Bone Health Mastery: Navigating Osteopenia and Osteoporosis

# Body of Wonder: Osteoporosis, Osteopenia, and Supporting Bone Health with Dr. Olga Kromo
# https://www.youtube.com/watch/SmtKM0cW0eM

00:00:00.530 [Music]
00:00:04.799 Hi Andy. Hi Victoria. Today we have one
00:00:08.400 of our own, one of our graduates, an
00:00:10.800 integrative rheatologist named Olga
00:00:13.599 Chromo who practices in Florida and is
00:00:17.039 an expert on osteoporosis. Well, I’d
00:00:19.920 love to see more integrative
00:00:21.359 rheatologists out there and I think she
00:00:23.680 is helping develop the field. Fabulous.
00:00:26.640 Let’s get her on. Okay.
00:00:29.439 Dr. Olga Chromo is an integrative
00:00:32.000 rheumatologist and a graduate of the
00:00:34.239 Andrew Wild Center for Integrative
00:00:36.239 Medicine at the University of Arizona.
00:00:38.960 She’s a staunch believer in the phrase
00:00:41.120 attributed to Hypocrates, let food be
00:00:43.680 thy medicine and she coaches her
00:00:46.160 patients on the importance of nutrition
00:00:48.320 and wellness. Dr. Cromo serves as the
00:00:51.280 president of the Florida Society of
00:00:53.399 Rheumatology and she founded the
00:00:55.920 National Integrative Rheumatology
00:00:58.120 Society. Welcome, Olga. Thank you so
00:01:01.440 much, Victoria. I appreciate that
00:01:03.120 introduction.
00:01:05.040 I see so many women who are worried
00:01:08.479 about their bone health. Some have
00:01:10.880 osteopenia, some have osteoporosis. Can
00:01:13.760 you explain to our listener what the
00:01:16.159 difference is?
00:01:18.119 Osteoporosis. First and foremost, let me
00:01:20.080 just say that most patients think that
00:01:21.680 it’s a disease. It’s really not. It’s
00:01:23.759 natural aging of the bone. And there’s
00:01:26.240 so many things that go into it, but just
00:01:27.840 the separation between osteoporosis,
00:01:30.400 which is significant bone weakness, and
00:01:32.799 osteopenia, which is essentially the
00:01:34.640 step built before. It’s your bone is
00:01:36.880 already thinning, but it’s not gotten to
00:01:39.040 a point where it’s considered very weak
00:01:41.439 bone, which is osteoporosis.
00:01:44.400 That’s really helpful. So what puts us
00:01:47.200 at risk besides as you said it’s part of
00:01:49.520 natural aging for us to have some bone
00:01:51.920 loss? I really do see it as a problem of
00:01:56.240 calcium and vitamin D metabolism
00:01:58.880 malnutrition which is a huge one for me
00:02:00.880 and I would love to discuss that further
00:02:03.200 and environmental toxin exposure that
00:02:05.680 damages either the bone directly or how
00:02:08.160 we form bone to begin with.
00:02:10.800 Maybe you could unpack a little bit
00:02:12.959 about those different factors that you
00:02:15.520 just mentioned.
00:02:17.360 Let me start with calcium and vitamin D
00:02:19.599 because that does start in our youth. We
00:02:22.720 really form the majority of our bone
00:02:24.720 when we’re younger um teens, young
00:02:27.680 adults, and this is really when
00:02:29.599 nutrition needs to be paid attention to.
00:02:31.920 And that usually involves having a good
00:02:34.640 intake of calcium and vitamin D. And
00:02:37.440 there’s just so many things that go into
00:02:38.879 it. It’s very much affected by our diet.
00:02:41.440 It’s very much affected by our cultural
00:02:43.680 preferences for foods and behaviors. And
00:02:46.319 it’s just so important to educate
00:02:47.920 yourself on that when we’re younger
00:02:49.760 because the best treatment of
00:02:51.519 osteoporosis is actually prevention of
00:02:53.440 bone loss and formation of good bone.
00:02:56.080 And that does require good calcium, good
00:02:58.720 vitamin D, good vitamin K2, and other
00:03:01.519 nutrients. So, we’ll get to the other
00:03:04.319 factors, but Andy, obviously, a huge
00:03:06.720 part of your career has been let’s get
00:03:09.519 people to eat a healthier diet and
00:03:12.640 especially let’s focus on kids,
00:03:16.200 adolescents. A lot of times their diet
00:03:18.159 is not particularly healthy. What would
00:03:19.760 you advise? Well, I think a very
00:03:22.239 important piece of information to get
00:03:23.920 across to young people is that both bone
00:03:26.480 and muscle are mostly formed early in
00:03:29.519 life in the teenage years up through
00:03:31.440 your 20s and after that all you can do
00:03:34.000 is slow down loss. You can’t make new
00:03:36.319 tissue. So, I think people need to
00:03:38.319 understand that in those early years uh
00:03:41.040 good nutrition and attending to all the
00:03:43.120 factors that build maximum bone and
00:03:45.280 muscle mass are very important.
00:03:48.480 So, one of the people I know you pay
00:03:51.120 attention to is Walter Willlet. And
00:03:53.360 Walter Willlet is famously quoted as
00:03:55.920 saying, "We have so much focus on
00:03:57.920 calcium, maybe it would be better to
00:03:59.360 take the cow for a walk rather than
00:04:01.599 drink the milk." I was fascinated to
00:04:03.760 learn that the countries with the
00:04:05.959 highest calcium intake uh often have the
00:04:09.760 highest rates of hip fractures. Same for
00:04:12.560 the highest rates of dairy intake. very
00:04:15.360 contrary to what the dairy industry puts
00:04:17.279 out about milk building strong bones. So
00:04:20.079 Olga, how do you explain that? I really
00:04:22.880 think that it needs to be appropriate
00:04:24.800 calcium intake but from food sources and
00:04:27.280 it needs to be combined with vitamin D
00:04:29.759 and other minerals. I as well as
00:04:32.240 protein. So it has to be done in
00:04:34.160 moderation. It has to be done with good
00:04:35.840 quality. I think a lot of the concerns
00:04:38.720 about calcium and protein really stem
00:04:41.440 from what it’s packaged with, what kind
00:04:43.840 of chemicals, what kind of pesticides is
00:04:46.400 it done in an appropriate ratio. But we
00:04:48.800 do see that calcium is essential for
00:04:52.080 bone building and but also protein and
00:04:54.560 exercise and everything else that goes
00:04:56.080 together with it. The American diet
00:04:58.000 unfortunately does not predispose our
00:05:00.320 current young adults and teens to a good
00:05:03.040 intake of these nutrients. Additionally,
00:05:05.199 I find that the sad American diet also
00:05:08.960 causes a lot of inflammation that
00:05:10.560 interferes with absorption and bone
00:05:12.400 building. Yeah. Is the problem mainly
00:05:14.080 with intake or was it is it with
00:05:16.320 absorption and utilization?
00:05:18.800 It’s actually both. I think some of the
00:05:20.720 toxins that come with the food that
00:05:22.320 we’re consuming interfere with
00:05:23.759 absorption and formation of bone. And on
00:05:26.320 top of that, we just don’t get enough of
00:05:28.479 the right nutrients from the current
00:05:29.919 intake that our teens and young adults
00:05:32.080 are seeing. So, I also want to say I’m
00:05:34.639 really a food first kind of person and I
00:05:37.840 really believe you can get adequate
00:05:39.759 calcium from food. There’s actually some
00:05:42.080 risk of calcium supplementation. We can
00:05:44.080 get to that later, but in terms of food,
00:05:46.720 high quality dairy can be a good source
00:05:48.880 of protein and calcium in in young
00:05:51.440 people. Some people don’t tolerate dairy
00:05:54.400 well as they get older. And there are
00:05:56.400 many plant sources of calcium. So figs
00:06:00.080 and almonds and legumes, I mean there’s
00:06:02.240 lots of other places to get your calcium
00:06:04.639 besides dairy so that you have an
00:06:06.880 adequate intake from food and don’t
00:06:08.680 necessarily need to supplement. Is that
00:06:11.280 something you would agree with? Because
00:06:12.800 I know the right now in the US we
00:06:16.080 recommend 1,200 milligrams. It varies a
00:06:19.199 little depending on your age and whether
00:06:21.280 you’re pregnant, but we recommend 1,200
00:06:23.520 and that’s a lot. That that’s harder to
00:06:26.000 get to food. Other countries recommend
00:06:28.240 500 or 700.
00:06:30.639 You know, I think it has something to do
00:06:32.080 with other factors in our diet, but yes,
00:06:34.160 the current recommendation is about
00:06:35.520 1,200 a day, 12-,400 a day, but only
00:06:38.880 about 600 to 700 of it from a
00:06:40.800 supplement. The rest does need to come
00:06:42.479 from food. And the food sources are much
00:06:44.880 better quality calcium and they’re
00:06:46.880 usually bound to other nutrients like
00:06:48.639 protein and vitamin D that are necessary
00:06:50.960 for its use in the bone. And even the
00:06:54.160 six to 700 milligrams in a supplement
00:06:56.479 still needs to be divided. We really
00:06:58.000 don’t absorb that much in one sitting.
00:07:00.400 So taking one large supplement at
00:07:02.639 nighttime without a meal really doesn’t
00:07:04.560 is not going to do a lot of benefit and
00:07:06.639 there is some potential risk. What’s the
00:07:08.880 role of vitamin K in bone health and
00:07:12.240 where do we obtain that from?
00:07:14.080 Absolutely. So vitamin K is essential.
00:07:16.479 It creates a lot of proteins that help
00:07:18.960 calcium actually make it to the bone.
00:07:20.720 and it chaperons the calcium and other
00:07:22.800 minerals to the bone so that it can be
00:07:24.880 used for formation. And we actually find
00:07:27.120 that majority of the trouble with taking
00:07:29.199 calcium without vitamin K is what is
00:07:31.919 concerning with heart disease and
00:07:33.919 deposition of calcium and the arteries
00:07:35.680 and such. Vitamin K2 is really egg
00:07:37.919 yolks, liver, animal products. There’s
00:07:41.039 two types. There’s vitamin K2 which is
00:07:43.199 the active form and there’s vitamin K
00:07:45.599 which is inactivated and that needs to
00:07:47.599 be activated by the liver. And I think
00:07:50.080 eggs is probably our most common source
00:07:52.160 in the American diet, but cheese,
00:07:54.800 butter, we don’t really consume that
00:07:56.560 much butter. Natto is actually a
00:07:58.400 fantastic source. So yeah, eat natto.
00:08:02.560 Yeah. Fermented stuff. I like it. Andy,
00:08:05.120 you are unique in liking it. It’s so
00:08:07.680 slimy. It’s like But it’s a power food
00:08:11.039 in so many ways. It just has so much
00:08:13.199 benefit. Japan is one of the few
00:08:15.440 countries that has an actually higher
00:08:17.840 rate of osteoporosis than the US and
00:08:20.560 Japan is where natto is really commonly
00:08:22.560 consumed.
00:08:24.080 I think it has a lot to do with other
00:08:25.919 things that they’re consuming that
00:08:27.280 actually contribute to bone thinning.
00:08:29.039 Plus, their true dairy intake is pretty
00:08:31.840 low as well. They’re not really they
00:08:33.599 don’t consume a lot of cheese or milk or
00:08:36.000 yogurt. But as far as I’m concerned, a
00:08:38.559 good grass-fed organic dairy product
00:08:41.760 like a cottage cheese in particular if
00:08:43.360 it’s fermented. It’s just magic. It’s
00:08:45.519 just such a great thing. You can
00:08:46.959 tolerate you if you can tolerate it.
00:08:48.720 Some patients truly cannot. So you
00:08:51.600 mentioned calcium, vitamin K. What about
00:08:54.399 some of the other you mentioned vitamin
00:08:55.839 D, some of the other vitamins and
00:08:57.519 minerals like boron, manganese, how
00:09:00.880 important are these? said, "Should
00:09:02.240 people be taking one of these kind of
00:09:04.720 bone specific because the typical
00:09:07.600 multivitamin doesn’t have vitamin K2 in
00:09:10.000 it?" It doesn’t and it usually doesn’t
00:09:12.160 even have enough vitamin D to tell you
00:09:14.000 honestly or calcium for that matter. So,
00:09:15.920 I actually very much do recommend taking
00:09:18.080 a bone specific calcium blend. It has to
00:09:21.200 be a blend. It has to be a good quality
00:09:23.600 calcium. Usually, I recommend citrate or
00:09:26.640 carbonate. It does have to come with a
00:09:28.959 vitamin D. It does have to come with a
00:09:30.720 dose of K2 and some of the other
00:09:32.959 minerals which is magnesium in
00:09:34.640 particular. So there’s a perfect blend
00:09:36.480 ratio without which we’re really not
00:09:39.040 utilizing that supplement in a good way.
00:09:41.120 So you know zinc, copper, maganese,
00:09:43.839 people can get carried away. A low dose
00:09:46.240 zinc maybe 12.5 to 25 milligrams a day I
00:09:49.279 think is enough. Andy, this makes me
00:09:52.240 think about the early years of
00:09:54.240 integrative medicine where everybody was
00:09:56.800 so focused on a single vitamin and then
00:09:59.200 they’d say, "Look, we did that study, it
00:10:01.040 didn’t work." And always really pointing
00:10:03.200 to the way in which these different
00:10:05.760 vitamins and minerals work
00:10:07.560 synergistically. Can you talk about that
00:10:09.519 a bit? Yeah, I think that’s a general
00:10:11.440 pattern in nature that the nature
00:10:13.360 produces complexes of related compounds
00:10:16.560 and probably it is desirable to take the
00:10:18.959 whole complex and the best way to get
00:10:20.640 that is from foods and supplements at
00:10:23.279 best partially represent what we find in
00:10:26.640 the naturally occurring. So you also
00:10:29.519 spoke earlier to the importance of
00:10:32.240 building not just bone but muscle and
00:10:34.800 our skeleton and the way we do that is
00:10:37.040 being physically active. In fact, one of
00:10:39.360 the easiest ways to lose bone density is
00:10:41.760 to go to bed. We used to put people to
00:10:43.600 bed rest. We don’t really do that very
00:10:45.279 much, not just because of the skeleton,
00:10:48.399 but also because of our skeleton. So,
00:10:51.519 Olga, do you have favorites? Like, these
00:10:54.320 are the very best exercises for bone
00:10:57.680 health. I truly do and this is one of my
00:11:00.480 favorite topics and it doesn’t have to
00:11:01.920 be anything scary and excessive. And
00:11:04.320 this is the issue that I think a lot of
00:11:06.320 our patients are having. Somebody older
00:11:08.240 will come in and they’re already weak.
00:11:10.079 They’re already fragile. They have this
00:11:11.680 new suspected diagnosis or potential
00:11:13.680 diagnosis of bone thinning. They’re
00:11:15.600 afraid to move. They’re afraid to do
00:11:17.200 anything that will make them fall and
00:11:18.959 potentially break. So, I usually start
00:11:21.360 with whatever is the easiest for them or
00:11:23.680 the easiest to understand and handle. Go
00:11:26.160 for a walk, take a backpack, put two
00:11:28.560 books in it. That’s weight on your
00:11:30.000 bones. Bone cells have these little
00:11:31.920 vibration receptors inside that um
00:11:35.120 mechano receptors and in response to a
00:11:38.160 little bit of bouncing, a little bit of
00:11:39.600 pressure from walking and a little bit
00:11:41.600 of weight built above as in a bag with
00:11:44.480 some books in it that will give you some
00:11:46.320 stimulation to those bone cells to start
00:11:48.640 depositing more mineral into the bone
00:11:50.640 and will thicken the bone. Another one
00:11:52.720 that’s amazing if the patient is able to
00:11:54.720 do it is yoga. You know, in particular,
00:11:57.120 you have to actually hold poses of yoga
00:11:59.120 for 12 seconds. That seems to be the
00:12:00.880 magic number. And that will stimulate
00:12:03.040 the same mechano receptors or those
00:12:04.959 little vibration sensors in the bones to
00:12:07.920 stimulate deposition of minerals in
00:12:09.760 those bones for those bones to feel a
00:12:11.440 little healthier, for the cells in the
00:12:12.800 bones to feel healthier. Pilates is
00:12:15.120 another amazing one. So, it doesn’t have
00:12:16.880 to be high impact. We’re not talking
00:12:18.800 about running or jumping or very
00:12:21.600 aggressive activities. just daily
00:12:23.519 activity, walking, yoga, pilates.
00:12:26.639 There’s another one that I really love
00:12:28.000 which is bar which is very controlled
00:12:29.760 movements. Those things will help. And
00:12:32.639 an exciting addition that’s happening or
00:12:34.480 an exciting interest that’s happening
00:12:36.000 now in osteoporosis and this is not new
00:12:38.240 but it’s seeing a resurgence is the
00:12:40.320 vibration plate and vibration plate
00:12:42.480 about that. Absolutely. I’m not sure if
00:12:44.800 it was developed by NASA, but it was
00:12:46.399 definitely used by NASA to prevent
00:12:48.800 osteoporosis or treat osteoporosis in
00:12:50.880 astronauts that had no pressure on their
00:12:53.360 bones from the atmosphere because they
00:12:55.040 were outside of it. And there’s a
00:12:56.880 resurgence and it definitely does make a
00:12:58.560 difference. This is something that’s
00:13:00.240 really easy to recommend to patients
00:13:01.839 because they literally just need to step
00:13:03.600 on it and be on it for 15 minutes, which
00:13:06.720 is not easy. If you turn that thing up,
00:13:08.720 pretty intense, but it also improves
00:13:11.120 balance muscles. So, it improves
00:13:12.959 stability a little bit. So, prevents
00:13:14.320 falls. So, there’s a ton of benefit. And
00:13:16.880 there’s some new gyms specifically
00:13:18.720 tailored for osteoporosis that now have
00:13:20.800 them, so it’s easier to find. It’s funny
00:13:23.200 because you just describe someone who’s
00:13:25.440 frail and at a higher risk perhaps of
00:13:28.000 falling and breaking a bone, but I have
00:13:30.480 to say I see a lot of women in my
00:13:32.399 practice who are very fit and have
00:13:35.160 osteopenia or early osteoporosis. Some
00:13:38.079 of them have significant osteoporosis
00:13:40.560 and they’re runners, they’re hikers, and
00:13:43.519 they’re devastated and they do not want
00:13:46.079 to take medicine. So, what do you think
00:13:48.399 about that particular profile? Can that
00:13:50.959 woman avoid medication through lifestyle
00:13:53.760 and supplements or does she really need
00:13:55.920 to think about medication? Absolutely. I
00:13:58.560 think every patient can do things in a
00:14:01.440 way to improve their bone health, but
00:14:03.920 there’s multiple factors that are taken
00:14:05.440 into account. We definitely need to
00:14:07.120 understand what their hor hormones are
00:14:08.800 doing, whether that’s testosterone in
00:14:10.480 men or estrogen in women. We definitely
00:14:12.800 need to understand what their diet looks
00:14:14.480 like. I think that healthy patient who
00:14:16.560 is very active and very physically fit,
00:14:18.720 but nevertheless has bone thinning,
00:14:20.800 there’s other issues there, including
00:14:23.680 environmental pollution, including
00:14:26.240 eating the wrong foods because sometimes
00:14:28.399 they just don’t have the right
00:14:29.519 nutrients. And obviously the hormones
00:14:31.760 need to be taken into account. thyroid
00:14:34.079 hormone. Too much or too little of
00:14:36.160 thyroid hormone in that healthy patient
00:14:38.160 will affect their bone quality. So, some
00:14:40.720 of the things that need to be assessed
00:14:42.240 is obviously how much contaminants, how
00:14:44.880 much pollutants they’re taking in.
00:14:46.639 Non-conventional foods will have a ton
00:14:48.560 of cadmium in them from the pesticides
00:14:51.120 used to grow those foods that interferes
00:14:53.279 with bone metabolism. I want to say
00:14:55.600 about 20% of current osteoporosis is
00:14:58.720 actually from cadmium in glyphosate.
00:15:01.839 Additionally, lead, which has been
00:15:03.760 illegal since 1970 in gas, but because
00:15:07.120 now we have unled gas. But before then,
00:15:09.519 so anybody who’s over 50 at this point,
00:15:12.079 that was inhaled and stored in the bone.
00:15:13.839 And during menopause, which is when the
00:15:15.680 bone starts to become more fragile,
00:15:17.760 that’s when it starts coming out and
00:15:19.360 it’s toxic to the kidneys and it’s toxic
00:15:21.680 to the liver and that affects bone
00:15:23.399 metabolism. What can we do about it?
00:15:25.839 Zinc actually helps. Resveratrol is
00:15:28.240 something that’s fantastic to take and
00:15:30.480 it’s easy to access. Glutathione is
00:15:32.920 wonderful. Alpha lipoic acid. So,
00:15:35.199 there’s a couple of natural things that
00:15:36.880 can help that very healthy middle-aged
00:15:40.320 men or women who wants to improve their
00:15:42.480 bone health and obviously exercise and
00:15:44.720 obviously vitamin D. And I think this is
00:15:46.639 really something that we do need to
00:15:47.920 discuss because it’s just so essential
00:15:49.600 vitamin D. And I want to say so many of
00:15:51.920 us are completely malnourished in that
00:15:53.920 specific nutrient. Vitamin D has become
00:15:57.120 more controversial recently with the
00:15:59.360 society saying you don’t actually have
00:16:01.360 to check vitamin D levels. I personally
00:16:03.600 still check vitamin D levels on my
00:16:05.360 patients because many are low and I’m
00:16:08.480 not sure that the current
00:16:09.600 recommendations are for optimal health.
00:16:11.519 What do you think? Where do you like
00:16:12.639 people’s vitamin D levels to be and how
00:16:15.199 often do you check them? Absolutely.
00:16:17.680 Vitamin D is my one of my most important
00:16:20.800 recommendations both in inflammation and
00:16:22.959 osteoporosis. I see so much benefit from
00:16:25.600 vitamin D replacement. All of us are
00:16:27.600 low. We only gain vitamin D from sun
00:16:31.440 exposure and let we can even discuss
00:16:33.199 that and nutrition but it’s really
00:16:35.759 sunexposed mushrooms and sun exposure.
00:16:38.000 There’s very little sources that we’re
00:16:39.600 getting and even with sun exposure you
00:16:42.880 need 20 to 30 minutes of exposure to
00:16:45.759 arms and legs below a certain latitude.
00:16:48.160 So in northern latitudes, we don’t even
00:16:49.920 make it regardless of how much time we
00:16:51.600 spend in the sun in the winter months. I
00:16:54.160 would love for all of my patients to be
00:16:56.000 at a vitamin D level between 60 and 90,
00:16:59.279 which takes effort. Nanogs per
00:17:01.440 milliliter. Correct. Yeah, we usually sh
00:17:04.079 usually we shake out between 20 and 40.
00:17:07.039 I very rarely see anything either below
00:17:10.160 that or above that. It definitely
00:17:12.240 contributes to muscle building. It
00:17:14.000 definitely contributes to control of
00:17:15.599 inflammation and it 100% is essential
00:17:18.480 for good bone quality. So, we have to
00:17:21.039 supplement. Whether we’re supplementing
00:17:22.799 once a week, which is not the best form,
00:17:25.359 or if we’re supplementing once a day
00:17:27.599 with D3, which is a better form, I
00:17:30.320 typically tell patients you need about
00:17:31.919 5,000 a day. And it has to be combined
00:17:34.400 with the calcium and it has to be
00:17:35.760 combined with magnesium to really show
00:17:37.360 its benefit. But this is one of those
00:17:39.440 things that is so valuable for
00:17:41.520 inflammation and just so needed for bone
00:17:43.919 quality and most of us are deficient.
00:17:46.160 And when you combine that with
00:17:48.880 microbiome disruption and leaky gut and
00:17:51.760 see and gluten intolerance that is just
00:17:53.760 so widely rampant right now, you’re not
00:17:56.880 absorbing vitamin D. And then the way
00:18:00.039 toxins affect us, the way lead and
00:18:03.039 mercury and some of the and cadmium and
00:18:04.960 some of the other toxins that we’re
00:18:06.080 picking up from the environment affect
00:18:07.440 us is they prevent us from being able to
00:18:10.520 activate vitamin D and that’s the main
00:18:13.360 cause on on osteoporosis. Algo I see
00:18:17.039 many women who have been diagnosed with
00:18:18.799 osteopenia and made very fearful about
00:18:21.679 that and in general I’m a little leerary
00:18:24.559 about preconditions. I think that we
00:18:26.720 have gone overboard in creating these
00:18:29.200 preconditions and opportunities for
00:18:31.360 medicating them. Correct. And I often
00:18:33.440 tell women that osteopenia does not
00:18:35.440 necessarily progress to osteoporosis and
00:18:38.320 it is a warning sign that you should be
00:18:40.799 taking better care of your bone health.
00:18:43.360 Absolutely. In fact, some women I don’t
00:18:45.360 think ever get to a bone density that’s
00:18:47.600 not quote unquote osteopenia because
00:18:50.240 some ladies just have smaller bones.
00:18:52.240 Some of us never get that super thick
00:18:54.000 bone, but that’s normal for us. So that
00:18:56.160 is not a place to treat. I think that’s
00:18:57.919 a place to introduce dietary
00:19:00.559 recommendations, maybe improve some
00:19:02.400 exercise, improve vitamin
00:19:04.360 supplementation. Absolutely. I agree
00:19:06.160 with you 100%. And even when somebody
00:19:08.400 truly gets
00:19:09.960 to a level that’s considered
00:19:12.320 osteoporosis, which is again that’s like
00:19:14.480 a cut off that we said, it’s not
00:19:16.360 necessarily immediately a high risk of
00:19:18.960 fracture. And there’s another way of
00:19:20.640 testing it and we we can discuss that.
00:19:23.120 Even there I think the first and
00:19:24.720 foremost assessment that needs to be
00:19:26.400 done is what is your nutrition? What are
00:19:28.559 your risk factors? What are you not
00:19:30.480 doing that you could be doing to
00:19:31.760 optimize bone density? And if it’s
00:19:34.000 somebody who is very close to menopause,
00:19:36.640 meaning they just started menopause,
00:19:38.400 there’s some things that can be done
00:19:39.840 there that are more natural for them
00:19:41.679 than for somebody who’s older and really
00:19:43.679 activate that estrogen system. And what
00:19:46.400 do you think about the bone building
00:19:47.919 drugs and when are they indicated and
00:19:50.400 what are their risks?
00:19:52.880 So we have several ways of testing for
00:19:55.600 osteoporosis. We have the traditional
00:19:57.360 bone density which is the dexa as people
00:19:59.840 know it which is really tells you
00:20:01.760 nothing about the structure of the bone
00:20:03.280 but only the mineral content of the
00:20:05.679 bone. And then we have a better test in
00:20:08.080 the dexa. The bone density has its
00:20:09.840 limitations. It doesn’t necessarily
00:20:11.360 predict fracture. And then we have
00:20:13.600 another way to predict fracture which is
00:20:16.120 frack and that actually tells us what is
00:20:19.039 the chance of somebody breaking a bone
00:20:21.760 or a hip in the next 10 years. So I
00:20:24.320 actually prefer to use the fra score to
00:20:26.960 predict who needs treatment and based on
00:20:29.760 that we decide which way we go and
00:20:32.320 osteoporosis treatment has to be a
00:20:34.880 wellplanned sequential approach. So for
00:20:38.000 somebody who is truly at risk for
00:20:40.720 fracture based on those two studies, I
00:20:43.280 first and foremost recommend doing
00:20:45.360 something that affects the estrogen
00:20:47.039 system for somebody who’s younger.
00:20:48.960 There’s a couple of medications, but
00:20:50.320 there’s also things like soy. Soy is a
00:20:52.559 wonderful phytoestrogen. We can start
00:20:54.400 with soy supplements if they’re early
00:20:56.760 on. Additionally, um the next step would
00:21:00.000 be another a medication called a vista.
00:21:02.080 It’s a STRM or selective estrogen
00:21:04.080 receptor modulator. It’s an older
00:21:06.320 medication. It does affect the estrogen
00:21:08.559 system, but it’s also anti-cancer in the
00:21:10.640 breast and it’s proestrogen in the bone,
00:21:12.720 which is beneficial to those patients
00:21:14.400 earlier on in their menopause course.
00:21:17.039 There’s always a hormone replacement
00:21:19.120 therapy if anybody’s interested. But
00:21:20.559 that is a decision that needs to be made
00:21:22.159 with them and their gynecologist and an
00:21:24.000 assessment of risk versus benefit. That
00:21:26.320 has to be a serious conversation. But
00:21:27.919 we’re doing it in a much gentler, much
00:21:32.120 more appropriate way now than it has
00:21:35.280 been done for the last 20, 30, 40 years
00:21:38.159 where it has caused some trouble. But
00:21:40.400 that’s I think a beautiful choice. We do
00:21:43.280 have some older medications like Fosamax
00:21:46.960 and Actone and some of the other ones
00:21:49.200 that prevent your bone from being broken
00:21:51.840 down, but those are older medications
00:21:54.000 and I’m not a big fan because they just
00:21:55.600 put your bone into paws. I prefer to do
00:21:57.760 something that actually activates your
00:21:59.600 bone and helps it grow and thicken. And
00:22:02.000 we have actually some new choices as
00:22:03.760 well that truly build bone. So for
00:22:05.440 somebody who’s really high risk, we have
00:22:07.679 some new biologic medications which
00:22:10.480 activate the natural processes within
00:22:12.720 the body to regain some bone thickness.
00:22:15.440 But those are reserved for patients with
00:22:17.520 more significant disease or somebody
00:22:19.919 who’s already had a fracture. And again,
00:22:22.080 the number one reason to treat
00:22:24.240 osteoporosis, this is what I tell all
00:22:26.320 patients, is to prevent a fracture.
00:22:28.400 That’s the reason. One of the things
00:22:30.880 people ask me is, is it working? And
00:22:33.919 like you said, we can do a repeat DEXA,
00:22:36.880 but that doesn’t
00:22:38.679 necessarily tell you that much about the
00:22:41.120 quality of the bone. And then there are
00:22:43.200 these bone marker blood tests. How much
00:22:47.360 do you like those as a follow-up tool?
00:22:49.919 We’re still not great at being able to
00:22:52.480 tell what’s going on with the bone, but
00:22:54.240 we do have more options than before.
00:22:56.320 Bone markers are usually markers of
00:22:58.720 either bone building or bone breakdown.
00:23:01.360 If we are using a medication that’s
00:23:05.440 building bone, that’s activating the
00:23:07.200 bone cells into a build mode. Because,
00:23:10.080 you know, there’s two types of bone
00:23:11.520 cells. There’s those that break down and
00:23:13.200 there’s those that build. If we’re
00:23:15.200 activating the builders, seeing blood
00:23:18.159 levels of a test showing that yes,
00:23:21.200 there’s active building happening, at
00:23:23.440 least give us hope that we’re doing the
00:23:25.840 right thing with the patient, that we’re
00:23:27.280 actually activating the right processes.
00:23:29.760 And those tests are also useful in
00:23:31.840 patients who have been on the older
00:23:34.000 medications that I mentioned like
00:23:35.440 Fosamax and Actel. And we want to know
00:23:38.240 if the bone is reactivating because
00:23:40.320 again the trouble with those medicines
00:23:42.400 is they do put your bone into pause. And
00:23:45.280 sometimes if we’re doing bone surgery or
00:23:47.440 trying to do a different direction with
00:23:49.200 their treatment, we want to see those
00:23:51.120 numbers come up. Yeah. One of the things
00:23:54.240 I know people are most fearful about and
00:23:57.039 it’s a reason people choose not to take
00:23:59.440 medication is osteonnecrosis of the jaw
00:24:02.480 which is rare but it’s this terrible
00:24:04.720 side effect where you have necrotic or
00:24:07.360 dead bone tissue and it makes for
00:24:10.480 example the dentists very reluctant to
00:24:13.200 take care of someone who’s on one of the
00:24:15.880 bisphosinate medicines although it also
00:24:18.320 happens with some of the other
00:24:19.400 medications. So what do you do? I mean,
00:24:21.919 for example, I usually ask people to go
00:24:24.400 see a dentist to make sure that they’ve
00:24:26.080 got really good dental care prior to
00:24:28.880 starting one of these medications.
00:24:31.760 So, this is one of the things that needs
00:24:33.360 to be assessed before we start any
00:24:35.120 treatment. What is your risk? Because
00:24:37.279 typically we will see osteo necucosis of
00:24:39.200 the jaw in somebody who does have before
00:24:41.520 treatment bad dental health or history
00:24:44.200 of root canals or chronic infections in
00:24:47.600 the bone because the way the bone heals
00:24:50.240 is by breaking down first and then
00:24:52.720 building. That’s a natural process in
00:24:54.320 the bone. And if we’re interfering with
00:24:56.720 the breakdown of the bone, we’re going
00:24:58.480 to be interfering with the healing of
00:25:00.320 that infection. And that’s the trouble
00:25:02.720 with some of these medications, in
00:25:04.240 particular the ones that are putting
00:25:06.240 your bone into pause because you will
00:25:08.640 not be able to clear that infection.
00:25:10.400 It’s interfering with that process. Some
00:25:12.799 of the medicines that we have now that
00:25:14.559 actually build bone, they avoid that
00:25:17.279 issue because they actually activate the
00:25:19.360 bone. And sometimes we will use the bone
00:25:22.640 activating medicines to clear out OJ if
00:25:25.840 it does happen or the osteo necrosis of
00:25:28.000 the jaw if it does happen. But dental
00:25:30.559 health is essential and that’s one of
00:25:32.000 the things that needs to be addressed in
00:25:33.360 somebody who’s doing bone treatment more
00:25:36.320 frequently than usual.
00:25:38.720 How does inflammation affect bone
00:25:40.799 health? You mentioned it briefly
00:25:42.559 earlier. I think most people in our
00:25:44.400 society are in a pro-inflammatory state.
00:25:47.440 Diet certainly is a major effect on
00:25:49.279 that. But what how does that affect bone
00:25:50.960 health? So we have the two types of bone
00:25:54.159 cells. We have the builders and then we
00:25:56.320 have the ones that break the bone down.
00:25:58.400 The ones that break the bone down are
00:26:00.640 activated by inflammation. So in fact,
00:26:02.640 when you have inflammation, you’re
00:26:04.840 activating bone breakdown. So that
00:26:07.840 includes your diet, that includes
00:26:09.760 rheumatoid arthritis, lupus, the
00:26:12.480 medications that we use to control
00:26:14.520 inflammation, at least the old ones like
00:26:17.520 predinazone and corticosteroids also
00:26:20.080 activate bone breakdown. So yes, uh
00:26:22.559 that’s really the process. Vitamin D
00:26:24.640 interferes with that process. So that’s
00:26:26.480 one of the reasons to give vitamin D in
00:26:28.320 patients with inflammation. That’s one
00:26:29.760 of the benefits. Another product that’s
00:26:32.000 fantastic for this is turmeric extract
00:26:34.159 or kirkamin. That’s one of the benefits
00:26:36.240 of kirkamin and I often give it together
00:26:38.559 with medications for inflammation for
00:26:41.200 that specific reason and the fact that
00:26:43.120 it improves their innate inflammation.
00:26:46.000 You mentioned the rheumatoid arthritis
00:26:47.919 and lupus. Let me just ask you a general
00:26:49.919 question. I think we’re seeing an
00:26:51.919 increase in autoimmunity in our society,
00:26:55.840 especially in women, and I’m not sure of
00:26:58.480 all the factors responsible for that.
00:27:00.480 We’re also seeing it a lot in children.
00:27:02.480 What is your impression that’s
00:27:04.320 contributing to that? I think it’s
00:27:06.400 environmental and diet. Yeah, I I would
00:27:08.320 I truly do. I think the genetic
00:27:10.480 predisposition has not changed, right? I
00:27:13.520 really do think that it’s all the
00:27:14.880 plastics, the PB, the BPAs, and the
00:27:18.440 phalates that actually trigger
00:27:20.559 inflammation in women quite a bit and
00:27:22.559 contribute to sugars and lupus. I think
00:27:24.960 the leaky gut and the glyphosate covered
00:27:28.400 wheat, the genetically modified
00:27:29.840 glyphosate covered wheat that we’re
00:27:31.360 feeding to our children, all of the
00:27:33.760 synthetic colorants and all the
00:27:36.080 synthetic additives that we’re adding to
00:27:37.840 their diet are contributing to
00:27:39.360 inflammation. And I think it majority of
00:27:41.600 this starts in the gut. You agree with
00:27:44.000 that? I’m really concerned about those
00:27:47.679 two triggers for autoimmune disease. And
00:27:50.880 just to give people a sense, one way to
00:27:54.159 protect yourself is with organic because
00:27:56.799 you can’t spray glyphosate on organic
00:27:59.279 crops. And so that rids that particular
00:28:02.000 issue. Even foods that aren’t
00:28:05.279 genetically modified, like wheat, are
00:28:07.200 often sprayed with glyphosate because
00:28:09.440 it’s a desicant. It makes it easier to
00:28:11.840 harvest the crop. So, organic is really
00:28:15.360 your friend. And then avoiding plastics.
00:28:17.760 It’s not as hard as it once was. We have
00:28:20.320 glass Tupperware. We have glass water
00:28:23.120 containers, stainless steel water
00:28:24.799 containers. You can put a water filter
00:28:27.279 in your own home and remove some things.
00:28:29.840 Reverse osmosis, which used to waste a
00:28:32.399 lot of water and now is more efficient
00:28:34.880 at working and wasting much less, is
00:28:37.919 affordable and can be added to home
00:28:40.640 sinks. And all of these things add up to
00:28:43.840 reducing the amount of exposure and
00:28:46.000 therefore reducing the likelihood that
00:28:48.000 you’re going to tip into one of these
00:28:50.159 autoimmune problems. Yeah, I think
00:28:52.240 protecting ourselves from microplastics
00:28:54.080 is a more difficult challenge. I totally
00:28:57.200 agree but my understanding is that some
00:28:59.600 of that is removed by the reverse
00:29:01.600 osmosis. I don’t think the nano plastics
00:29:04.159 we have an answer for. So we have to put
00:29:06.559 less of that in the environment which
00:29:08.080 again used to buy in glass. If we stop
00:29:10.880 using all these plastic water bottles
00:29:13.039 we’re going to have less. There’s an
00:29:15.600 interesting a very exciting publication
00:29:17.679 that came out about two weeks ago about
00:29:20.480 fermented dairy and a microacteria and
00:29:22.880 fermented dairy specifically a probiotic
00:29:25.120 called lactobacillus shrudery that has
00:29:28.159 shown absorption of microplastics from
00:29:30.399 the human body. So so this is my plug
00:29:33.520 for my favorite health food of all time
00:29:35.679 which is fermented dairy. Fermented
00:29:39.039 kefir fermented grass-fed kefir is
00:29:42.080 health food in every possible way.
00:29:44.480 protein, microbiome support, plastic
00:29:47.279 absorption, calcium, so many things. I’m
00:29:49.840 going to have to look for that article.
00:29:51.200 I hadn’t seen it, but another plug for
00:29:52.960 kefir is it actually has more organisms
00:29:57.200 than yogurt. And so, if you like them
00:29:59.919 both, go for the kefir. And there’s
00:30:02.480 strawberry flavored ones. I understand
00:30:04.159 that the plain one is a little hard to
00:30:06.080 get adjusted to. There’s strawberry
00:30:08.240 flavored ones. There’s
00:30:09.640 blueberry. Plug for kefir. But you know
00:30:12.559 there’s other things that are really
00:30:14.000 important to also discuss with we didn’t
00:30:16.159 really get a chance to touch on with
00:30:18.200 osteoporosis. One of the issues that we
00:30:20.399 have in the American diet is we are so
00:30:23.360 high in sodium. We very much see that
00:30:26.399 the higher is your intake of sodium, the
00:30:29.279 more calcium your body needs because we
00:30:31.360 actually kick it out into the urine to
00:30:33.200 balance the sodium that we’re consuming.
00:30:35.679 So that’s another issue to truly address
00:30:37.760 with our diet. And then again, the Sad
00:30:40.399 American diet, the SAD, high in sodium,
00:30:43.279 high in inflammatory seed oils, high in
00:30:46.080 sugar, and high fructose corn syrup. All
00:30:48.000 of those things really contribute to
00:30:49.840 osteoporosis, and that’s why I feel it’s
00:30:51.520 an environmental disease at this point.
00:30:53.360 So, the other thing that we do with our
00:30:56.240 bone is we buffer acids. You just talked
00:30:59.120 about the need to excrete sodium, but we
00:31:02.799 also buffer to keep our blood pH as
00:31:05.679 stable as possible by mobilizing calcium
00:31:09.200 and we worry. So, how much do you talk
00:31:11.840 to your patients about acidic foods?
00:31:16.000 I think acidic foods also mostly comes
00:31:18.559 from processed foods. So, for example,
00:31:21.520 sodas. There’s so much acidity that
00:31:23.840 comes with consumption of soda in
00:31:26.159 particular. So, Coke, diet sodas, all of
00:31:28.960 them. There’s additional chemicals that
00:31:30.640 come with those as well. And as we’re
00:31:32.240 trying to balance the chemical load that
00:31:34.240 comes with any sugar loaded soda,
00:31:36.960 carbonated beverage, a lot of that comes
00:31:38.960 out as acidic and our kidneys try to
00:31:41.519 balance that. So, florine, which
00:31:44.720 actually breaks down bone, actively
00:31:46.720 breaks down bone. That’s found in sodas,
00:31:48.720 it’s found in tea, so is mercury.
00:31:52.279 Unfortunately, in terms of truly
00:31:54.320 consuming too high of a protein though,
00:31:56.480 there’s some excitement right now about
00:31:58.320 these carnivore diets and keto diets.
00:32:01.760 Increased acidity will cause excretion
00:32:04.559 of additional calcium, but typically we
00:32:07.120 find that it’s not so much of a concern
00:32:09.279 as some of the pesticides and some of
00:32:10.960 the chemicals that are added to the
00:32:12.320 food. If I can get them to eat healthy,
00:32:14.640 it will balance some of the acidity from
00:32:16.559 their diet. Olga, a trace mineral that
00:32:19.039 you did not mention is stranchim. There
00:32:21.120 was a period when that was being
00:32:22.840 recommended as a supplement for bone
00:32:25.600 health. I haven’t actually visited
00:32:27.840 personally I know of it but in terms of
00:32:30.080 true recommendations as to what are what
00:32:33.679 intake is beneficial and how so I don’t
00:32:36.000 know too much. So there was a series of
00:32:38.960 studies uh it was it was actually sold
00:32:41.519 in Europe in the EU as a dietary
00:32:44.559 supplement that was recommended for
00:32:46.399 osteoporosis and then they found it
00:32:48.159 increased heart disease and so it was
00:32:49.919 pulled from the European Union
00:32:51.880 marketplace. We still see strontium as a
00:32:55.039 dietary supplement in the US but I
00:32:57.919 stopped recommending it when those EU
00:33:00.799 reports of increased heart disease came
00:33:02.960 out. Yeah. during my education, it was
00:33:05.600 not something that was offered as a a
00:33:08.159 useful additive and so I’ve never
00:33:10.480 actually had to use it. One thing
00:33:12.559 though, if you’re willing, I would like
00:33:14.080 to also mention is the stomach
00:33:17.159 medications. So the acid medications and
00:33:20.320 why are they associated with
00:33:21.919 osteoporosis? And now you’re talking
00:33:24.240 about PPIs. You’re talking about the
00:33:26.559 proton pump inhibitors as because
00:33:28.240 there’s lots of stomach med so
00:33:29.840 specifically PPIs. So pentopherol,
00:33:32.480 nexium, protonics, they’re commonly
00:33:35.039 used. They’re commonly prescribed and
00:33:36.960 unfortunately they’re commonly
00:33:38.000 prescribed in an incorrect way. They’re
00:33:40.480 never intended to be chloronic long-term
00:33:43.360 use medications, but this is how they’re
00:33:45.120 often used. And regular PPI, regular
00:33:48.480 pronics or nexium use increases your
00:33:51.279 risk of osteoporosis by 50% your
00:33:54.240 lifetime risk. Even short courses of
00:33:57.919 pronics can increase your osteoporosis
00:34:00.159 risk because they decrease stomach acid,
00:34:03.039 they decrease absorption of calcium,
00:34:04.960 they decrease absorption of vitamin D,
00:34:07.519 they can cause problems with your
00:34:09.239 microbiome, and they interfere with
00:34:11.440 absorption of just about every vitamin.
00:34:13.760 Well, you have given us so much
00:34:17.119 important advice and I know that
00:34:19.359 osteoporosis is a topic that Body of
00:34:22.079 Wonder listeners have really wanted to
00:34:24.079 hear more about. So, thank you so much
00:34:25.760 for sharing your deep expertise on this
00:34:29.199 important topic. Yes, I’m so grateful
00:34:31.918 for this time. Thank you. Thank you
00:34:33.760 both.
00:34:36.460 [Music]