared that my brittle bones are going to cause continuing problems. I'd like to get another 25 years out of this body (I'm 65).

Any advise?
Chris

[Gabes-Apg]

Chris
do you supplement with Magnesium?

[Gabes-Apg]

hows this for the powers of the universe and fate......
I saw your post, typed the reply and then went to do the washing up and while i do that I play podcasts - the podcast that cameup (i didnt chose it, it was next in line) started talking about cadmium being the major cause of osteoporisis.

I started paying attention big time as your post was top of mind, and because hair mineral analysis showed i had toxic levels of cadmium.
(which I am still trying to sort out how i got... anyways)

is there a possibility that you have high levels of cadmium?

some articles

http://www.functionalmedicineuniversity ... ic/904.cfm
http://www.eurekalert.org/features/doe/ ... 071403.php


before you consider taking the meds, my suggestion is to get hair Mineral analysis done and see if you have any of the toxic metals? and what the ratio's are of key minerals (like potassium, magnesium etc)
if this is the case, you can work on clearing any metals, getting mineral levels right and in better balance. This will help a multitude of things health wise, not just your bone health...

[Hopeful]

Wow - serendipity! I will read the articles. I've lived a pretty "clean" life in a small town, so not sure where the cadmium would have come from, but will look into it. How do you go about getting hair analysis?

I take 400mg. of magnesium and I'm building up to 600. I also take 50mg. potassium with iodine and 300mg. calcium bone builder.

Cold weather always seems to worsen my AI symptoms, aches, etc. but the stress fracture has been a real pain, literally. The crutches are such a drag and I'm not much of a "sitter-arounder". The rest is probably good for me, to some extent...

Thanks, Gabes. If you have any other thoughts, let me know...
Chris

[Gabes-Apg]

i also listen to these podcasts (really good)
https://www.bulletproofexec.com/hair-analysis-test/

Ensure you get a test that includes report/interpretation etc...

not easy for me to search for places in USA from Australia... I did find this one - pricing wise it is in line with what i paid in Australia
http://store.liveto110.com/htma/hair-mi ... pretation/

The example report is EXACT same as mine...


As you are talking calcium supplement it is pretty important to ensure you are getting at least 600mg of ELEMENTAL Magnesium (check the back of the magnesium bottle to check how much elemental mag you are getting)

[Gabes-Apg]

it is heat and humidity that makes my symptoms worse!

[tex]

Chris,

I can't add much to what Gabes posted, except to discuss the bisphosphonate issue. Yes, they are listed as a possible trigger for MC. But they also carry other health risks that would rule them out for me.

Have you considered strontium ranelate? You might be interested in the thread at the following link, because Gloria was in a similar situation with osteoporosis issues.

Bone Density Test Results with Strontium

The biggest problem that I have with the bisphosphonates is that they artificially create harder bones, but in doing so they also create brittle bones. They work by preventing the body from removing dead bone tissue. The way the healing process works is that dead bone must be removed first, before the body will generate new bone tissue to replace it. But the bisphosphonates prevent the dead bone from being removed, which then guarantees that no new healthy bone tissue can be created. This results in ossification of the bone. The bone looks good in a bone density test (because it becomes hard and brittle), but the effect is all smoke and mirrors as far as bone health is concerned. I can't believe that doctors are dumb enough to prescribe bisphosphonates in the face of the evidence, but they do it anyway.

By contrast, strontium ranelate promotes the growth of new, healthy bone tissue. But no one in the medical industry promotes it, because the drug companies apparently can't make any money out of it.

Tex

[Hopeful]

Thanks, Tex, can you direct me to where bisphosphonates are listed as a probable cause of MC? I want to share that with my friend.
Everything I am reading on the drugs goes along with what you're saying about the dead bone tissue. Why, indeed, would we want to initiate that vicious cycle?

Gabes, as always, you are a wealth of information. You have given me lots to read, listen to, and think about today.

So, if your symptoms are worse in high summer and mine in the dead of winter, we're probably both kinda miserable in Jan./Feb., eh?

Best to you both...Chris

[Hopeful]

So, now I'm confused about strontium. The literature says to make sure to be getting sufficient calcium before taking this, but I only take 300-400mg. calcium/day (Doctor's Best calcium bone maker) - not the recommended dose. I also take 400mg. magnesium.

Then there's the question of which strontium to take. Gloria suggest Doctor's Best (and I like that company) but that doesn't seem to be the strontium ranelate that Tex was talking about.

If Gloria is following this, has the strontium continued to improve your bone density over the last couple of years?
Thanks,
Chris

[Rosie]

I had considered using strontium supplements for my osteoporosis, but in the past few years there has been increasing evidence that strontium can increase the chances of a blood clot or other cardiovascular symptoms in people prone to that. I have a genetic susceptibility to increased blood clotting (Factor V Leiden) so quickly decided that it wasn't worth the risk. Strontium renelate is a prescription drug in Europe called Protelos that has been used for a number of years there, so there is more of a track record in Europe. The official position of the European Medicines Agency is that its use should be restricted to a subset of patients for whom there is no other treatment and who have been screened for cardiovascular conditions. So I would be cautious and investigate before using.

Here is a link to the official UK government web site on this issue:

https://www.gov.uk/drug-safety-update/s ... cular-risk

Rosie

[tex]

Hi Chris,

Regarding drug-induced MC, first you have to recognize that there is no proof that any drug causes MC. That kind of medical proof would require multiple RCTs, and no one is going to support such research since it would require an intentional iatrogenic procedure — namely intentionally inducing MC in humans. Such lab experiments are legal in lab animals, but not in humans.

So that means that all evidence concerning drugs that may cause MC is epidemiological, strictly based on observational associations between the use of the drugs and the development of MC. With that caveat, you will find bisphosphonates listed among the drugs suspected of causing MC in the abstract of an article published in The American Journal of Gastroenterology at the following link:

Drug Consumption and the Risk of Microscopic Colitis

Note that percentage-wise, some drugs are more commonly associated with the development of MC than others. But remember that statistics are sort of irrelevant to me (or you), if I (or you) happen to be among those who develop the disease because of using a particular drug. And note that the article fails to even mention antibiotics. Antibiotics are known to be one of the most common causes of MC.

Regarding the strontium: Rosie covered that very well. Numerous forms (compounds) of strontium are available. Strontium ranelate was the subject of original tests, and it produced impressive results for bone health, but as she pointed out, later studies revealed an increased risk of myocardial infarction, so to the best of my knowledge, strontium ranelate is currently restricted for use by postmenopausal women who have severe osteoporosis and who are at a high risk for fracture.

Gloria used strontium citrate because it is available, and it works well. You may find the article by Dr. Hoffman at the following link to be helpful. It covers the various forms of strontium that are available. But apparently the strontium citrate is the most absorbable form, which should make it the most effective form. But as Rosie noted, if you already have an increased risk of cardiovascular issues, stontium may not be safe. Unfortunately, all drugs carry risks.

Strontium for bone health

If Gloria doesn't happen to notice your post, please feel free to email her (or PM her). I'm sure she would be happy to try to answer your questions.

Tex

[Blueberry]

I shared this article with my mother who is concerned about brittle bones. Thought to pass along Dr. Heaney's article on protein in case it could help. He's a world renowned bone and osteoporosis expert.

"The Paradox of Osteoporosis Irreversibility"

http://blogs.creighton.edu/heaney/2014/ ... ibility-2/

excerpt from his article:

...That landscape began to change a few years ago when an insightful investigator at the Tufts Nutrition Research Center on Aging in Boston noticed that a high calcium intake did, in fact, lead to increased bone gain if the patient’s intake of protein was high. Bess Dawson-Hughes had previously published the results of a calcium and vitamin D supplementation trial, producing a better than 50 percent reduction in fracture risk in healthy elderly Bostonians with those two nutrients alone. But, like others before her, she noted that, while high calcium intakes reduced or stopped bone loss in her treated subjects, the two nutrients didn’t lead to bone gain. They didn’t, that is, in individuals consuming usual protein intakes. However, in a subset of her treated patients, who, it turns out, had protein intakes above 1.5 times the RDA (0.8 g/kg body weight), bone gain was dramatic (while it was zero in those with more usual – and usually thought “adequate” – protein intakes). The figure below shows the 3-year change in bone mineral density (BMD) at the hip in the calcium- and vitamin-supplemented participants in the Tufts study. Only with the highest protein intakes was there appreciable bone gain.

For me, it was an “Aha!” moment. Why hadn’t we thought of that? It was known that bone is 50 percent protein by volume (but only about 20 percent calcium by weight). And it was known that when bone is torn down (as with estrogen or calcium deficiency), its protein is degraded in the process. So it made sense that, to rebuild the lost bone, you would need not just calcium but fresh protein as well.

When I first heard of this result, I immediately went to our own Creighton database on calcium metabolism in midlife women (the “Omaha Nuns Project) and looked to see whether protein intake (which we had recorded and measured) made a difference in the bone metabolism of our nuns. There it was, just as the Tufts investigator had shown. Our nuns with protein intakes below the median for the group could not retain calcium, no matter what the intake (i. e., they couldn’t build bone). By contrast, those with protein intakes above the median for the group retained extra calcium reasonably well.

So, here were two distinct data sets, two quite different investigations, exhibiting the same interdependence of calcium and protein. What we, and probably most clinical nutritionists, had failed to recognize, was that the adult RDA for protein is just barely enough to prevent muscle loss, and is not enough to support tissue building or rebuilding. But, as already noted, when calcium deficiency leads to bone loss, the bone protein is lost as well, and that has to be rebuilt to restore the lost bone.

This mutual dependence of calcium and protein provides a good illustration of two key (and often underappreciated) aspects of nutrition. The first is that nutrients almost always act together with other nutrients. The second feature is what Bruce Ames of the University of California, Berkeley, has called a “triage” system within nutrition. The body operates a triage mechanism, ensuring that the most vital functions receive the nutrients first and leaving the other tissues and systems of the body to get by on what is left over. It seems that this triage mechanism is at work with respect to adult bone rebuilding. With limited protein intake, the body ensures that its most vital functions are served first. Bone, in effect, gets the leftovers. We need a high protein intake precisely to ensure that there will be something left for bone....

[tex]

That certainly makes sense. The protein RDA for human adults is analogous to the relatively low protein content of rations that ranchers use to maintain the health of cows (adult cattle). But if a rancher (or feed lot operator) were to feed that cow's ration to calves, they would be slow to develop, and they would mature with inferior bones and muscles, IOW they would be stunted, because the ration would not contain enough protein to grow healthy bones and muscle tissue.

It's just common sense, and so logical that I'm not surprised that mainstream medicine has overlooked it for so long, because they only believe what they can prove, and they only prove what they choose to prove. But geez — why have we also overlooked that aspect of bone development? We should know better, because we have long known that extra protein is required to heal the gut. So it's not much of a stretch to recognize that extra protein is required to heal the bones, also.

Thank you for bringing that important observation to our attention. I notice that I already had your reference bookmarked, so apparently I had already seen the article, but either I didn't read it or I forgot about it. Shame on me. Now we know how to prevent/treat osteoporosis.

Tex

[JFR]

The question about how much protein we need is debated in the low carb/ketogenic diet community, mostly in reference to type 2 diabetes. Some people, in order to get their diabetes under control (reduce insulin resistance thereby lowering blood sugar levels) find they also have to reduce protein intake because of gluconeogenisis where protein is converted to glucose. This problem, it seems to me, would only develop in someone who had been eating a diet that was too high in carbohydrates, especially the highly processed types, for long enough to develop type 2 diabetes. So by the time someone reaches an age where they are worrying about osteoporosis they may also be worrying about type 2 diabetes and would have to balance the needs of the bones for adequate protein with the dangers of too much protein because of glucose being produced through gluconeogenesis. And we can't forget the needs of the gut for enough protein so that it can heal which is what brings us all here in the first place. Seems to me that the best solution is to start out life eating a real food diet(s) that promotes optimal health (if we ever figure out exactly what that is or they are) rather than having to figure out what to eat to avoid or minimize all the later in life issue like osteoporosis and type 2 diabetes(which seems to be happening earlier and earlier in life for some people) along with perhaps MC. If we only knew then (when we were infants) what we know now.

I hope this makes some sense since my grasp of science tends to be shaky at best.

Jean

[Blueberry]

I enjoyed the article also, about protein helping build bones. My concern has less to do less with type 2 diabetes, it is a concern naturally but having the condition under control can have different meanings it seems - I am concerned about the mention of dairy being the perfect food to build bones. There are some observational studies finding the more dairy consumed the greater the problems seen with bone strength. Observational though doesn't mean proof. Vitamin D and other nutrients are important, such as protein. It is interesting, and there was a follow up study observational study on this that came out late last year finding similar.

When I saw the article and study mention with it, it made me think of weight lifter and their high protein diets being eaten to build bones and muscles.

On type 2 diabetes, one of the troubling aspects of our current management of type 2 diabetes is that it is not preventing complications. That's an important part that one wants to prevent with diabetes. Having blood glucose under control isn't preventing complications. There were a few studies that came out on that a couple years ago. As a result some are changing tactics on how they approach treating type 2 diabetes. Low carb Kidney specialist Dr. Jason Fung for example is now advocating low carb diets, along with fasting. Dr. Fung feels low carb diets and fasting will lower insulin levels, which is different from glucose levels, and he feels is the main important part now to look for in preventing diabetes complications.

On the studies Dr. Kendrick had this write up, with his belief that low blood sugar is more important to regulate when it comes to preventing complications:

"Turning diabetes upside down"

http://drmalcolmkendrick.org/2015/08/04 ... side-down/

...How well does this work? Some of you will have heard of the ACCORD study, others will not. In this study researchers, tried to force blood sugar levels down as far as possible using intensive treatment. They found the following:

‘Until last week, researchers, doctors and every medical professional has believed for decades that if people with diabetes lowered their blood sugars to normal levels, they could not only prevent the complications from diabetes, but also reduce the risk of dying from heart disease. But the Accord Study, (for Action to Control Cardiovascular Risk in Diabetes), a major NIH study of more than 10,000 older and middle-aged people with type 2 diabetes has found that lowering blood sugar actually increased their risk of death.2’

There is one other way of lowering blood glucose, by using insulin ‘sensitising’ drugs. In diabetes most doctors look at metformin as the wonder drug. This drug improves ‘insulin sensitivity’ i.e. it helps to reduce insulin resistance. It is the absolute mainstay of type 2 diabetes treatment. Once again, however, it is targeted at purely the insulin/glucose model:

‘Metformin has been the mainstay of treatment for type 2 diabetes since 1998 when the UK Prospective Diabetes Study showed reduced mortality with metformin use compared with diet alone. Recently a French meta-analysis of 13 random controlled trials questioned the central role of metformin in the care of patients with diabetes. In this meta-analysis, in which 9560 patients were given metformin and 3550 were given conventional treatment or placebo, metformin did not significantly affect the primary outcomes of all cause mortality or cardiovascular mortality. The secondary outcomes—myocardial infarction, stroke, heart failure, peripheral vascular disease, leg amputation, and microvascular complications—were also unaffected by treatment with metformin.’3

Today we have a virtually unquestioned model of diabetes that is very simple, and easy to understand. It should be simple to understand as it works like this. If the blood sugar goes up, the body produces insulin to lower it. If the blood sugar goes down, the body produces less insulin and the sugar level goes up.

This has meant that, if you find someone had high blood sugar levels, you basically hit them with insulin. I call insulin the ‘glucose hammer’ and, as a wise man once said. ‘If the only tool you have is a hammer, pretty soon everything starts to look like a nail’.

Reducing glucagon…. anybody?

Paradoxically, I was reading about the work of Dr. Walter Kempner of Duke University recently and his rice, fruit and sugar diet. One would think the all carb diet would be terrible for diabetics. Instead for most the opposite occurred. For many type 2 diabetics their condition improved, and complications went away. It makes me wonder if wheat gluten is the problem. Maybe dairy products. Scurvy. Hard to say.

http://rawfoodsos.com/2015/10/06/in-def ... ht-part-1/

Denise Minger wrote a long article on Dr. Kempner's work, part of which can be read here. Dr. Kempner was popular and well known in his day, treating around 15,000 patients if my memory is correct.

...All that said, the rice diet was about far more than impressively svelte before-and-after shots. As alluded to earlier, it also had the uncanny side effect of improving diabetes and insulin resistance—even when weight loss wasn’t part of the equation. I warned you this was gonna get weird! Kempner published a whole paper on the topic in 1958, which you wouldn’t know by looking at its hauntingly empty PubMed entry:

Effect of rice diet on diabetes mellitus associated with vascular disease.
(Email me if you want the full text!)

For starters, Kempner was just as perplexed as us modern-day health enthusiasts might be when it comes to the effect his diet had on diabetics. As he penned in the paper you cannot see:

We have for the past 15 years treated numerous diabetic patients with the rice diet. Since more than 90 percent of the calories in this diet are derived from carbohydrates, it was anticipated that increased amounts of insulin would be necessary to keep the blood sugar at its previous level. However, the opposite proved to be true. … Not only is the rice diet well tolerated but in many instances the blood sugar and the insulin requirements decrease.

In this report, Kempner analyzed 100 diabetics who’d entered the rice diet program between 1944 and 1955. All of them strictly followed the diet for at least three months (often much longer), and they were observed an average of nearly two years—with some folks monitored for up to eleven years after they’d first embarked on the carby cuisine.

The findings? Ladies and gents, place your bets…

More than half of those 100 diabetic ricers—63%—actually saw their fasting blood sugar drop by at least 20 mg/dL during the diet. Only 15% had their blood sugar go up significantly. The remaining 22 saw little to no change.

To get a visual sense of those numbers, here’s an aptly named pie graph (don’t worry; it’s fat and carb free!). “Increased” or “decreased” is defined as a change of at least 20 mg/dL:

fasting_blood_sugar_rice_diet

Let’s repeat that: eating almost nothing but starch and sugar and fruit, the majority of diabetic patients lowered their blood sugar levels. In fact, when everyone’s results were pooled together, the average blood sugar change was a drop of 47 points.

‘Twas a similar story in Insulin Land. Of the study’s participants, 68 entered the scene already dependent on insulin. As the carbs raged on, 21 of those insulin-injecters didn’t have to change their dosage; nine needed an increase (including four people who initially weren’t on any insulin at all); and—again comes the cruel, cruel defiance of prediction—42 slashed their usage significantly. In fact, 18 folks were able to discontinue their insulin entirely. Feasting on white rice. And sugar. And fruit juice.

Here’s another delicious graph of pie, calculated for the 72 patients who needed insulin at some point during the study:insulin_usage_rice_diet

Once again: eating virtually nothing but this…

kempner_foods

…the majority of diabetics ended up with better glucose control and insulin sensitivity, and in some cases freed themselves from diabetes entirely.

Let that sink in for a minute.

Or two, if you need to grab a glass of water and ward off the vapours.

Just to be clear, the point here isn’t that the rice diet is the Best Thing Ever for diabetics and everyone should trade their insulin pumps for a metric ton of Skittles (nobody needs to taste that many rainbows). After all, 15% of the rice-dieting diabetics actually got worse, many of the improvers still had above-normal blood sugar (despite huge drops from baseline), and we could probably hack Kempner’s protocol to make it more nutritionally sound without ruining its therapeutic effects. Clearly, it ain’t perfect. All I’m saying is that these results totally fly in the face of what most of us consider possible. Sugar and white rice improving diabetes? Blasphemy!

&

...NOPE. As Kempner pointed out, any obese patients were indeed encouraged to lose weight—but the improvements in blood sugar levels and insulin requirements occurred “both in patients who lost weight and in those who did not have a significant weight change” (his words). Kempner’s data, both in this paper and in the massive collection of his work filed away at Duke University, showed that the diet could benefit diabetics even when their weight and energy intake didn’t budge.

And it didn’t end there. The rice diet also proved helpful for heart failure. It rapidly healed psoriasis. It excelled at its original goal of treating high blood pressure. The “good for” list stretched on nearly as far as those endless bowls of rice! As early as 1949, Kempner had observed that the rice diet was healing more than 70% of his seriously ill, not-responding-to-other-treatments patients from a wide spectrum of disease backgrounds. That figure stayed pretty stable as the decades rolled on.

psoriasis_rice_diet
Psoriasis obliteration on the rice diet.

Just last year, the Journal of Electrocardiology published something of a Rice Diet Resurrection, dredging up Kempner’s key findings and blasting open his oft-forgotten legacy: “An archaeologic dig: A rice-fruit diet reverses ECG changes in hypertension.” In it, the authors pointed out something pretty important regarding the ultimate success of the diet. A band-aid treatment it was not; the rice diet actually seemed to permanently reverse the conditions it set out to treat, at least for many adherents:

A poorly known but important observation was that patients who were able to follow the regime, and who were slowly guided through a gradual modification of the diet over many months, were able to transition into a very tolerable low fat, largely vegetarian diet, while leading a normal, active life, without medications, indicating that the disease state had been permanently modified.

“Permanently modified” probably needs a qualifier, since those folks couldn’t make a total return to their former gustatory ways. But over time, they could start eating a more diverse diet with (lean) animal foods, all manner of vegetables, a moderate level of salt, and the magnificent return of tastiness. Not too shabby, considering many of those folks were initially riding a bullet train towards death. (In another very recent article, “Who and what drove Walter Kempner?“, the authors noted that in Kempner’s day, life expectancy for anyone with malignant hypertension—one of Kempner’s main patient demographics—was only six months. The fact that he gave most of them decades of recouped earth time was pretty fantastic.)

So whatever became of the rice diet? Like most things in life, it lost out to stuff that was newer, prettier, shinier, and easier to squeeze inside an FDA-approved pill. Kempner relinquished the Rice Diet throne in 1992 (and in case you’re wondering, died of a heart attack five years later, at the age of 94—though it’s unclear what his own diet and lifestyle actually were). After his departure, the rice diet predictably loosened up: the program later allowed “a wider selection of largely vegetarian food choices,” though still with low sodium and protein intake (and ostensibly less whipping).

In his 1983 article “Kempner Revisited,” Eugene Stead—who’d worked at Duke alongside the Rice Man himself—summed up Kempner’s unorthodox legacy in a way that captures my own thoughts:

Who in his right mind would have ever thought that rice and fruit could modify vascular disease appreciably? Who would have fed a protein-deficient patient, losing large quantities of protein in his urine, a protein-poor diet? Who would have dared to give a more than 90% carbohydrate diet to a diabetic? Every expert knew that cholesterol levels were not influenced by diet. Nevertheless, all these leads have paid off richly.