Friday, January 25, 2013

Environmental Toxins and Bone Loss: How Lipoic Acid can Help

Exposure to toxins in our environment can cause serious health issues. Heavy metals, bisphenols, pesticides, and phthalates are ubiquitous and impossible to avoid. These toxins are known to increase our risk of diabetes, heart disease, cancer, stroke, neurological disorders, and yes, osteoporosis. What can be done to reduce these risks? Eating organic and avoiding toxic environments (e.g. second hand smoke and highways...take your runs/walks in the woods!) are good places to start. You can also supplement with natural compounds such as spirulina and chlorella which are considered superfoods because they are loaded with essential fatty acids, enzymes, minerals, and antioxidants, and have potent detoxifying properties. Spirulina and chlorella (see our Osteo-pHBalance) have the ability to bind with toxic heavy metals and rid them from the body. Heavy metals can cause osteoporosis because they bind to bone, interfere with bone cell activity, and decrease formation of the hydroxyapatite crystal. This in turn lowers bone density and increases fracture risk.

In a Serbian study published in Toxicology and Industrial Health, Nikolic et al. tested the effects of lipoic acid on rats that had been exposed to lead, cadmium and copper. Rats exposed to these heavy metals had reduced red blood cells, hemoglobin and hematocrit (up to 30%). They found that "treatment with lipoic acid and glutathione [a powerful antioxidant in the body that is restored by lipoic acid] reduced the toxic effects of these metals in all cases." The reason OsteoStim has a full 300 mg of alpha lipoic acid is because of its powerful antioxidant capacity. This essential cofactor for mitochondrial activity and energy production protects us from oxidative damage and helps reduce the damaging effects of pro-inflammatory cytokines that hyper-stimulate osteoclast activity and cause excessive bone loss. With this study we see another benefit of lipoic acid--that of helping to lower the toxic effects of heavy metals.

Nikolic R. et al., Monitoring the toxic effects of Pb, Cd and Cu on hematological parameters of Wistar rats and potential protective role of lipoic acid and glutathione. Toxicology and Industrial Health 2013; Jan 4 [Epub ahead of print].

Sunday, January 20, 2013

Excess Cortisol Increases Fracture Risk

The use of laboratory tests for assessing what may be contributing to bone loss is one of the most important things you and your doctor can do in managing your treatment of osteoporosis. There are numerous lab tests available to physicians that have been found to be correlated in some manner or another with excessive bone loss and/or a heightened risk for breaking a bone.

Cortisol can be one such marker. Cortisol is a hormone produced by the adrenal glands (also called suprarenal glands because they sit atop of the kidneys) in response to stress. Measuring cortisol through saliva is simple, non-invasive, and accurately reflects of the amount of unbound cortisol levels in blood. Because salivary cortisol levels fluctuate throughout the day and night in what is called a circadian, or oscillating, daily rhythm, is most accurately assessed by collecting samples at four specific times throughout a day. If the evening sample is abnormally elevated this is a sign that you are producing too much cortisol and that you may have a condition called subclinical hypercortisolism (SH). What can be difficult about the diagnosis of this condition is that even though a person with SH has an excess production of cortisol, they may not display any of the symptoms common to hypercortisolism (central weight gain, excess sweating, thinning of skin and bruising, high blood pressure, elevated blood glucose, muscle weakness, irritability, etc). Unfortunately, elevated cortisol levels can be asymptomatic, and silently erode away bone density and strength. It is estimated that approximately 1 to 10% of people with osteoporosis have elevated levels of cortisol. In addition, elevated cortisol increases a person's risk for fracture because it not only reduces bone quantity but also the quality of bone. In fact, Morelli et al. (2011) found that in patients with SH who had normal or osteopenic (not osteoporotic!) bone density, 48% sustained fractures compared to 13% in the non-SH group.

In a study conducted by researchers at the University of Milan, Italy, 102 patients with adrenal incidentalomas* (with and without subclinical hypercortisolism) were assessed for bone quality and fracture risk. The authors concluded "that in patients with subtle cortisol excess, TBS (trabecular bone score)[a method of determining bone quality and strength] is reduced and correlates with the number and severity of vertebral fractures and with the degree of cortisol excess."

*Incidentalomas are adrenal gland tumors that have been found incidentally while performing another, unrelated, diagnostic procedure. Approximately 30% of patients with subclinical hypercortisolism are found to have adrenal masses.

Morelli et al. 2011. Risk of new vertebral fractures in patients with adrenal incidenaloma with and without subclinical hypercortisolism: a multicenter longitudinal study. Journal of Bone and Mineral Research. 26:1816-1821. 

Eller-Vainicher et al. 2012. Bone quality, as measured by Trabecular Bone Score (TBS), in patients with adrenal incidentalomas with and without subclinical hypercortisolism. Journal of Bone and Mineral Research. DOI 10.1002/jbmr.1648.




Thursday, January 17, 2013

Calcium and Vitamin D


You probably know that sufficient intake of calcium and adequate vitamin D from either diet or through exposure to the sun’s rays are necessary for bone health. Here are a few facts that may be new news:

Approximately 200 mg of calcium is lost from your skeleton each day and needs to be replaced.
Calcium is difficult to absorb. That’s where vitamin D comes in. When vitamin D receptors in the gut are adequately stimulated by the circulating vitamin D in your blood stream, then you are able to absorb more calcium. But even if your gut is healthy, fully capable of absorbing nutrients, and if you have at least 32 ng/ml vitamin D in your blood…even then, the bare minimum of calcium you will need to replace this loss is 600 mg/day. That is when everything is perfect.
And here is the definition of perfect in this case:
     -  You are a healthy individual with normal bone density
     -  Your 600 mg is quality, bioavailable calcium
     -  Your gut health is perfect
     -  You are less than 60 years of age
     -  You blood contains at least 32 ng/ml
         of vitamin D
     -  Your kidneys are healthy enough to resorb
         lost calcium
     -  Your kidneys are healthy enough to form
         active vitamin D
     -  You are not loosing extra calcium in your
         sweat (watch out athletes!)

Calcium (and vitamin D) affects both the formation of bone and its resorption.
Low calcium intake (or absorption) not only reduces your ability to form bone but – because low calcium stimulates your parathyroid glands to secrete more hormones – it also causes increased bone resorption (a break-down of bone) due to an increase in bone remodeling activity. When a person is osteoporotic, his/her bone remodeling activity is often increased; by taking in at least 1,000 mg calcium/day (and preferably 1,200), this remodeling activity (and therefore bone loss) can be reduced by 10 to 20%.

As you get older, your ability to absorb calcium decreases for several reasons.
First, some of the vitamin D receptors in your gut fade away and others become less responsive, thereby limiting your ability to absorb calcium. Second, with aging also comes a loss of hydrochloric acid in your stomach. With less acidity, you are less able to break down food and absorb nutrients such as calcium. Third, if you have any food sensitivities/allergies, nutrient absorption capacity is further reduced due to irritation of the gut lining.

Vitamin D helps you absorb calcium from the gut.
It’s best if you maintain vitamin D blood levels – year-round - of at least 32 ng/ml. Obtaining optimal vitamin D levels only through sun exposure is difficult; vitamin D production is compromised when people slather on the sunscreen. The solution is two fold: 1) take oral vitamin D3, and 2) make sure to have your vitamin D blood level tested annually – preferably in early spring when your D level will be at  its lowest. If it is lower than 32 ng/ml, you know you will have to increase your daily dosage of D for the next year.

In addition to its role in building bone, vitamin D is also important for immune health and muscle strength.
Vitamin D affects both the innate (promotes) and adaptive (represses) immune responses and is, therefore, important for overall normal immune function. Low vitamin D levels are seen in autoimmune disorders and are associated with chronic systemic inflammation - the powerfully destructive promoter of all chronic disease including osteoporosis. Vitamin D receptors are also present on muscle fibers and thought to play an important role in maintaining muscle performance. Trials that tested vitamin D supplementation in the elderly show over 20% reduction in risk for falls (the number one cause of fractures) with at least 800 IU/day of D.

Knowing these facts can be a life saver.
It has been determined that fewer than 1 in 10 women over the age of 70 and only 25% of all males obtain adequate calcium from their diet. If you are over 50, the U.S. Academy of Sciences recommends 1,200 mg/day of calcium.  As for vitamin D, blood levels vary dramatically depending upon sun exposure, diet, age, and latitude of where the individual lives. This is why it is extremely important to be tested for vitamin D.  Many doctors, myself included, recommend maintaining blood vitamin D [25(OH)D] at 40 to 60 ng/ml. Taking 2,000 IU/day of D3 should be adequate…but have your doctor test your blood level just to make sure.
Are calcium and vitamin D important only in adults? No! We must make sure that our children and young adults are getting enough calcium and vitamin D as well.

I hope you will make it a point to tell others about the importance of calcium and vitamin D. You may just help save someone else from future health problems.

Wednesday, January 16, 2013

Indivisible Pattern of Oneness

  Both matter and energy act like particles and moving interconnected fields at the same time. Whether studying an electron revolving around the nucleus of a molecule, the planets around the sun, or viewing galaxies playing within the forces of the universe, their movements, their existence, are of both quanta and the fields of energy that move them in an indivisible pattern of oneness. It's no wonder that different parts of the body--skin, joints, bones--may all be affected by a disease process even when they have no obvious physical, chemical, or neurological connection with each other or the process itself.
    --Crucibles of Will

Medications Associated with Osteoporosis

The following is a partial list of medications associated with secondary osteoporosis:

    -  Glucocorticoids such as cortisone and prednisone
    -  Thyroxine (excess)
    -  Antiseizure or anticonvulsants such as phenytoin and phenobarbital
    -  Lithium
    -  Anticancer drugs
    -  Depot medroxyprogesterone acetate (Depo-Provera)
    -  Heparin (long-term)
    -  Aromatase inhibitors such as Arimidex, Aromasin and Femara
    -  Cyclosporine A
    -  Gonadotropin-releasing hormone agonists such as Lupron and Zoladex
    -  Thiazolidinediones such as Avandia for type 2 diabetes
    -  Proton pump inhibitors (PPIs) such as Nexium, Prevacid and Prilosec
    -  Methotrexate
    -  Selective serotonin re-uptake inhibitors (SSRIs)

These and other drugs can cause bone loss, so make sure you ask your doctor if any of the medications you are taking are linked to increased fracture risk.

Tuesday, January 15, 2013

Natural Approach to Osteoporosis a Proven Success

Twelve years ago when I was diagnosed with severe osteoporosis I knew that simply taking osteoporosis medications to harden my skeleton was not the answer. I was in search of a natural solution to my osteoporosis, one that made them healthy and not just denser.

Each book or article and website I found claimed to have the "answer" to "cure" my osteoporosis, but all I found was the same thing, over and over again: eat better, take calcium, vitamin D, and exercise. Well, these are all very important--and I certainly did them all faithfully--but I continued to loose bone density.
Running past some "Skeleton" cactus (Teddybear Cholla) in Hell Hole Canyon, Anza

 Borrego, CA

It took me over 5 years, and 12 fractures, but my continued research paid off. I was finally able to find the right combination of natural compounds that really could improve the health of my bones and STOP (not just reduce) my state of constantly breaking bones. (That's why I can do things now like run through Hell Hole Canyon and enjoy the skeleton cactus'...and not just worry about my own skeleton!)

My book, The Whole-Body Approach to Osteoporosis, outlines this natural approach to osteoporosis. It includes the benefits of eating better, and taking calcium and vitamin D, and engaging in exercise...but there is MUCH more! If you or someone you care for has been diagnosed with osteopenia or osteoporosis, take advantage of a proven approach to turning that diagnosis around.

Saturday, January 12, 2013

Steroids (Oral and Injections) and Osteoporosis

If you have a chronic inflammatory or autoimmune disorder such as asthma, COPD, rheumatoid arthritis, inflammatory bowel disease, polymyalgia rheumatica or multiple sclerosis, most likely you were prescribed an oral glucocorticoid (corticosteroid) medication such as cortisone or prednisone. Unfortunately, long-term use of these steroids carry high risks for developing some very nasty side effects...including osteoporosis. In fact, 30 to 50% of patients prescribed prednisone, long-term, will sustain a fracture. Even low-dose prednisone, taken for just six months, can weaken bone and cause fractures.

Is the same true for steroid injections? Specifically, can the injection of corticosteroids into the spine for the treatment of low-back and leg pain increase your risk for fracture?

In my chiropractic practice I see patients every day who are suffering from severe lower back and leg pain. Thankfully, through a treatment regimen of gentle chiropractic spinal mobilization and manipulation techniques plus core exercise therapy, pain in most of these patients can be reduced and eventually eliminated.

However, there are those individuals who, due to the severity of their disc condition, do not achieve satisfactory relief of pain and are candidates for epidural steroid injections.

The fracture risk with steroid injections was recently addressed by Dr. Ahmad Al-Shoha and colleagues from Summa Health System in Akron, Ohio when they studied the effects of epidural steroid injections on bone mineral density (BMD) in postmenopausal women. What they found was that "there was a significant decline in hip BMD...at 6 months compared with baseline...A single epidural steroid injection in postmenopausal women adversely affects bone mineral density of the hip...Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy [sciatic leg pain]. The resulting decrease in bone mineral density, while slight, suggests that epidural steroid injections should be used with caution in those at a risk for fracture."

Bottom line: "Indeed, the osteoporotic effects of glucocorticoids may be no different when administered epidurally than through other routes such as oral or inhalation."

Although the beneficial effects of steroids on the underlying disease may partially offset the detrimental effects on bone, patients on long-term steroid treatment should have bone density monitored, and measures taken to try and preserve bone.


Al-Shoha A et al., 2012. Effect of epidural steroid injectin on bone mineral density and markers of bone turnover in postmenopausal women. Spine 37(25):E1567-71.

Wednesday, January 9, 2013

Vertigo, Vitamin D and Osteoporosis

If you have ever felt the world spinning around you with a loss of balance and possibly nausea and vomiting, you were having an episode of vertigo. Not something that anyone needs, most especially if you have a weakened bone structure that is vulnerable to breaking if you fall. Vertigo and the fragile bones of osteoporosis simply do not mix; combined, they are a sure recipe for disaster.

The causes of vertigo span a broad range...from an inflammation of inner-ear nerves, to medications, to tumors--so it is extremely important to have your doctor determine its exact origin.

The most common cause, and one that I see fairly regularly in my office, is benign paroxysmal positional vertigo (BPPV)--a condition linked to free floating calcium crystals in the inner ear.

   - Deep within the fluid-filled inner ear, part way between the semicircular canals and the cochlea, microscopic hair cells with attached calcium crystals wave gracefully back and forth similar to sea grass and attached barnacles in the ocean's currents. Any tilting, bouncing or turning of the head causes the crystals and hair cells to move, stimulating nerve fibers and sending messages of motion to the brain. It is through this mechanism that we are able to sense motion and maintain balance.

   - In BPPV, calcium crystals have broken away from their hair cell moorings and float into the fluid-filled tubular semicircular canals where they do not belong. Here, these crystals activate neurons haphazardly sending confusing neurological messages about body position to the brain. Simply tilting your head or rolling over in bed can set off a severe episode of vertigo.

Calcium crystals might be dislodged due to a head trauma or inner ear infection which can damage the hair cells. A third predisposing risk factor for BPPV is a disturbance in calcium metabolism, such as that seen in osteoporosis.
 
A new study reported by Jeong et al. in the Journal of Neurology demonstrates an association between BPPV and low blood levels of vitamin D. The researchers measured serum levels of vitamin D in 100 patients with BPPV and when compared to controls, found the group with BPPV to have lower vitamin D levels. They concluded that decreased vitamin D may be a risk factor for BPPV.

If you are experiencing episodes of vertigo, it is extremely important to work with your doctor to identify the cause. If the condition is identified as BPPV, have a blood test to determine vitamin D levels and, if you haven't had a recent bone density examination, it's time to get one.

BPPV is not considered to be intrinsically life-threatening. However, it can be tremendously disruptive to a person's work and social life, as well as pose a health hazard due to an increased risk of falls associated with dizziness and imbalance. Unfortunately, BPPV and osteoporosis travel together.


Jeong S.H. et al., 2012. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol Oct 25 [Epub ahead of print].

Sunday, January 6, 2013

Laboratory Tests for Osteoporosis

One of the best weapons we have for fighting osteoporosis is the availability of laboratory tests. Not only can they be used to identify the cause(s) of bone loss and to rule out other disease processes, but some of these tests can then be repeated to help monitor effectiveness of treatment. Any abnormal test results can then be used as therapeutic targets for improvement. On subsequent testing, positive changes will indicate that the therapies you and your doctor have initiated are making an impact--and that your health (and that of your bones) is improving. The 2004 Bone Health and Osteoporosis: A Report of the Surgeon General supports the use of lab tests to assess treatment effectiveness. I regularly use the information from lab tests to help me design nutritional support programs to optimize patients' bone health. These lab tests are an invaluable tool for reducing fracture risk.

The following are the "Basic Core" of laboratory tests that I find most helpful for diagnosing and managing osteoporosis:

    -  Comprehensive Metabolic Profile (CMP)
    -  Complete Blood Count (CBC)
    -  Vitamin D [25-hydroxyvitamin D or 25(OH)D]
    -  Urine calcium (24-hour)
    -  Celiac profile [Anti-tissue Transglutaminase Antibody (IgA-tTG); Total
                               Immunoglobulin A (Serum Total IgA); Anti-Gliadin Antibodies
                               IgG and IgA (IgG-AGA and IgA-AGA)
    -  Bone resorption marker (NTX, CTX, or DPD)
    -  Urine pH (first morning void)

The following are additional tests that may be appropriate depending on the patient:

    -  Protein electrophoresis
    -  PTH (parathyroid hormone)
    -  Calcitriol [1,25-dihydroxyvitamin D3 or 1,25(OH)2D3]
    -  Ionized serum calcium
    -  Osteocalcin
    -  TSH (thyroid function)
    -  Estrogen (estradiol)
    -  Homocysteine
    -  hs-CRP (high-sensitivity C-reactive protein)
    -  Erythrocyte Sedimentation Rate (ESR)
    -  Lipid peroxides
    -  8OH2dG
    -  Cortisol/DHEA
    -  Stool analysis
    -  Food allergy testing

Tuesday, January 1, 2013

Hope and Happy New Year!


It was a perfect first day to a new year here in New England...absolutely beautiful. The snow was crisp and the skiing exhilarating. I hope you were all able to enjoy the day.

As founder of OsteoNaturals, and someone who has personally battled osteoporosis, I would like to offer you encouragement. And, most of all, hope. I try to live by example and in doing so, maybe, just maybe, I can show you that there truly is hope. So even if you are experiencing fractures and pain...your future can be better.

Struggling with osteoporosis can be difficult, to say the least. I know how dark some of those days can be when that constant fear of breaking a bone just doesn't go away, or that pain in your back from the latest compression fracture is unrelenting, or your most recent DXA scores come back worse than the ones before. OH MY GOD...IS THAT HARD TO DEAL WITH! But I need to tell you...you can turn it around...you can improve...you can get stronger. I know because I did it. It may take some time but you can do it. You just have to stick with it...stick with your healthy diet, your supplements, your exercise. I've given you the guide (The Whole-Body Approach to Osteoporosis), and the supplements (OsteoNaturals), so now it is up to you. Strive each day...and you will eventually succeed.

Now that my skeleton is strong again, I'm so thankful that I can do all the things I do. I'm also thankful that I can offer you hope...hope that is real. You see, it wasn't too many years ago that skiing would have been out of the question for me. Back then I would break a bone with only the slightest of pressure against my body...even just leaning up against a wall could break my ribs. But those dark days are over (thank goodness because I fell three times today!). And as I can now say, dark days lead to brighter ones if you keep on fighting. Don't give up. Go for it...make 2013 your year to better health. Happy New Year to you all.
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