No matter who you are, if you walk deeply into the forest enough times, you’re going to get lost. I certainly have—several times. Dark, twisting ravines, steeply sloped hillsides, and impenetrable tangles can be disorienting. That’s the bad news. The good news is that if you persist, if you meet each obstacle as only an exaggerated distortion in the context of the whole forest, then your thoughts will remain centered and you’ll successfully find your way.
To reduce my fracture risk I had to do more than just make my bones heavier with calcium. I had to reduce the chronic systemic inflammation in my body that was putting me at risk for other chronic degenerative disease; I had to make my body more alkaline, less wasteful, and more receptive to the resources provided by food and supplements; and I had to keep my tissues supple and muscles strong so that as I age, I will have less risk of falling. I needed to first uncover and then rectify the causes of the catabolic process that permeated my entire unhealthy body. I found no magic bullets to fix my osteoporosis. Magic bullets in this arena are rare.
Although I advocate the use of lifestyle and dietary changes along with nutritional supplementation as the first choice for improving your skeletal and overall health, medications can help to reduce your fracture risk. But please use them wisely. In the long run they won’t fix your body’s intricately troubled, catabolic web, which took years of physiological imbalance to weave. The only magic I’ve ever discovered came with persistence and openness to all forms of healing. But that’s not magic, is it? Isn’t that just being pragmatic?
IT ’S ALL ABOUT BECOMING ANABOLIC
By now you realize that calcium and vitamin D, although integral to your skeletal health, may do you little good if your body is catabolic and in a constant state of destruction. Eliminating chronic, low-level metabolic acidosis, excess oxidative stress, systemic inflammation, and gastrointestinal dysfunction are far more useful for healing purposes than overloading your body with calcium. Your major objective, instead of simply swallowing a few key nutrients, should now be to build up your whole body—to become anabolic.
FIND A HEALTH CARE PROVIDER WHO WILL WORK WITH YOU
Finding a compatible health care provider may take some effort, but it’s crucial. The health care provider you choose to help you with your skeletal health should be knowledgeable about nutrition and laboratory
testing and should be willing to take the time necessary to manage your case. Remember that osteoporosis is a chronic condition and requires a long-term, thorough, and vigilant approach.
EAT HEALTHY FOOD AND MAINTAIN A POSITIVE, CONSTRUCTIVE ATTITUDE
Your goal is to improve the health of your entire body. If you succeed with your soft tissues, your bones will follow suit. It doesn’t matter if you’re fifty or eighty years old, if you want your body to respond, you need to care for it 24/7. Always remember that you want to make yourself stronger, more coordinated, and more capable. To do that, you must avoid harmful lifestyle activities and concentrate on foods that are healthy for you.
The foods you eat are your foundation for recovery. Consume predominately fruits and vegetables with lots of fiber. Be diligent about limiting your intake of refined sugars and other bone-robbing foods.
Cook with healthy oils like olive and organic virgin coconut oil. Make sure you eat good-quality protein and that you include some protein
with every meal. Eggs, poultry, fish, nuts, legumes, and whey or hemp powder are your best sources.
Go easy on red meat. If your body is catabolic, a daily consumption of 1.2 to 1.5 grams of quality lean protein per kilogram of your body weight will help you to become anabolic. Since a kilogram is equal to 2.2 pounds, if you weigh 125 pounds, that’s between 70 and 85 grams of protein a day. If you are like me and weigh in at about 150 pounds, your protein requirement would be between 80 and 100 grams a day. Protein will increase the level of IGF-1 hormone in your blood, help you gain muscle tissue and strength, and provide you with the amino acids necessary for bone collagen formation. Caution: If you suffer from kidney disease, consult your doctor before increasing your protein intake.
Goals are great motivators. Set a mental or physical challenge for yourself—something to stretch your abilities, something to reach for. Train for a walkathon, road race, or triathlon; write a story or a journal article; or take up a new activity.
USE NUTRITIONAL SUPPLEMENTS TO BOOST SKELETAL HEALTH
Refer frequently to the list of key bone nutrients in the appendix. Doing that will help you stay aware of deficiency signs and symptoms, pertinent laboratory biomarkers, and dietary sources of nutrients and their recommended daily intakes. Even if your diet is impeccable, the fact that you have bone loss puts you into the special needs category. Now your body requires more than what you can get from diet alone. You should take the following as minimal supplementation:
START YOUR THERAPEUTIC TARGETS CHART
If you haven’t already started your therapeutic targets chart (described in exercises 2.1 and 4.1), do it now. This will help you understand where you are and where you’re going in the management of your bone loss. Chart your signs and symptoms and correlate them to nutritional deficiencies or physiological dysfunction. Ask your doctor to help you. When your doctor orders laboratory tests, he or she will probably use one of the larger companies such as LabCorp or Quest for the basic core biomarkers.
For some of the specialty tests, such as stool analysis, IgG allergy testing, and 8OH2dG, your doctor will need to seek the services of a laboratory that performs functional testing. In the Resources section,
I’ve listed several reputable companies that I use for these purposes.
HAS YOUR DOCTOR ORDERED THE BASIC CORE OF LABORATORY TESTS?
Talk with your doctor about obtaining the basic core of laboratory tests for evaluating low bone density. Of course, he or she may want to do more extensive testing if it is needed.
DO A MONTHLY CHECK OF YOUR ACID-ALKALINE BALANCE
A diet too high in protein from cheese, meat, and grain products will lead to chronic low-level metabolic acidosis and ensuing bone loss. Study your food intake over a four-day period. Write down everything you eat. If your diet is too high in protein or especially heavy in grains and lacking in fruits and vegetables, make some changes. Increase your intake of high-potassium alkaline foods like broccoli, prunes, bok choy, kale, and squash.
Get into the habit of checking your first morning urine. This should be done every month for three to four days in a row. You’re aiming for an average pH of 6.6 to 7.5. If your pH is consistently below 6.0 even with an improved diet, try supplementing for a month or two with potassium citrate or potassium bicarbonate. When your urine pH stabilizes above 6.6, discontinue the potassium supplements but continue eating lots of fruits and vegetables.
ENSURE YOUR GASTROINTESTINAL HEALTH
Listen to your body. Are there signs and symptoms of poor gut health? Check with your doctor if you have any concerns. He or she will be able to order tests such as a stool analysis or a screening for food allergies. If you have osteoporosis, you should be tested for gluten sensitivity even if you have no gastrointestinal signs or symptoms.
ASSESS YOUR LEVEL OF INFLAMMATION
If your signs and symptoms indicate inflammation, you should try to obtain laboratory testing to assess your level of oxidative stress and systemic inflammation (see chapter 4). The more objective information you have as therapeutic targets, the better your treatment management will be. Don’t just guess when determining your treatment regime. Be as scientific about your therapy as possible. My favorite supplements for reducing oxidative stress and inflammation are alpha-lipoic acid, curcumin, fish oil, N-acetyl cysteine, taurine, and milk thistle.
CHECK FOR GOOD HORMONAL REGULATION
Sometimes, no matter how sound your nutritional program is, achieving good skeletal health may require hormone replacement therapy. Ask your doctor if hormonal therapy, preferably in the form of bioidentical hormones, would be useful to reduce your fracture risk.
RULE OUT TOXINS
If you have any concerns about heavy metal toxicity, check with your doctor about getting some laboratory testing.
SUPPLEMENT WITH BODY- AND BONE-BUILDING NUTRIENTS
Whey protein (20 grams/day) will help you increase your IGF-1 level and build both muscle and bone mass. (If your stomach doesn’t like all that protein at once, you can split up 20 grams into two shakes with 10 grams of whey protein in each shake.) Not only will this help to raise your body’s antioxidant levels of glutathione, the lactoferrin and lactoferricin in whey also will help to limit the growth of bad bacteria, such as H. pylori, in your GI tract.
In animal and cell culture studies, whey and its milk basic protein component have been shown to stimulate osteoblasts (Takada, Aoe, and Kumegawa 1996), suppress osteoclast-mediated bone resorption, and enhance bone strength (Takada et al. 1997). Moreover, a study of healthy adult women showed that supplementing with whey’s basic protein fraction significantly increased their BMD (Yamamura et al 2002). A shake made with whey, fruit, and your choice of other supplements is a refreshing, nutritious midafternoon snack. Also, nutrition companies are selling high-quality powdered supplement mixes and meal replacement mixes that can make your life easier and your afternoon snacking healthier.
If you are low on energy, acetyl-L-carnitine (2g/day), biotin, alphalipoic acid, and coenzyme Q10 will help to supply your cells with energy. These supplements will reduce fatigue and help you build muscle.
If you have osteoporosis but your bone resorption marker (NTX, CTX, or DPD) is normal, make sure your doctor orders a test for the bone formation marker osteocalcin. This will indicate if you need to work hard on stimulating your osteoblasts to form new bone. Nutrients such as vitamin K, milk basic protein, and whey protein, in addition to ensuring that your body is not acidic (check your urine pH), are most important for bone formation. When you succeed in stimulating osteoblastic activity, it will be reflected by the normalization of your blood osteocalcin levels. You might also want to try using the selective
kinase response modulators (SKRMs), berberine and/or rho-iso-alpha acids (RIAA), the latter from hops.
EXERCISE!
Exercise regularly to your own capacity, and it will help you maintain a healthy body and strong bones. For safety, check with your doctor and make sure he or she clears you for starting an exercise program.
If you are having musculoskeletal pain or have physical restrictions, a physical therapist can help you get started. Once you’re capable, a certified personal trainer can help you achieve the next level of fitness.
Once you feel comfortable on your own, exercise at least three to four times a week either at a gym or at home. If you get bored with your program, get excited about some new exercises. This is the fun part.
Enjoy it. Meet some new people. Experience how good it feels to take in deep breaths and move your body.
CONSIDER MEDICATIONS CAREFULLY
If your BMD is below -2.5, and especially if you have fractured, you should talk with your doctor about using a medication. Weigh all considerations; your decision should be made strictly from the information that pertains to you, and not from the dogma of any one therapeutic specialty. New drugs are constantly being designed, so if your doctor is considering an osteoporosis medication for you, make sure to ask about any new ones that may be available. For example, the drug odanacatib is currently in clinical trials. Odanacatib differs from bisphosphonates in that it can increase BMD not by killing the osteoclasts, but by inhibiting their release of a bone-degrading enzyme.
If you’re a small-boned individual and your BMD is low, your T-score may just be normal for you. Check out some biomarkers first before consenting too quickly to a prescription. If your bone resorption marker is normal, your vitamin D is normal, you don’t have gastrointestinal problems or gluten sensitivity, and you’re not on any bone-draining medications and don’t have any other risk factors, then your low BMD may just be normal for you.
MONITOR AND CONSTANTLY TWEAK
That is all there is to it. You’re on your own (with the help of your doctor, of course). For the first year or two, you and your doctor will need to use regular laboratory testing to monitor your progress. During this time you’ll be using various test results to tweak your nutritional supplementation program or, possibly, begin or alter your use of a medication. Eventually, however, you’ll settle into a program that suits your needs. You have the tools you need. Go for it!
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Excerpt from THE WHOLE-BODY APPROACH TO OSTEOPOROSIS: How to Improve Bone Strength and Reduce Your Fracture Risk (New Harbinger Publications)
R. Keith McCormick, DC, is a chiropractor in private practice in western Massachusetts. He specializes in the nutritional management of patients with bone fragility. McCormick is a former U.S. Olympian (1976) and a current Ironman Triathlon competitor.