Osteoporosis: A misinformed public

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Last of three parts

Some time ago at Seton Medical Center in Daly City, California, a prominent researcher and expert on osteoporosis gave a one-hour talk on the latest therapy and findings regarding that disease. It was an erudite and brilliant discussion, with the exception that no one made any mention of the effect of protein excess on net calcium balance. I raised my hand during the question and answer period and asked about it.

There were a few nervous titters as my medical friends anticipated the learned professor skewering the misinformed surgeon. To the surprise of all, the professor readily admitted the existence of the numerous articles on the subject. He further astonished us -- especially me -- by telling us that he and his fellow researchers were concerned about the problem and were busily working on new medications (bicarbonate buffers) so that the public could continue with its high level of protein ingestion! I didn't have the heart to ask the logical follow-up question: "Why not simply advise people to eat less protein?"

The circle was finally complete. In the June 23, 1994, issue of the New England Journal of Medicine, these same researchers published their data. Their conclusions about the cause of osteoporosis were exactly as I have outlined in the second part of this series: a negative calcium balance brought about by excessive protein intake.

When the authors added a potassium bicarbonate buffer to neutralize the acid produced by the excess protein, they found that the calcium and phosphorus balance became "less negative or more positive." But these brilliant researchers still failed to mention the obvious: individuals should cut down on protein.

One other study is notable. This is a review of hip fracture rates from 34 published studies in 16 countries. When these fractures were correlated with estimates of dietary animal protein, a strong positive association was found. When calcium intake was analyzed, there was a surprising association of high intake with high fracture rates! The increase was related to animal protein intake and not to total calories.

As far as the general, well-read, medical public is concerned, there is very little knowledge of the protein-osteoporosis link. Why are these results poorly publicized and understood? The reasons are not immediately apparent, but I think that they must include a lack of willingness for industries to fund studies that not only do not involve expensive new drugs but that also challenge the powerful dairy and meat industries. One source claims that it takes more than $50 million and 8 to 12 years for a new drug to be approved by the Food and Drug Administration (FDA).

A rather unpleasant matter that should be mentioned is the issue of the funding of scientific studies by industry groups. It seems that only a few studies have attempted to refute the protein-osteoporosis link, and they came from a single group of investigators who were sponsored by the meat and dairy industries. The methodology used and the results obtained have been challenged by other scientists. The researchers are accused of using subjects with pre-existing renal tubular disease, which makes their findings different from a generally selected group.

This is not a new concept in "motivated research." For example, in cholesterol studies sponsored by the egg industry, it is easy to "saturate" a subject with large amounts of cholesterol. When additional cholesterol (eggs) is added, there is no signficant shift. The researchers can then "honestly" report that the inclusion of a large number of eggs does not increase the serum cholesterol in this "saturated" study group. After all, you can't put more water into a full cup.

I regard these studies in the same way as I do lung cancer research funded by tobacco boards. Industry pressure that stifles important research should be exposed to public view. The importance of this approach cannot be overestimated.

Consider the case of a Mr. Sokolov versus a giant food company. He became convinced that his coronary artery disease was caused in part by the lard that the company used in making its famous French fries. As the result of a series of newspaper ads that he paid for personally, the corporation was forced by embarrassment and public outcry to change from melted lard to vegetable oil. (Whether this is a true advance in healthful eating is dubious, as oxidized vegetable oils are also deleterious, especially when hydrogenated, and the French fries are pre-parboiled in saturated fat prior to being shipped to the fast food outlet; however, Mr. Sokolov's story does illustrate the power of an individual with courage and tenacity.)

Protein excess is only one of the overlooked causes of osteoporosis. The hormonal basis of osteoporosis is also often overlooked.

It is generally accepted that estrogen replacement is helpful and that it can slow the loss of bone. It is less generally known that estrogen cannot fully prevent or reverse osteoporosis. What is needed is an additional hormone, progesterone -- natural progesterone, that is, not synthetic progestin.

And there are a variety of other factors in the causation of osteoporosis. This is truly a "multifactorial disease," meaning that various factors enter into the development of this disorder. They include gender, menstrual status, hormone levels, and intake of calcium and many other minerals, vitamins, and protein intake. Critically important is the effect of weight-bearing exercise. This alone can substantially reduce the risk of osteoporosis. Simply walking is sufficient.

ILLUSTRATION

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By Robert M. Kradjian, M.D.

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