A Food for the Ages, Not Just the Aged.
Alan Cook DC
Hippocrates was quoted, “Let food be thy medicine, and medicine be thy food.” This is often stated but not nearly as often believed nor acted upon. There is one fruit in particular that may change your mind.
Approximately one half of your adult patient population will experience one or more fractures due to osteoporosis in their lifetime.(1,2) You have a choice; sit on the sidelines or become participatory.
There are risks for your patients if you choose to not participate. The information avalanche of the internet is overwhelming. This does not equate with helpful nor correct. And there are the well-funded and superbly marketed messages of the pharmaceutical industry.
Rather than immediately jumping to treatment, remember that the underlying reasons for osteoporosis are numerous. Different causes require different treatments. A partial list of risk factors includes: female, smoker, excessive alcohol, high protein diet, family history of osteoporosis, early menopause, or a history of previous fractures. Also, an enormous percentage of the worldwide population is vitamin D insufficient or deficient.(3-7)
A partial list of diseases that can cause osteoporosis include: amenorrhea, malnutrition, Cushing’s disease, diabetes, hypogonadism, hyperparathyroidism, hyperthyroidism, and multiple myeloma.
Prescription medications that are associated with bone demineralization, and thus cause or contribute to osteoporosis, are: aromatase inhibitors, antiepileptic drugs, antiretroviral drugs, depo-provera, and corticosteroids.
There are many adults that are not taking the above bone demineralizing drugs nor do they have any of the above listed diseases. Yet many have, or will have, osteoporosis. Some of these are your patients.
In the United States, the poor quality of the Standard American Diet coupled with minimal or non-existent exercise habits greatly contribute to osteoporosis risk and disease. Now what?
This article would quickly turn into a book length if all aspects of osteoporosis were discussed; bone density tests, laboratory studies, vitamins, mineral, other natural compounds, medications, exercise, etc. There is one item that can be profound that rarely gets the deserved press.
Dried plums, prunes, contain compounds that are known to enhance bone health by increasing bone formation, decreasing bone resorption, and increasing trabecular microstructure.(8) These outcomes all decrease the risk of fracture.
Prunes are known for their laxative trait, sweet flavor, and for being an easy target of jokes. In fact, prunes are an excellent food in regard to bone health.
In looking through a reductionist lens, prunes contain generous amounts of: magnesium, potassium, boron, copper, several phenolic and antioxidant compounds, and vitamin K1.(8) Each of these play a positive role in bone metabolism.
When a new drug is being studied, investigations are performed as to the specific pathways and effects. Several research teams have pursued these types of experiments with prunes.
The specific bone effects are:
- Increase bone formation.(9, 12) [This is unusual as nearly all of the currently available drugs act by decreasing bone resorption, not by increasing bone formation.]
- Increase trabecular microstructure.(10, 11) [This, too, is unusual. Typically bone quality declines over years. Compounds within prunes have a unique capacity to benefit trabecular connectivity.]
- Decrease osteoclastogenesis.(11) [Fewer osteoclasts mean less bone resorption. There are no currently available drugs that both enhance bone formation AND decrease bone resorption.]
- Decrease RANKL.(13) [RANKL leads to increases in bone resorption. Inhibiting RANKL is exactly the mechanism by which the prescription drug, Prolia, works.]
Prunes taste sweet yet they have a low glycemic index. Their “sugariness” is due to sorbitol.(8) Prunes are a low calorie, natural sweetener.
Researchers used 100 grams or 10-11 prunes per day.(9,12,14,15) Given the known laxative effects, some patients may consider this dosage to be an edict that they live in a pasture. The way to overcome this is to begin with two prunes per day and slowly increase the number until reaching bowel tolerance.
Osteoporosis is a widespread and multifactorial disease. Steps need to be taken to inventory bone health (via a DXA test), understand the reason or reasons for your individual patient’s bone losses, and prescribe a program to enhance their skeletal health.
Prunes are low risk, high benefit when considering bone well being. Prunes should never be considered to be a complete treatment plan but should be included in the overall strategy for skeletal health.
Alan Cook DC has been in practice since 1989 and is currently working with EasyWebCE, an on-line provider of Chiropractic Continuing Education; www.easywebce.com
- Cawthorn PM. Gender Differences in Osteoporosis and Fractures. Clinical Orthopaedics and Related Research 2011; 469: 1900-1905.
- Kanis JA, Johnell O, Oden A, et. al. Epidemiology of Osteoporosis and Fracture in Men. Calcified Tissue International 2004; 75: 90-99.
- Holick M: High prevalence of vitamin D inadequacy and implications for health. Mayo Clinic Proc 2006, 81:353–373.
- Allain TJ, Dhesi J. Hypovitaminosis D in older adults. Gerontology. 2003;49(5):273-278.
- O’Malley G, Mulkerrin E. Vitamin D insufficiency: a common and treatable problem in the Irish population. Ir J Med Sci. 2011;180:7-13.
- Arunabh S, Pollack S, Yeh J, Aloia JF. Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab. 2003;88:157-61.
- Bandeira F, Griz L, Dreyer P, Eufrazino C, Bandeira C, Freese E. Vitamin D deficiency: a global perspective. Arq Bras Endocrinol Metabol. 2006 Aug;50(4):640-6.
- Stacewicz-Sapuntzakis M, Bowen PE, Hussain EA, et. al. Chemical Composition and Potential Health Effects of Prunes: A Functional Food? Critical Reviews in Food Science and Nutrition 2010; 251-286. https://doi.org/10.1080/20014091091814
- Armandi BH, Khalil DA, Lucas EA, et. al. Dried Plums Improve Indices of Bone Formation in Postmenopausal Women. J Women’s Health & Gender-based Medicine 2004; 11: Published Online:7 Jul 2004 https://doi.org/10.1089/152460902753473471
- Deyhim, Farzad PhD, RD; Stoecker, Barbara J PhD, RD, LD; Brusewitz, Gerald H PhD; Devareddy, Latha MS; Arjmandi, Bahram H PhD, RD. Dried plum reverses bone loss in an osteopenic rat model of osteoporosis. Menopause: 2005 - Volume 12 - Issue 6 - p 755-762.
- Smith BJ. DRIED PLUM IMPROVES BONE DENSITY AND MICROARCHITECTURE BY UP-REGULATING OSTEOBLAST ACTIVITY AND DOWN-REGULATING OSTEOCLAST DIFFERENTIATION. SHS Acta Horticulturae 841: II International Symposium on Human Health Effects of Fruits and Vegetables: FAVHEALTH 2007.
- Hooshmand S, Sheau CC, Saadat RL, et. al. Comparative effects of dried plum and dried apple on bone in postmenopausal women. Br J Nutr 2011; 106:923-930.
- Franklin M, Bu SY, Lerner MR, et. al. Dried plum prevents bone loss in a male osteoporosis model via IGF-I and the RANK pathway. Bone 2006; 39: 1331-1342.
- Hooshmand S, Kern M, Metti D, et. al. The effect of two doses of dried plum on bone density and bone biomarkers in osteopenic postmenopausal women: a randomized, controlled trial. Osteo Int 2016; 27: 2271-2279.
- Arjmandi BH. The Role of Phytoestrogens in the Prevention and Treatment of Osteoporosis in Ovarian Hormone Deficiency J Amer Col of Nutrition 2001;398s-402s. Published online: 21 Jun 2013.