A Food for the Ages, Not Just the Aged

Hippocrates was quoted as saying, "Let food be thy medicine, and medicine be thy food." This is often stated, but not nearly as often believed or 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 participate.

There are risks for your patients if you choose to not participate. The information avalanche of the Internet is overwhelming; often, that information is incorrect and/or misleading. And let's not forget about the well-funded and superbly marketed messages from the pharmaceutical industry.

Osteoporosis: Causes and Complications

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. An enormous percentage of the worldwide population is also 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, include aromatase inhibitors, antiepileptic drugs, antiretroviral drugs, Depo-Provera and corticosteroids.

Are Your Patients at Risk?

Many adults are not taking any bone-demineralizing drugs, nor do they have any of the above-listed diseases. Yet many have, or will someday have, osteoporosis. Some are your patients.

In the U.S., the poor quality of the standard American diet (SAD), coupled with minimal or nonexistent exercise habits, greatly contribute to osteoporosis risk and disease. Now what?

This article would quickly turn into a book if all aspects of osteoporosis were discussed: bone density tests, laboratory studies, vitamins, minerals, other natural compounds, medications, exercise, etc. Let's focus one item that can be profound, but rarely gets the deserved press.

Power of the Prune

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 and 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.

Prunes taste sweet, yet they have a low glycemic index. Their "sugariness" is due to sorbitol.⁸ Thus, prunes are also a low-calorie, natural sweetener.

Mechanism of Action

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 as follows:

• 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 also 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.

How Much?

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.

Maximizing Skeletal Health

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.

References

1. Cawthorn PM. Gender differences in osteoporosis and fractures. Clin Orthopaed Related Res, 2011;469:1900-1905.
2. Kanis JA, Johnell O, Oden A, et al. Epidemiology of osteoporosis and fracture in men. Calcified Tissue Int, 2004;75:90-99.
3. Holick M. High prevalence of vitamin D inadequacy and implications for health. Mayo Clinic Proc, 2006;81:353-373.
4. Allain TJ, Dhesi J. Hypovitaminosis D in older adults. Gerontol, 2003;49(5):273-278.
5. 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.
6. Arunabh S, et al. Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab, 2003;88:157-61.
7. Bandeira F, et al. Vitamin D deficiency: a global perspective. Arq Bras Endocrinol Metabol, 2006 Aug;50(4):640-6.
8. Stacewicz-Sapuntzakis M, Bowen PE, Hussain EA, et al. Chemical composition and potential health effects of prunes: a functional food? Crit Rev Food Sci Nutr, 2010:251-286.
9. Armandi BH, Khalil DA, Lucas EA, et al. Dried plums improve indices of bone formation in postmenopausal women. J Women's Health & Gender-Based Med, 2004;11(1).
10. Deyhim F, et al. Dried plum reverses bone loss in an osteopenic rat model of osteoporosis. Menopause, 2005;12(e 6):755-762.
11. Smith BJ. Dried plum improves bone density and microarchitecture by up-regulating osteoblast activity and down-regulating osteoclast differentiation. SHS Acta Horticulturae, Aug 2009;841(841):441-448.
12. 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.
13. 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.
14. 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.
15. Arjmandi BH. The role of phytoestrogens in the prevention and treatment of osteoporosis in ovarian hormone deficiency. J Am Col of Nutr, 2001Oct;20(5 Suppl):398S-402S.