Fitness

A few years ago in a rural area, I visited four old friends, all of whom had dentures which they put in “for company.” At mealtime the dentures were removed, and the food was gummed in comfort. If an adequate diet is adhered to and well absorbed, one set of dentures should fit during the remainder of one’s life.

The calcification 5 of a person’s bones, shown by dental X-rays, is probably a good index of the density of bones throughout the body. You might ask your dentist to compare your X-rays with those of some person whom he considers to have unusually well-calcified bones. Examine the bone structure both below and around your teeth; the denser bone casts a whiter X-ray shadow. If your own X-rays show poorly calcified bone, rigid adherence to an adequate diet may pay rich dividends.

Fragile bones break easily. Although most people expect to have pyorrhea sooner or later, few expect broken bones. Unfortunately, breaks do occur. When bones are so poorly calcified that teeth are lost from pyorrhea, the condition of the bones throughout the body can degenerate but little more before they may crumble or break at any minor twist or fall. Millions of Americans, including thousands of relatively young persons and almost every person sixty years old and older, have porous bones. It makes no difference except perhaps to some physicians whether or not the porosity is of such a degree that the condition can be called osteoporosis. Formerly it was believed that bones naturally became porous with age. When experimental animals are kept on adequate diets, however, the longer they live, the stronger their bones become. Such evidence indicates that poorly calcified bones are the result of nutritional deficiencies; elderly persons have eaten faulty diets more years than has the younger person; hence the condition is more universal among them.

Since bones cannot be seen, few people trunk of whether theirs are well or poorly calcified. The difference in bones, however, is almost unbelievable. I used to lecture at a dental college where there is a large collection of skulls. The bones of some are so dense and heavy that they appear impossible to crack with a sledge hammer. Other skulls in this collection are so thin and porous that light shines through them; in fact they would make excellent lampshades, Any orthopedic physician or X-ray specialist can tell you that poorly calcified bones are extremely common.

If you think bones do well without care, you should go through an orthopedic hospital and talk with patients; you would soon be convinced that anything which helps to build strong bones and prevents such misery as you would find is worthwhile. Let me tell you about a few cases I have known personally.

A woman in her late thirties hobbled in to see me not long ago and, after putting her crutches aside, told me the following story. Several years ago she had somehow twisted her leg while walking across a lawn; the femur, or thigh bone, had broken near the pelvic joint. She lay in the hospital month after month before healing was sufficient for her to walk with crutches; in time they were discarded. Then one day, without warning, she simply fell in a heap. This time the bone had crumbled at the spot where it had been broken before. A plastic head was put on the femur which involved deep, drastic, and expensive surgery; the gold pin which held it in place showed clearly in the X-rays. Again months were passed in hospital beds before she graduated to crutches, but pain in that joint remained acute. She had been told that the pain was probably caused by calcium forming in rough deposits over the plastic head of the femur; .she came to me requesting a calcium-free diet. She left with a nutrition program which included generous amounts of both calcium and vitamin D and was as adequate in all respects as I could make it. Only three days later she phoned to say the pain had completely disappeared. A month later she came to see me, carrying a cane; she walked, however, without using it and without a limp. Do you suppose she believes that any nutrient which helps to maintain normal bones is unimportant?

A plasterer, forty-two years of age, who had fallen from scaffolding, used to come on crutches to hear me lecture. He too had broken his femur; months had passed without healing. The jagged ends of the bone kept breaking apart. Apparently in desperation, his physicians put a steel plate around the bone to hold the ends together, but X-rays cannot be taken through such a plate to see whether healing has occurred. Eventually the plate had been removed, but the bone still had not knitted. Infection, called osteomyelitis, set in, and operation after operation followed. Great deep scars about two inches apart and each a foot long went round his entire thigh. The wound from the last operation was still draining; the bone was badly infected, and amputation had been recommended. During all these tragic years, he had never once been given vitamin D; certainly he had not been in the sunshine. No diet had been recommended rich in calcium, in protein necessary to form bone base, or in the B vitamins needed to insure that adequate hydrochloric acid could be produced to help the absorption of what little calcium he chanced to obtain. No extra vitamin C had been given to help prevent or fight the infection. When his nutrition was made adequate, improvement was rapid. He now walks to work but with a limp he will have throughout life. Do you suppose he thinks that vitamin D is a nutrient only for babies?

I have seen perhaps two dozen similar cases, most not so severe but many equally tragic. The elderly persons whose hip bones crumble after a minor fall, usually in a bathtub, seem to me most pathetic. The easy breaking of bones and/or their slow healing are, in my opinion, completely unnecessary. Yet such fire insurance, which in this case should cost no more than a dollar or two per year, is usually purchased, if at all, only after the house is burned. The adult who is ignorant of the advantages of vitamin D usually pays both figuratively through the nose and literally through the pocketbook.

Perhaps I am making a mountain out of a molehill, and “vigorous adults leading normal lives” do not need vitamin D. A friend jokingly implied as much once when I had mentioned something about saving teeth; he remarked, “Some of the nicest people I know wear dentures.” He is undeniably right. In fact, there are some 32,000,000 nice people in these United States wearing dentures. I myself would gamble that all of these 32,000,000 nice people wish they had 32 nice teeth stuck firmly in their own jaw bones.

Long ago it was learned that excessive amounts of vitamin D can be toxic. A toxic dose for adults appears to be 300,000 to 800,000 units per day provided this quantity is taken daily for several months: Toxicity causes vomiting, diarrhea, and sluggishness; calcium is withdrawn from the bones, the amount in the blood becomes excessively high, and much is lost in the urine. These symptoms are prevented if generous amounts of vitamin C are supplied. Fear of toxicity has caused the National Research Council to recommend only 400 units daily for persons of all ages.

Almost nothing is known of the amount of vitamin D which can be taken advantageously by an adult. Dr. Johnston 2 of the Henry Ford Hospital in Detroit studied the needs of adolescent girls, some of whom had ceased growing. He found that even though a generous amount of calcium was supplied by the diet, if no vitamin D was taken, more calcium was excreted than was eaten. When the vitamin was supplied, the amount of calcium absorbed into the blood paralleled the vitamin-D intake. For example, when 650 units of vitamin D were given daily for a time, and later 3,900 units were given, the quantity of calcium absorbed was increased tenfold. In some cases 1,950 units of vitamin D were given with more calcium than could be obtained from an average quart of milk (1,343 milligrams); still no calcium whatsoever was retained in the body; this amount of calcium was well absorbed when vitamin D was increased to 3,900 units daily.

Unfortunately, Dr. Johnston did not study the calcium absorption when still larger quantities of vitamin D were given. His studies indicate, however, that the adult can profit by taking at least 4,000 units of this vitamin daily. It is entirely possible that the ideal intake may be nearer 7,000 units per day; since this amount is certainly not toxic, it appears wise to err on the side of obtaining slightly too much rather than too little. Aside from the need during pregnancy and lactation, I suspect the. highest requirement is during the menopause; the calcium intake is usually lower then than during adolescence. Hot flashes, night sweats, leg cramps, irritability, nervousness, and mental depression, so frequently experienced at this time, can usually be overcome in a single day by giving calcium and vitamin D; when the calcium intake is already adequate, vitamin D alone can relieve these symptoms.

Vitamin D can be stored in the body provided an excess is obtained. For example, in England during World War II mothers were given cod-liver oil for their babies. Uncooperative babies sometimes burp up the oil, which stains clothing and smells bad; the oil is a nuisance for a busy, tired mother to give. Despite the fact that the oil was supplied free, severe bone abnormalities developed. English physicians, desperately trying to solve this problem, studied the effect of giving single massive doses of vitamin D by mouth to tiny infants in the doctors’ offices. Many similar studies were made later on the Continent and in America. It was found that a single dose of 300,000 units of the vitamin promoted good bone growth for a year, indicating efficient storage of the excess; this amount was never found to be toxic.

Since vitamin D is stored, the cheapest source I know of for adults is a capsule of 25,000 units each which can be taken once a week, as after breakfast on Sunday. When the requirements are unusually high, as during adolescence, pregnancy, and menopause, such a capsule might be taken to advantage every Wednesday and Sunday. These capsules, although available,” are so little used that druggists often tell customers they cannot be sold without a prescription. The Food and Drug Administration has asked that the 50,000 unit capsules of vitamin D be sold only on prescription but not the 25,000 unit capsule. Since vitamin D, like vitamin A, cannot be absorbed unless in the presence of fat and bile, this vitamin should be taken after a meal containing some fat.

The positive results gained by taking adequate vitamin D throughout adult life are identical with the advantages of having ample calcium, to be discussed in chapter 21. Since adults can absorb calcium without vitamin D, the taking of this vitamin is similar to buying fire insurance: you hope you will never need it, but if you do, it is wonderful to have.

An advantage is that vitamin D helps to prevent tooth decay. All decay is apparently caused by sugar being broken down by bacteria-produced enzymes into lactic and pyruvic acids; any acid can combine with calcium. If the saliva can reach the area where the acids are being formed, and if it contains ample amounts of dissolved calcium, these acids are neutralized by the salivary calcium, and no decay results. Dental erosion appears to be prevented in the same manner. Although the subject is still controversial, an increasing amount of evidence 4 indicates that both the enamel and dentin of mature teeth can be built up provided the nutrition is adequate; probably the two most important nutrients in such rebuilding are calcium and vitamin D.

Ample vitamin D undoubtedly plays an important role in the prevention of pyorrhea. If the diet is made adequate and all infection is removed, even severe pyorrhea can usually be arrested. Although pyorrhea is a disease involving infection and resulting from multiple nutritional deficiencies, the loss of teeth is caused by decalcification of the bones. When too little calcium is supplied the tissues, minerals are withdrawn from the jaw bones; the bones themselves become smaller and recede from around the teeth. As the bones recede, the gums likewise recede, exposing more of the tooth surface. The teeth appear longer than they should be, and the gums cannot fit tightly around the base of each tooth. Eventually, so little bone structure remains that it cannot hold the teeth firmly in place; the teeth, though they may be free from decay, become loose and must be removed.

Even when the teeth and all infection are removed, the destruction of jaw bones does not cease, nor does this destruction cease to be a problem. Dentures can fit well only when sufficient jaw bone remains on which to anchor them. If the nutrition is poor, so much bone tissue can be lost even six months or less after perfectly fitting dentures are made that the dentures shift, wobble, or refuse to stay in place. One of the delightful memories of my childhood is an occasion when a malnourished Methodist minister, apparently believing that the gospel was more effective when thundered, shouted his upper dentures into the congregation. An innocent dentist was probably blamed even by this good Christian; at least a dentist usually is. It is not a dentist’s fault that a person’s diet cannot maintain normal bone structure.

Often set after set of dentures have to be made as the destruction continues. Furthermore, persons whose bones are undergoing rapid destruction are so deficient in calcium that they are nervous wrecks; often they cannot stand to wear dentures no matter how well they fit. For a time a dentist referred to me many patients who complained that new dentures did not fit. As soon as the patients’ diet was made adequate and their nerves relaxed, there were no more complaints.

It is undisputed that vitamin D aids the absorption of calcium, favors its retention, and improves its utilization.

Certainly it is a fact that calcium is needed by adults; this mineral helps to relax nerves, induce sound sleep, and decrease sensitiveness to pain. The National Research Council concedes that small amounts of vitamin D are desirable for people working at night, for elderly persons, and for nuns and others whose clothing shields them from the sunlight. According to this Council, however, “vigorous persons leading normal lives” appear not to need vitamin D. What about the almost vigorous person leading an almost normal life? It seems to me the scientific scientists are indulging in unscientific double talk here.

Vitamin D is scantily distributed in foods. There is some in egg yolks provided the hens sat in the sunshine and preened their feathers well; .50 to 200 eggs daily might supply your needs quite adequately if modern hens were not forced to live in shaded cages. Caviar contains some vitamin D; there is a little in the milk from cows pastured on high mountain slopes. Artificially produced vitamin-D milk is excellent, but as a sole source it has little value in my opinion. Fish-liver oils are the only natural foods containing sufficient quantities of this vitamin to promote health; that is, if you call them natural foods as my children do.

Vitamin D can be produced in foods or oils by exposure to ultraviolet light; the commercial concentrate, viosterol, is made bv such a method. This vitamin is formed by ultraviolet light from sunshine in the oils on the skin, provided you have oils on your skin and the shortest rays from the sun reach the earth. In winter, these rays do not penetrate our atmospheric blanket; during the summer they reach the top of the Empire State Building but usually not the street below it. Sunshine would be an excellent source of this vitamin if it were not for the facts that people are surrounded by smog, wear clothes, live in houses, have bathtubs and hot-water heaters, and listen to soap operas.

Most medical textbooks say that vitamin D is formed by sunlight on the oils in the skin although it was proved 16 years ago 1 that the oils must first be on the skin, then exposed to ultraviolet light, and later absorbed back into the body. If persons take a bath before going into the sunshine, the oils are washed off, and no vitamin D is formed; if they do not bathe before exposure to sunshine but bathe immediately afterward, the oils are removed before the vitamin can be absorbed into the body. Most of the oils appear to be washed off by cold water, and still larger quantities by warm water; warm soapy water does the job thoroughly. Time was when wood was hard to split, water hard to carry, and soap hard to make (and smelled too bad to use anyway); the Saturday-night bath was then a family institution. During the remainder of the week the oils stayed on the skin and absorbed any ultraviolet rays which reached them. The early settlers described the Indians as being great of stature with teeth “as even as piano keys,” both the advantages of having no hot-water heaters and no soap. Now as a nation we are bath-happy and soap-happy; I, for one, call it progress.

There are to be found in any medical library many books and thousands of articles concerning the need of vitamin D by children. Except for a few articles and short paragraphs on diseases known as osteomalacia, meaning literally bad bones, and osteoporosis, meaning porous bones, the need of adults for vitamin D is rarely mentioned. These diseases are identical except in degree; bad bones are worse than porous bones. In both, so few minerals are available that the bones become porous and honeycombed; the persons so afflicted may become shorter and may suffer from muscle cramps, twitches, and even convulsions, or tetany. Osteoporosis is usually painless, but in osteomalacia pain is experienced, especially in the hips; such pain is customarily spoken of as rheumatism; spontaneous fractures and breaks may occur. This disease is common in China and India, particularly when the need for minerals is increased by pregnancy and «becomes more piteous” (p. 684 of ref. 2, p. 36) with each child, especially when the mother “suckles her infant in the vain hope of thus warding off her tragic fertility.” Skeletal remains indicate that the Norse colony founded by Eric the Red in Greenland gradually became extinct because the pelvic deformities of women suffering from osteomalacia hindered childbirth; it is thought that the colonists did not eat the local diet of fish and fish-liver oils; too little vitamin D could be obtained from the Arctic sun. Osteomalacia results from famines and food shortages during and after wars. It occurs in American and English cities “where solitary old people live in proud self-respecting poverty rather than apply for charity” (p. 684 of ref. 2, p. 36). This disease can be cured by vitamin D alone, but to speed recovery calcium and phosphorus are customarily given with the vitamin.

Sir Robert McCarrison, the great English physician, wrote of osteomalacia in India among the Mohammedan women observing the custom of purdah. These women veil their faces at adolescence and rarely go outside their homes. No milk or other food rich in calcium is eaten. Vitamin D, however, either from sunshine or cod-liver oil, so increases the absorption and utilization of the meager dietary calcium that health is restored. Here, at last, is proof that vitamin D alone, without any increase in calcium or phosphorus, can help adults as well as rapidly growing children.

Americans have no more cause to worry about osteomalacia than about scurvy; 60 per cent or more of our population, however, obtain too little calcium in their diets. Much of this supply fails to reach the blood. Calcium is tricky in that it does not dissolve easily; your teeth and bones, even though washed by saliva or tissue fluid, do not dissolve. Unless calcium from food is dissolved, it remains in the intestine and is lost in the feces. The calcium supply to the tissues can be increased by eating more foods containing calcium or by obtaining ample vitamin D; both should be adequate.