TRANSCRIPTS PART I / page 1

Transcription

1 Module I

2 MEDICAL DISCLAIMER The information in this program is for educational purposes only. It is meant to as a guide towards health and does not replace the evaluation by and advice of a qualified licensed health care professional. For detailed interpretation of your health and specific conditions, consult with your physician.

3 TRANSCRIPTS PART I / page 1 Dr. Williams: In this program I d like to talk about one of the most amazing works of nature in your body, truly a masterpiece of nature. That s your skeleton, your bones. We normally see bones when they are removed from the body, or think of them as a skeleton in the anatomy lab or a piece of bone that you find from a bird who has died in your yard, which are very static pieces of calcium and phosphorous. But in reality they are extraordinarily dynamic tissue, largely composed proteins and types of collagen. The structural part that we know as bone is calcium and phosphate. When bones are healthy they last a lifetime. In fact, your bones continuously remodel and rebuild themselves every ten years. So there should be no reason why you have osteoporosis or any other bone disease. They provide the structure for your body. They determine your height. They build your blood cells. Inside the bone is bone marrow and from that comes our stem cells, our pluripotent cells that differentiate into other tissue in the body, both white and red blood cells. Extraordinary amazing structures. They contain lots of minerals, nutrients, proteins as I mentioned, particularly the collagen-type one. They are embedded in soft tissues, wrapped around them, including the cartilage, ligaments, tendons and on top of that is muscle. The bones have their own blood supply and nerve supply. They re highly-dynamic, living tissues. It s very important when we start to talk about bones because we tend to imagine bones or think of bones as static, as something that can be remodeled or chiseled into or added to or things taken away from. They re not. They are in one level, and they re not in another level. So during our lifetime we have lots of different stressors on our bones. They re subject to breaks and bruises and bumps as well as possible infections and other stressors. Nutrition plays a critical role in bone development and managing bones through a lifetime. During the normal every day wear and tear during your lifetime you have continued micro-damage. It takes place in the bones and they need sufficient nutrients to repair. They repair themselves. They don t need to be told what to do. They handle it quite fine. We re going to mainly look at bone health in general, but also osteoporosis in specific. Let s define osteoporosis as a progressive deterioration. Without corrective repair it results in diminished bone density. This leads to inadequate bone strength to perform your normal daily activities, therefore you easily break bones. The bones that are most broken, typically from falls, are hips. They become the least dense. Also, the spine. Those are usually compression fractures that happen without any fall related to them. It s a silent disease. It occurs gradually over a long period of time. There s an imbalance that goes on. I think we can look at two things right now. The diminished bone density, just keep that word in mind, bone density, because that s how we re going to be looking at bone particularly in osteoporosis. And then balance and imbalance in the remodeling cycles. That s going to largely have to do with proteins, but it s also going to be very important to think about minerals, particularly calcium and phosphorus but also magnesium and other trace minerals, other nutrients like vitamin D, vitamin K, trace minerals like boron. We re going to talk about those in the second part. All of those have to be compensated for during normal wear and tear. So they have to be provided in the diet or supplemented.

4 page 2 / THE COMPLETE BONE HEALTH SOLUTION From the clinical point of view, the way I consider osteoporosis is a very vicious, silent, slowly progressive, degenerative disease. Once you know you have it it s been going on for 10 years, 20 years, 30 years or sometimes longer. It s related to the bone but it s also related to the bone-forming mechanisms. Those are influenced by modern lifestyle, sedentary behavior, nutritional deficiencies or nutritional imbalances. A large part of correcting or improving bone density and overall bone health is through lifestyle, diet and nutrition. It s also important to keep in mind as we get into this part of the program is that this activity, this balance and imbalance in the bone, the whole process is bone homeostasis. It s dynamic, biochemical and structural characteristics maintain normalcy. How can you lay down and sleep? How can you jump up and run? How can you climb a tree and fall out and bounce up or break a bone and then put it back into, more or less, as close as possible and it can form a callus around that and shifting itself and realign itself and heal? In China I had the great opportunity to do some of my hospital rotations over a period of several months in a department for bone. We used Chinese herbs primarily to heal, and very fast, too, three times the speed that would happen in the United States with just casting a bone. In the early days they always were hard casts. Now they use more soft casting. What the Chinese were doing was using herbs that were ground and powdered and then mixed with other substances to make them into a paste. They use hard rice paper, but it s still quite flexible. They make a soft cast with this paste and then mold that to your bone and wrap that around. They change it every day or every few days. You come into the clinic once a week and they check everything. It s quite amazing to see the speed of the recovery. Of course, they were given special diets. We know there has to be a balance between all these different factors. You can t just do one thing and expect to get it right. That s the main thing. The other aspect is we re learning more now, and the way I apply it clinically, is that the bone, sometimes called the Latin word, the osteo-environment or the environment of the bone, is also an immunological environment. So there s an osteo-immunological endocrine hormone homeostasis. The old way of thinking about it is it s minerals and you supply calcium. One of the myths of osteoporosis is that if you supply enough calcium it will fix bone. It doesn t work that way whatsoever. The reason is because of this continuum, this interplay between the immune system, the endocrine system and between the osteo homeostasis itself. Osteoporosis is really an epidemic health problem. It s also associated with low bone mass or osteopenia, which is full-blown bone density loss. Approximately 44 million adults, both men and women, in the United States, have osteoporosis over the age of 50. That constitutes about 55 percent. A majority of middle-age, older adults have some form of bone disease. That s unacceptable statistics. Healthy bones are resilient. They re hard to break. They last a lifetime, like I said. However, many things can go wrong and it can result in a vast array of other diseases besides osteoporosis, including osteoarthritis, the most common bone disease, and osteomalacia, softening of bones, osteomyelitis, infection of bones, osteonecrosis, where bones actually are dying due to lack of blood supply, Paget s disease, rickets, a nutritional disorder, rheumatoid arthritis and there s many others. When we look at many of these bone diseases we find that the primary cause, other than infectious

5 TRANSCRIPTS PART I / page 3 causes, is really nutritional deficiencies or a combination of the modern Western diet, and sedentary lifestyle plays a major role. Now we re going to go into these factors and understanding bones in some detail. Kevin: Dr. Williams: So what are some of the myths that people have around osteoporosis and bone health? For me, in general, in my clinical practice there s five that I see most commonly. There s no specific order to these. Myth number one would be that an alkaline diet will prevent and cure osteoporosis. There s a lot of truth, we re going to talk about this in a moment, about acid and acid buildup in the diet. Becoming more and more alkaline doesn t reverse bone loss but too much acid participates in bone loss. So you do need more vegetables. You do need more healthy food. You need to move away from those foods that participate in unhealthy bone homeostasis. However, just alkalizing your diet will not turn osteoporosis back towards normal bone. In fact, I ve seen many patients, some of them have gone into severe osteoporosis believing this myth and going for years without being tested and in their own mind thinking that their bones must be better. Then they have a break and come to see me and we find out that their original bone density five years ago was at one level and then when I checked it again they re severely advanced. So that s one myth we want to dispel. The second one is that calcium supplementation alone restores bone growth. Absolutely does absolutely nothing for osteoporosis. You can take all the calcium you want. You ll cause yourself more harm than good. It will do nothing to repair bone. It s important in the program to have enough calcium, but we re going to find out that there s many factors in calcium metabolism and there s many reasons why the body prevents calcium absorption. There s many reasons why in nature calcium, though relatively abundant, like in seashells which are almost pure calcium, it s very difficult to chew. It s very hard to get into the body. So we ll talk about that too. So calcium alone is not enough. It s not dose-dependent. The higher the level of calcium the better your bones are is part of that myth. You need a moderate amount of calcium and you need many other factors along with it to work. Myth number three is osteoporosis is a common disease of aging and that it s just bone loss, it happens to everybody and there s nothing you can do about it. That s completely not true. Bones should last you a lifetime. If you re to have osteoporosis it would be at very advanced age and it would be slow going and not result in fractures. Native American populations who I work with in the field, you see almost no osteoporosis or related bone disorders well into middle age and very few in older age. You do seem some. Some of the women will get shorter and have a more rounded spine and shrinking in stature. However, those people are in their 90s and 100s. I think that s acceptable statistics. It s really a disease of modern living and specifically Western sedentary lifestyle and Western diet. Myth number four is it only happens with women. Not true. Men also have osteoporosis. They can have it just as advanced. But it s more common in women. It s not only in elderly people. It can happen at any age, including quite young. Women with anorexia can also have severe osteoporosis at a very young age. The reason for that is because estrogen, the main female hormone, is the key sex hormone related to bone homeostasis. Women have more estrogen. As estrogen goes down bone density tends to go down as well. Myth number five is that it s an incurable disease and that the only way to treat it is with drugs. That s completely untrue. It s not incurable. But it s extraordinarily difficult to reverse. Once you find it you usually have progressed too far into the disease to completely reverse it. I ve helped reverse it in a statistically significant way almost every case that I ve had. Some more than others.

6 page 4 / THE COMPLETE BONE HEALTH SOLUTION The best approach is prevention, diagnostics that catch the problem early and then appropriate and comprehensive treatment and then good follow-up. At the end of the this program I ll talk about a plan that puts together all of these elements. Kevin: Dr. Williams: Dr. Williams, what are some of the foods that are negative influences for bone health? There s many of those. I m going to go through those one by one. Let me remind our listeners that there are multiple factors, food being one of them, that influence bone health and are associated with bone loss. The negative dietary influences are acidic diet. If your body is too acidic, your urine is too acidic, you will have more bone loss. It may not push all the way to osteoporosis but if you have the genetics and if you have the lifestyle that you re already moving towards osteoporosis, it will accelerate it. So an acidic diet, a lot of meat-eating, sugar, colas and not enough vegetables and alkaline food. High salt. Too much salt and sodium in the diet, from other sources besides table salt, contributes to calcium loss through urinary output. Calcium is lost in the stool and in the urine. So it s metabolized in multiple ways and excreted in two ways. You lose a lot of calcium through urinary excretion. Salt changes the fluid dynamics in the body and over time is associated with one of the main influences on our bone health, particularly bone loss. Excessive caffeine. That s usually considered to be more than three cups of coffee. My patients, if they re going to drink a standard American filtered coffee, one cup is more than enough. Caffeine has a tendency to also cause calcium excretion. Cola, drinks, it doesn t seem to be associated with carbonated water like you get from Italy or Northern California. But it seems to be associated with cola-type drinks which are high in caffeine, high in sugar and high in phosphorous. Excessive alcohol consumption. Interestingly, the newer studies show that men and women have a strong difference there, that osteoporosis in men seems to be associated with excessive alcohol consumption and in women moderate amounts of alcohol seem to help bone. There s many of these things we talk about, some of them are well-defined and some of them are amorphorous and we re figuring it out as we go. In indigenous cultures in America that drink fermented substances that have alcoholic content, two or three or four percent, including in Mexico, Amazonia and the Andes, like the Peruvian Chicha, they seem to have no problem with osteoporosis. It seems to be associated with excessive alcohol use that may also be related to them not eating properly. We don t know exactly. Dietary deficiencies that the Western diet induces, such as key trace elements like boron, is another role. So it s not necessarily bad food but it s that we re not getting enough of the right foods. Also, we tend to have too much calcium, too much phosphorous. Meat has a lot of phosphorous. Colas have a lot of phosphorous. Milk has a lot of calcium. That disrupts the body s ability to metabolize bone properly. You might build bigger bone but in the long run they end up to be weaker bone. Low calcium itself in the diet is a key factor in bone health and osteoporosis development. Calcium absorption from the gastrointestinal tract is a key factor. So you may be getting enough calcium in your diet but you may not be absorbing it well enough. Low magnesium, found in seeds, nuts and vegetables. It s very low in the American diet.

7 TRANSCRIPTS PART I / page 5 The other groups of foods that tend to influence bones in a negative manner are high oxalates that contain oxalic acid. Those are spinach, beet greens, chard, tea and coffee. When I see my vegan friends and patients putting down the kale and collards every day, two or three times a day and using them as wraps and everything, oh my goodness. In small to moderate amounts they re excellent foods but when overdone they tend to cause problems. Oxalic acid is poisonous. These plants have lower amount when they re cooked but when they re raw they re very high. They inhibit calcium absorption and interfere with calcium metabolism. High phydates, phytic acid. Those include Brazil nuts, wheat bran, soy and other dried legumes. If I m working with a young female yoga teacher who is vegan, raw foods, eating lots of sprouted legumes and kale and spinach, that worries me. Those are the main negative dietary influences in food. Kevin: Dr. Williams: Besides diet, what are some of the other factors that can interfere or affect bone health? There s two main areas. One is lack of exercise. The human body was made to move and the skeleton was made to lift. You should be able to lift your own body weight comfortably and normally, whether that s through yoga exercises doing headstands, handstands, things like that, and body lifts, or if you re, like the Native people carry heavy loads on their back or shared slung things between them. They carry extremely heavy loads. To us it s really heavy but to them it s nothing. It s more or less body weight and they know how to adjust that so they never carry too much. But they do carry a lot. Bones are made to withstand that type of pressure. If you re sitting all the time, then you have no load on the bone and the bone is not going to respond. Just like muscle is going to respond to exercise, become more toned, more active and larger, bone also responds to the right type of exercise, which is weight-bearing. That means lifting heavy things, pushing against things. So that s one of the main lifestyle contributing factors. Part of the treatment for osteoporosis, to repair bone and promote density, is through exercise. I also know that in Chinese martial arts, and we ve x-rayed martial artists in China as well as they ve excavated the graves of martial artists that were buried, they find two things. Their lower arms, their skull and their lower legs have extremely dense bones. They may see old breaks in there but they are well-healed and well-recovered. So we know when they do the practice they re hitting against their arms, against wooden dummies or their partners. That stimulates bone strength. We have other scientific data on that. Stress does not play an active or primary role in bone density loss. However, because it s so ubiquitous and so pervasive in society, the result of stress is disruption of the hormonal cycles, inflammation and influences bone homeostasis. So the outcomes of stress, not the stress itself, but the outcomes of long-term, chronic, insidious, psychological, emotional stress, can cause other physiological imbalances that participate in bone changes. We know that stress influences and causes changes in the higher centers, like the hypothalamus in the brain and that influences the adrenal health and influences kidney function and many other aspects of the body and finally influences bone. Kevin: Dr. Williams: What tests are there to diagnosis osteoporosis or overall bone health? Let s take a look at how we diagnose osteoporosis in the clinic. There s no way you can tell by just feeling the patient, by just examining them, if they have osteoporosis. You can t push on their wrist

8 page 6 / THE COMPLETE BONE HEALTH SOLUTION and say, Oh, that s soft. Your bone is soft. Hopefully not anyway. We have to go through a procedure - medical history, general examination. We know what some of the risk factors are. We ll go through that list in a moment. But then we need to look at laboratory testing and specifically the main test we re going to look at is bone density. There are also some biochemical markers and I d like to talk about those as well. Then there s some other tests that we do. We can also look at x-rays and bone scans. Let s focus on the ones that we mainly use, which is bone density study, biochemical urinary markers and a couple of markers in the standard blood test. Before we do that we want to look at medical history, because that s always important. The age of the person is going to be predominantly 50 years and older. It s going to be predominantly women, but not exclusively women and not only over 50. Post-menopausal. When you look at estrogen, which is the main steroid sex hormone involved in bone homeostasis, when estrogen levels start to drop at menopause, in women they drop off very rapidly, almost as if you were just going over a cliff. Bone loss occurs dramatically. By the time that estrogen is getting towards the bottom of that cliff, bone loss is happening. It goes quite fast. Then it stabilizes. So at the age of say 50 to 55 if she was going to lose bone, she would lose most of the bone and then again at around 80 to 85 there s another drop-off of estrogen and that s where the majority of the bone loss would then occur. In men, their estrogen levels are relatively low, remain relatively stable as they age. Sometimes they even go up. It s not uncommon. Their testosterone, their main steroid sex hormone, tends to drift down little by little. So age, gender. In women, post-menopause, which age group is she in? Then personal history. Have you had a lot of broken bones? Do you have a tendency to break bones? That s very important. Childhood and young adult as well as adult. Family history of osteoporosis. There are genetic factors. Smoking is another lifestyle negative influence on osteoporosis. Alcohol use, as we mentioned. Dietary habits, particularly around calcium, vitamin D. Then exercise and your general physical habits. Like if you sit a lot at work or if you re a bus driver or a woman drives kids back and forth to school and then sits at a desk job. So sitting is a negative factor. If they have a history of anorexia or bulimia they would not be getting appropriate nourishment. Any type of history related to hormonal health in women, like irregular menstruation, amenorrhea, if they have long periods without having a period, and also children. Women who have never had children it seems statistically that they have a higher rate. In men, and women as well, looking at their hormones, testosterone and DHEA in particular, in women looking at their estrogen levels is important, particularly their estrodiol. Then other medications that they may be taking and other diseases that they may have. The physical examination follows and then we start to do the lab testing. The main one is the bone density study called the DEXA scan. The bone density test is really the only test that can diagnose osteoporosis before fracture occurs. It helps to estimate the density of bones by using a type of x-ray. That information is fed into a computer and generates an image. Then we have World Health Organization standards that tell us if your bones are strong, if you have lost bone and what else you have lost.

9 TRANSCRIPTS PART I / page 7 There are two scores in a bone density test. There s a T-score and a Z-score. The T-score compares your bone density with that of an average, healthy young adult, usually about 30 years old. So as you go through life your bones become stronger. As you re active when you re younger your hormones become more abundant. You reach your maximum bone density strength at about age 30. That s the T-score. That s the one we re going to compare. You should be able to maintain most of that you ve gained through the rest of your life. The Z-score is an age-matched comparison. I want my patients to be not at their age-matched unhealthy population but at the 30-year old healthy population. That s the one we use, the T-score. A normal T-score, the numbers go from pluses to zero and then to minus. When they go into the minus range, now we re starting to show bone loss. Normal bone would be less than minus one. If it s a zero or one or two, that s very, very strong. If it s -1.0 or -1.7, that s still relatively normal. Osteopenia or early stages of bone density reduction is a T-score between -1.0 and Anything greater than -2.5 is osteoporosis. Severe osteoporosis is when it gets to -3.0 to This is very important. From a clinical perspective and from a person doing self-treatment or partnering with their doctor, you want to know what your T-score is. The higher the number in the minus range, the worse your osteoporosis is. So your treatment is going to be different. If you were -3.5 or -4.0, that s severe osteoporosis. You re going to need to be very aggressive and very comprehensive and make serious lifestyle changes in order to make changes. If it s an osteopenia, say of -2.1 or -1.9 or -1.5, you have plenty of time and plenty of room to start working with that. Then you re going to redo your bone density every few years. If you have very good bones then every four to five years is enough. But if we re actively treating then we re going to evaluate every year until we ve stabilized it and reversed that. There are a couple of other tests that we want to look at. Standard blood chemistry. We always want to look at thyroid. If you have too much thyroid hormone it interferes with the bone remodeling cycle and can participate in osteoporosis. So you want the TSH to be healthy, but not too low. In terms of hormones, we want to make sure that the testosterone, estrogen and DHEA, those are all boneimportant hormones. Here s something very important to understand. Estrogen is the most important steroid sex hormone for bone homeostasis, but it does not rebuild bone. It prevents bone loss and it stops loss if you re having active osteoporosis. But it doesn t actively rebuild bone. So you ve built your bone already through having other hormones, growth hormone, testosterone, DHEA, which are very strong when you re young, and having enough of estrogen to prevent any loss. Then you have bone-trophic, or bone-building hormones, which are testosterone, DHEA and even progesterone is a little bit bone-trophic. So then you have to interfere with, if you have osteoporosis, interfere with bone loss and you focus on stopping the loss if it s active at the time and then rebuilding. So you have to work with the process to slow it down, then to arrest it and then to turn it around. Different phases of therapy. Vitamin D studies are important and calcium studies are important. Vitamin D levels, normal values are nanograms per milliliter. Desirable levels are at least 39. I want my patients to be stronger. If they have osteoporosis I want them up to 70, up towards 100. In terms of calcium in the blood, calcium is a very narrow range, between 8.7 to 10.2 milligrams per deciliter. It s in the serum. That test gives you an idea of the rate that calcium enters the body from the gastrointestinal absorption and the levels through which the bone is demineralized and leaves the body through the stool or the urine. So the range is very narrow. It stays tightly within that range. Very

10 page 8 / THE COMPLETE BONE HEALTH SOLUTION important. The body controls that through bone homeostasis very tightly. Also, the gastrointestinal tract prevents absorption of calcium. You don t need too much. You need just enough and no more. So taking more highly-absorbable forms of calcium, except during active treatment, is not good for the body. In nature calcium is in shells - seashells, eggshells, chalk, dolomite, very hard substances. Small amounts are in food other than milk, which are only for young, growing mammals. So nature tells us that we need calcium but we need just the right amount and we need it controlled perfectly. It can t go into too much into your cells. If it goes into the cells it kills them instantly. So you have several mechanisms. One, nature produces calcium in abundance but it makes it in a form that s difficult to absorb. Dolomite, bone meal, calcium is only absorbed by about five percent. Calcium citrate, we ll talk about these in module two, is absorbed a little bit better but not greatly better. There s a reason for that. You need just the right amount, not too much. If we look in the serum levels of calcium in the blood, they should be desirable levels within that range, towards the middle is better, not too high and not too low. The optimum levels would be milligrams per deciliter. To determine the health of your bones and if you have osteoporosis, you re going to start with a bone density study, that s your DEXA scan. You re going to look at some of the hormones. You re going to look at your calcium. Your doctor is going to do that for you. You re going to evaluate then where you are. If you have osteopenia, then you have plenty of time. It may never turn into osteoporosis. It may stay that way the rest of your life. But you ve already lost some bone. So you start taking the steps slowly, gradually, to recover that bone. If you have early stages of osteoporosis, -2.5, -2.6 or even -2.1 or something like that, which is on the borderline between osteopenia and osteoporosis, then you need to be more diligent. You need to be more active. You need to be more comprehensive on that. If you have osteoporosis, -2.5 or greater, then what you want to do is you want to see if this is active bone loss or is this bone that s already been lost. If it s bone that s already been lost and you re stable, because you can be relatively stable for long periods of time, years or more, then you have time to make the changes through lifestyle, diet and supplementation. However, if you re having active bone loss you could be losing a lot of minerals within months or a few years. That we have to become very aggressive with in terms of clinical intervention. The way you do that is through biochemical markers in the urine. There s two tests. They re readily available from all standard lab companies. I usually use the NTX, which is the N-telopeptide crosslinks. The other one is the pyradinium crosslinks tests. Both of those measure the rate of turnover or give you an idea of how rapidly collagen is spilling out in the urine. If you re losing a lot of collagen, not minerals but collagen, which is protein from the bone, you are losing active bone. It s a simple urine test. For the NTX values male and female are a little bit different. For the adult male it s 3-51 and for the female it s Optimal levels are going to be within the or towards mid-range or towards the lower-end of the range. What we don t want is higher than normal values. If it s greater than, typically we look at level for women, even though the range goes up to 65, if it s higher than that level there s a possibility that they re actively losing bone. If it s greater than 65 in the NTX study, they re definitely actively losing bone. So then I get very aggressive, depending on where the T-score is, in terms of how we re going to intervene. They pyradinium crosslink values are for both male and female. Those are nanomoles per millimole of creatinine. The same value assessment is higher numbers indicate more spillage of collagen and indicates active bone loss. So biochemical urinary marker, bone density, are the gold standard. They clearly define your level of bone strength, loss or active loss. Kevin: Why don t we talk about traditional treatment of bone health and osteoporosis and bone disease.

11 TRANSCRIPTS PART I / page 9 What are some of your thoughts on some of these treatments? Dr. Williams: As I mentioned in the myths, one of those is that it s an incurable disease that happens to everybody when they get older and the only way is through pharmaceutical drugs. That s completely erroneous. I proved it over and over and over again with my patients. There s a lot of trouble and issues with the drugs that are used to treat osteoporosis. We ll talk about those in some detail because it s important to understand. However, they do have some value. I m not completely opposed to using them. If patients are -3.5 on their T-score, I may do short-term use of the bone-reabsorption drug for five or six months to help to stop the bone loss. If they re anything less than that there s sufficient number of interventions that are natural that work. Let me start with medical conditions that are associated with osteoporosis because these are important, too. There are certain drugs that cause osteoporosis. You could be taking an osteoporosis and taking four other drugs that are causing your problem. That doesn t make sense whatsoever to my view. There s five main conditions that are associated with osteoporosis. The first is diabetes. We don t know everything there is to know about it but we do know that high glucose levels seem to shut down the bone-building mechanisms. So the bone doesn t remodel well and diabetics tend to have higher incidence of osteoporosis than non-diabetics. In my patients there s two important things. I don t want them to be diabetics to begin with. If they are we want to get them to be non-diabetics or to manage their glucose as best possible and then to protect their bones as best possible. If I m looking at pre-diabetes or even patients with fasting glucose levels on their blood test at or 101, 110, I consider those as being too high. That s too much glucose in the blood. The blood is too sweet. They re going to have many problems that can participate in osteoporosis. They could be moving towards diabetes. It s going to accelerate aging. It s going to cause skin changes, combine sugars with proteins and then we have more glycosolated hemoglobin and a variety of other problems. So we want to bring that glucose down into a healthy range, not too low, but into the mid-range of Also look at the hemoglobin A1C because even if patients, say their glucose is 90-95, not too bad, it s not good enough for me, though, their hemoglobin A1C could be 5.2 or 5.3. That tells me that their average glucose is likely going to be over 100. So we have to look at it from both ways. Diabetes is one problem and then also people who are pre-diabetic or just having trouble metabolizing the glucose. I ll go after that right away. There s another condition that interferes with gastrointestinal absorption of nutrients. That s celiac disease, or any inflammatory bowel disorder, but particularly celiac and related food intolerances and food sensitivities. That creates enough inflammation in the small intestine to prevent sufficient absorption. Also minerals, calcium, has to be broken down well in the body. It should be in solution before it goes into the body. You don t chew calcium so much as it goes into solution in a liquid form and then you drink that through soups. If you take a calcium pill that has to be broken down. It has to come apart. The hydrochloric acid influences that. It has to be in a form in solution that s going to be absorbable. If you have inflammation, irritation, from celiac disease or related food intolerances and sensitivities, you may reduce your gastrointestinal nutrient absorption, including calcium, which is the main mineral in terms of bone.

12 page 10 / THE COMPLETE BONE HEALTH SOLUTION There are three others. Lupus and connective tissue diseases like rheumatoid arthritis, multiple sclerosis and asthma. The main thing associated with those conditions is that they all are given steroids, prednisone, to treat them, to knock down the immune system to manage inflammation. Usually relatively high doses over a long period of time. Steroid use, corticosteroid use, is one of the main drugs that cause bone loss, severe bone loss. If you use too much of it, if you re having life-threatening inflammation like from influenza into your lungs, you may be getting massive doses of cortisone in the hospital. That can cause a meltdown of your bones into a condition called osteomalacia or softening of the bones. The bones can literally fall apart in your body. It happened in thousands of cases in China during the SARS epidemic. They thought they had a short-term cure. They used massive intravenous doses of corticosteroid hormone and managed the inflammation relatively quickly but not 100 percent and caused severe cases of bone deterioration. Even small amounts, 10 milligrams per day, over a long period of time can cause osteoporosis. Other drugs, there s a long list of those that are associated with bone loss, antacids particularly, aluminum-containing antacids, mostly over-the-counter types. Anti-seizure medicines. The most common ones, Dilanten and phenobarbitol, are rheumatase inhibitors. [indecipherable] don t want to lose any more hair, have too much dihydratestosterone or men who are taking testosterone for antiaging purposes and their estrogen levels are going up too much, take these drugs. It interferes with bone homeostasis. Cancer and chemo-therapeutic drugs, cyclosporines, hormones that are used to suppress and for regulating female hormones in women who are unable to conceive or to reset their menstrual cycle, like Lupron, also are associated with bone loss. Heparin is associated with that. Lithium, used for depression. As I mentioned, the corticosteroid drugs like Prednisone. Also, synthetic progestins that are used for contraception, Depo Provera. Methotrexate, used to suppress the immune system. Common protein pump inhibitors like Nexium, Prevacid, Prolisec. These are given out like candy for acid indigestion and reflux disorders. They inhibit calcium absorption and break down in the gut because they inhibit hydrochloric acid at the cell production site. Selective serotonin reuptake inhibitors, SSRIs like Prozac, Zoloft. Tamoxifen, used to suppress estrogen during cancer, can solve one problem and potentially create another. Then thyroid hormones, particularly Synthroid, used in excess suppresses TSH, makes the patient artificially hypothyroid. Kevin: Dr. Williams: What about specific bone health drugs? There s a number of FDA-approved osteoporosis-preventing and/or treatment drugs. The ones that we know quite well are Fosamax. These are a very specific type of molecule. We have now several generations of them. They re called bi-phosphenates. These are very powerful drugs that cause dramatic changes in bone physiology. The problems start to show up, some of them in the beginning and some of them four or five years down the road. The one that shows up right away is it has very severe gastrointestinal irritation. In the beginning of these drugs I remember when they first came out there was a lot of hand-clapping with my conventional medical colleagues. We ve found a solution to one of the worst problems of aging. Osteoporosis and hip fractures cost a lot of money when older people break their hips. Look at all the good we re going to do. Never thinking that it s the Western lifestyle and modern Western diet that s the cause and that maybe they should fix that first. The first evidence that something was wrong was that patients were coming in and complaining about severe upset stomach, pain and constant nausea. It turned out that these drugs are directly associated with that problem. The next thing that they were saying was, You have to take the pill standing up and you have to move around for two hours afterwards. You can t take it while you re working at a stationary work station of some type. You can t take your biphosphonate drug, your

13 TRANSCRIPTS PART I / page 11 Fosamax, and then stand there. No, you have to move around for a few hours. It went from silly to ridiculous. Then they had several other generations and it came out that you only had to take it once a month. You still had to take it standing up but you don t have to take it once or twice a day anymore. So they ve improved something on the compound that allows you to have all of the side effects but the short-term irritation to the stomach is less. Now it s gone from the silly to the ridiculous to the dangerous. However, as I mentioned, they do have very profound dramatic changes in bone density. But they build the wrong kind of bone. When they first came out I remember attending a big conference with my medical colleagues. The drug company had sponsored it. It was a magnificent restaurant. Everything was paid for. We had a great lecture. It was a really brilliant orthopedic surgeon who was delivering the talk. I was watching all the biochemistry and everything like that. We put this molecule into this place and this does this. You have this type of bone rather than the type of bone that you want, which is more resilient bone, you d have a more brittle bone. So at the end I raised my hand and I said, If you put this molecule this way and you do this and you do that, don t you build this type of bone, which is a stronger bone density but a more brittle type of bone and not the true type of bone that we want which is a more resilient type of bone? The speaker said, Very good question. Biochemistry is right. I agree, however this is such a serious problem and we re in the early stages. We don t have any long-term studies. I said, Well, I would think that in approximately eight years of chronic ingestion of these that you would have increased incidence of osteoarthritis, essentially creating inflammation in the joints, or other type of fractures. So you would replace one for the other. Now they re finding that it doesn t take eight years it takes about four or five years for those to show up. However, they re not in all cases. The problem is multi-dimensional. You start off with stomach upset and inflammation in the esophagus. If you get through that then you only have to worry about a couple other things. One is osteonecrosis, particularly in the jaw. This is a problem where the bone cells die. Why it s selective to the jaw I m not sure. I don t think we have enough evidence on that. It s a complication that keeps showing up in more and more of these patients. It s usually found by the dentist and it requires pretty serious surgery to repair it. Bone, joint and muscle pain. People can have unusual aching feelings that can be severe. These folks will go to their chiropractor. First they ll go to their general medical doctor and they ll say, I don t see anything wrong with you. Here s some anti-inflammatory medication, which makes their stomach worse. Then they go to their chiropractor or their masseuse. Then they go to their acupuncturist. It s actually a problem caused by their supposedly osteoporosis-helping drug. Another drug causes severe similar symptoms. Those are your cholesterol-lowering drugs. If you re taking one drug to lower your cholesterol, like Lipitor, and you re taking another one fix your bones, you could have two drugs that are going to make you sore and achy. You could have tendonitis, almost to a debilitating level. The solution is to discontinue the drugs. There s atrial fibrillation. You have a rapid and irregular heartbeat. It can be associated with these drugs. The worst one, the one that s getting the most attention, is femur fractures. These are a very specific type of fracture. The bone just basically snaps. It doesn t usually occur until at least four years of taking the drug. However, we re seeing more of those. They re still in the very small amount of the population but they re dramatic and they re attracting a lot of attention. For my patients, we try to do it without the drugs and in eight out of ten cases I can do it completely drug-less and we can slow down, arrest and replace some bone. In patients who have bone density study of -3.0 to -3.5 or worse, then often I will recommend that they take a Fosamax or similar drug

14 page 12 / THE COMPLETE BONE HEALTH SOLUTION for five or six months, maybe up to a year, and then we discontinue once we have it under control. So what does it all mean? I think we have to start with a goal. You re going to have two goals. One is to prevent osteoporosis. That means you start as young as possible. If you re 35 and older, it s good to have a bone density study to see, both for men and women. Even in some young men I ve found advanced osteoporosis. So have a baseline. Get a bone density study so you know where your bones are when they were more or less at their strongest and when they might start to go down. If you re 48 years old, into your 50s, let s say 48 to 55, you definitely should have a bone density study, for women, and see where that is, see where the level is, what your T-score is and then start making decisions. That s the preventative aspect of that in terms of evaluation. Also, evaluate your lifestyle. Make changes that are bone-healthy and move away from those things that are not good for your bones. The other part of the goals is if you already have osteoporosis or osteopenia, partner with a holisticminded physician or a naturopathic physician who knows bone health and can work with you and help you overcome the problem with regular evaluation and changes in lifestyle and nutraceutical supplementation. In part two we re going to put all of this together. We re going to look at what it means more. We re going to show you how to establish goals, preventative and treatment, and we re going to look at that in basically five steps. Step one is to have a plan. So you re going to have your specific osteoporosis plan. You partner with a knowledgeable healthcare provider and get tested. Do the discovery and then step three is define the main factors that are causing your bone loss. Are they poor diet or are they lifestyle? Are they vitamin D deficiency? Is it not enough calcium? Low estrogen? We re going to influence those main factors. We want to make sure that they re modifiable factors, because that s what we can influence. Then we re going to go after those while developing a comprehensive lifestyle and nutraceutical program. That would be step four and then step five is to implement that program and use bio-identical hormones if indicated.

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