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Your Shoes Could Be Hurting Your Health

Thursday, August 8th, 2013

It’s no secret by now that high heels are harmful to your health. You are probably aware that wearing high heels can increase your risk of falling or developing foot, leg, or back problems due to the pressure exerted on various parts of the foot and the misalignment of your ankles, hips, and spine. You probably already know that you should limit high heels to no more than two inches and avoid tight, pointy-toed shoes.

But did you know that your beloved flip-flops are just as bad?

Flip-flops literally expose your feet to a whole host of potential problems. From relatively benign issues like cold feet or stubbed toes to more serious injuries like cuts or broken bones, there are many problems which are completely avoidable by wearing protective and supportive shoes.

As if the potential for injury weren’t enough, researchers now suspect that flip-flops may prevent you from being as fit as you could be. When you wear flip-flops, you are forced to bunch your toes up to hold them on your feet. This prevents your arch from flexing naturally, which alters the way you walk. Think of this as a ripple effect, where you grip your shoes with your toes, which prevents you from flexing your arch, which prevents you from “pushing off” from each step strongly enough, which forces you to compensate with your hips, which puts more stress on your knees. The result is an unnatural gait that does not fully engage all the muscles in your legs and backside that walking should engage.

So think twice before wearing those flip-flops out to run errands or to the office (if you are lucky enough to work in that kind of office!). Flip-flops are great for occasional wear – to the pool or the beach – but not for hours on end, day after day. Your day-to-day shoes should be supportive and ergonomically correct. If you want to wear an open shoe like a sandal, at least make sure it has a strap that wraps around your ankle so that you aren’t tensing those toes up to hold the shoe on.

You should be aware that, with their lack of arch support, ballet flats do not fare much better under scrutiny than flip-flops. Incidentally, research shows no additional benefit from wearing “toning” sneakers; regular walking or running shoes will do just fine for exercise, and any comfortable, well-fitting shoes with good arch support are fine for daily wear.

– Yvonne S. Thornton, M. D., M. P. H.

Osteoporosis Cannot Be Prevented By Calcium Alone

Thursday, February 14th, 2013

Everyone knows how important calcium is in the long-term prevention of osteoporosis. By drinking dairy in your youth, you are building strong bones that will hold up longer against the disease in adulthood. However, few people understand how calcium is absorbed into the body. When you drink a glass of milk, the calcium doesn’t simply soak into your bones on the way down. It must interact with other molecules in your system and bond to them in a way that makes them part of your digestion. Without this bonding, the calcium will simply be flushed out. Unfortunately, many people who try to get enough calcium in their diet don’t get as much as they think they do because it is not properly absorbed. To absorb calcium, your body also needs vitamin D.

Think of vitamin D like the doorman. You can make sure calcium pays a visit to your body by eating an adequate amount, but it will be turned away if no one is there to let it in. To make sure your body actually absorbs calcium and transfers it into your bones, you need to also get enough vitamin D. Studies show that vitamin D and calcium on their own do not effectively prevent fractures in people with osteoporosis.

To learn how much vitamin D you should be getting at your age, make sure you talk to your doctor. He or she will perform tests to first find out whether or not you are deficient in the first place. You can get vitamin D from sun exposure, but you should be careful to avoid too many UV rays at a time. You can also get it from dietary supplements and certain foods such as egg yolks, liver, and fortified milk.

Calcium is certainly important in the prevention of osteoporosis, but vitamin D is equally so. Don’t assume that just because you are getting a lot of calcium, you are safe from weakened bone strength in old age. To prevent the pain and inconvenience of fractures later in your life, start increasing the amount of vitamin D you get today.

– Yvonne S. Thornton, M. D., M. P. H.

Osteoporosis and Alcohol

Monday, July 16th, 2012

Like any reputable physician, I don’t condone heavy drinking, but that doesn’t mean I don’t necessarily partake in a glass of my favorite wine every now and then.  The truth is, a little alcohol once in a while never hurt anyone.  While recent studies suggest that a little bit of drinking may actually help our bones, my personal opinion is that one might be jumping the gun a bit.  Nevertheless, in the “spirit” of being complete and open, I wanted you to know about the recent research that has been covered by the media.

As odd as the connection may seem, a study by the College of Public Health and Human Sciences at Oregon State University found that even small amounts of alcohol have an impact on bone metabolism.  Their study of 40 postmenopausal women who drank moderately did show some benefit.  In fact, according to the principal investigator, “moderate alcohol [use] may slow bone loss by lowering bone turnover.”  That can help to reduce a woman’s risk for osteoporosis later in life.  Urzula Iwaniec, associate professor at OSU, explained that bones are living tissue with old bones constantly being replaced by new bone.  This is why increasing the metabolism of bones helps to stimulate the growth of new bone and keep older, thinning bones at bay.  One of the problems I had with this study is the sample size.  The number of patients studied was way too small to arrive at such a conclusion.  The three main mechanisms by which osteoporosis develops are an inadequate peak bone mass (the skeleton develops insufficient mass and strength during growth), excessive bone resorption, and inadequate formation of new bone during remodeling. An interplay of these three mechanisms underlies the development of fragile bone tissue.  This study only addresses one aspect of osteoporosis and fails to investigate the other possibilities.

Women who are postmenopausal are normally most at risk for bone thinning because of their reduced estrogen.  With that said, researchers did warn against drinking by young adult women, whose bones are still building and that excessive drinking is not a healthy idea for anyone.  However, even the lead author concluded that “the study doesn’t prove that moderate alcohol consumption wards off osteoporosis; it merely shows an association between the two.”  Those who drank one or two alcoholic beverages per day showed increased bone metabolism, and when they stopped drinking for two weeks, the risks for osteoporosis immediately began to show in their blood.  When they resumed drinking again, researchers were amazed to see their bone marker turnover rate return to previous levels.  Unfortunately, the researchers did not test any other hypothesis or mechanism for this change. They believe the reason for this effect is the ability for alcohol to act like estrogen, but it may not be due to this mechanism with respect to bone turnover.

We once thought that calcium and Vitamin D supplementation should be taken to prevent bone fractures.  However, the United States Preventive Services Task Force, an independent panel of experts in prevention and primary care, recently issued a draft statement in June, 2012 recommending that healthy postmenopausal women should not take low doses of calcium or vitamin D supplements to prevent fractures.  Why?  Because the supplements were found not to prevent fractures and only increased the risk of other problems, such as kidney stones.   So the risk outweighed the benefit and taking these supplements may actually be harming you.

While this seminal study about imbibing alcohol doesn’t give us an excuse to throw our healthy calcium- and vitamin D-rich diets out the window, it may be another factor to consider when it comes to our bones.  We already know that red wine may help prevent heart disease, so perhaps, in time, larger studies may support the conclusions of this research and that we may pour ourselves a drink and raise a glass to women’s health.

– Yvonne S. Thornton, M. D., M. P. H.