Sunday, December 24, 2017

DX Severe Osteoporosis: Part X - Impacting Skeletal Health

This is Part X of a multi-part essay chronicling my personal experience with osteoporosis. In this series I have been taking readers through the diagnostic and treatment phases of my care that began over 18 years ago when I was diagnosed with severe osteoporosis. Over the years, the combination of experiencing multiple fragility fractures along with an intense immersion into the study of bone pathophysiology has given me a unique understanding of this disease. If you are just joining the series, I encourage you to skim through the previous DX Severe Osteoporosis essays on my blog as they provide background to each new installment. It is my hope that this series will provide you with a better understanding of osteoporosis in general, plus a few "pearls" that you may be able to incorporate into your own quest for better bone health. If you have been reading the essays all along...welcome back.    Dr.M

                                "It's a good idea to keep at least a vague idea of
                                  where you are, no matter how much you are used to 

Now, with this inflammatory reaction to gluten being such an obvious concern, I began to look at this strand of the web through every lens I could. It didn't take long to find a few more important connections. Glutamine, an amino acid energy source for cells that line the intestinal wall, is often found deficient in professional athletes that train hard every day and I certainly fit into that category. Cells of the digestive tract need glutamine for sustenance, growth, and energy production. In an exhausted body that isn't being properly replenished, glutamine levels drop and cells of the gut suffer, with poor absorption of nutrients the unfortunate result.

Even if absorption is normal, a hard-working athlete piles on both oxidative and adrenal stress producing copious amounts of free radicals and high blood titers of the catabolic, destructive hormone, cortisol. Excessive free radical and cortisol levels places high demand on essential fatty acid supplies. An athlete's body extracts aerobic energy from molecules reacting with oxygen. In this process, the oxygen molecule looses an electron and becomes an unstable scavenger called a "radical." These free radicals are insatiable, stealing electrons from their closest molecular neighbors, which results in cellular damage. It's the phospholipids (made from fatty acids) in a cell's membrane, that often get damaged...and a cell's membrane, as I would find soon find out, is vital for more than just defining the cell's boundary.

Fatty acids and phospholipids are vital for optimal cell membrane function including the transference of signals from one cell to another. If omega 3 fatty acid intake is deficient, cell membranes (and their ability to transfer signals) suffer. Athletes are particularly demanding of omega 3 fatty acids and optimal intake is necessary to achieve high level performance. Without omega 3s, cell membranes loose some of their functional capacity. This loss of function not only alters the normal signaling of important information but it also increases the signaling for a heightened inflammatory response!

Over the next few months, I discovered more strands in this elusive web. Amazingly, there was no paucity of evidence in the literature showing that the cells and substances that the body releases in response to inflammation were also the cells involved in the destruction of bone. As the bone in our body ages, it becomes less resilient and develops microfractures. This old weakened bone must be replaced with new bone. Both bone resorption, the dissolving of the old, microfractured bone, and inflammation in response to injury, are crucial to overall health. But when the body fails to limit these processes, the immune system gets out of balance and the skeleton goes into a spiral of disrepair.

In my case, the inflammation in my hip began as a response to the stress fractures but then something went wrong—the injured tissues didn't heal, and the inflammation became chronic. And the Gilbert's* syndrome...?...The condition where bilirubin (a breakdown product of blood) increases due to a specific genetic enzyme deficiency? Where did that fit in? This "harmless," hereditary liver disorder, I found, interferes with fatty acid absorption from the gut. (Yes, the same fatty acids that are often found to be depleted in athletes.) With 5 to 7 percent of the population having this disorder, it seemed to me that it should be taken more seriously by the medical community, especially when dealing with people with an ongoing disease process...such as osteoporosis. An athlete with Gilbert's is under double the physiological stress and at a higher risk for inflammatory related disorders, including osteoporosis. Combine this with a sensitivity to gluten and we have a condition ripe for severe bone loss.

The doctors had assured me that there was "no connection" between Gilbert's and my hip pain or my osteoporosis. But that was NOT what I was seeing. What I was beginning to see was that in medicine, the term "no connection" really meant "we have not yet made that connection" or "we don't have the time or money to research it right now." In their eyes, if it hasn't been researched, it isn't worth thinking about. (And if pharmaceutical companies don't see a way to make money on it, it won't be researched.)

Of course, it is not only the essential fatty acids that can become deficient as a result of the athlete's frequency and intensity of exercise. Vitamin and mineral deficiencies are common, as are deficiencies in amino acids. Glutamine and methionine are often in short supply in both the athlete and in people with Gilbert's syndrome. Not a good thing considering the almost endless biological functions that these two amino acids are involved in: energy production, muscle building, fuel for cells of the immune and gastrointestinal systems, collagen synthesis for both joint and bone, the production of glutathione (the body's most important antioxidant), etc... These two amino acids are needed for just about everything. I immediately began supplementing my diet with glutamine and methionine, and whey protein which is a balanced source of essential amino acids. I also began to take milk thistle (sylymarin). If Gilbert's was involved in the liver's ability to function, I wanted to cleans and optimize the function of my liver as much as possible. With my chiropractic training and interest in nutrition, I knew that consuming lots of fresh green vegetables and supplementing with milk thistle could help. Milk thistle is known for its ability to fortify the liver and, as I found out, prevent the depletion of glutathione and limit free radical damage. It finally felt like I was not only starting to see patterns in this complex web, but that I was also finally starting to understand enough that I was able to do things to positively impact my skeletal health.

...Stay tuned for Part XI of DX Severe Osteoporosis

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