Ways to improve bone density, not just for people with osteopenia/osteoporosis

Breaking a hip was something my mother worried about, especially in her 80s and 90s.  She worked hard to avoid bone loss after age 60 or so.  She took calcium and Vitamin D supplements, made good nutrition choices, and did basic exercises to keep her bones as healthy as possible.  In her 90s, she walked for exercise a few times a week or used a small hydraulic stepper in her apartment (independent retirement community) if she did not feel like going out.  She was quite successful at avoiding any fractures, even after a couple hard falls at age 95.

I did not do a bone density screening until close to age 60.  Turned out that my legs and hips were in great shape.  The ski conditioning I started doing after knee rehab at age 57 probably was helpful.  However, my T-score for my spine was classified as osteopenia.  After a little research, I learned that it's possible not only decrease bone loss, it's even possible to improve bone density with appropriate exercise.  There are several relevant studies that include women over 70.

Found a video made by two physical therapists that is a good introduction to why bone loss in the spine can cause problems.  It's done in serious but light-hearted way.  Their focus is on people who probably are not out hiking, skiing, or even walking very much.  They mention four elements that should be addressed by specific exercises:

• weight bearing
• resistance
• posture
• balance

After showing what can happen with a model of a spine, they demonstrate three basic exercises: modified dead lift, lunge, push up.

The key point is that bones are not static.  Bone is constantly being re-modeled by osteoblasts and osteoclasts in response to the needs of the body.  The goal of exercises based on weight and/or resistance is to provide appropriate levels of stress to stimulate osteoblasts and build more bone.  Aerobic exercise from swimming or cycling is good for cardio but do not help build bone in the spine.  For more details, check out this webpage about weight bearing exercise as a way to prevent fractures in older people.

Working with heavy kettle bells is a straightforward way to to improve bone density.  Must be using enough weight.  8-10 pounds is not nearly enough.

The 66yo woman in this video is using 26 pounds.  Of course, her trainer had her work up to that weight.  Good form is especially important for anyone with osteoporosis in the spine already.

I found working with my trainer that 20 pounds was okay for the kettle bell swing and chest-hold squat when she started adding bone building exercises to my sessions.  The ideal is to do the exercises 3 times a week, possibly alternating between heavier and slightly lighter weights.

Here are a couple other examples of exercises with weights.  The first is a lunge and press, the second is a single leg deadlift with weights.  I started with 12 pound dumbbells.  Fewer reps with more weight at slow speed is better.

Benefits of fasting for active people goes beyond weight loss

Although intermittent fasting starting making news in 2016 and really became popular in 2017, researchers began considering the effectiveness of fasting a decade earlier.  Dr. Mark Mattson has studied in the connection between nutrition and diseases such as Alzheimers for quite a while.  He is the chief of the Laboratory of Neurosciences at the National Institute of Aging and Professor at Johns Hopkins.  His research influenced Dr. Michael Moseley, who did a BBC documentary in 2012 about the benefits of intermittent fasting.

I became more curious about Mattson after reading Kyle Boelte's May 2017 article in Outside Online entitled "What I Learned from a Year of Intermittent Fasting."  Boelte is an active man in his 30s who does not need to worry about losing weight.  However, he tried fasting to address issues that were compromising the quality of his life.  The subtitle for the article is "It won't solve all your health problems, but it might make your life a bit better."  In Nov 2017, he wrote a followup article entitled "How to Start Fasting: A beginner's guide to the burgeoning nutrition trend" that is also a good read.  It's the best introduction I've found so far for active people willing to experiment with fasting.

"I settled on the 16-hour fast, where I’d limit eating to an eight-hour window every day. As Mattson explains, the liver stores glucose (the body’s main energy source when you are regularly eating carbohydrates) for about ten to 12 hours after a meal. When you fast for more than 12 hours, your body switches from glucose metabolism to fat metabolism, which leads to a bunch of positive adaptive cellular stress responses. So, if you fast for 16 hours each day, you’re receiving the benefits of those adaptive responses without limiting your total caloric intake." 

https://www.outsideonline.com/2181151/what-i-learned-year-intermittent-fasting 
https://www.outsideonline.com/2258396/how-start-fasting

The 2014 medical journal article by Dr. Mattson referenced in Outside Online is entitled "Meal frequency and timing in health and disease."  There is a long list of references for those interested in learning more.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250148/
Proc Natl Acad Sci U S A. 2014 Nov 25; 111(47): 16647–16653. 
Published online 2014 Nov 17. doi:  10.1073/pnas.1413965111

Reasons to avoid diet soda

The idea that diet soda is "healthy" seems to be more a function of good marketing since the 1960s than any scientific research.  The same could be said of sugar substitutes in general, but those who drink diet soda regularly probably consume far more soda than other food with the same amount of sugar substitutes.  The negative impact of drinking 1+ diet sodas per day in the U.S. is not new information.  However, the long term impact from an epidemiological standpoint is probably more obvious in 2018 than it was fifty years ago when diet drinks were still relatively new.  Coca-Cola and Pepsi were selling diet sodas by 1963.

A search on "reasons not to drink diet soda" will bring up lots of articles.  Here are a few to think about.

10 Reasons to Give Up Diet Soda - 2013

11 Reasons You Should Never Drink Diet Soda, Like Ever - 2017

Diet Soda: Good or Bad?

includes links to references - 2018

Looking for clinical trials related to diet soda can get pretty complicated.  Here's an example.  This 2015 study from the American Journal of Clinical Nutrition compared diet soda to water over a 24-week period.  It's a small study considering obese women with about 30 subjects in each group.  The soda group drank 1 soda at lunch 5 days a week.  The results was that the group drinking water at lunch lost more weight and the difference was statistically significant.  The level of insulin resistance was also measured and the water group did better.

Effects on weight loss in adults of replacing diet beverages with water during a hypoenergetic diet: a randomized, 24-wk clinical trial

It's clear that a diet soda causes just as much of an insulin spike as a regular soda.  Higher insulin levels means less chance the body switches over to burn stored fat.  That can be a key reason people who drink diet soda all day long have big waistlines and trouble staying at a healthy weight, no matter how much they restrict calorie intake and/or exercise.

The development of diabetes, kidney failure, heart failure, or osteoporosis takes years and there are many risk factors.  The research in the last 10-20 years generally supports the idea that finding an alternative to diet soda that does not include sugar substitutes is worthwhile for people interested in long term health.

When I was growing up, my family never drank soda of any kind.  Now that I am over sixty, I am rather glad I do not like soda or the taste of any sugar substitute in any type of drinks.

Science behind fasting, hunger, and daily eating habits

As I looked around for information about fasting, I came across a series of well researched videos by an American living in Tokyo in a blog called What I've Learned.  Some of the videos go together with a blog entry of the complete text.  My interest in learning more about fasting is in longevity with a high quality of life, as opposed to any need to lose more than a few pounds.

The 2018 video below is a good summary of about why someone who is fasting does not feel hungry all the time.  There are several hormones involved with eating and how the body finds fuel from food or stored fat that have only been measured relatively recently as part of medical research.  An example of of Ghrelin (hunger hormone) levels during fasting begins at the 5 min. mark.  Note that 2017 book The Obesity Code by Dr. Jason Fung is referenced.

The 2016 video about eating one meal per day includes references that demonstrate that the idea of fasting as beneficial are not particularly new.  What's actually new in the history of human beings is the concept that three meals a day are necessary for a healthy lifestyle.

Intermittent Fasting & Hunger - What the Science says, 11 min - 2018

https://www.patreon.com/posts/16239257

https://youtu.be/dFT2IKmwyfg

Longevity & Why I eat once a day, 16 min - 2016

https://lifeforbusypeople.com/2016/07/23/longevity-why-i-eat-once-a-day/

https://youtu.be/PKfR6bAXr-c

A few bone building exercises based on lifting heavy weight

EDIT Dec2017: The Super Senior Fitness website is gone.  But the videos are still on YouTube.

Came across a website created by a Canadian born in the 1940s who retired to Mexico after a career in fitness and martial arts.  It's called Super Senior Fitness.

These short videos show the proper way to handle lifting weights, either a kettle bell or a dumb bell.

For me, I'm happier learning proper form from a trainer.  Plus she makes sure that I increase weight at a reasonable pace.  After a couple months of focusing on strength training with the goal of building bone to help my spine, I'm using a 20 or 25 lb kettle bell.  For dumb bell exercises, I use 8, 10 or 12 lb depending on the situation.  In a class, I use lighter weights.  With my trainer or working out on my own at the fitness center, I use heavier weights.

One Arm Row

Dumb Bell Overhead Press

Kettlebell Swing

7-Minute Workout based on HIIT to do anywhere

Back in 2013, the NY Times wrote up a 7-Minute Workout and it proved to be quite popular.  The basic premise is that the workout uses HIIT to achieve maximum results in a short amount of time.  HIIT stands for High Intensity Interval Training and has been researched a reasonable amount in recent years.  The NY Times article was inspired by an article with the title "High-Intensity Circuit Training Using Body Weight: Maximum Results With Minimal Investment" from the Amer. College of Sports Medicine's Health and Fitness Journal.  My personal trainer suggested I give it a try during a training session about a year after I completed physical therapy for knee rehab.  After that I found a free app that makes it easy to do the workout, especially when I am traveling.  All that's needed is a little space, a towel, and an appropriate chair.

https://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/

When I first started doing the 7-Minute Workout, I was in decent shape but I wasn't ready for 30 seconds for some of the exercises.  I did what I could, and then took a longer rest until it was time for the next exercise.  I felt it was more important to maintain good form than worry about the number of reps.  For instance, I started with about 8 pushups at a slow pace.  Once I got into better shape, I started doing 10-15 pushups in the 30 seconds.  When I'm in good shape, I can do 20 pushups.

Possible progression from easy to harder:

1. Very slow, stopping before 30 sec up if needed, complete rest for 10 sec
2. Slow and steady, continue for 30 sec, complete rest for 10 sec
3. Normal pace for 30 sec, simpler versions for a few exercises, complete rest for 10 sec
4. Normal pace for 30 sec, good form for all exercises, complete rest for 10 sec
5. Normal pace for 30 sec, good form for all exercises, active rest for 10 sec

This video demonstrates the entire 7-Minute Workout.  She gives good explanations.  In this case, active rest is used instead of complete rest.  She does exercises that rely on upper body strength the easier way.  For instance pushups or the plank from her elbows.

Bone density and hyperthyroidism

An additional factor for some women, and men, to consider when thinking about bone density are thyroid hormones.  People with hyperthyroidism are at higher risk of low bone density.  People taking medication for hypothyroidism who are not being monitored often enough can end up taking too much synthetic hormone that causes them to have too much in their system.  That's a reason to check thyroid labs at least every six months, as well as pay attention to common symptoms for hyperthyroidism and hypothyroidism.

Thyroid Disease, Osteoporosis and Calcium

The good news is that once thyroid hormones are back in normal range and stable, it's possible to build up stronger bones to get back to a normal level for a given age.

References about Osteoporosis on MyThyroid.com

A good source of information about thyroid imbalance is the latest edition of a book first published in 1999.  The Thyroid Solution by Dr. Ridha Arem, covers diagnosis and treatment for hypothyroidism and hyperthyroidism in great detail.  The third edition was published in 2017.

I was diagnosed with an over active thyroid aka hyperthyroidism in October 2016.  In my case, the source was Grave's Disease.  It took almost a year to get the correct dose for medication.  After the initial treatment, the maintenance dose is quite low.  Most of the symptoms went away within six months, but it took another few months to feel completely back to normal.