You Are What You Drink

In the Allergy specialty, we prescribe steroids on a daily basis. Usually, they are just inhaled corticosteroids, where we can delivery microgram amounts directly the nose or the lungs. I've been worried, though, that decades of daily use of these steroids may contribute to osteoporosis. Steroids taken by mouth are notorious for causing osteoporosis. The whole point of the "topical" steroids is to deliver a much smaller dose of the medicine directly to the target organ (e.g., the nose or the lung). After all, there are 1000 micrograms in each milligram.

We encourage our patients on Flonase, Nasacort, Advair and Pulmicort to eat a calcium-rich diet and to take calcium supplements. We've heard that calcium citrate (e.g., Citracal) is better absorbed than calcium carbonate (e.g., TUMS). What worries me, though, is what else is being consumed in the diet.

We have suspected that there was a link between reduced bone density and soda consumption; now, it seems that facts back up this hypothesis. Phosphoric acid in soft drinks may be the culprit. The excess phosphoric acid in Coke, Pepsi or Dr. Pepper binds to calcium in the gut, which may keep calcium from being absorbed. Why do I pick on Diet Coke instead of Coca-Cola? Because Diet Coke drinkers think they're helping their health by drinking it instead of its sugary sibling. Some dieticians think it's the calcium-phosphorus ratio in the diet that's critical: a ratio of one part calcium to one part phosphorous promotes the highest level of calcium. Sodas can have ratios in excess of one part calcium to 30 parts phosphorus, draining calcium from bones and teeth. Not surprisingly, the National Soft Drink Association denies any risk of osteopenia (thinning of the bones) from drinking soda. On the other hand, the Carpet and Rug Institute claims that a carpeted room is better for the dust-mite allergic patient than a wooden or tile floor. Yet I digress.

Phosphorous may just be a red herring. Perhaps the connection to bone weakening and osteoporosis is the result of a lifestyle that includes soda drinking. Soda drinkers often are guilty of skipping meals, downing a soda instead of milk, and avoiding high calcium foods such as spinach, beans, or corn tortillas.

Regardless of dietary habits, we encourage all of our patients to participate in regular weight-bearing exercise. That doesn't have to mean pumping iron; walking at a brisk pace is the perfect "weight-bearing exercise". Another wonderful way to exercise if you hate gyms is gardening! Gardening can be a real workout, says Bottom Line Health. You can even plan your garden to minimize its impact on your allergies.

Long-term studies on the effects of inhaled steroids on bone density are still being done. Rather than assuming inhaled steroids are harmless to bones, I'd hedge my bets: more calcium, fewer Diet Cokes.

That doesn't mean no sodas – just fewer.

Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.