You Can Run, But You Can’t Hide …

One of the reasons many runners chose to be active and eat “right” is to, ostensibly, enjoy many years of wonderfully good health.  Isn’t that why we tie up our shoes and step out the door rain or shine, after all?  Order a single instead of double scoop of “Chunky Monkey?”  Stop after the second drink?  Certainly, there’s a pay-off for virtuous living.

But, is there?

  • Question:  What do four-time Boston Marathon Champion, Bill Rogers, one of America’s best female distance runners, Jody Hawkins, and our favorite Flying Nun, Sally Field, have in common?
  • Answer:  Osteoporosis.  That’s right.  And they’re not alone.

Osteoporosis, a condition that typically develops unnoticed, is frequently diagnosed only after an osteoporosis-related fracture occurs.  It is a disease in which the density and quality of bone are reduced, leading to an increased risk of fracture.  The hip, spine and wrist are generally most susceptible to fracture, although any bone can be affected. A major public health concern, the cost of osteoporosis-related fractures in the U.S. in 2005 was $19 billion; it is predicted that by 2025, those costs will exceed $25 billion.

In the U.S., 10 million people are estimated to already have this disease, and 34 million more are estimated to have low bone mass, putting them at an increased risk for developing osteoporosis.  Long considered a disease affecting only elderly women, it is now known to be a much more “inclusive” condition.  Two of every ten people affected are men, and runners are not immune from developing the disease. One in 2 women and 1 in 4 men over 50 years of age in the U.S. can expect to experience an osteoporosis-related fracture during the remainder of their lives.  Even young girls are at risk of developing the “Female Athlete Triad,” consisting of a set of three interrelated health issues — low energy levels, cessation of menstruation and, believe it or not, osteoporosis.

Some people are more likely to develop osteoporosis than others.  Risk factors include a set of conditions one can’t change, and another set that an individual has control over.  Risk factors that can’t be changed which increase one’s risk for developing the disease include:

  • Being female
  • Family history of osteoporosis
  • Being small (body weight under 127 pounds for women; not yet established for men), thin and of certain race/ethnicity such as Caucasian, Asian, or Hispanic/Latino
  • Low levels of sex hormones (estrogen or testosterone)
  • Being older

Risk factors that can be changed include:

  • Diet low in calcium and vitamin D, and high in protein, sodium or caffeine
  • Inactive lifestyle
  • Certain medications (e.g., steroids)
  • Smoking
  • Alcohol abuse

Runners operating under the assumption that just putting in the miles will guarantee adequate bone health have been sold a bill of goods.  While true that running builds more bone density in legs than either swimming or cycling, British researchers studying female endurance runners discovered a negative association between running distance and bone mineral density in the femoral neck (top of the femur) and the lumbar spine of subjects.  Another study done at the University of Maryland reported that male runners training approximately 50 miles per week may have spines 10% thinner than average individuals.

A variety of options for treating osteoporosis, or at least mitigating the damage once diagnosed, are available.  As always, though, it’s better to try to avoid a problem in the first place.  Recommendations for bone health for the general population include the following:

  • Build as much bone mass as possible during childhood and adolescence, as 85 – 90% is acquired by 18 years of age in girls, and 20 in boys.
  • Get plenty of calcium and vitamin D.  Current research points out that Western Europe and North America have both the highest rates of bone demineralization as well as the highest consumption of calcium-rich dairy products.  So, what’s up?  Apparently, bone health is dependent on dietary acid-base balance, not just calcium consumption!  When the diet creates an acid load, the system must buffer it with alkaline stores from somewhere in the body.  Bone provides the calcium salts to buffer the acidic condition; bone minerals are depleted and eliminated in the urine during this process to bring the body’s pH back into balance.  Acid-producing foods include coffee, alcohol, corn syrup, sugar, canola oil, butter, soft drinks, and most meats, dairy, beans and cereal grains.  The body treats almost all fruits and veggies, chicken, eggs and almonds as alkaline-forming foods. The bottom line is to replace processed foods in the diet with lots of fruits and veggies, be sure to supplement with calcium and make sure you’re getting plenty of vitamin D.  In Humboldt County, getting adequate vitamin D can be a challenge.  Get outside when the sun shines and consider supplementation.  Remember, though, that supplementation will not make up for ignoring weight-bearing exercise.
  • Engage in weight-bearing and muscle-strengthening exercises regularly.  Long-distance running may not provide the force and compression on bones necessary for long-term bone health, particularly in the spine.  Variable-resistance machines found at the gym are not generally helpful in creating the forces necessary to stimulate bone growth, either.  Effective weight-bearing exercises will not involve either sitting or lifting 5-pound dumbbells.  Riding a bike won’t work, and swimming, where water supports the body, won’t either, as neither of these activities provide ground reaction forces on the skeleton.  Exercises to include in your line-up include jumping (jump rope, explosive jumps up onto boxes of increasing height and finally building up to drop jumps), push presses, overhead presses, deadlifts and squats.  The exercises in a routine should be done with careful attention to form and should be performed at a heavy enough load that only 3 sets of 5 reps can be completed in a session and only 3 sessions should be done in a week.  Consider consulting a personal trainer for instruction on safe execution of any heavy lifts, or pick up a copy of The New Rules of Lifting by Lou Schuler and Alwyn Cosgrove, or anything by Mark Rippetoe.
  • Discuss the possibility of having a bone density test with your healthcare provider to provide a personal base line, particularly if you have any risk factors or are “middle-aged.”  A variety of tests are available, and some provide more information than others.  All are painless and non-invasive, and the current Medicare policy allows reimbursement for the test every two years, provided conditions for reimbursement are met.

There is no cure for osteoporosis, but it can be treated. Evaluating treatment options is a complicated task, as each person’s situation is unique and each treatment option provides specific benefits and carries particular risks.  It is important to seek advice from a healthcare professional, as treatment is not as simple as tweaking your diet and exercise routine and getting plenty of fresh air and sunshine.

As a runner, you’ve already made a commitment to taking care of yourself.  With just a little thought and, possibly, some minor adjustments in lifestyle, you should be able to continue to run well for many, many years to come.

Further Reading:

This article is informational only, and should not be interpreted as a recommendation for a specific course of action.  The author is bummed with her recent diagnosis of osteopenia (low bone density not yet quite low enough to be called “osteoporosis”) and is exploring every avenue available to arrest the decrease in bone density that often follows on the heels of a drop in estrogen.  These include a short-term “assist” from pharmaceuticals, changes in diet (which has always been, according to “conventional wisdom,” excellent), as well as changes in her exercise regimen.  Knowing that running isn’t enough, she now jumps a lot and regularly lifts heavy weights (go ahead … ask about her deadlift) in the belief that jumping and lifting heavy $&%#@ off the floor will help maintain or rebuild her bone density. (*The author is a National Strength and Conditioning Association Certified Personal Trainer and Certified Yoga Instructor.)

© Cathy Larripa and KissWorkouts Blog, 2010. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Cathy Larripa and KissWorkouts Blog with appropriate and specific direction to the original content.

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