Looking after our bones… the natural approach
This year’s theme for World Menopause Day on the 18 October is bone health. For our Lunch and Learn, we were joined by Dr Marilyn Glenville to discuss how to look after our bones through menopause and beyond.
Henpicked: First and foremost: why is it so important to look after bone health?
Dr Marilyn Glenville: Women reach peak bone mass around the age of 25-30 and it pretty much stays stable until we reach menopause. Then, because of oestrogen declining, there can be an accompanying decline in bone density. This can affect one in two women over the age of 50, compared to one in eight for breast cancer. And yet we have national screening for breast cancer and don’t have anything for osteoporosis. It’s something that’s very important to think about, maybe earlier than we do at the moment.
We think of osteoporosis as an old person’s disease. But it really isn’t. And it’s important to know what state your bones are in as early as possible, so if there are risk factors you can take action earlier. With osteoporosis we want to aim for prevention rather than waiting for it to happen when it can be more difficult to treat.
Henpicked: What are the risk factors?
Dr Marilyn Glenville: Generally things that have happened earlier in life. If you didn’t have periods for six months or more that can have an impact, due to loss of hormones. Premature menopause or certain medications, like steroids, can also have an impact. As can any kind of digestive issue, like Crohn’s or coeliac disease. Anything that impacts on the absorption of nutrients. Family history is also important. Your mother or grandmother may not have had a definite diagnosis, but you might have noticed them shrinking, or gaining a ‘dowager’s hump’.
Henpicked: What does osteoporosis look like, how might you know if your bones are not healthy?
Dr Marilyn Glenville: Literally it means porous bones. Think of a Malteser cut in half. There may not be any change in shape, no symptoms, no pain. The first sign is often a fracture, as our bones become less dense and more fragile. Then a small knock against the side of a desk or turning your ankle can cause a fracture. Even something as simple as a sneeze.
If you think you are at risk, you can ask for a DEXA scan, which looks at the bone density in your hip and spine. This offers three results ranges: normal, osteopenia (low bone density) and osteoporosis. You can sometimes get these on the NHS, or arrange to have one done privately.
If you are in the osteopenia range, then you can look at doing something about it before it becomes osteoporosis. Prevention is key.
Henpicked: If I know I’m at risk, what can I do to look after my bone health?
Dr Marilyn Glenville: Let’s think of the food side first of all. Try to follow something like the Mediterranean diet and put more emphasis on your diet being more alkaline. Calcium is stored in our bones and teeth and neutralises acid. When we follow an acidic high-protein diet, this is not good for us around menopause. The more acidic our diet becomes, the more calcium is leached from the skeleton to neutralise that acidity.
So we need a good balance. Vegetable proteins like quinoa, nuts and seeds are fine, but we need to watch our intake of animal protein. If you know you’re at risk maybe think about cutting down on things like caffeine which may be more acidic. I know it doesn’t always seem fair, but it’s looking at what you need to do as an individual. This may be more than someone without the risk factors.
This is an investment in our long-term health. We could live 30-50 years beyond menopause, and we want these to be healthy, good-quality years.
Henpicked: Exercise is important too isn’t it?
Dr Marilyn Glenville: Yes, it really is use it or lose it. We have to make demands on the skeleton. I often talk about the Russian astronauts who went into space years and years ago. Really fit, healthy men. When they came back they’d lost a huge percentage of bone density. Your body doesn’t produce something it doesn’t need and in that gravity-free environment it didn’t produce the bone density.
Things like walking and dancing are great. And while exercises like yoga don’t have the same sort of impact they can help with balance and coordination we have less risk of falling over and putting down our arm, which can cause fracture.
Weight training is also good, as if you strengthen your muscles you’re strengthening bone to match muscle strength. Really, a good mix of exercise is best.
Henpicked: What about supplements?
Dr Marilyn Glenville: Vitamin D is crucial. Some women develop osteoporosis because of vitamin D deficiency. You need vitamin D to aid calcium absorption. Make sure you choose D3, not D2, as this is known to be much more effective. You can take around 2000 ius on a daily basis. Even better, there’s a simple fingerprick test which can check your vitamin D levels. If they’re low, you may need to take more for a few months to correct the deficiency. We absorb vitamin D mainly through our skin. Whatever diet we follow, we are not going to get enough in our food. So it’s very difficult to maintain levels between October and March, when it’s so much darker and we have less sunlight.
Calcium is important, and so is magnesium, as this converts vitamin D to its active form. And vitamin C manufactures collagen, which makes up 90% of our bone matrix. This is also important for our immune system, as well as our skin.
Combinations of nutrients are much better than single ones. And It’s not just getting nutrients in but digesting and absorbing them, so digestive enzymes are also important, especially if someone has a digestive issue.
Henpicked: Can you reverse poor bone health?
Dr Marilyn Glenville: It depends if you’re in the osteopenia or osteoporosis range, and on your age. If it’s caused by medication, this could be altered. If you’ve had a DEXA scan, you can’t retest for at least two years as the machines aren’t sensitive enough to pick up the changes. So you could introduce diet, exercise and lifestyle changes but not know if they’re working.
If you want to find out, you can have a bone turnover test, but this is not available on NHS. It’s done using a urine sample, and measures collagen markers that are excreted as the bone breaks down. Our bones are building up and breaking down all the time. But when we go through the menopause, there can be more break down than build up and density can be less. If your bone turnover is too high then you’re actively losing density on a daily basis.
We can test bone density after three months, so you can see the effects of any changes you’ve made. This is great, as can really help boost people’s confidence, knowing that what they’re doing is working.
It’s always a good idea to speak to your GP if you have any concerns. If they think you’re eligible, they can refer you for a DEXA scan. If not, it’s still worth doing privately, even just as a one off. If your results aren’t too good, you can introduce some changes and try a bone turnover test three months later.
Dr Marilyn Glenville PhD is the UK’s leading nutritionist specialising in women’s health. She is the Former President of the Food and Health Forum at the Royal Society of Medicine and the author of a number of internationally bestselling books including ‘Natural Solutions to the Menopause’.