Re: Bone and gut disorders 'linked'

From: TC (tunderbar_at_hotmail.com)
Date: 03/02/05 

Date: 2 Mar 2005 08:50:25 -0800

TC wrote:
> Roman Bystrianyk wrote:
> >
>
http://www.healthsentinel.com/news.php?event=news_print_list_item&id=649
> >
> > "Bone and gut disorders 'linked'", BBC News, March 1, 2005,
> > Link: http://news.bbc.co.uk/1/hi/health/4306133.stm
> >
> > Osteoporosis patients should be screened for a gut disease, US
> > researchers believe.
> >
> > A Washington University Bone Clinic study of 840 people found those
> > with the brittle bone disorder were 17 times more likely to have
> > coeliac disease.
> >
> > The disease, an intolerance to gluten which makes digestion
> difficult,
> > is found in 1% of the general population.
> >
> > The team told the Archives of Internal Medicine the study provided
> > evidence of the benefits of a screening programme.
> >
> > Although coeliac disease patients commonly have a low bone mineral
> > density, the benefit of screening everyone with osteoporosis has
been
> > unclear to date, the Archives of Internal Medicine reported.
> >
> > The team tested 266 patients with osteoporosis and 574 without,
> putting
> > those with positive coeliac tests on gluten-free diets.
> >
> > Lead researcher William Stenson said the coeliac risk rate was
"high
> > enough to justify a recommendation that all individuals with
> > osteoporosis undergo screening."
> >
> > He said osteoporosis patients should first be tested using a simple
> > blood test, known as serologic screening which tests for antibodies
> > associated with the disease.
> >
> > Diagnosis
> >
> > If that test proved positive, he suggested patients should undergo
a
> > more accurate intestinal biopsy to confirm the diagnosis.
> >
> > And he added the patients could then be put on a gluten-free diet,
> > which could then benefit the osteoporosis.
> >
> > "Treatment with a gluten-free diet for a year resulted in improved
> bone
> > density in individuals with coeliac disease and osteoporosis."
> >
> > Dr Martin Sarner, honorary secretary of Core, formerly the
Digestive
> > Disorders Foundation, said he would welcome a screening programme
in
> > the UK.
> >
> > "It would be a positive move, the blood test is relatively simple
and
> > could be carried out by GPs. It would not be hugely expensive so
> could
> > prove cost effective.
> >
> > "The problem is not that many doctors know about the test, I fear
> this
> > is the reason it has not been introduced yet."
>
>
> This is an interesting example of how an insight, into a disease,
that
> might hurt the pharmaceutical industry is co-opted to sell tests.
>
> The study found a link between coeliac disease and osteoporosis. We
> already know that gluten-containing foods have a causal relationship
> with coeliac disease. The intelligent person would deduce that
> gluten-containing foods may be one of the the causes of osteoporosis.
> If that is the case, we may be able to conclude that we can
effectively
> treat or even cure both these conditions by a simple change in diet.
No
> drugs, no testing, just apply a change of diet and possibly cure two
> conditions at once. Kinda like advocating low carb, except the carbs
> being restricted are strictly the gluten-containing carbs.
>
> But that does nothing for pharmaceutical sales does it?
>
> So what they do instead is suggest that we now test all people with
> osteoporosis for ceoliac disease. They can now sell millions of tests
> for ceoliac disease.
>
> Now that's marketing.
>
> And I notice that they say precious little about actually treating
> osteoporosis with a gluten free diet. I would think that that would
be
> a breakthrough considering that the mainstream is obsessed with
people
> getting enough calcium in their diets to pre-empt osteporosis. This
is
> a clear indication that getting calcium in the diet is not as
critical
> as removing gluten-containing foods from the diet. This represents an
> entirely different approach to treating osteoporosis than what is
> currently done.
>
> TC

Here is a direct quote from the Merck Manual:

******
Prevention and Treatment
The goals of management of osteoporosis are to prevent fractures, to
decrease pain when present, and to maintain function. Pharmaceutical
agents are used to minimize further bone loss. The risk of fracture is
reduced by nonpharmaceutical measures, including maintenance of
adequate body weight, increased walking and other weight-bearing
exercises, avoidance of long-acting benzodiazepines, minimal caffeine
and alcohol intake, decreased smoking, and treatment of impaired visual
function. Educating patients about the risks of falls and developing
individualized programs to increase physical stability are important.

Women should be advised to consume >= 1000 mg of elemental Ca in their
daily diet, but if a strong family history of osteoporosis is present
or if osteoporosis has already been diagnosed, total Ca intake should
be 1500 mg/24 h. Typically, a small daily supplement of vitamin D (400
IU) is recommended, unless the patient is hypercalciuric or has
abnormal levels of vitamin D. Calcium carbonate tablets 600 mg four to
six times/day (equivalent to 1 to 1.5 g/day of Ca) may be given, but
calcium citrate is better absorbed in achlorhydric patients and may
have fewer GI side effects.

Osteoporotic men are given Ca supplements, 1 to 1.5 g/day. When there
is evidence of decreased Ca absorption (assessed by urinary Ca levels <
100 mg/day [2.5 mmol/day]), supplements may be increased up to 3 g/day,
and vitamin D should be concomitantly given. The vitamin D dose depends
on the initial levels of vitamin D in the serum. For some patients,
vitamin D 400-800 IU/day is enough, but for those whose levels of 25
hydroxy vitamin D and 1,25 dihydroxy vitamin D are not returned to the
expected range, 50,000 IU po may be given once or twice weekly. Serum
and urine Ca should be monitored closely at these latter dosages to
avoid hypercalcemia, hypercalciuria, and renal failure.
25-Hydroxyvitamin D facilitates Ca absorption in some patients.

Women should consider hormone replacement therapy with estrogen, with
or without progestin, in addition to Ca; eg, conjugated estrogen 0.625
to 1.25 mg/day, omitting the dosage for 5 consecutive days each month
to help prevent uterine endometrial hyperplasia, or progestin as
described below (see also discussion under Menopause in Ch. 236).
Estrogen may arrest or decrease disease progression. It is most
effective if started within 4 to 6 yr of menopause, but it may slow
bone loss and reduce fractures even when started much later. Estrogen
produces withdrawal bleeding in about half of postmenopausal women and
may increase the risk of endometrial cancer (a progestin, such as
medroxyprogesterone acetate 5 to 10 mg/day, for the last 10 days of the
cycle decreases the risk of endometrial cancer but increases the
occurrence of withdrawal bleeding and produces a more unfavorable serum
lipid profile). Estrogen also increases risk of biliary disease but may
prevent heart disease and stroke. Risk of breast cancer may be slightly
increased. Raloxifene, an estrogen-like drug, decreases bone loss
without measurable effects on the uterus, decreases serum LDL levels,
and does not increase serum HDL; its effects on the breast are still
unknown.

Bisphosphonates inhibit osteoclast-mediated bone resorption;
alendronate has been approved for osteoporosis. Therapy with 10 mg/day
decreases the risk of fracture at the vertebrae and hip in
postmenopausal women with osteoporosis and increases bone mineral
density over at least 4 yr of constant therapy. In addition, in
patients who are postmenopausal without osteoporosis, alendronate 5
mg/day prevents bone loss. A patient who is resistant to Ca
supplementation and who will not or cannot take hormone replacement
therapy should consider alendronate therapy alone. The drug must be
taken on an empty stomach with a full glass of water, and the patient
must remain upright for >= 30 min afterwards to decrease the risk of
esophageal irritation. Other bisphosphonates are also in development.

Women who are unable to tolerate estrogen because of side effects, or
in whom estrogen therapy is contraindicated, can be given salmon
calcitonin, which is available in parenteral and nasal spray forms. The
parenteral dose is 100 IU sc daily or every other day, whereas the
nasal spray dose is 200 U/day in alternating nostrils (one spray); both
formulations require adequate vitamin D and Ca supplementation. Salmon
calcitonin may be helpful as an antiresorptive agent and as a
short-term analgesic (< 3 mo) after an acute fracture.

Combined therapy with sodium fluoride 50 mg/day and >= 1 g of
supplemental Ca appears to increase bone mass, but the bone is abnormal
(increased trabecular but decreased cortical bone density) and more
fragile. Thus, fluoride is not recommended. Slow-release fluoride is
reportedly beneficial; however, the long-term benefit of this therapy
is unknown.

There is significant investigation on the use of growth factors as
stimulants to produce new bone. Small, intermittent, daily doses of PTH
stimulate bone formation without stimulating bone resorption.

Acute back pain from a vertebral crush fracture should be treated with
an orthopedic support, analgesics, and (when muscle spasm is prominent)
heat and massage. Salmon calcitonin therapy also has analgesic
properties. Chronic backache may be relieved by an orthopedic garment
or, more physiologically, by hyperextension exercises to strengthen
paravertebral muscles. Avoiding heavy lifting and falls is important.
However, immobilization should be minimized and consistent
weight-bearing exercise encouraged.

In severe, uncontrolled fractures caused by osteoporosis, short-term
androgens (< 3 mo) can be considered for women when all else fails.
Stanozolol and nandrolone increase bone density in women, but their use
is limited because they lower serum concentrations of high density
lipoprotein, cause virilization, and risk hepatotoxicity. Men with
osteoporosis also require evaluation for androgen deficiency, for which
replacement therapy may be considered.
*****

This is how medical people currently treat osteoporosis.

Not a single mention of gluten.

TC

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