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Getting lasting strength with a weighted vest exercise program.

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People’s bones have tended to become less dense as they get older, leading to increased risk of fractures. Having low bone mineral density puts you at high risk for fractures, including severely debilitating hip fractures.  About 250,000 people break their hips every year in the US.  This costs billions in health care and can result loss of mobility, bone necrosis (decay of the tissue), lots of pain and suffering and sometimes, death.  Hip fractures can be extremely difficult to heal because bone breaks can result in loss of blood supply to sections of bone.  Luckily bone density is something over which we have some control.  There are several things that are important: diet, vitamin D, and weight-bearing exercise.  They are important as a threesome.

Weight-bearing exercise

Most of us are probably aware that weight-bearing exercise helps build bone. Weight stresses bones.  Bone responds by getting thicker, stronger and more dense.  It needs calcium to do this.   If there is not enough calcium in circulation, your body will take calcium from bones that are not under particular stress and stick it where it thinks it needs it.  This means you can build your femurs while weakening your wrists.  Strengthening hip bones is important because the consequences of hip fracture can be devastating, but it is important to keep the whole picture in mind.  Whole body workouts, along with a good diet, are best.

How much weight-bearing exercise do I need?

Research indicates one hour of weight bearing exercise three times a week is enough to prevent bone loss.  This doesn’t mean that this is the ideal amount.  It just means that it produced measurable results.  More might be better.  Less might be OK.  But one hour, three times a week, works!

What type of weight-bearing exercise is best?

The aim is to put mechanical stress on your bones without causing injury.  This can take any number of different forms.  A major study used very basic lower body exercises, including jumping, with a weighted vest.  Participants started out slowly, adding weight as they went along, with weights tailored to each individual.  Participants were all older women described as “active and not sedentary”.  They did lunges, lateral lunges, chair raises, stepping, and jumping down from an 8-inch step in a group exercise class.  Vest weights were increased incrementally over the course of the study. The women were followed for five years, which is terrific.  It is really hard to do these kinds of studies without losing people to moves, injuries, etc.  A control group was instructed to refrain from new exercise, but to otherwise carry on life as they normally did. Measures of bone density were made at the beginning of the study and five years later.

Results

Women who participated in the weighted vest exercise program increased bone density by about 1%.  That may not seem like much until you look at the results from the women who did not do the weighted vest exercise.  The control women, who were also described as active and not-sedentary) had about a 4% loss of bone mineral density.  The extra weighted vest exercise prevented what used to be considered an inevitable part of growing older.

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What I found particularly interesting was the amount of emphasis placed on jumping as a means of stressing bone.  Jumping has been shown to produce measurable results in young women in as little as two weeks.  (Kishimoto et al. 2012).  Maybe we should be grateful for box jumps and burpees, instead of hating them, like I do.  If you are someone who steps up as an alternative to jumping up on box jumps, consider stepping up and then jumping down.  The landing will stress your hips and leg bones and help strengthen them.  Jumping down may actually be more productive, in terms to increasing bone strength, than the trip up.

A note about rowing:  rowing helps build bone in the spine.  This is important too. Remember whole body training and care.

Here is a short video for those who want to learn more about hip fractures.  I found this video series very helpful in medical school.  There is something soothing about them too.

Shaw JM, & Snow CM (1998). Weighted vest exercise improves indices of fall risk in older women. The journals of gerontology. Series A, Biological sciences and medical sciences, 53 (1) PMID: 9467434

McNamara, A., Gunter, K., & Snow, C. (2005). Postmenopausal Women Who Participate In Rowing Exercise Have Higher Spine BMD Than Controls Medicine & Science in Sports & Exercise, 37 (Supplement) DOI: 10.1249/00005768-200505001-00815

Weighted vest exercise program can build hip bone mineral density

Anti-Depressants increase bone fractures in older women.

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Do anti-depressants increase bone fractures?  Evidence from a new study says yes.  Anti-depressants in the SSRI family have been shown to increase risk of bone fracture before. The new study, hot in Google News, looked at women who were new users without a diagnosis of depression (and presumably prescribed SSRIs for menopausal symptoms) and their risk of bone fracture.  SSRIs are sometimes used to treat menopausal symptoms such as night sweats, hot flashes and mood changes.  Their use has increased since estrogen replacement therapy fell into disfavor.    This study is different and important because:

 

  • Women who are using SSRIs to treat menopausal symptoms are often prescribed doses lower than those used to treat women suffering from depression.
  • We didn’t know if low-dose SSRIs would increase fracture risk
  • Data was available for very large numbers of women (more than 100,000 for each group).  This makes for some pretty reliable conclusions.

Study Structure

Subjects were between the ages of 40 and 64 who had not been diagnosed with depression or other mental disorder.  They were compared with a similar group of women who were taking proton pump inhibitors or H2 antagonists.  These are drugs often used to treat GERD (Gastroesophgeal reflux disease).  They may also increase risk of bone fracture because of their ability to interfere with calcium absorption . . . but the risk appears to be very small.

Study results

After six months of SSRI use, fracture risk was greater than it was among women who did not use SSSRIs.   The difference between the two groups decreased slightly over time, but was still significant after 5 years.  So yes, it looks like anti-depressants increase bone fractures.  At least SSRI anti-depressants.

Conclusions and further thoughts

This may be the first study to show an increased risk of fracture among peri-menopausal women using SSRIs to treat menopausal symptoms.   The study’s authors suggest that use of SSRIs to treat menopause be limited to shorter durations.  Researchers were not able to look at the effects of different doses.  (The actual doses used were not available). Or differences according to type of SSRIs.

Other things to consider

Bone density and fracture risk are dependent on many factors that were not available to the researchers.  Nothing was known about the women’s exercise habits or diet.  Bone building exercise might offset any bone weakness potentially caused by SSRIs.  A good diet and vitamin D might as well.  More research would be needed to understand risks from SSRIs and how they might be controlled.

The two groups were chosen for study not because they were ideal for them, but because the data were available.  It would be nice to have a study that looked at SSRIs, untreated depression, untreated menopause, bone density, fracture risk, and diet.  But studies are expensive.  We are currently in a period where the proportion of funds we devote to research has fallen severely.  According to Reuter’s journalist Sharon Begley:  Government spending on science is the lowest it’s been since WWII, and it’s holding back potentially life-saving advances.  You can write your congressman and tell him or her that research is important.    We all benefit from research.

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Ito T, & Jensen RT (2010). Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Current gastroenterology reports, 12 (6), 448-57 PMID: 20882439

Sheu YH, Lanteigne A, Stürmer T, Pate V, Azrael D, & Miller M (2015). SSRI use and risk of fractures among perimenopausal women without mental disorders. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention PMID: 26113668

Weighted vest exercise program can build hip bone mineral density

Low Vitamin D, Atherosclerosis and CardioVascular Disease

Vitamin D has received tremendous interest over the last ten years.  One of the many things to come out about Vitamin D is that is that it protects against vascular calcification.  Vascular calcification causes or contributes to:

  • Stiff arteries
  • Poor elasticity
  • Increased blood pressure
  • Kidney damage
  • Increased risk of heart attack and stroke
  • Congestive heart failure
  • Early death
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That is terrible.  Not long ago calcification was considered a normal part of aging. Then it was considered an issue of cholesterol and a high fat diet.  The contributions of dietary cholesterol and dietary fats continue to be explored and challenged, however, researchers are uncovering other factors.  Vitamin D insufficiency has been strongly associated with risk of poor health and death.  This includes increased risk of death from cardiovascular disease.  Research groups are  now working to figure out more of the details.

Chronic Vitamin D Deficiency vs. On-again Off-again Vitamin D deficiency

A recent article in the Journal of Nutrition reports on an investigation of Vitamin D and vascular calcification.  The study used groups mice.  It lasted 32weeks.  Different groups of mice were fed either

  1. mouse version of a typical Western diet with adequate vitamin D for 16 weeks
  2. mouse version of a typical Western diet with low vitamin D for 16 weeks
  3. mouse version of a typical Western diet low vitamin D for 32 weeks
  4. mouse version of a typical Western diet with low vitamin D for 16 weeks then switched to a normal D diet for another 16 weeks.

Research Findings

Mice on the 16 week low vitamin D diet had more calcified arteries than mice fed the higher vitamin D diet, but not by that much.  (See the article for details).  The low vitamin D diet, however. turned up something interesting:

  • Vascular cells in the Low Vitamin D mice appeared to change into osteoblast-like cells.  Osteoblasts are build bone.  They also create dense, crosslinked collagen and create a matrix for bone.   This may not be the best thing for vascular health.
  • Mice fed a low D diet for 32 weeks had significantly more plaque than other mice, more osteoblast-like cells and more tumor necrosis factor.
  • Mice who were returned to the normal D diet had less calcification.  This is a nice finding.  It looks like increasing vitamin D  will improve the quality of arteries if your diet has been low in vitamin D.

Takeaway:

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It looks like low vitamin D plays a strong role in hardening of the arteries. Not all is lost,  Damage you have accumulated to date may be reduceable.  Please note too that this was a study of dietary vitamin D and not vitamin D made through sun exposure.  You can make your own vitamin D with exposure to sun light.  Please remember not to go overboard.  Too much vitamin D may also cause calcification of arteries.

 

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Nadine Schmidt, Corinna Brandsch, Alexandra Schutkowski, Frank Hirche, & Gabriele I. Stangl (2014). Dietary Vitamin D Inadequacy Accelerates Calcification and Osteoblast-Like Cell Formation in the Vascular System of LDL Receptor Knockout and Wild-Type Mice Journal of Nutrition

Ellam T, Hameed A, Ul Haque R, Muthana M, Wilkie M, Francis SE, & Chico TJ (2014). Vitamin d deficiency and exogenous vitamin d excess similarly increase diffuse atherosclerotic calcification in apolipoprotein e knockout mice. PloS one, 9 (2) PMID: 24586387

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Is Chewing Gum Good for Teeth? Exercise and gum may protect your jaws and prevent tooth loss.

Exercise, especially weight-bearing exercise, builds bone and protects against osteoporosis and frailty later in life.  Unfortunately, only bone under stress seems to benefit.  For example, runners, who carry their own body weight, tend to have stronger leg bones than cyclists.  Crossfit provides excellent training for bone strength.  It includes weighted movements that target, stress and should strengthen most of the bones in the human body.  That is provided you don’t over train and damage them or have an accident (see post on the risks and benefits of box jumps.)

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Exercise may help protect against tooth loss or weakness.

One area that weight lifting and most forms of exercise will not target are the bones that make up our jaws (although some do manage to make an exception here.  Look around and check facial expressions during heavy lifts).  It is important that these bones stay healthy.  If they degrade they will not be able to hold onto your teeth.  Unfortunately, there has been very little research on exercise and tooth loss.  The only study found in a literature search of Web Of Knowledge saw less tooth loss among older Japanese men who exercised daily (Yoshida et al. 2001.)  This doesn’t quite tell us enough, because of other variables that are also associated with more or less tooth loss such as hygiene, frequency of professional care, dietary habits and smoking.

Is chewing gum good exercise for the bones supporting teeth?

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Gum chewing good for teeth?  Maybe yes.

Chewing gum may strengthen jaw bones and could protect chewers from tooth loss or improve the outcome of periodontal disease.  A research team in Russia studied the effect of chewing gum on bone density in 93 periodontal patients (Loginova et al. 2006.) Bone density increased on the active chewing side.   For optimal effect make sure to switch your gum from right to left periodically.  Goes for the rest of your training too. The full paper is available in Russian.   Yoshida Y, Hatanaka Y, Imaki M, Ogawa Y, Miyatani S, & Tanada S (2001). Epidemiological study on improving the QOL and oral conditions of the aged–Part 2: Relationship between tooth loss and lifestyle factors for adults men. Journal of physiological anthropology and applied human science, 20 (6), 369-73 PMID: 11840690   Loginova NK, Veĭsgeĭm LD, & Churina SV (2006). [Influence of course use of chewing gum on alveolar bone density]. Stomatologiia, 85 (2), 22-4 PMID: 16710273

The WODMASTERS Rhino Design ruminates on Vitamin K

Vitamin K may keep your brain from falling apart

Keeping your brain from falling apart is serious business.  Tape and twine have their places, but we are writing to report on some other . . . . “stuff.”   Today’s stuff is Vitamin K.

Vitamin K, Health and Research

Research is indicating that Vitamin K may be important in protecting brain function. Researchers recently measured vitamin K levels in blood (as serum phylloquinone) and compared them with how well people did on several tests of cognitive function. People with higher levels of Vitamin K did better on tests of verbal memory and recall.   320 men and women between the ages of 70 and 85 participated in the study. This is good news because we do have some control over our vitamin K intake. The study has its limitations of course.  A blood test measures only what is currently in a person’s system.    The blood test used in this study was not able to measure people’s Vitamin K intake over a long period of time.

What is Vitamin K?

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Vitamin K is a fat soluble vitamin.  There are two common forms K1 and K2.  K1 comes from plants.   K1 was the form of vitamin K evaluated on the study of cognitive function.

Animals (like us) use K1 to make K2.  K2 is also synthesized by bacteria in the gut.   People may have many different kinds of gut bacteria.  Your gut bacteria will be influenced by your diet and medical history.

Vitamin K is best known as the vitamin the helps blood clot.  Good dietary sources of Vitamin K include:

  • Leafy greens
  • Brussels sprouts, cabbage, cauliflower, broccoli
  • Grains (minor sources)
  • Liver, eggs, meat, fish

Vitamin K may be important for maintaining bone health as well as brain health.  Vitamin K is being evaluated as a possible treatment for osteoporosis.  Until we hear more on that it is probably best to eat real food and plenty of vegetables rather rely on supplements.  Vitamins in vegetables come “packaged” with many other biologically important molecules.  You may need the entire package (by which we mean vegetable not multivitamin).  A dose of one particular molecule may not be particularly helpful.

Presse N, Belleville S, Gaudreau P, Greenwood CE, Kergoat MJ, Morais JA, Payette H, Shatenstein B, & Ferland G (2013). Vitamin K status and cognitive function in healthy older adults. Neurobiology of aging, 34 (12), 2777-83 PMID: 23850343

Knapen MH, Drummen NE, Smit E, Vermeer C, & Theuwissen E (2013). Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 24 (9), 2499-507 PMID: 23525894

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Bone Health and Osteoporosis: Ups and Downs of Bisphosphonates.

Bone Health and Osteoporosis Risks

CrossFit Bone Health and Osteoporosis.

A CrossFit Masters Athlete from CrossFit Bare Cove in Hingham, MA. takes care of her Bone Health.

If you are young you should eat well, not smoke, and get plenty of weight bearing exercise. Preferably starting from birth (which would be moving your little arms and legs.) There is a lot of research going on in Bone Health. We are learning about it at a rapid rate. This is exciting, but it also means there is a lot that is unknown. And our understanding may change. So far, the agreed Major risk factors for Osteoporosis include:

  • Being female (women lose bone at faster rates than men, and have less to start with)
  • Being white
  • Being small-boned
  • Smoking
  • Drinking
  • Poor nutrition
  • Sedentary lifestyle
  • Losing weight
  • Menopause

Bone Health Protection

  • Being black
  • Having a larger frame
  • Gaining weight (but can cause other health problems)
  • Good diet, not smoking, minimal alcohol intake
  • Weight bearing exercise
  • Being on hormone replacement therapy for menopause (but this increases risk of heart disease and breast cancer)
  • Sufficient vitamin D
  • Sufficient calcium intake

Some things are within our control.  Others are not.  If you are having bone loss you should consider taking bisphosphonates.

 

Bone Health and Bisphosphonates

Bisphosphonates are drugs used to prevent osteoporosis (excessive bone loss). Bone is living tissue. It is constantly replenishing and remodeling itself. Visualize a busy sculptor with modelling clay. If your body (sculptor) senses that bone is not under much stress it will stop paying so much attention to it and focus its energies somewhere else. Bisphosphonates block the cells that break down bone. Cells that produce bone are not bothered by bisphosphonates. This leads to thicker bones.

Bisphosphonates can make bone thicker, reducing hip fractures. They can also make bone more brittle. Some people who have been on bisphosphonates have suffered peculiar shattering of bones. Hip fractures are very dangerous, whether you have osteoporosis. Especially for older people who do not heal as quickly as young people. If you are over age 50 there is a 25% chance that a hip fracture will kill. The odds are worse for the elderly and frail. If you are thinking of taking a bisphosphonate drug to prevent osteoporosis you should probably think about the odds of getting a “traditional” hip fracture vs. a bisphosphonate fracture. The odds of getting a bisphosphonate-type fracture are quite small compared to the risk of getting a traditional hip fracture. Easy choice?  Not yet.

Bisphosphonates and other health risks and benefits.

Bisphophonates may improve “bone health”. They are also associated with

  • Cancer of the Esophogus
  • Atrial Fibrillation (this seems to be more of a risk with intravenous administration)
  • Decreased risk of colorectal cancer (Yea!)
  • Decreased risk of stroke. (Yea)
  • Disintegration of the jaw and tooth problems.
  • Making you feel crappy.   If you take bisphosphonates you should sit quietly for 30-60 minutes afterward.  This will reduce the risk of damage to the esophogus.

Bone Health, Bisphosphonates and Duration of Treatment

Your doctor may recommend that you take bisphosphonates for several years (maybe 5) and then stop for a year or two.  You would be monitored during your “vacation” time to see if your bone has stabilized.  If you start to lose bone again, your doctor may put you back on bisphosphonates.

Meanwhile, continue to eat well and exercise.  Think about giving CrossFit a try too.

I hope this helps.

Here are a few references.  There are many more.

Thosani, N., Thosani, S., Kumar, S., Nugent, Z., Jimenez, C., Singh, H., & Guha, S. (2012). Reduced Risk of Colorectal Cancer With Use of Oral Bisphosphonates: A Systematic Review and Meta-Analysis Journal of Clinical Oncology, 31 (5), 623-630 DOI: 10.1200/JCO.2012.42.9530

Kang JH, Keller JJ, & Lin HC (2012). A population-based 2-year follow-up study on the relationship between bisphosphonates and the risk of stroke. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 23 (10), 2551-7 PMID: 22270858

Kang JH, Keller JJ, & Lin HC (2013). Bisphosphonates reduced the risk of acute myocardial infarction: a 2-year follow-up study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 24 (1), 271-7 PMID: 23152093

Watts, N., & Diab, D. (2010). Long-Term Use of Bisphosphonates in Osteoporosis Journal of Clinical Endocrinology & Metabolism, 95 (4), 1555-1565 DOI: 10.1210/jc.2009-1947