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Dr. Susan E. Brown

Diabetes and osteoporosis

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With World Diabetes Day on November 14, this is an ideal time to take a look at what osteoporosis and diabetes have in common. It’s a lot more than you may realize!

High blood sugar and high insulin levels damage bone

Scientists are untangling a multitude of ways in which high blood sugar and high insulin levels damage bone, including:

  • Suppressing bone turnover. Insulin has been known to contribute to the bone remodeling process for a number of years (Rosen & Motyl, 2010). But when insulin is present in excessive amounts (as in type 2 diabetes), bone resorption and circulating levels of osteocalcin both decrease — within hours of an insulin surge, according to a recent study (Ivaska et al., 2015).
  • Increasing inflammation. Hyperglycemia has been found to increase oxidative stress, which in turn promotes inflammation throughout the body (Fiorentino et al., 2015).
  • Weaknesses in collagen that occur when blood sugar is chronically high. This means that bone in someone with diabetes (regardless of type) is more fragile than would be expected for a given bone density, putting them at greater fracture risk. One recent symposium of international scientists even called for recognition of “diabetic osteodystrophy” given how well-known the connection between diabetes and poor bone health has become (Epstein et al., 2016).

Diabetes dramatically increases fracture risk

Even though folks with diabetes often have higher bone densities then their non-diabetic peers, they fracture much more. A recent systemic review of 16 studies confirms that those with type 2 diabetes have nearly 3 times the risk of hip fracture as age-matched non-diabetics. Persons with type 1 diabetes fare even worse, having more than a 6-fold increased risk of hip fracture as they age.

3 steps to manage blood sugar and support bone health

Given these connections, it might not be surprising that many steps you can take to manage blood sugar are the same things we recommend to support bone health:

  1. Get regular exercise. Just as exercise stimulates osteoblasts to build bone, it also makes cells more receptive to insulin — particularly in skeletal muscle. Studies have shown that even short-duration exertion can improve blood glucose levels (Colberg et al., 2013). So every time you walk, hop, or do yoga for bone health, you’re also maintaining your insulin sensitivity and reducing blood sugar.
  2. Try the Alkaline for Life diet. People with diabetes are urged to eat a diet rich in vegetables, legumes, whole grains, nuts and seeds, and lean meats with very limited processed sugars — sound familiar? My Alkaline for Life diet and diabetes-friendly diets such as DASH or the Mediterranean diet (Ley et al., 2014) advocate these foods for good reason, as they reduce inflammation and support stable blood sugar levels, making them good for bones as well as diabetes.
  3. Test your vitamin D. We know that vitamin D is essential for bone health. No surprise, correlations between both types of diabetes and low vitamin D have also been found (Song et al., 2013; Raab et al., 2014), so have your vitamin D level tested and make sure you have a 50 to 60 ng/dL level all year round.

And should you be among the nearly 10% of our population that already has diabetes, or if you have been told you are “pre-diabetic,” now is the time to get serious about both controlling your blood sugar and implementing my comprehensive Better Bones Program.

So in honor of World Diabetes Day, I urge everyone to remember that taking care of your blood sugar is taking care of your bones — and vice versa!

 

References:
Colberg, SR, Hernandez, MJ, and Shahzad, F. Blood Glucose Responses to Type, Intensity, Duration, and Timing of Exercise. Diabetes Care 2013 Oct; 36(10): e177-e177. http://dx.doi.org/10.2337/dc13-0965

Epstein S., Defeudis, G., Manfrini, S., Napoli, N., and Pozzilli, P on behalf of the Scientific Committee of the First International Symposium on Diabetes and Bone. (2016). Diabetes and disordered bone metabolism (diabetic osteodystrophy): time for recognition. Osteoporosis International 27: 1931–1951.

Fiorentino TV, Prioletta A, Zuo P, Folli F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Curr Pharm Des. 2013;19(32):5695-703.

Ivaska, K.K., Heliövaara, M.K., Ebeling, P., et al. The effects of acute hyperinsulinemia on bone metabolism. Endocr Connect 2015; 4(3): 155-162.

Janghorbani,M., et al. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166 (5):495–505.

Ley, S.H., Hamdy O., Mohan V., Hu F.B. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet 2014; 383(9933):1999–2007.

Raab, J., Giannopoulou, E.Z., Schneider, S. et al. Prevalence of vitamin D deficiency in pre-type 1 diabetes and its association with disease progression. Diabetologia (2014) 57: 902. doi:10.1007/s00125-014-3181-4

Rosen, C.J., Motyl, K.J. No bones about it: Insulin modulates skeletal remodeling. Cell 2010;142:198–200.

Song, Y., Wang, L., Pittas, A.G., Del Gobbo, L.C., Zhang, C., Manson, J.E., Hu, F.B. Blood 25-Hydroxy Vitamin D Levels and Incident Type 2 Diabetes. Diabetes Care 2013 May; 36(5): 1422-1428. http://dx.doi.org/10.2337/dc12-0962

 

Better Bones Blog
Dr. Susan E. Brown

Blood sugar curve

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This graphic shows a common fluctuation in blood sugar or glucose to demonstrate why blood sugar stabilization is a key to better health.

What’s Happening

1.
normal blood sugar level
2-3.
sudden rise in blood sugar
3.
pancreas overreaction produces excessive insulin
4-5.
stimulants are used by habit and by choice to restore glucose levels
5-6.
apparent shift of cognitive brain function results in loss of rational control and behavioral symptoms similar to depression or burnout result

Stimulants

A variety of addictive stimulants can alter your blood sugar level:

  • Sugar / sweets
  • Caffeine
  • Nicotine
  • Alcohol
  • Chocolate
  • Cola
  • Simple processed carbohydrates

Even emotional distress can disrupt blood sugar stability.

Return to Blood Sugar

Better Bones Blog
Dr. Susan E. Brown

Blood sugar, and bones

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Each of us is formed physically by some 63 trillion cells. Each cell is an intelligent, thinking being, so intricate that even a full life of study would not reveal all its secrets. How the body maintains balance functioning between all cells is amazing. Let’s explore just one aspect of that integrated function, the all-important aspect of blood sugar stabilization.

Blood sugar regulation

Within each of us there are a thousand self-regulatory “thermostats.” Like a series of ever-adjusting “on-off” switches, regulating uncounted internal balances, these “thermostats” maintain water within and outside of cells, hormone levels, temperature, blood pressure, blood nutrients, blood sugar, and myriad other critical internal balances.

The maintenance of precise levels of blood sugar provides fuel to each of our cells on a second-to-second basis, and the effects of blood sugar dysregulation are profound. Excursions into both low blood sugar (hypoglycemia) and high blood sugar (diabetes) stress all cells and immediately threaten full functioning. With low blood sugar, one feels weak, irritable and craves sweets and often salt, as the cells run out of fuel. With high blood sugar, the diabetic feels sluggish and tired. Worse yet, high blood sugar actually damages cells and can lead to life-threatening infections and blindness. Both low and high blood sugar are caused largely by dietary factors, and both can be corrected, or better, prevented by proper dietary management. In short, problems of blood sugar dysregulation are often unnecessary.

The six step program

Most often, problems associated with blood sugar originate from the excessive consumption of food and drinks that are easily converted into sugar (like sweets, sugar, bread, sodas, chocolate, candy, and processed carbohydrates) or from the intake of stimulants that trigger hormonal signals which increase blood sugar (as caffeine and nicotine). With such intakes, blood sugar quickly rises and either stays high (in diabetes) or is lowered too quickly (in hypoglycemia). Stable blood sugar, not too high or too low, is one of the most important keys to physical and emotional well-being.

Here’s your clinically proven program for blood sugar stabilization. Implementing it will yield clear and immediate benefits!

  1. Eat regular meals (and snacks, if necessary) of fresh, whole foods. Eat at least 3-4 cups of low carbohydrate vegetables per day with adequate protein, as needed. Do not skip meals!
  2. Substitute fruit and/or crackers or pretzels for baked goods, candy, and sweets.
  3. Drink plenty of pure water, herb tea, and a bit of fresh juice while avoiding sodas and caffeine.
  4. Take time to consume a protein snack in the afternoon. A little tuna, humus, almond butter, or egg salad on crackers works well. Avoid using coffee, sodas, or sugary foods as pick-me-ups from the “3 p.m. slump.” Rest a bit in the afternoon, if necessary.
  5. Use daily a broad spectrum vitamin/mineral supplement which includes 200 mcg of chromium, and a full range of all other essential nutrients.
  6. Reduce your production of stress hormones by practicing relaxation, stress reduction, and playful physical exercises. Meditating 20 minutes twice a day is helpful.

All of these steps will help maintain good blood sugar levels and will help create a healthy relationship between blood sugar and bones.

How to Stabilize Your Blood Sugar

How to Stabilize Your Blood Sugar

See the Blood Sugar Curve for additional information.