Monday, December 12, 2016

BoneSmart Pilates: Aging Strong - Volume 1

Teresa Maldonado Marchok, LPT, just produced a very impressive DVD that will help improve your
posture, balance, muscle tone, AND bone strength. Teresa, a licensed physical therapist and certified Pilates teacher (at my alma mater, Stanford University, no less!) will show you how to improve hip and leg strength and stabilize your spine through exercise - all key for helping to reduce fracture risk if you have a weakened skeleton from osteopenia or osteoporosis.

This is Teresa's second DVD and it builds on the exercises from her first video. Teresa really steps up the intensity level in this one but continues to keep you safe by expertly explaining the mechanics of each exercise. This video will definitely challenge you...in a GOOD way.

I am always touting the virtues of exercise, but when it comes to weak bones, it can be difficult to find inexpensive, safe, and effective programs designed specifically for promoting skeletal health. Teresa does an incredible job with this DVD in showing you how to improve bone strength, safely.

As Teresa explains, aging is inevitable but much of HOW we age is under our control. This is so true. By eating a bone-healthy diet, taking OsteoNaturals supplements, and engaging in safe, bone-specific exercise, you will have all of what you need in your armamentarium against osteoporosis. For more information or to order Teresa's BoneSmart Pilates: Aging Strong DVD go to www.BoneSmartPilates.com.   

Friday, December 2, 2016

Proton Pump Inhibitors Not Only Cause Osteoporosis but a New Study Points to Increased Risk for Stroke

I am continually dismayed at how many of my patients with osteoporosis are taking PPIs. They have
been prescribed proton pump inhibitors by their medical physicians to help reduce stomach acid and treat the symptoms of heart burn or GERD. But PPIs have the nasty side effect of reducing bone density and increasing a person's risk for breaking a bone. With GERD symptoms easily remedied through conservative, non-drug, therapy, I am always left scratching my head wondering WHY!...Why in the world would doctors prescribe PPIs, especially to their patients with osteopenia or osteoporosis. Most cases of GERD respond well to conservative therapy of dietary changes and the use of probiotics and digestive aids to improve gut function. For the majority of people who experience GERD symptoms, they should not have to use PPIs. And, if they do, these medications should be taken in low doses.

Findings from a recent study out of Denmark indicate there is another reason to stay far away from PPIs if possible. Thomas S. Sehested, a medical doctor from the Danish Heart Foundation, showed an "association between use of PPIs and increased risk of first-time ischemic stroke and a positive dose-response relationship between PPI dose and stroke risk." Dr. Sehested's findings are based on the medical histories of 244,679 individuals. Histories were accessed from nationwide Danish registries in this observational study. The investigation looked at 4 different PPI medications and found that stroke risk increased from 33% to 79% depending on the particular drug being taken. Also, the higher the dose, the higher the risk for stroke.

Sehested, T.S., et al. American Heart Association (AHA) 2016 Scientific Sessions. Abstract 18462: Proton Pump Inhibitor Use Increases the Associated Risk of First-Time Ischemic Stroke. A Nationwide Cohort Study. Presented November 15, 2016.

Tuesday, November 8, 2016

Calcium Supplementation IS Vital for Individuals with Osteoporosis

Over the years there have been numerous studies about the benefits and risks of calcium - much of it inconsistent - and this has led to a lot of confusion and frustration. It all began in 2008 when Mark Bolland and Ian Reid (1) from New Zealand studied 336 healthy, older women (mean age 74) and concluded there may be a slight increase in cardiovascular events when taking supplemental calcium. Although numerous researchers found fault in Bolland and Reid's research methodology, a new study by Norwegian researcher Gunhild Hagen (2016) concludes that although we don't know for sure if calcium has this negative
effect, “the modest effect of supplemental calcium and vitamin D on the risk of fracture is not large enough to outweigh the potential increased risk of cardiovascular disease."(2) Is your head spinning yet?

Since improving the strength and density of my own skeleton after a diagnosis of severe osteoporosis at age 45 (with 12 fractures in 5 years), I have been helping others with bone fragility for over 10 years now. Because I have a personal interest and bias, I review each published article on bone health and carefully evaluate it based on the type of study, the populations included in the study, the quality of the design and execution, analysis of the data, etc. I hope, because of this, I can continue to be your trusted source of effective, reliable information in your quest to combat osteoporosis.

Let's look at the facts: 

FACT: We need adequate calcium for good health. Calcium is important for skeletal health, as well as a host of other essential functions. Without calcium there would be no nerve transmission, muscle contraction, cell signaling, blood clotting, constriction and relaxation of blood vessels, or secretion of hormones like insulin.(3) Studies have consistently found that higher calcium intakes reduce the risk of hypertension, obesity, and type 2 diabetes.(4,5,6,7) In a 2015 study from the National Osteoporosis Foundation, Weaver, C.M., et al. found a "significant decrease in fractures with calcium and vitamin D supplements."(8)

FACT: People should strive to meet the calcium levels recommended by the Institute of Medicine (IOM), using food sources to the greatest extent possible. The Recommended Dietary Allowances (RDAs) for most adults (ages 19 to 70) is 1,000 mg of calcium daily, and women older than 50 and men older than 70 should aim for 1200 mg of calcium per day.(9) A healthful, well-balanced diet should include dairy (especially yogurt and kefir), dark leafy greens, and other calcium sources like sardines, almonds and beans.

Unfortunately, some people are sensitive or allergic to dairy. In addition, although many physicians recommend dairy as a calcium source, high dairy intake may come with other undesirable effects. Besides grave concerns over the dairy industries use of rBGH (growth hormones), milk is acidifying to the body (not good for bones) and casein, the major protein found in milk, has neoplastic (cancer) potential. Also, D-galactose (from the lactose sugar in milk) has been shown to increase inflammation, contribute to neuro-degeneration and reduced immune function. To this point, Michaelsson, et al. (British Medical Journal, 2014) observed a link between high milk intake (3 or more glasses per day) and higher rate of both mortality and fracture in women, and a higher rate of mortality in men. "There were positive associations between milk intake and concentrations of markers for oxidative stress and inflammation." The authors concluded "A higher consumption of milk in women and men is not accompanied by a lower risk of fracture and instead may be associated with a higher rate of death."(10)

FACT: Many Americans do not meet the RDA for calcium. The 2015 Dietary Guidelines Advisory Committee (DGAC) concluded that many Americans, due to a variety of socio-ecological factors and the concerns cited above, don't meet the IOM recommendations and declared calcium "a nutrient of public health concern for under-consumption."(11)

FACT: Inadequate intake from dietary calcium impacts individuals differently. Healthy, active individuals with strong bones may efficiently absorb enough calcium to maintain bone density. They are also more likely to have a balanced bone remodeling system without excessive osteoclastic (bone destroying) activity that would require a greater intake of calcium to keep up with demands. Individuals with bone fragility, on the other hand, are already at a deficit because their remodeling system is out of balance. The osteoclasts within their bones are destroying it faster than the osteoblasts can build new bone. "If there isn't enough calcium coming in from the diet, the body will pull calcium from the bones for all the things that need to be done,” notes Andrea J. Singer, MD, FACP, CCD, director of women's primary care and bone densitometry for the Department of Obstetrics and Gynecology at MedStar Georgetown University Hospital and clinical director of the National Osteoporosis Foundation.
FACT: Adequate calcium intake (1200 - 1400 mg), taken as directed, is vital for Individuals with bone fragility.  By now you may be thinking, "I know I need calcium for bone health yet it is difficult to get adequate calcium unless I drink a lot of milk. But high dairy intake doesn't sound wise either...so what am I supposed to do in light of the recent research concerning the safety of supplemental calcium?

First, always try to get as much calcium from your diet as possible. As they say, "you are what you eat." Eating foods high in calcium is good for you...and your bones. 

Second, take supplemental calcium (and magnesium and trace minerals) to ensure you are getting the minerals necessary for skeletal health. But, take your calcium in small doses through-out the day. It is not wise to take large doses of supplemental calcium such as those used in Bolland and Reid's studies. High amounts (400 mg or more) of calcium all at once can cause an excess spike of calcium in the blood - a problem that could potentially interfere with normal heart function. This may be the link between calcium and cardiovascular events, if indeed it exists.

Our OsteoNaturals’ OsteoSustain tablets contain only 175 mg because I believe in GENTLY providing the body with what it needs to build bone. Taking 3 tablets spread out over the day with meals provides 525 mg calcium in a safe, effective manner. For many patients with severe bone loss, I advocate taking an additional one or two tablets of OsteoMineralBoost for more calcium plus trace minerals in addition to the OsteoSustain. Taking one OsteoSustain and one OsteoMineralBoost at a sitting provides 315 mg calcium which is well below the 400 mg level.
As a general protocol for severe bone loss, 3 tablets of OsteoSustain and 2 tablets of OsteoMineralBoost provide 805 mg supplemental calcium daily. This, along with a diet rich in veggies, will put that person just right at 1200 to 1400 mg calcium per day - PERFECT for someone with bone loss. In addition, OsteoNaturals’ products provide the body with bioavailable magnesium, vitamins D and K, and trace minerals...all important for utilizing the calcium and helping your body put this vital mineral where it belongs...in your bones.
FACT:  In addition to ingesting an adequate (not excessive) amount of minerals for bone building, the key to fighting osteoporosis is to focus on balancing bone remodeling – reducing osteoclastic bone resorption and increasing osteoblastic bone formation. As explained in my book, The Whole Body Approach to Osteoporosis, regaining balance is best achieved by eating a healthful, well-balanced, alkaline diet; taking quality, nutritional supplements like OsteoNaturals' OsteoStim (our product designed to enhance balanced bone remodeling activity); exercising (both cardio and weight-bearing); and evaluating health-related lifestyle behaviors.
Calcium is important for skeletal and overall health. Most advocacy organizations and health policymakers stand by the IOM recommendations for daily calcium levels. It's best to get calcium through diet but this is often extremely difficult, if not impossible. Quality, trusted supplements – taken as directed – should be used to make up the shortfall. 

If you have bone loss, I urge you not to run from calcium because of some shaky research that used excessive amounts of an important mineral and came up with a possible link to an adverse effect. The same thing happened in 2001 with the Women's Health Initiative Study that concluded estrogen was bad for women. This study used excessive amounts of estradiol in a population of women they should not have used (advanced age and asymptomatic). The researcher's back then concluded that estrogen was BAD and did a huge dis-service to women. Because of this, instead of using estrogen PROPERLY (using smaller dosages and initiating it in women no more than 5 years after menopause) doctors ran the other way and stopped prescribing estrogen all-together. Let's NOT let this same reaction prevent us from obtaining the most abundant mineral in the body, calcium.


(1) Bolland, M.J., et al. 2008. Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. BMJ 336:262-6.
(2) Hagen, G., et al. 2016. The predicted lifetime costs and health consequences of calcium and vitamin D supplementation for fracture prevention - the impact of cardiovascular effects. Osteoporos Int 27(6)2089-2098.
(3) Linus Pauling Institute. Calcium dietary supplemental fact sheet. National Institutes of Health Office of Dietary Supplements website: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Updated November 21, 2013.
(4) Alender, P.S., et al. 1996. Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. Ann Intern Med 124:825-31.
(5) Bucher, H.C., et al. 1996. Effects of dietary calcium supplementation on blood pressure. A meta-analysis of randomized controlled trials. JAMA 275:1016-22.
(6) Villegas, R., et al. 2009. Dietary calcium and magnesium intakes and the risk of type 2 diabetes: the Shanghai Women's Health Study. Am J Clin Nutr 89:1059-67.
(7) Teegarden, D., et al. 2003. Calcium intake and reduction in weight or fat mass. J Nutr 133:249S-51S.  
(8) Weaver, C.M., et al. 2016. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 27:367-376.  
(9) Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press.
(10) Michaelsson, K., et al. 2014. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ 349:g6015.  
(11) US Department of Agriculture, US Department of Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Published February 2015.

Wednesday, August 31, 2016

A Crisis in the Treatment of Osteoporosis can be Turned Around with a Paradigm Shift

According to an editorial by Drs. Khosla and Shane in the August 2016 Journal of Bone and Mineral Research, there is A Crisis in the Treatment of Osteoporosis.(1) I totally agree...but my call to action is different.

The point of the editorial is that even with all the “remarkable advances in the diagnosis and treatment of osteoporosis…many patients, even those who unequivocally need treatment, are either not being prescribed osteoporosis medications at all, or when prescribed, refuse to take them.” Khosla and Shane point out that this paradox has been brewing for some time, but the issue was brought to a head in a recent article by Gina Kolata in the New York Times titled, Fearing Rare Side Effects, Millions Take Their Chances with Osteoporosis. Coincident with media and public concern about side effects such as osteonecrosis of the jaw (ONJ), atrial fibrillation, and atypical femur fractures from osteoporosis medications, Kolata found bisphosphonate use declined by greater than 50% from 2008 to 2012. The pattern was confirmed by another recent study that used claims data from a U.S. commercial health plan. Those authors found that "among 22,598 patients with hip fractures, use of bisphosphonates decreased from an already dismal 15% in 2004 to an abysmal 3% in the last quarter of 2013." The editorial also notes that the scope of the problem may be worse because the underlying studies did not evaluate patient compliance. “…Most of us in practice have observed that a significant proportion of the patients we see clinically are reluctant to initiate bisphosphonate therapy and many on these drugs want to stop taking them and do so despite our best advice." Khosla and Shane are saddened (and rightly so) because they feel that the medical community has "failed our patients, and that is something we cannot allow to happen." Their call to action is to find ways to ensure that patients who need them are prescribed effective medications and equipped to make informed choices on taking these drugs.

I have dedicated my life to helping others with osteoporosis for the past 15 years and I feel the same sadness. Sad because a diagnosis of osteoporosis just does not have to lead to devastating life-altering consequences of chronic pain, loss of mobility, and the all-to-often "death-spiral" following a hip fracture. It just does not have to be this way.

I am particularly saddened because we (as doctors) have failed our patients by:
  • Pushing medications with potential serious side-effects and not "working with the body" to normalize physiology. We have turned people completely away from approaching osteoporosis treatment in a sane, effective, none-harmful manner. Many of these patients have become afraid of osteoporosis medications. So afraid that they will not use them even as emergency treatment. 
  • Not offering them a "balanced" treatment option. Medications are not inherently "bad" or necessarily harmful...if they are used properly. There are two issues here: (1) the unfortunate practice of prescribing them to patients who don't really need them and/or keeping patients on them for too long; and (2) little or no emphasis on normalizing the bone remodeling process naturally by encouraging a reduction in overly aggressive osteoclastic bone resorption and a boost to osteoblastic bone formation. This, can usually be accomplished through improved diet, exercise, and specific vitamins, herbs and nutritional compounds such as those found in our OsteoNaturals products.
  • Allowing the confusion and fear that media sensationalism causes in our patients to dictate their health care choices. Yes, osteoporosis drugs can cause serious adverse effects and too much supplemental calcium is not good for you but that does NOT mean that a person should never take medications and that does NOT mean that supplemental calcium should not be taken. EVERYONE with osteoporosis NEEDS to take at least 600 mg of calcium/day and there are SOME people that NEED to use osteoporosis medications at least for a short time.

I think the call to action should be to change the medical model for the treatment of osteoporosis. Drugs...and only drugs (ok...also some vitamin D) defines the current model for too many doctors. It is certainly true, osteoporosis medications CAN be helpful, but they should NOT be the primary emphasis of treatment except when the patient is in a situation of impending fracture. Then and only then can we look at medications as the primary short-term EMERGENCY or TRIAGE treatment. But our real effort, even in these situations, is to find a way to slowly change the biochemistry, change the way the patient’s body is functioning, and help promote healthy bone remodeling.

(1)  Khosla, S. and Shane, E. 2016 Editorial: A Crisis in the Treatment of Osteoporosis. Journal of Bone and Mineral Research 31(8):1485-1487.
 

Thursday, June 30, 2016

Early Detection and Intervention are Crucial to Stop the Progression of Bone Loss - How Biomarkers Can be Used to Improve Treatment of Osteoporosis

As you know from my book The Whole-Body Approach to Osteoporosis,(1) I am a strong advocate for working closely with your health care provider and using specific laboratory tests to gather critical information about your bone health.

Both men and women begin to lose a small amount of bone mineral density in their mid-thirties. A “healthy” person may lose 0.7% to 1.0% per year after they reach their 40s but this loss is slow and typically has a minimal detrimental effect on their over-all health longevity, especially if they had normal bone accrual as a young adult. But for women, the sharp loss of estrogen at menopause can precipitate a dramatic loss of bone density, up to 3 or 4% per year. A rapid decline in bone mineral density leads to unwanted changes within the microarchictecture of bone, such as cortical thinning and a loss of trabeculae – the microscopic support beams within bone. These changes cause a loss in bone quality. Together, when both bone quantity and quality are lost, there is a sharp decline in bone strength and an increased risk for fractures. Identifying women at greater risk for developing osteoporosis, and especially those who are loosing bone rapidly during transmenopause,* is of key importance. The earlier the detection the better!

When bone densitometry (a DXA exam) is used to determine bone loss, the doctor must compare two consecutive exams over a two-year period to assess the speed in which a person is loosing bone. The larger the loss in bone density, the more rapid is the bone loss and the greater is their risk of breaking a bone. Having to wait two years before identifying those at greater risk can, and often does, result in catastrophic results such as sustaining a hip fracture or spinal compression fracture. Once bone is lost it is very difficult to regain, placing these women at a much higher risk for fracture. With earlier
identification of those at high risk for rapid-bone loss…by eliminating this 2-year period of time…we can intervene with appropriate therapy and reduce the incidence of subsequent fractures.

The GOOD NEWS: Natural therapeutic methods to improve skeletal health works! Changing a person’s diet, taking quality supplements such as the OsteoNaturals line and engaging in bone-healthy exercise work to improve skeletal health by “gently nudging” bone cells into a new and healthier course of being. When working with nutrition, we aren’t just sprinkling more calcium into bones, we are changing the "habits" of cell metabolism. While we can't alter our genetic code - our DNA, we can improve the way a person's genes "express" themselves - the epigenetics of cells. It is through changes in a person's epigenetics that we can put a stop to rapid bone loss and move out of the "high risk for rapid-bone loss" osteoporosis category.

The “NOT SO GOOD NEWS”: Natural therapeutic methods to change skeletal health can take time to “engage”. If a person has had a poor diet for the past 20 years, is in a nutritionally sub-optimal state, and has low-level chronic systemic inflammation, simply improving his or her diet will NOT result in instant success. The sooner we can identify the heightened level of bone cell activity, the quicker we can start “encouraging” bone destroying cells to calm down and reduce their excessive level of bone resorption. Think of osteoclasts (the cells that break down bone) as a gang of wild maniacs on the loose. If you just tell them to stop their wild behavior they probably won’t just “normalize”….on the other hand, put them into a quality therapeutic counseling program, change their eating habits and destructive lifestyle habits and, over a period of years, they may be able to re-enter society as constructive members. The earlier a person is tapped into therapy, the better the results. Changing the way cells “behave” can take several years, several generations of cellular division, even after being immersed into a new, healthier environment.

Back to the GOOD NEWS: With the science of current biomarkers constantly improving and new, even more sophisticated biomarkers being developed, we have come a long way in our understanding of osteoporosis and ways to treat it effectively. Most recently, in a study published in the Journal of Bone and Mineral Research,(2) Shieh, et al. assessed the clinical utility of measuring N-telopeptide (a bone resorption laboratory marker) during the menopause transition as a way of identifying women at high risk for developing osteoporosis. The study included 604 women. The authors concluded that higher levels of N-telopeptide during the early postmenopausal period were most strongly associated with a higher rate of bone loss during transmenopause. This correlation, elevations in N-telopeptide to the rate of bone loss, was most pronounced in the lumbar spine but also in the hip. More studies like this are needed to ensure individuals at highest risk for rapid bone loss are identified as quickly as possible.

I have been using biomarkers such as N-telopeptide (and the other bone resorption markers C-TX and DPD) for over fifteen years to assess and monitor patients with bone loss. I have seen the benefits of early detection of those at great risk of developing osteoporosis and those who have rapid bone loss and thus even a higher risk for fracture. Please help pass the word to everyone you know – especially women approaching transmenopause – about the importance of specific laboratory tests to gather critical information about their bone health. Armed with this information, they can work with their health care provider to customize a plan to address the underlying causes of their bone loss, ultimately enabling them to improve bone health, reduce the risk of fracture, and enjoy a more active lifestyle.

* Transmenopause or menopause transition refers to the period of greatest estrogen loss. Rapid bone loss often begins 1 year prior to a woman's final menstrual period and lasts for 2 to 3 (or more) years after their last period. After this 3 to 5 year (up to 10 years in some cases) period, the rapidity of bone loss normalizes to prior menopause levels. 


(1) McCormick, R.K. 2009. The Whole-Body Approach to Osteoporosis, How to Improve Bone Strength and Reduce Fracture Risk. New Harbinger Publications.

(2) Shieh, A., Ishii, S., Greendale, G.A., Cauley, J.A., Lo, J.A., and Karlamangla, A.S. 2015. Urinary N-Telopeptide and Rate of Bone Loss Over the Menopause Transition and Early Postmenopause. Journal of Bone and Mineral Research DOI: 10.1002/jbmr.2889.

Thursday, June 2, 2016

Becoming Anabolic in the Face of Osteoporosis - Even While Running 50 miles at the 2016 Pinelands Salomon Trail Running Festival


Reducing fracture risk is about more than just making bones denser with calcium. It is also about: 1) reducing chronic systemic inflammation, 2) staying strong and supple, and 3) remaining positive as you navigate through life. 

As I was slogging through a 50-mile race in Maine a few days ago, I began to wonder if what I was doing was really a good idea. After all, going non-stop for over 10 hours....eating M&Ms, potato chips, pretzels and guzzling down gallons of disgusting sugary drinks as I beat my joints and muscles to a pulp...intuitively doesn't SEEM like a smart thing to do to reduce systemic inflammation! And, as far doing things to promote strength and suppleness...well, just watch the short video on our OsteoNaturals Facebook Page (please "like" us while you're there!) as I slowly hobble across the finish line, and you will see that running 50 miles at one clip doesn't promote suppleness (especially

when you have achilles pain that started at mile 2). Strength of will, maybe, but suppleness, certainly not!

OK, so last weekend I failed miserably at accomplishing the first two things that I say are so important for bone health. But what about the third?...the "remaining positive" bit? My thought is that ONCE IN A WHILE it is OK to indulge in TOTALLY WACKY THINGS to keep your engines running on all cylinders. I know what you are thinking..."Didn't Dr. M just go up Mt. Kilimanjaro last month and didn't he just do an Ironman last year?", and "Is this REALLY a 'once in a while' thing that he does?" Well for me, a guy who just 17 years ago was breaking so many bones from osteoporosis that running 50 miles, doing Ironmans, or going up Mt. Kilimanjaro were not only out of the question but total pipe dreams....these are all REALLY important things for me to do for promoting my positiveness factor.

While I may have questioned my sanity as I slogged through the miles at the 2016 Salomon Trail Running Festival, I also relished at how lucky I was to be able to do such a crazy thing once again in my life. Years of struggling with osteoporosis, breaking bone after bone, was quite a challenge. I know many of you have face a similar challenge. And that is why I founded OsteoNaturals. And that is why I write these crazy newsletters. I want you to know that there ARE solutions and that people CAN bounce back from osteoporosis. That YOU CAN bounce back from bone fragility and regain physical confidence. It took me years of constant vigilance to diet and consistently taking important healing supplements such as OsteoNaturals, but my bones are now strong enough to push the envelope again (on a limited basis). Yes, I get incredible satisfaction from these adventures, but what I am most proud of is when I receive letters from people who have been taking OsteoNaturals products and hear how well they are doing. THAT is the best! I did it...they are doing it...and you can do it.

In my book, The Whole-Body Approach to Osteoporosis, I cover all the key points you need to know about creating an anabolic body for improved bone health. I talk about the importance of exercise (sane exercise), diet (no, no M&Ms or potato chips), gut health, and taking nutritional supplementation for reducing chronic systemic inflammation and improving bone health. Some of the most critical supplements I talk about are: calcium, magnesium, vitamins D and K, alpha-lipoic acid, N-acetyl cysteine, and berberine. My book explains how these and other important vitamins, minerals, and herbs can help reduce chronic systemic inflammation and improve skeletal health. Our OsteoNaturals products combine all of these ingredients, in just the right ratios, making it easy to ensure you are getting exactly what you need for better bone health.

So last weekend I may have failed miserably in reducing systemic inflammation and promoting suppleness but I made up for it with an overdose of the "remaining positive" thing. I'm not saying I will ever do another 50 miler but I will certainly do many more wild and crazy adventures in my life. Now back to being anabolic by eating better, getting lots of sleep, and taking my OsteoNaturals supplements. Rock on and stay tuned for more adventures!

Wednesday, May 4, 2016

Probiotics May Be Repurposed for Therapy in Osteoporosis


In my book, The Whole-Body Approach to Osteoporosis, I write about the importance of gut health when treating osteoporosis. An unhealthy digestive tract can not only interfere with optimal nutrient absorption but it disrupts the immune system and can lead to chronic systemic inflammation. As with the loss of estrogen at menopause, another common cause of osteoporosis is when the immune system gets out of balance (especially in postmenopausal women). Since 70% of the immune system is housed in the gut, keeping it healthy is critical for skeletal health. In a study published recently in The Journal of Clinical Investigation, researchers (Jau-Yi Li et al) working with mice reaffirm this premise and suggest that giving the mice probiotics improved the immune response and improved bone density. In this blog, I would like to help readers better understand how a healthy gut keeps chronic systemic inflammation at bay, and why it is so important to keep inflammation to a minimum if you want healthy bones.


The gastrointestinal tract is home to literally billions of bugs. Some good...some not so good. When the gut is over run by the not so good ones, (often due to a poor diet, allergies to foods and/or frequent use of antibiotics) it can be damaged and begin to leak. A chronically inflamed digestive tract causes gaps to form through which partially digested food particles and microbes can pass. Now, instead of being a protective barrier, this "leaky gut" becomes a portal to ill health. The particulate and microbial toxins that filter through these newly opened gaps set off reactions, which are a constant source of inflammation that insidiously permeate the entire body. This "leaking gut syndrome" or intestinal dysbiosis not only causes a chronic inflammatory reaction and a disruption of proper immune function in the person but when the gut is damaged it can no longer absorb nutrients effectively. So we NEED "good" bacteria to thrive in the gut. When healthy microbiota predominate in the gastrointestinal tract we are much healthier and so are our bones.


Our immune system and bone cells use the same signaling molecules (cytokines) to relay messages. When the immune system is out of balance it sends out way too many abnormal signaling molecules and the bone cells, especially the osteoclasts (the cells that break down bone), "hear" these abnormal signals and become hyper aggressive, eating up excessive amounts of bone. In chronic systemic inflammation, a condition I talk a lot about in my book, the "out of wack" immune system ends up being the cause of excessive bone loss. With too much inflammation in the body the osteoclasts become turned on ALL the time and the result is bone loss...osteoporosis. People often think that the most important thing they can do for osteoporosis is to take supplemental calcium. Yes, calcium is important but it isn't the whole story. We need to take in approximately 1,200 mg/day which is best achieved through a combination of dietary and supplemental sources. But we also need to make sure we get enough magnesium and vitamins D and K. AND we also must make sure our gut and immune systems are functioning optimally. Having all the nutrients available won't help much if the gut can't absorb them or if there are so many inflammatory cytokines circulating in the blood that the osteoclasts just destroy all the bone that is being made. When we give the body the minerals and vitamins it needs, PLUS have a healthy gut and immune system...then better bones will follow. Take out just one of those from the equation and the whole system falls apart.


Postmenopausal osteoporosis is typically the result of two things: 1) the loss of estrogen production from the ovaries, and 2) chronic systemic inflammation. Often, these go together as estrogen helps to reduce inflammation. In the published study using mice, researchers found that with the loss of estrogen there was an increase in ‘gut leakage’ and the subsequent inflammation resulted in increased osteoclastic or bone resorbing activity. After giving the mice probiotics, there was improvement in the immune response and improved bone density. 


Taking oral probiotics and eating fermented or cultured foods such as yogurt, kefir, sauerkraut, and miso encourages healthy gut microbiota which in turn helps gut function (as a barrier to pathogens and for improved digestion and absorption of nutrients) and regulation of the body's immune system. The bottom line from this study is that the use of probiotics has potential in the treatment of postmenopausal osteoporosis.

 Jau-Yi Li, et al. Sex steroid deficiency-associated bone loss is microbiota dependent and prevented by probiotics. The Journal of Clinical Investigations. 2016;10.1172/JCI86062.
 

Monday, April 25, 2016

Zolpidem (Ambien) Increases Fracture Risk In Men and Women with Osteoporosis

People break bones when they fall. In fact, falling is the number one cause of fractures especially in the elderly. It therefore makes sense that people with osteoporosis should avoid taking medications that increase their risk of falling. That is exactly what a recent study published in Osteoporosis International concluded. Park et al. conducted a large (1,092,925 participants) systematic review and meta-analysis and concluded that Zolpidem (Ambien), a medication often prescribed for insomnia, was associated with increased risk for fracture. The study noted that the increased fracture rate was especially pronounced for hip fractures.

This finding makes total sense when you realize that Ambien, a short-acting nonbenzodiazopine hypnotic, can cause ataxia, poor motor control, difficulty maintaining balance, dizziness, and sleepwalking. The last thing a person with fragile bones needs to be doing is dizzily walking around in their sleep . The kicker here is that a 2012 NIH study published in the British Medical Journal concluded that much of Zolpidem's effectiveness is psychological...in other words, a placebo effect. The study concluded that greater caution should be used when prescribing Ambien to individuals at risk for fracture and that "increased attention should be directed at psychological intervention of insomnia".

Park, S.M. et al.  2016. Zolpidem use and risk of fractures: a systematic review and meta-analysis. Osteoporosis International April 22.

Huedo-Medina, T.B. et al. 2012. Effectiveness of non-benzodiazopine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ (Clinical Research ed.) 345:e8343.

Thursday, April 21, 2016

Do Calcium Supplements Contribute to Clogged Arteries?


"Am I at risk for clogged arteries by taking calcium supplements?"
                   Woman age 65 living with osteoporosis

Excellent question.

The short answer:
Healthy bones DO need a sensible intake of supplemental calcium, along with adequate vitamin D and K, and magnesium for proper absorption. They also need ingredients that (1) promote balanced bone remodeling and (2) help prevent blood vessel calcification. OsteoNaturals products fit all these requirements.

The long answer:
In a recent study published in Climacteric, C.E. Lampropoulos, et al. assessed the correlation between osteoporosis and vascular calcification in postmenopausal women. The goal was to determine not only if there was a correlation (there have been numerous studies linking these as comorbidities) but also to determine if low dose calcium supplementation plus vitamin D contributed to calcification of arteries.

The study concluded that "Calcified plaques were significantly correlated with osteoporosis."  Osteoporotic women were "16 times more likely" to develop calcification of the abdominal aorta and "seven times more likely" to develop plaques and thickening of blood vessels compared to normal individuals. It also concluded that "low doses of supplements do not appear to cause any increase in vascular calcification in osteoporotic women." In other words, although bone loss and calcification of arteries go hand in hand their connection is NOT due to taking calcium supplements. And this is key! We need calcium for our bones to be healthy. Taking supplemental calcium is safe when used in moderation. Taking huge amounts of any supplement, including calcium, is never advisable. But a sensible intake of 600 to 1,000 mg/day of supplemental calcium (plus another 500 or so from the diet) is important for getting your 1,200 to 1,500 mg calcium/day as recommended by most bone-health experts. Making sure you get adequate vitamins D and K, and magnesium is also a vital part of the equation. You NEED these to ensure that the calcium you take in goes to the right places in your body: muscles, nerves and bone...and NOT settle into the blood vessels!

So what is it that makes women with bone loss be more susceptible to calcification and hardening of the arteries? The answer is INFLAMATION. We at OsteoNaturals know that simply taking in adequate calcium is NOT the total answer to improving bone health. The MOST important thing you can do for better bone health is to reduce inflammation-driven, excessive osteoclastic bone resorption. Inflammation, not a lack of calcium, is usually what fuels excessive bone loss. And that is where OsteoStim comes to the rescue. OsteoNaturals' OsteoStim has ingredients designed to do exactly that: modulate the activity between the osteoclasts and the osteoblasts so that the bone remodeling process comes more into balance. A balanced bone remodeling system is important for the skeleton to renew itself periodically...important for keeping it young, supple, and strong. AND, not only does OsteoStim have ingredients that promote balanced bone remodeling but it also has 300 mg of a very important antioxidant that, yes, you guessed it...helps prevent blood vessel calcification!

And as Lampropoulos, et al. showed in their research, since osteoporotic women are 16 times more likely to develop calcifications it is EXTREMELY important to address this head on! Alpha lipoic acid is THE perfect antioxidant that can help prevent this calcification. Studies such as the one by Ying, et al. demonstrate this beneficial effect. In this 2010  research, published in Life Sciences, Ying, et al. showed that lipoic acid "reduced atherosclerotic plaques in the abdominal aorta".

The combined effect of supplemental calcium, magnesium and other minerals from OsteoSustain and OsteoMineralBoost, plus improved bone remodeling and lowered atherosclerotic risk from our OsteoStim makes OsteoNaturals products your first choice for improved skeletal health.  

Lampropoulos, C.E., et al. 2016. Osteoporosis and vascular calcification in postmenopausal women: a cross-sectional study. Climacteric April 5:1-5.

Ying, Z., et al. 2010. Lipoic acid effects on established atherosclerosis. Life Sciences 86(3-4):95-102.   

Saturday, April 9, 2016

Climbing Mt. Kilimanjaro

Success/failure...?...well, the course of this adventure was certainly not the way I had planned it... but I'm going to put it in the category of success none the less. I guess that is the way I will interpret my ascent up Mt. Kilimanjaro (19,341 feet) two days ago. My plan had been to take the Umbwe route up to the top in three days, going slowly to get used to the altitude. Then on day four head back down the mountain to the starting point at Umbwe gate (about 5,000 feet above sea level) and then do a speed ascent/descent on the fifth day. That all changed on the third day when snow and freezing rain made the going extremely dangerous. After camping at 17,000 feet at the Lava Tower we (my guides Julius, Jonas and myself) started our ascent up the dangerous Western Breach. We only made it approximately 2 kilometers when we hit an impasse on a ridge with 30 foot drop-offs to each side. It was just too treacherous to continue up and trying to make steps with the ice axe was of no help due to the loose shale rock beneath the snow. We

had no choice but to head back down the mountain. I knew at this point that a speed attempt would not happen. With rain and snow for five days straight this, the beginning of the rainy season in Tanzania, was not the optimal time to try a speed ascent.

After descending to about 14,000 feet we spent the night at Barranco camp. On day four we headed back up to 17,000 feet to Barafu where we camped and from where we would try again to reach Uhuru peak, the top of Mt. Kilimanjaro, on the morning of day five.

Julius and I started our ascent at 1 a.m. It was cold and the trail was snow covered the whole way. Not too long into the ascent I became extremely ill with altitude sickness throwing up numerous times. The nausea never let up and it was tough going. We reached Uhuru peak just before sunrise. Freezing cold at 20 degrees and with extreme nausea I couldn't enjoy the view and headed back down off the mountain after only 5
View from the top of Africa
minutes at the top of Africa. I just had to get down to a lower altitude and breath some air again.

I will certainly never forget this adventure up Mount Kilimanjaro. I would love to try for a speed attempt again someday but I'm still nauseous two days later so it is hard for me to make that commitment right now. I'm just happy to have made it to the top. My advice for anyone wanting to tackle this amazing mountain is to NOT try in the rainy season. The altitude is a problem no matter what season but by not having to deal with snow and ice your odds of success will improve greatly. So, what ever your next dream...dream big, I always do. Don't be afraid to try...and don't be afraid to fail. The more failures you rack up in your life just means the more things you have tried...and that is awesome in and of itself. Most of all, enjoy what ever you do. Onward!

Friday, April 1, 2016

Follow Your Dreams

In a week from now I'll be heading up the slopes of Mt. Kilimanjaro for an attempt at a speed ascent. I arrived in Nairobi three days ago and after logging a few miles at a slight altitude (between 5 and 8,000 feet), seeing some cool animals, and very unsuccessfully trying to shake off jet lag, I take off for Arusha, Tanzania later today. With this challenge just around the corner, I find myself reflecting on just why I get so excited by adventures such as this. What is it that makes me so excited about something that will hurt so much?

In Run or Die, super endurance athlete (and former record holder for the Mt. Kilimanjaro speed ascent) Kilian Jornet writes, "Winning isn’t about finishing in first place. It isn’t about beating the others. It is about overcoming yourself. Overcoming your body, your limitations, and your fears. Winning means surpassing yourself and turning your dreams into reality."

Limitations...fears...dreams...yes, these are all certainly part of why I love to challenge myself. No
matter if I am competing in a race or simply challenging myself in some cooked-up crazy scheme  like tackling Mt. Kilimanjaro in one day. I absolutely love pushing my body to its limit. And, probably equal to challenging myself, I love the feelings that are born with the blending of my surroundings with my own body, with my own struggles. The visual beauty of trees and sky, the sounds of wind and birds, the scents of flowers and shrubbery (Wow, the wild basil when running through the Ngong hills here in Nairobi was awesome!), and the constant impact of my feet with the earth and my body funneling through the air...this blending of my surroundings with "me" is a feeling that has always drawn me to running. It was like that when I was 5 years old and it's still like that today. I guess it's something like when multiple forces collide...new and refreshed energy emerges. It is this energy that fuels me, keeps me going forward. Not just physically but propelling me forward in life itself with all of its continual challenges.

As someone who has gone through the challenges of osteoporosis, I am constantly thankful that I can do crazy things like this attempt to run up (and down) Mt Kilimanjaro in a day. As people age, activities of daily living (ADLs) can become challenging especially for those who suffer from musculoskeletal disease (such as osteoarthritis and osteoporosis). Increased rates of depression are also part of what can be a spiraling downward cascade of ill-health in the elderly. Now I'm not saying I'm elderly at 61 and I'm not saying that running up Mt. Kilimanjaro is an ADL, but I'm just saying that I'm totally excited that I can still do things like Ironman triathlons and endurance runs and that I continue to follow my dreams. Continuing to engage in physical activity as we age has been shown to not only improve skeletal health but also improve brain function and dramatically reduce depression. So whether you love to exercise or don't even list it as a top 100 things you like to do, I hope that these benefits are enough to get you out there walking, running, lifting weights, or just moving and playing in the mountains.

Everyone has their struggles in life, both physical and emotional, and they will meet those challenges in different ways. But I hope that what ever your dreams are, and no matter how difficult things might seem at times, that you will always live each day and follow all your dreams. Having osteoporosis can certainly impose its own set of unique challenges the likes of which I happen to know a lot about. But whatever your challenge, what ever mountain it is you are trying to climb, don't just dream it...get out there and do it...today. Sometimes all it takes is just one step at a time...and don't give up on your dreams.

Friday, March 18, 2016

Magnesium is Important for Healthy Bones and RBCs Even if You Are NOT Tackling Mount Kilimanjaro on the Run



I've been a runner since I was about 6 years old. It was just something I did, naturally. I would look at hills or mountains off in the distance and run to them. Half the time my mother never knew where I was. Usually I didn't follow roads...I would just cut though fields and woods while keeping the hill in site the best I could. It might take an hour, or half a day, if it was far away. The distance really didn't mater to me...I just wanted to get to the top. They were magical and drew me to them like a magnet. 

Mount Kilimanjaro is the highest free-standing mountain in the world, looming 19,341 feet high  
over the surrounding Tanzania plains, and its magic is drawing me. This majestic mountain is Africa's most-visited trekking destination, attracting tens of thousands of tourists and adventurers every year. While you don't have to be a technical climber, you need to be pretty physically fit to attempt the 5 to 6 day hike to the summit. Typical issues include fatigue, dehydration, muscle strains, knee pain, bonking (lack of sufficient energy stores) and, of course, the potential for sprained ankles and falls. But the biggest challenge is the altitude. Approximately 75% of the 25,000 people who make the attempt each year develop some form of altitude sickness (1), and only 60% succeed in summiting.

If you prefer running to hiking, the challenge is even greater. Yes, in April, I will attempt a speed ascent and decent of Mt. Kilimanjaro in one day (under 14 hours of daylight).  I love physical tests and running (instead of hiking) Mt. K sounds like a cool one to tackle. Cool yes, but also one fraught with some extreme physiological challenges that I have never dealt with before - ultramarathoning at high altitudes. (2)

Those of you who know me are aware that I can be fairly tenacious.  When I was first diagnosed with severe osteoporosis in my 40’s and sustained 12 fragility fractures over a 5-year period, I did not take it well. I did the research to learn about everything that impacts bone health. I experimented with a myriad of minerals, vitamins, and herbs sifting through all the hype and finding out what really would make a difference to bone health. I became an expert on the subject and developed my own nutritional supplements using natural ingredients chosen for their safety and efficacy. Today, my bone health has improved and I’m back to competing in triathlons and not breaking bones. That said, I have given this Mt. K decision a great deal of thought and deliberation – most specifically the altitude issue, and the endurance consideration. 

Altitude and Oxygen Circulation:
Red blood cells (RBCs) carry and distribute oxygen to your body. People with osteoporosis often have a lower RBC count and therefore a slightly reduced capacity to carry oxygen to their tissues (3). When expending a lot of energy, such a person might feel weak and tired and experience shortness of breath. At the altitude of 19,341 feet there is 49% less oxygen than at sea level, so the potential danger is obvious. To compensate for this paucity of oxygen carrying red blood cells, the heart has to work harder. It beats more rapidly. Up to 20 beats per minute faster than normal. Not only does this take a considerable amount of additional energy but it also places a huge mechanical strain on the heart when calculated over time. The good news is that I have been able to increase my RBC count slightly as I have improved my health AND I have optimized the function of the RBCs that I have. (4)

Most people know that iron is important for blood's oxygen carrying ability. What they don't know is that magnesium also plays a huge role in this capacity. Magnesium is one of the most important nutrients in your body and is a major component of bone. Magnesium is vital for cell energy metabolism, blood glucose control, nerve conduction, cell membrane integrity, electrolyte balance, and the proper functioning of over 300 enzymes. Specific to bones, magnesium helps osteoblast cells make new bone. And, it is extremely important to have adequate amounts of magnesium for the production and release of calcitonin (from the thyroid gland) and parathormone (from the parathyroid glands), for maintaining a balanced bone remodeling system.

Magnesium is also a vital component of RBCs ability to hold on to oxygen molecules. Optimal levels of magnesium in the body are necessary for blood to be able to transport oxygen. Magnesium helps transport nutrients into RBCs so that they can do their job. If a person is deficient in magnesium his or her heart will either have to beat faster and/or they need to take in more oxygen (breath more times per minute) to get the same job done as someone with good magnesium stores. This is why magnesium supplementation often helps lower a person's blood pressure.

Strong Bones and Endurance:
I have to admit that my muscle mass is declining (as is the case with everyone as they get older). I can see muscles starting to sag here and there and just don't feel as strong as I used to. Less muscle leads to less power and with the increased body fat that goes along with aging it will be more dead weight for me to drag up the mountain. The good news is that I have done 3 important things to help keep my "fitness age" substantially lower than my real age.

First, I have been able to maintain a fairly steady training regimen over the years. I am always training for something; whether it is a triathlon or running race; I never let my fitness level drop too much. I’m also pretty consistent about getting to the gym for strength training with weights. The feeling I get from this and the benefit to my bones are what motivate me to keep it up. I feel more "put together" when I lift regularly. Even if it is only 20 minutes a day 3 times a week (although I usually get in 45 minutes, 5 days a week) I feel I get great benefits from strength training.

Second, I train for a multi-sport event...triathlon...which also puts me ahead of the game. Research shows that people who vary their training have more muscular power and higher endurance capacity than athletes who constantly do the same workouts day in and day out.

Third, I often "put the pedal to the metal" during my various training sessions. This habit of "red-lining" with multiple high-intensity workouts each week helps me maintain a good lactate threshold. By doing so, my body's chemistry is able to neutralize and eliminate lactate levels fairly rapidly because I've trained my enzyme systems to do this. 

Physical and Mental Well-being:
I did not accomplish what I set out to do in my last challenge (the Ironman World Championships in Hawaii) - mainly due to a bout of flu.  The good news is that my positive attitude is still intact.  I also eat fairly well and take nutritional supplements. Eating lots of fruits and vegetables (and taking OsteoMineralWhey for its powerful alkalinizing effect) each day helps me stay alkaline and gives me the trace minerals I need to process fats and sugars for energy. One of the most important nutrients I take in everyday is magnesium (available in our OsteoSustain and OsteoMineralBoost). Magnesium, it's not just for skeletal health...your red blood cells need it too. I will certainly be putting both to the test in a few weeks.

Having weighed the pros and cons of this one-day speed ascent/descent attempt, I am relying on my positive attitude, my improved skeletal and over-all health, and my diet and nutritional supplementation to get me through this. I think that I’ve been able to limit some of the normal decline seen with aging and that this will translate into more power and speed up the mountain. I am holding on to the confidence that I’ve been able to keep my body more on the anabolic side of the aging curve and less on the catabolic side. I’m also holding on to a quote from Barry Finlay in his book Kilimanjaro and Beyond:  “Every mountain top is within reach if you just keep climbing.”  I'm hoping that together these will give me the edge I need to succeed in this venture. 

I hope that when you read my next blog that it will tell of my success in finding this next mountain top. But most of all, I hope I have you all thinking about your own next goals: places you would like to see, activities you would like to do, things you would like to accomplish, adventures you would like to tackle. It is an amazing world out there. Go have fun. And don't forget…while you are doing all this, make sure you get your daily quota of magnesium, it will help you reach your own mountain top.


(1) Altitude sickness comes in 3 forms:  Acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACA).  AMS is the mildest form of altitude sickness, causing headaches, nausea, diarrhea, vomiting, and loss of appetite. Not pleasant but bearable. HAPE and HACA (fluid on the lungs/brain) are not just unpleasant, they are life threatening.



(2) When I race in Ironman competitions I often get nauseous to the point of throwing up. The reason for this is that the stomach is constantly being jostled and there is a shunting of blood away from the stomach and toward the muscles in your legs where it is really needed. When there is no blood going to the stomach, any food or liquid you take in just sits there. If it just sits there and you keep cramming it in sooner or later it’s going to come back up the other way. This often leads to extreme gastric distress causing both vomiting and diarrhea. Add into the mix extreme altitude (which in and of itself causes nausea) and I have quite a few nutritional challenges in store for me.



When a trained athlete runs at or just below his or her anaerobic threshold, they have only 3 hours of glycogen stores in their legs. Since I am expecting this run to take a good portion of 14 hours, I will need to consume a lot of calories throughout the day to prevent bonking. My goal is to take in 200 to 250 calories plus 18 to 25 ounces of fluid each hour… and try hard to not throw it all up. I've never run above 14,000 feet before and all I have to train on here in Massachusetts is 1,200 foot Mt. Tom, so this will be all new territory.



(3) Next time you get your Complete Blood Count (CBC) taken by your doctor, check out your RBCs. If you have osteoporosis, your RBC count will more than likely be on the low side. When I was diagnosed with severe osteoporosis 16 years ago, one of the procedures I had performed was a bone biopsy. The severity of my bone loss, my relatively young age at the time of diagnosis, the fact that I am a male, and, that I've been an athlete all my life all made the endocrinologist extremely concerned that I may have a rare form of bone cancer that was the cause of my osteoporosis. To rule this out, he took a core sample of bone from my pelvis and analyzed it under a microscope. What he found was not cancer (thank goodness) but extremely poor bone quality (thus the 12 fractures over a 5 year period) and LOTS of FAT in my bone marrow. All this fat makes for less room for hematopoietic stem cells; the cells that make RBCs.  



Typically, having a somewhat reduced amount of RBCs isn't a huge problem in people with osteoporosis. It is just one of those "interesting" medical facts when looking at someone's lab results. But when the person relies on getting the most out of his or her body as an athlete, then it does present somewhat of an obstacle....especially when planning a run up into the clouds of Mt. Kilimanjaro.



(4) In my 20s, I was a professional athlete competing for the United States in World Championships and the Olympic Games. I had my VO2 max (maximum oxygen consumption) assessed 5 times during those years. A person's VO2 max is a measure of how well he or she utilizes oxygen and for the most part it is genetic. A person can improve it slightly with hard work but in general "you got what you got"...and there is very little you can do to substantially change it. VO2 max is a huge determinate of how well you will do as an endurance athlete. And genetics, when it comes to VO2 max, is really important. At 56 mL, my VO2 max was never that great. Most of my athlete buddies who I competed with had VO2 max's in the 70s and one guy was in the low 80s (thus my excuse for never being a real hot shot). I mention VO2 max for obvious reasons in that if I am attempting a run up Mt. K with its rareified air, having a low VO2 max puts me at somewhat of a disadvantage. The fact that VO2 max begins to tumble at age 40....and I'm 61, presents an even bigger problem. The reason why VO2 max declines is because our heart isn't able to beat as fast as it used to as we get older. If we take me as an example, when I was in my 20s I could regularly get my heart rate up to just over 200 beats per minute during hard workouts. Now, I have trouble getting it to 175.
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