20th October is the world osteoporosis, around 3 million people in the UK are affected by osteoporosis and 500,000 people receive hospital treatment for fragility fracture every year. In Europe, the disability due to osteoporosis is greater than that caused by cancer (except lung cancer). BUT what is osteoporosis

Osteoporosis means Porous bone. Bone is a living tissue that is constantly being broken down and replaced, we all have some degree of bone loss as we get older but osteoporosis occurs when this balance is disturbed and either body loses too much bone or makes too little new bones. Bones lost their density and become porous and fragile. Osteoporosis develops slowly over several years

osteoporosis affects women and men of all races but white and Asian women, especially older women who are past menopausal are at high risk.

Symptoms

osteoporosis is silent diseases as symptoms appear very late, often only diagnosed when a fall or sudden impact causes a bone to break.

• Chronic back pain
• Loss of height over time
• Stooped or hunched posture
• Limited mobility

what are risks

• GENDER
• ETHNICITY
• FAMILY HISTORY
• AGE
• MENOPAUSE
• LOW BODY WEIGHT
• PREVIOUS FRACTURES
• MEDICAL CONDITION; Early menopause, thyroid disorders
• MEDICATIONS; Glucocorticoids, Antacids

HOW TO PREVENT OSTEOPOROSIS

Osteoporosis is preventable by adopting healthy lifestyle guidelines. Nutrition, physical activity, weight, smoking cessation, avoiding heavy alcohol drinking can improve bone health.

Eat well for bone health

• Well balanced diet consist of all food groups play a critical role in building and maintaining good bone health at every stage of life. There are certain vitamins like vitamin D and K play an important role in preventing osteoporosis. similarly, minerals like calcium, magnesium, phosphorous and copper are important for bone health.
• Building strong bones begin in childhood and are essential to the prevention of osteoporosis. Good nutrition with plenty of calcium rich food like milk and dairy products or other calcium rich sources helps children to achieve their highest possible peak bone mass.

Recent research has found that olive oil, soybeans, blueberries, and food rich in omega 3 fatty acids are like fish oil, and flax seeds may have bone boosting benefits.

EXERCISE

Regular physical activity like aerobic exercises aimed at 30-45 minutes per day or 150 minutes every week helps in preventing osteoporosis.

Studies show that weight bearing exercises such as weight training, walking, hiking, jogging, climbing stairs and playing tennis over a period of time can improve bone density even build a new bone.

WHAT TO AVOID FOR GOOD BONE HEALTH

There are certain foods that should be consumed in moderation like soda, caffeine, saturated fats, salt and alcohol. They have no direct effect on bone health but they impair calcium absorption and reduce bone density.

smoking and bone health;

several studies found smoking as risk factor for osteoporosis and bone fracture.How smoking affects bone health, still unclear that decrease in bone density is due to smokng itself or to other risk factors common among smokers. For example women who smoke also tend to have early menopause than nono smokers and in many cases people who smoke are less physical active, drink more alcohol and poor diet as compared to non smoker.

Osteoporosis is not an invietable part of ageing; it is preventable.So it is vital that all of us, of all ages, start taking care of our bones now , before it is too late. love your bones protect your fracture

FODMAP is not a single entity, but a group of an acronym that stands for fermented, oligo, di, monosaccharides and polyols. FODMAPs are found in a variety of fruits, vegetables, milk and wheat.

HOW FODMAP WORKS;

FODMAP may exacerbate IBS symptoms through a various mechanism such as ;

OSMOTIC OVERLOAD; Poor absorption of FODMAP causes osmotic overload and distention of small intestine and abdominal symptoms.

BACTERIAL FERMENTATION; FODMAPs are rapidly absorbed by colonic bacteria and produce colonic distention due to gas production associated with abdominal pain and bloating.

FODMAPs are not bad for everyone, in normal healthy individuals they have important physiological effects like; they increase stool bulk, enhance calcium absorption and modulate immune function. They selectively stimulate the growth of Bifidobacterium a species of good bacteria.

FODMAPs and the irritable bowel syndrome (IBS)

IBS is a chronic functional disorder of the intestine, the most common symptoms are abdominal pain, bloating and altered bowel movements.The global prevalence of IBS is around 12% and is more common in women.

Treatment of IBS consist of pharmacological and non pharmacological measures. Among the non pharmacological options; stress reduction, dietary modifications ( restriction of certain food (FODMAP) and cognitive behaviour therapy are the most important.

LOW FODMAP DIET

In recent years, there is a growing body of research which support low FODMAP diet for the management of IBS, studies have shown that it can help up to 70-85% of patients with IBS achieve relief of their symptoms. it is now included in NICE guidelines as a second line intervention for IBS.

Following a low fodmap diet may helpful in alleviating symptoms of IBS like

• Abdominal pain
• Bloating
• Altered bowel movement
• Gas

There is no evidence that low FODMAP diet works for non digestive symptoms that are associated with IBS, such as headache and skin or joint problems.

Phases of low FODMAP diet

It is three phased elimination diet, first phase is the restriction phase in which high FODMAP food should be completely avoided. This phase lasts for 2-6 weeks. Second phase is reintroduction in which food with high FODMAP reintroduced but one at a time. This will enable you to identify which FODMAP you are sensitive too. This stage can take several months to complete and ideally should be completed under the guidance of a dietitian. Personalized stage the third phase is a combination of phase 1 and phase 2 and involves the long term, modified FODMAP diet. For more information regarding a high FODMAP food list https://www.monashfodmap.com/about-fodmap-and-ibs/high-and-low-fodmap-foods/

WHAT IS DOWNSIDES OF LOW FODMAP.

There is short term risk associated with insufficient protein, dietary fibre, B group vitamins and calcium intake.

Low levels of prebiotics;

Prebiotics are indigestible carbohydrates that are resistant to gastric acid and fermented by bacteria present in the large intestine. Prebiotics predominately found in food containing Fructans and Galacto-oligosaccharides.The low FODMAP diet restricts the intake of many high prebiotic (high FODMAP) foods and prolong restriction of high FODMAP can alter gut microbiome diversity. Studies have shown low levels of total bacterial abundance and reduced level of bifidobacterium following a low FODMAP diet. This is why re-introduction phase is very important as it allows you to have more variety in your diet but also maintain a healthy gut.

Calcium in low FODMAP diet;

The restriction of lactose containing dairy products may enhance the tendency to poor calcium availability since these items are primary source of calcium and promoting effect of lactose on calcium absorption is lost.

Lactose or dairy free calcium sources are; Kale, lactose free plant based milk fortified with calcium, hard cheese, firm tofu.

TAKE HOME MESSAGE

Low fodmap diet is considered as a second line treatment option for patients with IBS as recommended by NICE guidelines. This diet should not be used without specialized dietary advice from a registered professional. Vegan or vegetarian are at increased risk of protein deficiency due to limited plant protein sources however well constructed meal plans by registered dietitians may reduce possible nutritional deficiencies.

We know that obesity is a risk factor for several non communicable diseases, it can lead to diabetes and other metabolic conditions, but there is less awareness that obesity can lead to serious liver disease.It is estimated up to 1 in every 3 people in the UK has early stages of NAFLD, where there are small amounts of fat in their liver.

Non-alcoholic fatty liver disease is the accumulation of triglycerides in the liver cell and this buildup is independent of alcohol consumption. It is a spectrum of disorder ranging from less severe steatosis (fatty liver) to more severe non-alcoholic steatohepatitis (NASH), where the liver has become inflamed; this is estimated to affect up to 5% of the UK population. Fibrosis and cirrhosis develop at later stages and lead to liver failure and sometimes liver carcinoma.

what causes NAFLD

• The exact cause of NAFLD remains unclear, however, it is linked with genetic and environmental factors like
• 1.Obesity
• 2.Diabetes
• 3.Hyperlipidemia
• 4.Women with PCOS5.
• 5.Sedentary lifestyle

Treatment and prevention

There is no specific pharmacological treatment for NFALD. However, various medicines can be useful in managing the problems associated with the condition like;medications for high cholesterol, high blood pressure and Insulin sanitizers.

Life style modifications;

There is a strong consensus that lifestyle interventions such as diet, physical activity and weight reduction can help in preventing and reduces the progression of the disease. A metanalysis of 23 trials shows that lifestyle modification including weight loss and physically activity consistently reduced liver fat and improved histopathology.

WELL BALANCED DIET; Diet consists of vegetables and fruits with less processed carbohydrates. Low Glycemic index carbohydrates with more fibre content also reduce insulin resistance which is directly linked with NAFLD. Low caloric diet intake ( 3-6 months) either low carbohydrates or low fat diet results in weight loss and improved lipid profile.

Intake of polyunsaturated fats especially omega 3 fatty acids reduces the risk of NAFLD. Mediterianean diet is a best source of mono unsaturated fatty acids( MUFA) like n– oleic acid (olives, nuts, avocado), which play an important role in the metabolic profile of human metabolism. MUFA has been demonstrated a beneficial effect on lipid profile bt decreasing  plasma triacylglycerol and very low density lipoprotein (VLDL) cholesterol concentrations and modestly increasing high density lipoprotein (HDL) cholesterol without adversely affecting low density lipoprotein (LDL) cholesterol concentrations. 

Soft drinks are leading cause of added sugars in the world and different observational studies report a positive association between soft drink consumption and NAFLD. Soft drinks like cola drinks contain caramel coloring, which is rich in advanced glycation end products (AGEs) that may increase insulin resistance and inflammation.

Observational studies have demonstrated a favourable impact of coffee intake on health and in particular a protective effect from the metabolic syndrome. Coffee contain polyphenols chlorogenic acid which acts as antoxidants, anti inflammatory and reduces the risks of developing NAFLD and cardiovascular diseases.

Regular physical activity: There is a dose-response relationship between NAFLD and physical activity (both prevalence and disease severity,  therefore, the more physical activity performed throughout the day, the better! Aim to do at least 150 minutes/week of physical activity like walking or cycling. Increasing daily walking has also been shown to improve fat oxidation and is a way of increasing physical activity levels at no cost and without additional equipment. Aerobic and resistance exercises both improves NAFLD. A systematic review (24 exercise-only studies) revealed that exercise produced a 20–30% relative reduction in hepatic steatosis, independent of weight loss in NAFLD patients.

weight reduction: Based on available data, patients should optimally achieve a 5%-10% weight reduction. A prospective study with 7 years of follow up emphasized that even a modest weight change of 3–5 kg is an independent predictor for the development and remission of NAFLD, regardless of baseline body mass index (BMI).

TAKE-HOME MESSAGE

Lifestyle interventions can be highly effective in treating NAFLD across the disease spectrum and offer a holistic way of managing not only liver health, but also cardiovascular and metabolic health. Patients often feel difficult to achieve and implement these modifications, however with proper and individualized support suffient long term changes can be possible.

always set Smart, Meaurable, Achievable, Relevant, Timely goals