The Dr. Hyman Show - A Functional Medicine Approach to Osteoporosis with Dr. Todd LePine

Episode Date: January 4, 2021

A Functional Medicine Approach to Osteoporosis | This episode is sponsored by ButcherBox and Dr. Hyman’s Sleep Master Class We have been led to believe that drinking milk is the key to bone health. Unfortunately, the prevailing myth that drinking milk as children builds up a calcium bank that helps us avoid osteoporosis and fracture later in life is simply not true. Our bone health is determined by a number of things including what we eat, our stress and activity levels, our muscle mass, and other factors that contribute to the delicate balance between bone build-up and bone breakdown. Unfortunately, osteoporosis is a very common and life-threatening problem, it is also highly underdiagnosed. This is part of the reason why prevention is so important when it comes to osteoporosis.  In this episode, Dr. Hyman sits down with Dr. Todd LePine to discuss the Functional Medicine approach to osteoporosis. They get into how chronic inflammation acts as one of the main drivers of osteoporosis, why both bone density and quality are so important, and much more. Dr. LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders and the neurobiology of mood and cognitive disorders. Dr. LePine teaches around the world, and has given lectures to doctors and patients at American College for Advancement in Medicine (ACAM), Age Management Medicine Group (AMMG), the University of Miami Integrative Medicine Conference, The Kripalu Center in Lenox, MA, and is on the faculty for American Academy of Anti-Aging Medicine (A4M). Dr. LePine is the head of the Scientific Advisory Board for Designs for Health and a consultant for Diagnostic Solutions Laboratory. He enjoys skiing, kayaking, hiking, camping and golfing in the beautiful Berkshires, and is a fitness enthusiast. This episode is sponsored by ButcherBox and Dr. Hyman’s Sleep Master Class.  When you sign up for ButcherBox today, you can get 2lbs of wild-caught Alaskan salmon free in your first box. Just go to butcherbox.com/farmacy.  In this modern world, we place too much value on staying busy and deprioritizing sleep, which is why Dr. Hyman created his first-ever Master Class. It guides you through the most important steps to getting better sleep, starting today. Get free access to Dr. Hyman’s Sleep Master Class at drhyman.com/sleep.  In this episode, Dr. Hyman and Dr. LePine discuss: Why drinking milk is not the key to bone health Common causes and risk factors of osteoporosis, including inflammation, diet, stress, and more Why bone density and quality are both important How smoking negatively affects bone health The traditional vs functional medicine approach to diagnosing and treating osteoporosis The benefit of getting your bone density tested at various ages Leaky gut, gluten sensitivity, celiacs disease, and other unexpected precursors to osteoporosis The benefits of resistance exercise for bone health, muscle mass, stability, and balance Bone building foods Lead toxicity and osteoporosis Additional Resources: Milk and Health https://www.nejm.org/doi/full/10.1056/NEJMra1903547 Got Proof? Lack of Evidence for Milk’s Benefits https://drhyman.com/blog/2013/07/05/got-proof-lack-of-evidence-for-milks-benefits/ Why Lead Poisoning May be Causing Your Health Problems https://drhyman.com/blog/2010/09/28/why-lead-poisoning-may-be-causing-your-health-problems/ Why Most Everything We Were Told About Dairy Is Wrong https://drhyman.com/blog/2020/08/19/podcast-ep131/ Is Gluten-Free A Fad Or Is Gluten A Real Threat To Our Health? with Maggie Ward https://drhyman.com/blog/2020/11/30/podcast-hc32/ Protein and Your Health: What you need to know https://drhyman.com/blog/2019/07/09/protein-and-your-health-what-you-need-to-know/ Calcium Without Dairy? It’s Possible! https://www.ultrawellnesscenter.com/2017/10/31/calcium-without-dairy-its-possible/ Ultra-Aging: Ultra-Living at Any Age – Part One https://www.ultrawellnesscenter.com/2020/05/21/ultra-aging-ultra-living-at-any-age-part-one/ Hosted on Acast. See acast.com/privacy for more information.

Coming up on this episode of The Doctor's Pharmacy. Chronic inflammation is one of the big things that's tied in with osteoporosis. And there's a term called inflammation. So as you age, your body can develop more inflammation. So chronic low-grade inflammation, patients who have colitis, patients who have rheumatoid arthritis are at higher risk for osteoporosis. Hey everyone, it's Dr. Mark. One of today's episode sponsors is ButcherBox. I love

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Just go to butcherbox.com forward slash pharmacy. That's butcherbox.com forward slash pharmacy F-A-R-M-A-C-Y and you'll get two pounds of wild-caught salmon for free. ButcherBox sticks to strict fishing and handling practices when it comes to wild-caught, sustainably harvested seafood so you can feel good knowing you're eating the highest quality salmon available. I hope you'll take advantage of this great offer. I know you're going to love ButcherBox as much as I do. Right now, more than ever, we need a strong immune system. And that is why I'm offering my eight-part sleep masterclass free to my entire community. If you want to get access to my free course and reclaim your sleep,

go to drhyman.com forward slash sleep and sign up today free. That's drhyman.com forward slash sleep and sign up today free. That's drheimann.com forward slash sleep. Welcome to Doctors Pharmacy. I'm Dr. Mark Heimann. That's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you've ever suffered from osteoporosis, low bone mass, increased fracture risk or multiple fractures? Are you worried about getting old and frail and that hunchback? You better listen up because today's podcast, a special episode of the House Call podcast for Doctors Pharmacy is on osteoporosis and osteopenia, which means low bone mass. And we've got with us our incredible physician from

the Ultra Wellness Center, Dr. Todd Lapine. He's a grad from Dartmouth Medical School, Internal Medicine Board certified. He's worked with me for 25 years at Kenya Ranch and here at the Ultra Wellness Center. He's one of the smartest dudes on the planet in functional medicine, teaches all over the place, and is just such a brilliant mind. And we get to go deep into your bones today. We're going to get into your bones. So Todd, welcome to the doctor's pharmacy again. Thank you, Mark. All right. So osteoporosis, this is kind of a big deal. Yeah.

It's one of those invisible killers that people kind of ignore. Yep. Heart disease, cancer, diabetes, dementia. We're all scared of that. But osteoporosis actually kills a lot of people. Silent killer. Yeah. So how common is this problem?

It's very common. It's common because it's underdiagnosed. And this is a condition where what I would say is that you want to preempt the condition. You want to diagnose the condition, which is, you know, you mentioned osteopenia. So osteopenia stands for, it's Latin for bone poverty. So before you develop osteoporosis, which is a technical definition, when you measure on a DEXA scan, you've got to have a T-score, you know, greater than negative 2.5. And that's, there's, they have a standard. There's just a definition of how we measure it on an x-ray,

basically. And it's a statistical in terms of your bones compared to the normal healthy population. And osteoporosis, when you have that, you're at much higher risk for fractures of the bone. So, you know, a lot of times older people, when they fall, they'll break a hip. If you break a hip, you're at a much higher chance of dying in that first year after a hip fracture because of complications related to the hip fracture. So osteoporosis is a condition that you don't want to have. You want to preempt it. You want to take the horse out of the barn. By the time you have osteoporosis- Well, that's the thing.

I mean, it's really the thing that often is killing people because if you're old and frail, you fall, you break your hip and you end up with a blood clot and you get pneumonia. And it's really a killer. And life expectancy a year after a hip fracture is dismal. It's like worse than cancer. It's like 50% life expectancy.

So it's no joke. And there's about 10 million Americans, older Americans that have osteoporosis and about 43 that have osteopenia or low bone mass. That's like 53 million Americans who are headed for disaster. And it's one of those things that most doctors don't check they don't really think about until the horse is out of the barn and you've already broken a hip or you've already got osteopenia or osteoporosis and i don't know if it can start early yeah so why are we seeing this incredible rate of osteoporosis because

you know we as a society drink so much milk and have so much calcium and we should, we're told to take calcium, but what is going on? Why are we seeing these incredible rates of osteoporosis? Well, you bring up a really good point, which is that most patients and most doctors think, oh, I just need more calcium for osteoporosis. I need to drink more milk for my osteoporosis.

And I'll never forget it, when I was in my primary care practice, I had a patient who was an older woman who had severe kyphosis. So she was, you know, had the hunchback. And guess what she did for a living? She was a farmer and her family had a dairy farm. And guess what? She drank milk every day of her life. And she had the most severe case of osteoporosis I've ever seen. And it didn't work out so good for her. Exactly. Right. And I think, as I mentioned earlier as we were talking, is that for every 200 grams of milk that you drink, you have a 9% increased risk for osteoporosis. Okay. So every glass of milk that you have, you increase your risk of osteoporosis by 9%?

Yeah. Of a fracture or osteoporosis? Osteoporosis. A fracture though. Yeah. I mean, this is incredible. I encourage people to check out this brilliant article in the New England Journal of Medicine. You can just go online and Google. It's called Milk and Health by Dr. David Ludwig and Walter Willett.

And it really is one of the most well-researched, profound analyses of all the data on milk and whether or not there's any data to support its health benefits. And I do believe it's nature's perfect food, but only if you're a calf. Because for humans and adults, it seems to cause a lot of issues, including osteoporosis, so it doesn't decrease fracturus. But that's not the cause of osteoporosis. What are the real causes in our society of osteoporosis? Why are we seeing these high rates? Because it seems like a design flaw.

Why are we seeing such high rates of osteoporosis in this population? Well, I mean, the risk factors for osteoporosis, obviously, as you get older, you will lose some bone mass. I mean, that's part of the aging process. And I always want to look at the risk factors. So women are more prone towards that. Is it aging or is it what we do while we're aging? Inflamaging. Inflamaging. Is it what we do while we're aging that makes us age faster? Yeah. Actually, it's inflammation. Chronic inflammation is one of the big things that's tied in with osteoporosis. And there's a term called inflamaging.

So as you age, your body can develop more inflammation. So chronic low-grade inflammation, patients who have colitis, patients who have rheumatoid arthritis are at higher risk for osteoporosis. Patients who have heart disease. Yeah, absolutely. So there's this phenomena where we're seeing

high rates of osteoporosis. And as I dug into it, and one of the things we had to do at Canyon Ranch was we had to give lectures three or four times a week. And one of the lectures I gave was on osteoporosis. I got really smart about it. And we also, at Canyon Ranch, it's a lot of preventive screening. And we have to do a lot of DEXA scans. Now, a DEXA scan is a special machine that is a low-dose x-ray.

It's like flying across from New York to LA, that amount of radiation you'd get when you fly in a plane, very low dose. And it looks at the bone density. So you can see on this very low dose x-ray, whether or not you have thin bones or strong bones and where they're weak or where they're thin. And so we treat a lot of patients, but I gave these lectures. I started looking, why are we seeing such high rates in this society? And we came up with so many different factors. Our diet, we know that sugar, alcohol, caffeine, salt, and even what is consumed in massive quantities, about 10% of our calories, soda, phosphoric acid in sodas, in the col colas is incredibly dissolving of your bones. Stress makes your bones soft. And of course, lack of activity. We're all sedentary. We don't use our

bodies. And you mentioned aging, but if you keep up your muscle mass and if you keep up your activity level, you can maintain your bone mass. You know, we often talk of osteopenia or osteoporosis, but we don't talk of sarcopenia, which is the loss of muscle. And that's what goes along with bone loss. So you have all these factors and we're literally, you know, peeing out calcium in our urine because, you know, in some countries like in Africa, they have like intakes of calcium of two, 300 milligrams a day, but they don't really have osteoporosis. Here, we have intakes of 1,000 or 1,500 milligrams a day, and we see high rates of osteoporosis. What's the difference? It's not the total calcium. It's the calcium balance.

Exactly. It's what you're peeing out compared to what you're taking in. So in Africa, they're not doing all these bad things, and they're not losing their bones and their urine. And we actually have tests where we can measure if you're peeing out your bones. When you do that at the ultrawounder center here, we measure markers of increased bone turnover, because there's this constant dance

between bone buildup and bone breakdown. And so we've got to kind of make sure we're constantly pushing the bone buildup and not so much the bone breakdown. Exactly. Yeah. The osteoclast, the analogy of is like somebody building a wall and osteoclast, which are the cells that break down bone. And then there's the osteoblast, which the cells that build up bone. And normally our bodies are constantly doing it in a balanced way. So there just as much bone breakdown, turnover, and then you rebuild the bone. When you have too much osteoclastic activity, which happens in chronic inflammatory conditions, then what you're doing is you're breaking down more bone than you're building up.

The other important thing, which is also it's not actually determined by DEXA scanning, is the quality of the bones. Yeah. Tell us about the quality of the bone because you can look at a scan and see it's good or not good. But what if it's more fragile or brittle? Exactly. So you want flexible bones.

You want bones that bend. You want bones that are a little more rubbery, if you will. Yeah. And I remember this very well because when I was in my training, one of the things that they used to give for patients with osteoporosis was fluoride. Do you remember using fluoride? And what they found is that, guess what? You did get denser bones with taking fluoride, but guess what?

The bones were more brittle. So they broke. So you want actually healthy quality bones, not just the density, but it's the quality of the bones. And what determines the quality? The connective tissue that's in the center of the bones. It's not just the calcium, it's the connective cartilage tissue that's in the center of the bones that makes it healthy. And that's also, this is a very simple thing to remember is one of the big things that increases a person's risk for osteoporosis is smoking. And I always tell my patients,

you ever see somebody who's a chronic smoker? What do they have? Wrinkles. Okay. They have more wrinkles. Right. Smoking upregulates matrix metalloprotease enzymes, which are breakdown collagen. And that's why patients who are smokers have higher risk for cardiovascular disease, higher risk for osteoporosis, because they're actually breaking down their connective tissue. Wow. Yeah. That's another reason to stop smoking. Exactly. Right. Well, actually, it's funny, because if you have a woman who's a smoker, they oftentimes

have, one of the things I'll tell them is, well, you don't want to have wrinkles, and they'll stop smoking, because, you know, the vanity, that name is woman. That's right. That's right. Well, you know, you mentioned something I want to come back to, which is this whole idea of inflammation. And we've talked about all kinds of conditions on this podcast and the house call. And the truth is most chronic illnesses are related to inflammation, heart disease, cancer, diabetes, dementia, depression, autoimmune

disease, obviously. But osteoporosis just seems a little bizarre to be related to inflammation. How does that work? And how do we identify what the factors are that are causing the inflammation that leads to osteoporosis? There are measures that you can do to check for sort of low-grade inflammation, things like HS or high-sensitivity C-reactive protein, Glyc-A, looking at their diet. So an anti-inflammatory diet helps to decrease inflammation. Looking at essential fatty acids are also important. Looking at whether or not there's any silent gut inflammation. When you do stool analysis, you can check for markers, which I call my CRPs of the gut,

which is calprotectin. So if you have chronic gut, low-grade gut inflammation, that's going to potentially increase your risk for osteoporosis. If you have sort of low-grade osteoarthritis, rheumatoid arthritis, which is more severe than osteoarthritis, it's more of a significant joint destructive inflammatory arthritis. Those are things which break down bone very, very slowly. It's like a slow leak. And our American diet is, our standard American diet is a very inflammatory diet of processed foods, sugars, refined oils, and lack of protective anti-inflammatory foods, which are the phytonutrients and plant foods. And so we get this incredibly upregulated immune system, which is why we're all suffering from COVID in America. We've had over 11 million cases, over a quarter million deaths to date as this recording. And I think we're uniquely susceptible

because we're so inflamed. And osteoporosis is one of the victims of inflammation. Our bones are one of the victims. And it's from leaky gut. It's from our processed diet. It's from lack of protective foods. So we really have an opportunity to really change that dynamic and shift the balance from bone breakdown to bone buildup, right? Exactly. Healthy bones. Yeah. And how do we normally treat this with traditional medicine? What is the general approach in terms of diagnosis and treatment?

Well, diagnosis, as we mentioned, is really with DEXA scan. And I always like to emphasize, especially as women tend to have osteoporosis more than men, but men can get osteoporosis. And there are certain medications that can do that. But I actually think that one of the ideal things to do is to actually get your bone density checked when you have no symptoms whatsoever. When you're at peak bone mass, which is around 30 to 35 years of age, you want to know what your bones are then. What your baseline is. Right, exactly. Because I can't tell you the number of times that I've seen a patient,

and they're a woman, especially a woman, they're entering into the menopause. And I asked him, have you had your bone density check test check? No. Well, I said, well, you need to actually have that checked. And if you have one when you're at peak bone mass, which is around maybe 20, 25 to 30 years old, and then you get one as you're entering menopause or the perimenopausal area, then you can see, okay, where are your bones going? Where are they going? You have two points. One data point doesn't show you much. Two data points show you a trend of is going up, going down, staying the same. Very, very important information. So make sure you get your bone density early and at intervals that are depending on what your bone density shows. If you're great at 30, you can probably wait till you're 50. But if you're

menopause, you want to check more. And men, men get osteoporosis too. It's not just a ladies' disease. It's not exactly, anybody can get it. And again, high levels of alcohol, high levels of caffeine, the PPIs which are acid blockers, big ones, big time. Okay, that's the third leading most prescribed drug in the world, and it's an acid blocker.

And if you take this for heartburn or reflux, you're gonna get osteoporosis because you're inhibiting mineral absorption. That's like Protonix, Prilosec, Asafix, Nexium, all those drugs. Chronic steroid use is a big risk factor for osteoporosis, a huge one, and then, as I mentioned earlier, smoking, and then just sedentary lifestyle.

If you're not stretching your bones, you're not putting stress on your bones. There's a – I remember when I was in my training – Use it or lose it, basically. Use it or lose it. And there's actually an interesting thing. It's called Wolf's Law, which is that bone responds to stress. And I remember reading this article, looked at astronauts. They were in their young – 30 years old, and they went up into outer space.

And guess what? In outer space, you float around. There's no stress on your bones. And when they came down on planet Earth, they actually lost a significant amount of their bone mass because they were not having the body. And it says, oh, we don't need our bones. We're just going to jettison. It's like a balloon where you jettison the balest. And you get rid of the bones that you don't need. So our bodies naturally will make stronger,

better bones when we respond and use stress, weight resistance exercise, bands, resistance machines, et cetera, is very, very important for maintaining good bone mass. Absolutely. And let's get back to the diagnosis part, because you do a DEXA scan, let's say you have low bone density, what do you look for next? Because there's a lot of things that doctors don't often check that we look at here.

What do you think about? What are the most common things that maybe a traditional doctor might look at, and what are the tests that we might do that are quite different? Oh yeah, so some of the tests that we'll do is the, as I mentioned, the DEXA scan. We will then do urinary bone resorption. So we can actually measure the collagen breakdown products like

N-telopeptides in the urine. Basically, you're peeing out your bones. We can check that. Exactly. When you lose your bones, you pee them out. That's exactly right. You can do that. Measuring the vitamin D level is very, very important. That's another. Vitamin D helps to regulate calcium and calcium metabolism. Far more important than calcium. Yeah, way more important than calcium. And then the other thing that's also important is to realize is that you do not want to take too much calcium. And I actually tell my patients, I don't want you actually taking a calcium supplement most of the time. I want you getting it through your diet. Yes.

Exactly. And if you do take it in a supplement form, you probably don't need, and you don't want to go over probably about 600, 500 to 600 milligrams. And there's studies showing that women who are taking higher doses over a thousand, like 1200, 1500 milligrams, they actually get more calcification in their arteries too. Yeah. Well, that's the calcium is the nature's band-aid. So wherever there's inflammation, calcium goes. And so when you talk about hardening of the arteries, it's somebody calcium buildup in the arteries and plaque. So that's not good. So we look at vitamin D.

We look at the bone density. We look at the bone resorption. We look at- Vitamin K. Vitamin K. Vitamin K is a big one. Which is a vitamin made in your gut. And if you don't have a good microbiome, that can be a problem.

Exactly, yeah. So there's actually two forms of vitamin K. There's the vitamin K that you find in plants, and the vitamin K that you make from gut bacteria. And vitamin K is traditionally thought of as a vitamin which helps with clotting, but vitamin K actually has an effect on bone density, and it's very, very important to get adequate amounts of vitamin K.

So you can actually take low levels of vitamin K and that can help with clotting issues, but you need much higher levels of vitamin K to have a bone effect. And we do the test here, which is a, it's a mouthful, but it's called under carboxylated osteocalcin. And it is a biomarker for a functional vitamin K deficiency. And this is a test I love to do in patients. Yeah, people don't know about it. Doctors don't usually do it. Yeah, yeah. Right now, there's only one lab that actually does it.

But measuring that can tell you whether or not you have a functional vitamin K deficiency. And I oftentimes, and actually most of the time, if I'm giving vitamin D, I will give vitamin K at the same time. Otherwise, you'll start getting calcium deposition in tissues that you don't want to. That's right. And then there are other conventional things that often get looked at, like parathyroid hormone. Parathyroid hormone. If you have a tumor on your parathyroid gland, it causes more bone turnover.

Yep. If you have certain cancers, like, you know, blood cancers, but you can look at protein levels in the blood that look like protein can be affecting bone health. And also, you know, people can get weird things like Cushing's or adrenal tumors or brain tumors that cause high steroid levels in the body. So there's a lot of things that we look at. Most of those don't turn out to be. It's mostly the age-related, just general sedentary life, bad lifestyle habit, osteoporosis.

But we also look here at the Altra Juana Center at a lot of other things that give us clues about why you might have a problem. For example, we look at the gut because if you have leaky gut, you could drive inflammation that causes problems. If you have digestive issues and not absorbing minerals, if you're taking an acid blocker, we care about that. And also gluten is a huge cause of osteoporosis.

People don't realize that if you have celiac for sure, but even if you have low-grade non-celiac gluten sensitivity, definitely it causes leaky gut, impairs absorption. So there's a lot of things we look at that may be different than what you see at a normal practice. Yeah, it's interesting you mentioned that because one of the biggest risk factors is having celiac disease because gluten issues can affect mineralization. And one of my take-home things when I do with patients is I often ask them, because I have a family of dentists, is I often ask, you know, how many fillings do you have? Do you have any cavities?

Do you have weak teeth? It's a very common thing. People say, well, my dentist said I have weak enamel. Well, why do you have weak cavities? Do you have weak teeth? It's a very common thing. People say, well, my dentist said I have weak enamel. Well, why do you have weak enamel? Well, guess what? Celiac disease is associated with enamel defects. So not only do you have weak enamel, you've got weak bones. Yeah. So we do this workup and someone has osteoporosis. And a traditional doctor, what do they give them? Usually the bisphosphonates. Those are the things like- Like Fosamax, Actonel.

Fosamax, Boniva, Actonel, those kinds of things. And the interesting thing about them is they have a not so good risk-benefit ratio. You can get significant side effects. You can get osteonecrosis of the jaw. They're not to be used to- They're not risk-free. They're not risk-free. They're not cheap. And there's injectable drugs they do them injectable now and also there's forteo which is like a parathyroid hormone like drug yeah and sometimes doctors even use drugs like avista which blocks estrogen

receptors there are selective estrogen blockers and of course doctors use hormones like estrogen therapy although that comes with certain risks. And even in men, testosterone therapy. So these are all therapeutic options out there, but we take a different approach in functional medicine. So what would be an approach that we would focus on with osteoporosis that's different? Where do you start with patients and how do you build up the treatment model for them? Well, the first thing I get people to do is to start using their bones, start using their muscles. So getting people to the gym, you know, doing some resistance exercise at least three days a week where you're really stressing the bones is going to be the biggest thing. Optimizing their vitality.

Strength training. Strength training. Weight lifting. Absolutely. Bands. And also. Body weight exercise. Like you just really need to push your bones.

And at the same time, you're building the muscles building the muscles and then you're also helping with balance so it's not so much that when you fall because you know everybody falls okay but you want to have the the muscles and the reflex time to be able to catch yourself so that you don't necessarily break something that's right so really important to have the muscle mass and the uh the uh the it's true yeah the core strengthening exercises are so important people have just so low stability as they get older and they lose their balance. And that's an important point. And then also optimizing vitamin D levels. And we actually will do some genetics related to that.

And interestingly, there are some gene variations related to the vitamin D receptors. So people who have genetic variations of the vitamin D receptors need higher levels than quote-unquote normal so if you look at the range of normal vitamin D the standard laboratory is about 30 to 100 and if you're at 32 your doctor will say oh you're fine you have enough vitamin D well guess what if you have a problem with the polymorphisms related to the vitamin D receptor you need to have that be on the higher end you may be up to about 80 to 100 in order to have that be on the higher end. You may need to be up to about 80 to 100 in order to have the beneficial effect. That's right. So we really focus on exercise and strength training, focus on vitamin D levels.

We also do a lot with diet, right? Because you want to eliminate the bone dissolving things in your life and your lifestyle and your diet, and you want to add the bone building things. So what are the bone dissolving things we want to help people get rid of? And you talked about it a little bit, but. Yeah, well, excess amounts of protein, and also if you have acidic urine, you can actually be more susceptible

to more or less peeing out your bones. So decreasing those things. Which is our processed diet, will cause you to be more acidic. Exactly. And then the green leafy vegetables are very good. And then, you know, things like sardines, which are great because they have natural, sardines are one of my favorite foods because guess what? They got great protein, they have great omega-3s, and they have great calcium. And it's highly absorbable calcium.

That's right. So if you want to actually help your bones, eat sardines. Yeah. Herring, sardines, mackerel. That's what I remember for lunch. I'm havingines mackerel that's what i remember for lunch yeah mavin canned mackerel with the they get what ones with the bones in them is even better exactly that's how a lot of the populations who lived on islands would get their calcium they'd eat the fish bones yeah yeah so so getting rid of things like alcohol caffeine excess salt excess protein uh too much sugar obviously all the sodas the junk food the food additives that's so important and then adding in all the foods that are going to food, the food additives, that's so important. And then adding in all the foods that are going to build your bone, like the sardines or herring or mackerel, but also the greens.

I mean, where do cows get their calcium from? Grass, right? So you can actually get more calcium, more absorbable calcium from things like tahini, which is sesame seeds. Sesame seeds is probably the highest source. Chia seeds have more calcium per serving than milk, and it's better absorbed, plus omega-3s and fiber. All the dark green leafy vegetables that you mentioned. The vitamin K is also in these green leafy vegetables.

So your omega-3 fats are really important, which you can get those from the sardines and the fatty fish. So a lot of foods that are bone building foods. Absolutely. Yeah. The other thing which we talked about earlier is when I measure, this is an interesting thing in preparing for this talk, is looking at women who are postmenopausal. And there's an interesting finding.

And I sort of stumbled upon this when I had a patient who had severe osteoporosis and I did testing on her. I did serum testing of her hormones. And it turns out that when you're low in your hormone levels, whether it be testosterone or estrogen, your body's pituitary gland starts making FSH and LH, which are follicle stimulating hormones or luteinizing hormones. And it turns out that the higher you have of FSH levels in a postmenopausal woman, the higher your osteoclastic activity. So in women, it's important to not only measure the hormones, but measure the pituitary hormones because lowering the FSH level can be one of the tools that you can help to prevent

worsening osteoporosis. That's incredible. So we really take a comprehensive approach of diet, lifestyle, stress reduction, and then we use very specific nutritional supplements to help. Absolutely. So what are the things that, you know, you obviously hear calcium, but there's just so much more than just calcium when it comes to osteoporosis. So what are the key things? We mentioned vitamin D. And also trace minerals, things like making sure you have sufficient amounts of zinc, copper, magnesium, manganese. There's also some evidence that boron can be helpful.

Silicon can be helpful in overall. So you want like a complex multi-mineral. Yes. And you want the vitamin K2. And you want the vitamin D. And magnesium too. Yep. And I don't give you too much calcium, a few hundred milligrams at the most.

Diet is the best way to get your calcium. And don't drink your milk. Exactly, don't drink your milk. That is just a bunch of hooey. I wrote an article, you know, based on this Got Milk ads. The Got Milk ads were actually funded in part by our government, by USDA

and the Dairy Council. They weren't science-based. And the FTC, which is the federal, I mean, the FCC, which is the Federal Trade Commission, actually ruled that they were not scientific and had to be removed from all the air. And that's why you don't see them anymore. Wow. Because they were like, there's no proof that it builds better bones. There's no proof that it does this or does that.

You guys are making this crap up. It's actually the opposite. The opposite, yeah. And so I wrote an article called Got Proof? Got Proof, yeah. And the answer is no. So I think that's why I encourage you all to check out that Milk and Health article by Dr. Ludwig and Dr. Willett.

So I think if you are looking at wanting to live to be 120 like I am, then it's important that you know what your bone density is because you don't want to end up, you know, having everything be healthy, but you have thin bones and then you fall and then you end up in a disastrous situation. And it's hard to get ahead of the game. But, you know, I have some cases that are pretty amazing. I had this one woman who was 70 years old,

came in with pretty significant osteoporosis. We did all the things we said and she got into vigorous yoga. This lady was 70. She did vigorous yoga every day, like five, six days a week. She came back without any drugs and didn't just not lose bone, but she gained 10% in her bone mass, which sounds like nothing, but it's a lot. You rarely see those changes. Like you see a couple of percent with these drugs, but you see 10%,

that's massive. So when you take a comprehensive functional medicine approach, you really can increase your bone density, you can prevent further bone loss. And as a side effect, you're going to get healthier all the way around. Absolutely. Absolutely. One other, this is a clinical pearl, and I learned this, Mark, in seeing patients is we oftentimes do testing for heavy metals. And it turns out that nowadays we don't have as much exposure, but lead actually gets stored in bones. And there are cases where I've tested for heavy metals in women who are post-menopausal.

And guess what happens? Their bones dissolve. Lead is coming out of their bones massively, and they're starting getting problems related to lead toxicity from osteoporosis. And that's a clinical pearl that most doctors, including functional medicine doctors, do not know. I did notice that. I paid attention.

And you know what? Yeah. I remember this study I read once where they had to move some old church in Europe and they had to dig up this graveyard and it was 300 years old. And when they dug up all these bones they and to rebury them they actually ran them through dexam machines to see their bone density and then they compared them to modern day humans uh and and and they looked at lead levels as well they found obviously the bones are far more dense but the lead levels were 300% higher in modern humans than those who were from 300 years ago.

Wow. And so it's everywhere. Like we had leaded gas, leaded paint. It's in our food. I mean, if you have a garden in a city and you're not importing the soil, you probably had coal burning in that city and the soil is contaminated with lead. It doesn't go away. So I think we often miss these really subtle things in patients. And that's the beauty about functional medicine, that we really address these things comprehensively. And I think if you'd have suffered from osteoporosis or bone loss, if you really want a comprehensive view, we're here to help you at the Ultra Wellness Center. We're in Lenox,

Massachusetts, but we do virtual consultations now with telemedicine. Go to ultrawellnesscenter.com to learn more about what we're doing. And we'd love to help you here. We are really excited to be able to offer a type of medicine that really just is unusual, but it's the future of healthcare. And it really is a comprehensive systems approach.

And Todd, you have been at the forefront of this forever. And I'm just so glad you were able to be on The Doctor's Pharmacy again on our special episode of The House call. If you love this podcast, please share with your friends and your family, subscribe wherever you get your podcasts, leave a comment about maybe how you've dealt with your osteoporosis. And we'll see you next time on the doctor's pharmacy. Thanks Mark. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast.

It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health.

It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash pics to sign up. That's drhyman.com forward slash pics, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Hi, everyone.

I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained,

who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.