To every action there is an equal and opposite reaction.
—Sir Isaac Newton
Before we discuss facts, we need to establish the context. I believe that having a theoretical framework, or mental model, about how things work is essential. This framework helps us understand what’s going on, make predictions about what might happen next, and thereby make decisions.
We all have some sort of mental model of the world. It is cobbled together from our personal experiences, explanations offered by the social system in which we live, and additional information we gather as we grow and learn. I want to share my own viewpoint with you so that you can see where I’m coming from, and so that you can decide what mental model makes sense for you.
My Experience with Bone Health
First, let me share some of my personal observations and experiences about bone health, starting with my mother. She died in 1991, at the age of eighty-six, and was quite healthy for most of her life. Even at an advanced age, she never suffered from any illness except progressive deafness. I believe what harmed her most was a car accident she suffered at the age of eighty-one, where she was thrown from the car she was driving and given up for dead. She recuperated, but the blow to her head appeared to have started a senility process that took her downhill.
Even with the accident and several falls in the street, she never broke a single bone. She also didn’t seem to shrink much as she aged, and she wasn’t stooped over. Her bones may have been thin, but they didn’t fracture, not even with a serious accident! Here are the aspects of her life I find meaningful in this respect:
Another person who influenced my thoughts about bone health is my aunt, who was actually my mother’s cousin and one year younger. She died in 1997, six months before turning ninety. She also never broke a bone as far as I know. What I saw in her was an interesting progression with weight. She was of normal weight all her life until menopause, when she put on about thirty pounds. By the time she turned eighty, she had lost that weight and more and was beginning to look really thin. Her health was quite good, and her only complaint was about her fading eyesight.
Both my mother and my aunt lived in Argentina since the late 1940s, and I returned to visit yearly from 1988. On one visit, when my aunt was about eighty-four, I noticed that she had become very thin and bowlegged, a condition she had never had before; her knees hurt on the outside, as well. She was living alone at the time and eating very little. Like my mother, she used no medications and her diet was semivegetarian, but she ate white bread and many more nightshade vegetables (potatoes, tomatoes, eggplant, and peppers—more about this later). I arranged for her to live with a caretaker, who fed her abundantly and eventually helped her put on about twenty pounds. I also instructed that her intake of potatoes and tomatoes be curtailed. Within a year, her legs had gotten stronger and the pain in her knees had disappeared.
Neither my mother nor my aunt took hormone replacements, calcium supplements or any other supplements or vitamins, or medications. They shared a disdain for pills, and I have surely inherited it. They did eat some dairy foods, both having been born in Holland, but only cheese or yogurt on occasion. They didn’t drink milk regularly, or eat ice cream except as a rare treat.
More distant family members, cousins, and elderly friends did break bones on occasion. However, nobody I knew in my youth ever broke a hip. Osteoporosis wasn’t a concern, and I don’t recall any older women who had that thin, fragile look that is so common nowadays. However, my mother’s bone strength apparently wasn’t completely passed on to me, as I myself had two minor fracture episodes.
One came about when I was eleven years old and playing leapfrog with some friends at night. One of my leaps went too far, and I crashed to the ground and dislocated my right elbow. A couple of weeks later we found I had a hairline fracture and needed a cast. Fifty years later, at age sixty-one, I was marching down the street one evening in New York City, rushing toward a class I was to teach, and tripped on something in the street. Although it’s usually possible recover with the other foot, in this case the other foot also tripped on the same something (I think it was a metal plate covering a hole in the street), so I went down like a tree with all my weight on my right hand. As I sat up to examine the damage, the hand looked seriously distorted. I tried to pull it straight while it was warm, but to little avail. I didn’t know if the hand was sprained or broken. After some miso soup that helped me recover somewhat from the shock, I went on to teach my class—on how to keep your bones healthy, no less!—with my right hand in a sling. Then I went to the hospital.
It turned out that I had broken my wrist in what is known as a Colles’ fracture, a fairly common type of break. I also had sprained many of the joints in my hand, and it took the young ER doctor about half an hour to set everything straight again. That was fairly painful and resulted in my walking around with purple fingers sticking out of my cast for a few weeks, followed by green and yellow fingers as everything healed. The fracture healed in a little over five weeks, so the cast came off quickly. The sprains took longer.
Of course I was embarrassed, as my first book on bone health had been published and I was teaching people how to keep their bones healthy. On the other hand, because it had been such a heavy and awkward fall, I felt that the fracture was perhaps inevitable and couldn’t be ascribed to fragility. I suppose the entire experience fell under the category “you teach what you need to learn.” Much to my chagrin, I joined the ranks of postmenopausal women who had broken a bone. Why had that happened to me? In the previous month, I think I had eaten sugar much more frequently than is my custom. But it was also the hurried way in which I walked. As Gillian Sanson says in her book The Myth of Osteoporosis (2003), one of the major ways to prevent fractures is to prevent falls! After my incident, I learned to walk slower and keep my weight more centered instead of pitching forward in a rush, which was my usual style. I did, of course, use food extensively to help me heal from this event.
There are trauma fractures, and then there are low-trauma or fragility fractures. This book addresses the latter. I am certain that what we eat can help keep us strong, prevent us from becoming weak and fragile, and thus prevent fragility fractures. But before I go into those details, I’ll establish the basic theoretical framework from which I start. In order to make good decisions and choices, we need more than rules; we need a basic philosophy that directs us and is cohesive enough that our choices have the desired results. Otherwise we are at the mercy of other people telling us what to do based on their philosophy. Once you know where I stand, you can better make your own decisions, whether you agree or disagree with me. Follow me, then, as we take a short detour into a philosophy of life.
The Complexity of Living Systems
Energy moves between opposite poles, and every action has its consequences. Newton integrated these concepts into the pillars of his physical laws, and many systems of thought throughout history concur. Action and reaction, up and down, night and day—these are all sets of opposites, like the two sides of a coin, and just as inseparable. You could visualize that life works like a seesaw or a pendulum. Right and wrong and yin and yang are two of the better known social constructs on this theme. For the past five thousand years, right and wrong has been the basic mode of thought in Western civilization, while yin and yang has been the foundation of Chinese thought.
The main difference between those two viewpoints has to do with judgment. Right versus wrong implies that if one part is good or right, the other automatically has to be bad or wrong, and often that is taken to mean that whatever is “opposite” must be eliminated. Yin and yang, on the other hand, are nonjudgmental descriptions. No superiority of one over the other is implied, and no destruction of one or the other is required. In fact, the two are seen as complementary and integrally interwoven. In the Chinese system, it is assumed that when one of the opposites shows up, the other isn’t far behind.
When we deal with right and wrong, or good and bad, and try to eliminate whatever is considered wrong or bad, it’s like cutting off your nose to spite your face. Trying to eliminate one part of the set of opposites will negatively affect the other part. This is a universal law and cannot be escaped. Here’s an example: In the early 1900s, it was decided that mosquitoes were bad because they carry malaria. It was decided that mosquitoes should be eradicated, and DDT was used liberally to that end. This was action. What was the reaction? Not only did the mosquitoes die, but many birds died as well, poisoned by the pesticide. In fact, the whole earth was poisoned, and most of those toxins remain with us to this day.
Our bodies are extremely complex. John Apsley, DC, in his chapter on biogenic medicine in The Advanced Guide to Longevity Medicine (2001),points out that every cell in the body registers more than a million disturbances or alterations daily, all of which need to be corrected just to maintain the integrity of the system against these stresses. Multiplying that by 75 trillion (the number of cells in the body), that means that every second of every day the body is performing close to 870 trillion corrections! He further states that the ability to manage such a task points to a regenerative technology that can operate at near quantum speeds, that is, unlimited by time and space.
Clearly it isn’t possible to manage such a complex system with linear or reductionistic thinking: one cause, one effect; or one problem, one drug. Many variables need to be addressed and accommodated. This is where a holistic approach comes in, endeavoring to look at the entire picture and attend to consequences way down the line. What does this have to do with bones? It underscores the danger inherent in going single-mindedly after a focused goal; for example, bones contain calcium, so let’s take more calcium to make the bones stronger. With this approach, we may find ourselves stumbling over the law of unintended consequences because we fail to take into account the other aspects of this complex issue. We’ll take a close look at this particular topic in chapter 3.
One aspect of the holistic approach is trust in the life process—trust that the body has its reasons that reason does not understand. The body’s job is to stay alive day in and day out, knowing what to do with air, food, and water and how to go about repairing itself. Our bodies are born with this knowledge. It is part and parcel of each of us. When things go wrong, I believe it is important to work with the body’s knowledge, to listen carefully to what it tells us and provide what’s missing or remove what’s in excess. This is what the natural healing model proposes to do: bring the body back into balance by paying attention to the law of opposites and thereby avoid triggering unexpected consequences.
Most natural healing therapies, such as acupuncture, homeopathy, naturopathy, dietary therapies, and energy medicines, look at the body as a whole system. In contrast, the conventional medical model tends to work in a simple linear fashion (if you have a headache, take a pill to eliminate the pain) rather than looking at what caused the headache to arise in the first place. That’s why so many medicines actually work against the body, as witnessed by the list of “anti medications”: antibiotics, anti-inflammatories, ant(i)acids, and the like. The all-too-common adverse effects of these drugs are often unexpected reactions of the highly complex body to the overly simplistic standard approach.
In my personal experience, the natural healing model is more accurate and has better results in dealing with disorders of function—things that the body isn’t doing “right.” Western medicine does a great job of dealing with structural problems and mechanical issues; in fact, nothing comes close to its ability to save lives in emergencies like car crashes, burns, gunshot wounds, and, of course, broken bones. Pharmacological drugs, on the other hand, are more problematic. All man-made drugs or supplements have unbalancing or adverse effects. They are a double-edged sword with both desired effects and adverse effects. Both are equal. Both count. We cannot have one without the other. When we rely on drugs for our health needs, the adverse effects must be taken into account, and expected, at all times.
No matter what your philosophy is, holistic or conventional, you’ll be right in some cases and wrong in others. C. Sidney Burwell, former dean of the Harvard Medical School, has been quoted as saying, “My students are dismayed when I say to them, ‘Half of what you are taught as medical students will in ten years have been shown to be wrong, and the trouble is, none of your teachers knows which half’” (Pickering 1956, 113).
For bone health in particular, numerous medications, supplements, and drugs are regularly recommended for making bones more dense, and for the fracture prevention benefits that denser bones are expected to provide. Using drugs to prevent something that may or may not happen (at least 50 or 60 percent of postmenopausal women don’t get osteoporotic fractures) could cause adverse effects that may be worse than the problem presumably avoided. The axiom that the benefits of pharmaceutical drugs outweigh the risks mainly holds true in life-threatening situations. If the choice is between suffocating from an asthma attack and losing a little bone mass from the steroids, the choice is fairly clear. But it’s an entirely different situation if the choice is between shrinking a little less and an increased risk of breast cancer associated with hormone replacement therapy. My preference is to use the natural healing model first and as much as possible, including lifestyle modifications, appropriate foods, and complementary therapies such as acupuncture, chiropractic, and massage, and only consider conventional medicine as a last resort, or in certain situations when it would be most useful.
A Philosophy of Nutrition
The philosophy or theoretical framework underlying classical nutrition is based on biology and chemistry. It looks at nutrient particles and assumes a mechanistic interaction between nutrients and the body. It is reductionistic in that it reduces foods, and humans, to their constituent parts, and then studies those. In nutrition, the reductionistic model supports getting specific nutrient particles that humans are known to need. This fits in with the prevailing mechanistic model of the mainstream view of health.
Another part of the study of food is based on the discipline of thermodynamics (the study of the movement of energy and how energy instills movement). The application of the concepts of thermodynamics to digestion and absorption originated in the second half of the 1800s with the work of Justus von Liebig, a German scientist who was among those who pioneered the study of heat, oxygen, and production of carbon dioxide in humans. His work established the importance of the macronutrients—protein, carbohydrates, and fats—in energy production. After his work was widely disseminated, it became accepted dogma in Germany during the nineteenth century that these macronutrients comprised the major nutritional requirements for humans and animals. As a result, it became widely assumed that the laws of thermodynamics related to human beings and animals, and not just inert substances. This is the model that underlies the concept of calories and energy pathways. In the early 1900s, studies of human basal metabolism were conducted at the Nutrition Laboratory of the Carnegie Institution of Washington, in Boston, Massachusetts, under the direction of Frances G. Benedict. This work yielded equations that, although not error free, are still being used to calculate basal energy expenditure, or the energy required for a body at rest (Frankenfield, Muth, and Rowe 1998).
While a useful model, the reductionistic approach presents only half the picture—the trees, so to speak. It is equally as important to look at the forest, or the human being as a whole system, as well as food as a whole system. This is the holistic approach that I have used for many years. These days it is supported by complexity theory, one of the “new sciences,” which states that the whole is more than the sum of its parts and that we cannot understand the behavior of the whole by studying its separate parts. Complexity science also makes it clear that the behavior of the whole cannot be approximated by adding up the behavior of the parts. For example, the qualities of water, a liquid at room temperature, cannot be inferred or approximated from the qualities of its constituents, hydrogen and oxygen, which are both gases at similar temperatures (Waldrop 1992).
Whole foods, then, contribute to the wholeness of humans because of the full complement of their nutrients, both known and unknown, and their interactions.
In making decisions about how to use foods for general health, as well as for particular conditions, I like to rely on several models. Three theoretical frameworks underlie all the work in this book. They don’t always agree with one another, but I usually find that what one model doesn’t cover, another one does:
Now that you have a sense of the orientation of this book and my philosophy of nutrition, let’s take a look at the basic facts of how problems arise with the bones. The next chapter will take a look at what creates weak and brittle bones, the major causes of osteoporosis, and various risk factors.