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Episode 37
The Doctor's Farmacy: House Call

A Functional Medicine Approach To Osteoporosis

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

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We have been led to believe that drinking milk is the key to bone health. Unfortunately, the prevailing myth that drinking milk as children builds up a calcium bank that helps us avoid osteoporosis and fracture later in life is simply not true. Our bone health is determined by a number of things including what we eat, our stress and activity levels, our muscle mass, and other factors that contribute to the delicate balance between bone build-up and bone breakdown. Unfortunately, osteoporosis is a very common and life-threatening problem, it is also highly underdiagnosed. This is part of the reason why prevention is so important when it comes to osteoporosis.

In this episode, Dr. Hyman sits down with Dr. Todd LePine to discuss the Functional Medicine approach to osteoporosis. They get into how chronic inflammation acts as one of the main drivers of osteoporosis, why both bone density and quality are so important, and much more.

Dr. LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders and the neurobiology of mood and cognitive disorders. Dr. LePine teaches around the world, and has given lectures to doctors and patients at American College for Advancement in Medicine (ACAM), Age Management Medicine Group (AMMG), the University of Miami Integrative Medicine Conference, The Kripalu Center in Lenox, MA, and is on the faculty for American Academy of Anti-Aging Medicine (A4M). Dr. LePine is the head of the Scientific Advisory Board for Designs for Health and a consultant for Diagnostic Solutions Laboratory. He enjoys skiing, kayaking, hiking, camping and golfing in the beautiful Berkshires, and is a fitness enthusiast.

This episode is sponsored by ButcherBox and Dr. Hyman’s Sleep Master Class.

When you sign up for ButcherBox today, you can get 2lbs of wild-caught Alaskan salmon free in your first box. Just go to butcherbox.com/farmacy.

In this modern world we place too much value on staying busy and deprioritizing sleep, which is why Dr. Hyman created his first ever Master Class. It guides you through the most important steps to getting better sleep, starting today. Get free access to Dr. Hyman’s Sleep Master Class at drhyman.com/sleep.

In this episode, Dr. Hyman and Dr. LePine discuss:

  • Why drinking milk is not the key to bone health
  • Common causes and risk factors of osteoporosis, including inflammation, diet, stress, and more
  • Why bone density and quality are both important
  • How smoking negatively affects bone health
  • The traditional vs functional medicine approach to diagnosing and treating osteoporosis
  • The benefit of getting your bone density tested at various ages
  • Leaky gut, gluten sensitivity, celiacs disease, and other unexpected precursors to osteoporosis
  • The benefits of resistance exercise for bone health, muscle mass, stability, and balance
  • Bone building foods
  • Lead toxicity and osteoporosis

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. Todd LePine

Dr. LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine,
specializing in Integrative Functional Medicine, and has advanced clinical training through the Institute for Functional Medicine. He has been practicing Functional Medicine for over 15 years focusing on Optimal Aging, Bio-Detoxification, Gastrointestinal Health, Systemic Inflammation, Autoimmune disorders and the Neurobiology of mood and cognitive disorders.

Show Notes

  1. Milk and Health
  2. Got Proof? Lack of Evidence for Milk’s Benefits
  3. Why Lead Poisoning May be Causing Your Health Problems
  4. Why Most Everything We Were Told About Dairy Is Wrong
  5. Is Gluten-Free A Fad Or Is Gluten A Real Threat To Our Health? with Maggie Ward
  6. Protein and Your Health: What you need to know
  7. Calcium Without Dairy? It’s Possible!
  8. Ultra-Aging: Ultra-Living at Any Age – Part One

Transcript

Dr. Todd LePine:
Chronic inflammation is one of the big things that’s tied in with osteoporosis. And there’s a term called inflammation. So, as you age, your body can develop more inflammation. So, chronic low grade inflammation, patients who have colitis, patients have rheumatoid arthritis are at higher risk for osteoporosis.

Dr. Mark Hyman:
Welcome to the Doctor’s Farmacy. I’m Dr. Mark Hyman, that’s Farmacy with an F, F-A-R-M-AC-Y, a place for conversations that matter. And if you’ve ever suffered from osteoporosis, low bone mass, increased fracture risk or multiple fractures or you’re worried about getting old and frail man hunchback, you better listen up because today’s podcast is a special episode of a house call podcast for Doctor’s Farmacy is on osteoporosis and osteopenia, which means low bone mass. And we’ve got with us our incredible physician from the UltraWellness Center, Dr. Todd LePine.

Dr. Mark Hyman:
He’s graduated from Dartmouth Medical School, internal medicine board certified. He’s worked with me for 25 years at Canyon ranch and here at the UltraWellness Center. He’s one of the smartest dudes on the planet and functional medicine. Teaches all over the place. And he’s just such a brilliant mind. And we get to go deep into your bones today. We’re going to get into your bones. So, Todd, welcome to the Doctor’s Farmacy again.

Dr. Todd LePine:
Thank you, Mark.

Dr. Mark Hyman:
All right. So, osteoporosis, this is a big deal. It’s one of those invisible killers that people ignore are heart disease, cancer, diabetes, dementia. We’re all scared of that but osteoporosis actually kills a lot of people.

Dr. Todd LePine:
Silent killer.

Dr. Mark Hyman:
Yeah. So, how common is this problem?

Dr. Todd LePine:
It’s very common. It’s common because it’s underdiagnosed. And this is a condition where what I would say is that you want to preempt the condition, you want to diagnose the condition, which is, as you mentioned osteopenia. So, osteopenia is Latin for bone poverty. So, before you develop osteoporosis, which is a technical definition when you measure on a DEXA scan, you’ve got to have a T score greater than negative 2.5 and they have a standard.

Dr. Mark Hyman:
Because there’s a definition of how we measure it on an x-ray basically.

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

Dr. Mark Hyman:
Well, that’s the thing. I mean, it’s really the thing that often is killing people because if you’re old and frail, you fall, you break your hip and you end up with a blood clot and you get pneumonia and it’s really a killer and life expectancy a year after a hip fracture is dismal. It’s like worse than cancer. It’s like 50% life expectancy. So, it’s no joke. And there’s about 10 million older Americans that have osteoporosis and are 43 that have osteopenia or low bone mass, that’s like 53 million Americans who are headed for disaster.

Dr. Mark Hyman:
And it’s one of those things that most doctors don’t check, they don’t really think about until the horse is out of the barn and you’ve already broken a hap or you’ve already got osteopenia or osteoporosis and don’t know if it can start early. So, why are we seeing this incredible rate of osteoporosis? Because we as a society drink so much milk and have so much calcium and we’re told to take calcium but what is going on? Why are we seeing these incredible rates of osteoporosis?

Dr. Todd LePine:
Well, you bring up a really good point, which is that most patients and most doctors think, “Oh, I just need more calcium for osteoporosis. I need to drink more milk for my osteoporosis.” And I’ll never forget it. When I was in my primary care practice, I had a patient who was an older woman who had severe kyphosis. So, she had the hunchback. And guess what she did for a living? She was a farmer and her family had-

Dr. Mark Hyman:
Dairy farm.

Dr. Todd LePine:
Dairy farm. And guess what? She drank milk every day of her life. And she had the most severe case of osteoporosis I’ve ever seen.

Dr. Mark Hyman:
I’ve seen workouts that are good for her.

Dr. Todd LePine:
Exactly. Right. And I think, as I mentioned earlier as we were talking is that for every 200 grams of milk that you drink, you have a 9% increased risk for osteoporosis.

Dr. Mark Hyman:
Okay. So, every glass of milk that you have, you increase your risk of osteoporosis by 9%?

Dr. Todd LePine:
Yeah.

Dr. Mark Hyman:
Of a fracture or osteoporosis?

Dr. Todd LePine:
Osteoporosis.

Dr. Mark Hyman:
A fracture though?

Dr. Todd LePine:
Yeah.

Dr. Mark Hyman:
I mean, this is incredible. I encourage people to check out this brilliant article in the New England Journal of Medicine. You can just go online and Google. It’s called Milk and Health by Dr. David Ludwig and Walter Willett. And it really is one of the most well-researched profound analysis of all the data on milk. And whether or not, there’s any data to support its health benefits. And I do believe it’s nature’s perfect food but only if you’re a calf. Because for humans and adults, it seems to cause a lot of issues, including osteoporosis. So, it doesn’t decrease fractures, so. But that’s not the cause of osteoporosis. What are the real causes in our society of osteoporosis? Why are we seeing these high rates? Because it seems like a design flaw. And why are we seeing such high rates of osteoporosis in this population?

Dr. Todd LePine:
Well, I mean, there’s the risk factors for osteoporosis. Obviously, as you get older, you will lose some bone mass. I mean, that’s part of the aging process and you always want to look at the risk factors. So, women are more prone towards that.

Dr. Mark Hyman:
Is it aging or is it what we do while we’re aging?

Dr. Todd LePine:
Inflamm-aging. Inflamm-aging.

Dr. Mark Hyman:
Is it what we do while we’re aging that makes us age faster?

Dr. Todd LePine:
Yeah. Actually, it’s inflammation. Chronic inflammation is one of the big things that’s tied in with osteoporosis. And there’s a term called inflamm-aging. So, as you age, your body can develop more inflammation. So, chronic low grade inflammation, patients who have colitis, patients who have rheumatoid arthritis are at higher risk for osteoporosis. Patients have heart disease.

Dr. Mark Hyman:
That’s right.

Dr. Todd LePine:
Yeah. Absolutely.

Dr. Mark Hyman:
That’s right.

Dr. Todd LePine:
Absolutely.

Dr. Mark Hyman:
So, there’s this phenomena where we’re seeing high rates of osteoporosis. And as I dug into it… And one of the things we had to do at Canyon Ranch was we had to give lectures three or four times a week. And one of the lectures I gave was on osteoporosis. I got really smart about it. And we also at Canyon Ranch, it’s a lot of preventive screening and we used to do a lot of DEXA scans. Now, a DEXA scan is a special machine that is a low dose x-ray, it’s like flying across from New York to LA, that amount of radiation you get when you fly in a plane, very low dose. And it looks at the bone density. So, you can see on this very low dose x-ray whether or not you have thin bones or strong bones and where they’re weak or where they’re thin.

Dr. Mark Hyman:
And so, we treat a lot of patients. But I give these lectures. I started looking at why are we seeing such high rates in this society? And we came up with so many different factors, our diet, we know that sugar, alcohol, caffeine, caffeine-

Dr. Todd LePine:
Caffeine.

Dr. Mark Hyman:
Salt and even what is consumed in massive quantities is about 10% of our calories soda, phosphoric acid and sodas in the Colace is incredibly dissolving of your bones.

Dr. Todd LePine:
Oh, yeah.

Dr. Mark Hyman:
Stress makes your bones soft. And of course, lack of activity. We’re all sedentary. We don’t use our bodies. And you mentioned aging but if you keep up your muscle mass and if you keep up your activity level, you can maintain your bone mass. We often talk of osteopenia or osteoporosis. But we don’t talk of sarcopenia, which is the loss of muscle. And that’s what goes along with bone loss. So, you have all these factors and we’re literally peeing out calcium-

Dr. Todd LePine:
Yeah. Exactly.

Dr. Mark Hyman:
In our urine because in some countries like in Africa, they have intakes of calcium of two, 300 milligrams a day but they don’t really have osteoporosis. Here, we have intakes of a thousand or 1500 milligrams a day and we see high rates of osteoporosis. What’s the difference? It’s not the total calcium, it’s the calcium balance.

Dr. Todd LePine:
Exactly.

Dr. Mark Hyman:
It’s what you’re peeing out compared to what you’re taking in. So, in Africa, they’re not doing all these bad things and they’re not losing their bones in their urine, they’re not… And we actually have tests where we can measure if you’re peeing out your bones-

Dr. Todd LePine:
Yeah. Exactly.

Dr. Mark Hyman:
While you do that [crosstalk 00:08:22] we measure markers of increased bone turnover because there’s this constant dance right between bone buildup and bone breakdown, right? And so, we’ve got to make sure we’re constantly pushing the bone buildup and not so much the bone breakdown.

Dr. Todd LePine:
Exactly. Yeah. The osteoclast, the analogy of is like somebody building a wall. And osteoclasts, which are the cells that break down bone and then there’s the osteoblasts, which the cells that build up bone. And normally, our bodies are constantly doing it in a balanced way. So, there’s just as much bone breakdown, turnover and then you rebuild the bone. When you have too much osteoclastic activity, which happens in chronic inflammatory conditions, then what you’re doing is you’re breaking down more bone than you’re building up. And the other important thing, which is also, it’s not actually determined by DEXA scanning is the quality of the bones.

Dr. Mark Hyman:
Yeah. So, tell us about the quality of the bone because you can look at a scan and see it’s good or not good but what if it’s more fragile or brittle.

Dr. Todd LePine:
Exactly. So, you want flexible bones. You want bones that bend. You want bones that are a little more rubbery if you will because… And I remember this very well because when I was in my training, one of the things that they used to give for patients with osteoporosis was fluoride. Do you remember using fluoride? And what they found is that guess what? You did get denser bones with taking fluoride but guess what? The bones were more brittle. Yeah. So, they broke. So, you want actually healthy quality bones, not just the density but it’s the quality of the bones.

Dr. Mark Hyman:
And what determines the quality?

Dr. Todd LePine:
The connective tissue that’s in the center of the bone. So, it’s not just the calcium, it’s the connective cartilage tissue that’s in the center of the bones that makes it healthy. And this is a very simple thing to remember is one of the big things that increase a person’s risk for osteoporosis is smoking. And I always tell my patients, you ever see somebody who’s a chronic smoker. What do they have? Wrinkles. Okay?

Dr. Mark Hyman:
They have more wrinkles.

Dr. Todd LePine:
Right. Smoking upregulates matrix metalloproteinase enzymes, which are breakdown collagen. And that’s why patients who are smokers have higher risk for cardiovascular disease, higher risk for osteoporosis because they’re actually breaking down their connective tissue. Yeah.

Dr. Mark Hyman:
That’s another reason to stop smoking.

Dr. Todd LePine:
Exactly. Right. But actually, it’s funny because if you have a woman who’s a smoker, they oftentimes, one of the things I’ll tell them is well, do you want to have wrinkles and they’ll stop smoking because the vanities [crosstalk 00:10:50]-

Dr. Mark Hyman:
That’s right. That’s right. Well, you mentioned something I want to come back to, which is this whole idea of inflammation. And we’ve talked about all kinds of conditions on this podcast in the house call. And the truth is most chronic illnesses are related to inflammation, heart disease, cancer, diabetes, dementia, depression, not immune disease obviously. But osteoporosis just seems a little bizarre to be related to inflammation. How does that work and how do we identify what the factors are that are causing the inflammation that leads to osteoporosis?

Dr. Todd LePine:
Well, I mean, there are measures that you can do to check for low grade inflammation things like HS or high sensitivity C-reactive protein, GlycA, looking at their diet. So, an anti-inflammatory diet helps to decrease inflammation. Looking at essential fatty acids are also important. Looking at whether or not there’s any silent gut inflammation. When you do stool analysis, you can check for markers, which I call my CRPS of the gut, which has calprotectin. So, if you have low grade gut inflammation, that’s going to potentially increase your risk for osteoporosis. If you have low grade osteoarthritis, rheumatoid arthritis, which is more severe than osteoarthritis, it’s more of a significant joint destructive inflammatory arthritis, those are things which break down bone very, very slowly. It’s a slow leak.

Dr. Mark Hyman:
And our standard American diet is a very inflammatory diet of processed foods, sugars, refined oils and lack of protective anti-inflammatory foods, right? Which are the phytonutrients and plant foods. And so, we get this incredibly upregulated immune system, which is why we’re all suffering from COVID in America. We have over 11 million cases over a quarter million deaths today as this recording. And I think we’re uniquely susceptible because we’re so inflamed. And osteoporosis is one of the victims of inflammation. Our bones are one of the victims. And it’s from leaky gut. It’s from our processed diet. It’s from a lack of protective foods. So, we really have an opportunity to really change that dynamic and shift the balance from bone breakdown to bone build up, right?

Dr. Todd LePine:
Exactly. Healthy bones.

Dr. Mark Hyman:
And how do we normally treat this with traditional medicine? What is the general approach in terms of diagnosis and treatment?

Dr. Todd LePine:
Well, diagnosis, as we mentioned is really with DEXA scan. And I always like to emphasize especially as women tend to have osteoporosis more than men but men can get osteoporosis. And there are certain medications that can do that. But I actually think that one of the ideal things to do is to actually get your bone density checked when you have no symptoms whatsoever. When you’re at peak bone mass, which is around 30 to 35 years of age, you want to know what your bones are there.

Dr. Mark Hyman:
What your baseline is.

Dr. Todd LePine:
Right. Exactly. Because I can’t tell you the number of times that I’ve seen a patient and they’re especially a woman they’re entering into menopause and ask them, “Have you had your bone density test check?” No. Well, I said, “Well, you need to actually have that checked.” And if you have one when you’re at peak bone mass, which is around maybe 25 to 30 years old and then you get one as you’re entering menopause to the perimenopausal area, then you can see, okay, where are your bones going? Where are they going? You have two points. One data point doesn’t show you much, two data points show you a trend of either is going up, going down, staying the same, very, very important information. So-

Dr. Mark Hyman:
So, make sure you get your bone density early and at intervals that are depending on what your bone density shows. If you’re great at 30, you can probably wait until you’re 50 but after menopause, you want to check… And men get osteoporosis too.

Dr. Todd LePine:
Absolutely. Men get osteporosis also.

Dr. Mark Hyman:
[crosstalk 00:14:17] a lady’s disease, right?

Dr. Todd LePine:
It’s not exactly. Anybody can get it. And again, high levels of alcohol, high levels of caffeine, the PPI’s, which-

Dr. Mark Hyman:
Acid blockers.

Dr. Todd LePine:
Acid blockers, big ones.

Dr. Mark Hyman:
Okay. That’s the third leading most prescribed drug in the world. And it’s an acid blocker. And if you take this for Hyper-V or reflux, you’re going to get osteoporosis because you’re inhibiting mineral absorption, right? That’s protonics, prilosec, acefex, Nexium, all those drugs.

Dr. Todd LePine:
Yeah. Chronic steroid use is a big risk factor for osteoporosis, a huge one. And then as I mentioned earlier, smoking and then just sedentary lifestyle. If you’re not stretching your bones. So, you’re not putting stress on your bones. There’s a… I remember when I was in my training-

Dr. Mark Hyman:
Use or lose it basically.

Dr. Todd LePine:
And there’s actually a interesting thing. It’s called Wolff’s law, which is that bone responds to stress. And I remember reading this article, looked at astronauts, they were in their young 30 years old. And they went up into outer space and guess what? In outer space, you float around. There’s no stress on your bones. And when they came down on planet earth, they actually lost a significant amount of the bone mass because they were not having… The body… And it says, “Oh, we don’t need our bones. We’re just going to jettison.” It’s like a balloon where you’re jettison the Baylist and you get rid of the bones that you don’t need. So, our bodies naturally will make stronger, better bones when we respond and use stress, weight resistance exercise, bands, resistance machines, et cetera, is very, very important for maintaining a good bone mass.

Dr. Mark Hyman:
Hey everybody. It’s Dr. Hyman, thanks for tuning into The Doctor’s Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do. And introducing you all the experts that I know and I love and that I’ve learned so much from. And I want to tell you about something else I’m doing, which is called Mark’s Picks. It’s my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements, to gadgets, to tools, to enhance your health. It’s all the cool stuff that I use and that my team uses to optimize and enhance our health. And I’d love you to sign up for the weekly newsletter. I’ll only send it to you once a week on Fridays. Nothing else I promise.

Dr. Mark Hyman:
And all you do is go to drhyman.com/picks to sign up, that’s drhyman.com/picks, P-I-C-K-S and sign up for the newsletter. And I’ll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Now, back to this week’s episode. And let’s get back to the diagnosis part. Because when you do a DEXA scan, let’s say you have low bone density, what do you look for next? Because there’s a lot of things that doctors don’t often check that we look at here. What do you think about? What are the most common things that maybe a traditional doctor might look at? And one of the tests that we might do that are quite different.

Dr. Todd LePine:
Oh, yeah. So, some of the tests that we’ll do is the, as I mentioned, the DEXA scan, we will then do urinary bone resorption. So, we can actually measure the collagen breakdown products like NTL peptides in the urine.

Dr. Mark Hyman:
Basically you’re peeing out your bones.

Dr. Todd LePine:
Exactly. When you lose your bones, you pee them out. That’s exactly right. You can do that. Measuring the vitamin D level is very, very important. That’s another… Vitamin D helps to regulate calcium and calcium metabolism.

Dr. Mark Hyman:
Far more important than calcium.

Dr. Todd LePine:
Yeah. Way more important than calcium. And then the other thing that’s also important is to realize that you do not want to take too much calcium. And I actually tell my patients, “I don’t want you actually taking a calcium supplement most of the time. I want you getting it through your diet.” Exactly. And if you do take it in a supplement form, you probably don’t need… And you don’t want to go over probably about 500 to 600 milligrams. And there’s studies showing that women who are taking higher doses over a thousand, like 1200, 5,000 milligrams, they actually get more calcification in their arteries too.

Dr. Mark Hyman:
Yeah. Well, that’s the calcium is the nature’s bandaid. So, wherever there’s inflammation, calcium goes. And so, when you talk about hardening in the arteries, if somebody’s calcium buildup in the arteries is in plaque. So, that’s not good. So, we look at vitamin D, we look at the bone density, we look at the bone resorption, we look at-

Dr. Todd LePine:
Vitamin K.

Dr. Mark Hyman:
Vitamin K.

Dr. Todd LePine:
Vitamin K is a big one.

Dr. Mark Hyman:
[inaudible 00:18:24] vitamin made in your gut. And if you don’t have a good microbiome, that can be a problem.

Dr. Todd LePine:
Exactly. Yeah. So, there’s actually two forms of vitamin K. There’s the vitamin K that you find in plants and the vitamin K that you make from gut bacteria. And vitamin K is traditionally thought of as a vitamin which helps with clotting. But vitamin K actually has an effect on bone density. And it’s very, very important to get adequate amounts of vitamin K. So, you can actually take low levels of vitamin K and that can help with clotting issues but you need much higher levels of vitamin K to have a bone effect. And we do the test here, it’s a mouthful but it’s called undercarboxylated osteocalcin. And it is a biomarker for a functional vitamin K deficiency. And this is a test I love to do with patients.

Dr. Mark Hyman:
Yeah. People don’t know about it. Doctors don’t usually-

Dr. Todd LePine:
It’s… Yeah. Yeah. And then right now, there’s only one lab that actually does it. But measuring that can tell you whether or not you have a functional vitamin K deficiency. And most of the time, if I’m giving vitamin D I will give vitamin K at the same time. Otherwise, you’ll start getting calcium deposition in tissues that you don’t want to.

Dr. Mark Hyman:
That’s right. And then there are other conventional things that often get looked at like parathyroid hormone. If you have a tumor on your parathyroid gland, it causes more bone turnover. If you have certain cancers like blood cancers but you can look at protein levels in the blood that look protein can be affecting bone health. And also, people can get weird things like cushing’s or adrenal tumors or brain tumors that cause high steroid levels in the body. So, there’s a lot of things that we look at. Most of those don’t turn out to be. It’s mostly the age-related just general sedentary life bad lifestyle habit osteoporosis.

Dr. Mark Hyman:
But we also look here at [inaudible 00:20:06] and a lot of other things that give us clues about why you might have a problem. For example, we look at the gut because if you have leaky gut, you could drive inflammation that causes problems. If you have digestive issues and not absorbing minerals, if you’re taking an acid blocker, we care about that. And also, gluten is a huge cause of osteoporosis. People don’t realize that if you have celiac for sure but even if you have low grade non-celiac gluten sensitivity, definitely it causes leaky gut, impairs absorption. So, there’s a lot of things we look at that may be different than what you see at a normal practice.

Dr. Todd LePine:
Yeah. It’s interesting you mentioned that because one of the biggest risk factors is having celiac disease because gluten issues can affect mineralization. And one of my take home things when I do with patients is I often ask them because I’m from a family of dentists is I often ask how many fillings do you have? Do you have any cavities? Do you have weak teeth? It’s a very common thing. Peoples who say, “Well, my dentist said I have weak enamel.” Why do you have weak enamel? Well, guess what? Celiac disease is associated with an enamel defects. So, not only do you have weak enamel, you’ve got weak bones.

Dr. Mark Hyman:
Yeah. Yeah. So, we do this work off and someone has osteoporosis and a traditional doctor, what do they give them?

Dr. Todd LePine:
Usually the bisphosphonates. Those are the things.

Dr. Mark Hyman:
Fosamax.

Dr. Todd LePine:
Fosamax, Boniva, Actonel, those kinds of things. And the interesting thing about them is they have a not so good risk benefit ratio. You can get significant side effects. You get osteonecrosis of the jaw. They’re not to be used-

Dr. Mark Hyman:
They’re not risk-free.

Dr. Todd LePine:
They’re not risk-free. They’re not cheap.

Dr. Mark Hyman:
And there’s injectable drugs also.

Dr. Todd LePine:
And they do have an injectable now.

Dr. Mark Hyman:
And also there’s fotale, which is a parathyroid hormone like drug. And sometimes doctors even use drugs like Invista, which blocks estrogen receptors that are selective estrogen blockers. And of course, doctors use hormones like estrogen therapy. Although that comes with certain risks. Even in men, testosterone therapy. So, these are all therapeutic options out there but we take a different approach in functional medicine. So, what would be an approach that we would focus on with osteoporosis different? Where do you start with patients and how do you build up the treatment model for them?

Dr. Todd LePine:
Well, the first thing I get people to do is to start using their bones, start using their muscles. So, getting people to the gym, doing some resistance exercise at least three days a week where you’re really stressing the bones, is that going to be the biggest thing, optimizing the right-

Dr. Mark Hyman:
Strength training, weight lifting, hands, body weight exercise. You just really need to push your bones.

Dr. Todd LePine:
And at the same time you’re building the muscles and then you’re also helping with balance. So, it’s not so much that when you fall… Because everybody falls. Okay? But you want to have the muscles and the reflex time to be able to catch yourself so that you don’t necessarily break some of them.

Dr. Mark Hyman:
That’s right.

Dr. Todd LePine:
So, really important to have the muscle mass and the most-

Dr. Mark Hyman:
It’s true. Of course, strengthening exercises are so important. People have just so low stability as they get older and they lose their balance. And that’s an important point.

Dr. Todd LePine:
And then also optimizing vitamin D levels. And we actually will do some genetics related to that. And interestingly, there are some gene variations related to the vitamin D receptors. So, people who have a genetic variations of the vitamin D receptors need higher levels in “normal”. So, we look at the range of normal vitamin D, the standard laboratory is about 30 to a hundred. And if you’re at 32, your doctor will say, “Oh, you’re fine. You have enough vitamin D.” Well, guess what? If you have a problem with the polymorphisms related to the vitamin D receptor, you need to have that be the higher end, you may need to be up to about 80 to a hundred in order to have the beneficial effect.

Dr. Mark Hyman:
That’s right. So, we really focus on exercise and strength training. Focus on vitamin D levels. We also do a lot with diet, right? Because you want to eliminate the bone dissolving things in your life and your lifestyle and your diet and you want to add the bone building things. So, what are the bone dissolving things we want to help people get rid of and you talked about it a little bit but-

Dr. Todd LePine:
Yeah. Well, excess amounts of protein. And also, if you have acidic urine, you can actually be more susceptible to more or less peeing out your bones. So, decreasing those things-

Dr. Mark Hyman:
Which is our process diet will cause you to be more acidic.

Dr. Todd LePine:
Exactly. And then the green leafy vegetables are very good. And then things like sardines, which are great because they have natural… Sardines are one of my favorite foods because guess what? They got great protein, they have great omega threes and they have great calcium. And it’s highly absorbable calcium. So, if you want to actually help your bones, eat sardines.

Dr. Mark Hyman:
Yeah. Herring, sardines, mackerel, that’s what I’m having for lunch. I’m having canned mackerel thinking of what the ones with the bones in them is even better. But that’s how a lot of the populations who lived on islands would get their calcium that eat the fish bones. Yeah. So, getting rid of things like alcohol, caffeine, excess salt, excess protein, too much sugar, obviously all the sodas, the junk food, the food additives, that’s so important. And then adding in all the foods that are going to build your bone, like the sardines or herring or mackerel but also the greens.

Dr. Mark Hyman:
I mean, where do cows get their calcium from? Grass.

Dr. Todd LePine:
Grass.

Dr. Mark Hyman:
Right? So, you can actually get more absorbable calcium from things like tahini, which is sesame seeds. Sesame seeds are probably the highest source, chia seeds have more calcium per serving than milk and it’s better absorbed plus Omega threes and fiber. All the dark green leafy vegetables that you mentioned. The vitamin K is also in these green leafy vegetables. So, your omega three fats are really important, which you can get those from the sardines and the fatty fish. So, a lot of foods that are bone building foods.

Dr. Todd LePine:
Absolutely. Yeah. The other thing which we talked about earlier is when I measure… This is an interesting thing in preparing for this talk is looking at women who are post menopausal. And there’s an interesting finding and stumbled upon this when I had a patient who had severe osteoporosis and I did testing on her, I did serum testing of her hormones. And it turns out that when you’re low in your hormone levels, whether it be testosterone or estrogen, your body’s pituitary gland starts making FSH and LH, which are follicle stimulating hormones or luteinizing hormones. And it turns out that the higher you have of FSH levels in a post-menopausal woman, the higher your osteoclastic activity. So, in women, it’s important to not only measure the hormones but measure the pituitary hormones because lowering the FSH level can be one of the tools that you can help to prevent worsening osteoporosis.

Dr. Mark Hyman:
That’s incredible. So, we really take a comprehensive approach of diet, lifestyle, stress reduction and then we use very specific nutritional supplements to help.

Dr. Todd LePine:
Absolutely. Yeah.

Dr. Mark Hyman:
So, what are the things that… You obviously hear calcium but there’s just so much more than just calcium when it comes to osteoporosis. So, what are the key things? We mentioned vitamin D.

Dr. Todd LePine:
And also trace minerals. Things like making sure you have sufficient amounts of zinc, copper, magnesium manganese, there’s also some evidence that boron can be helpful, silicon can be helpful in overall [inaudible 00:00:27:18]-

Dr. Mark Hyman:
So, what? Like a complex multi-mineral?

Dr. Todd LePine:
Yes.

Dr. Mark Hyman:
And you want the vitamin K2 and you want the vitamin D and magnesium too. And I don’t give you too much calcium. A few hundred milligrams at the most.

Dr. Todd LePine:
Diet is the best way to get your calcium.

Dr. Mark Hyman:
And don’t drink your milk.

Dr. Todd LePine:
It’s [inaudible 00:27:34]. Don’t drink your milk.

Dr. Mark Hyman:
That is just a bunch of hooey. I wrote an article based on this got milk ads. I’ve got milk ads were actually funded in part by our government by USDA and the Dairy Council. They weren’t science-based and the FTC, which is the federal… I mean, the FCC, which is the Federal Communications Commission or Federal Trade Commission actually ruled that they were not scientific and had to be removed from all the air. And that’s why you don’t see them anymore. Because there’s no proof that it builds better bones. There’s no proof that it does this or it does that. You guys are making this [crosstalk 00:28:08]-

Dr. Todd LePine:
It’s actually the opposite.

Dr. Mark Hyman:
The opposite. Yeah. And so, I wrote an article called Got Proof. And the answer was no. So, I think that’s why I encourage you all to check out that Milk and Health article by Dr. Ludwig and Dr. Willett. So, I think if you were looking at wanting to live to be 120 like I am, then it’s important that you know what your bone density is because you don’t want to end up having everything be healthy but you have thin bones and then you fall and then you end up in a disaster situation. And it’s hard to get ahead of the game. But I have some cases that are pretty amazing. I had this one woman who was seven years old, came in with pretty significant osteoporosis, we did all the things we said and she got into vigorous yoga.

Dr. Mark Hyman:
This lady was 70. She did vigorous yoga every day like five, six days a week. She came back without any drugs and didn’t just not lose bone but she gained 10% in her bone mass, which sounds like nothing but it’s a lot. You’d really see those changes. You see a couple of percent with these drugs but you see 10%, that’s massive. So, when you take a comprehensive functional medicine approach, you really can increase your bone density, you can prevent further bone loss. And as a side effect, you’re going to get healthier all the way around.

Dr. Todd LePine:
Absolutely. Absolutely. One other… This is a clinical paroll. I learned this Mark in seeing patients is we oftentimes do testing for heavy metals. And it turns out that nowadays we don’t have as much exposure but lead actually gets stored in bones. And there are cases where I’ve tested for heavy metals in women who are post-menopausal. And guess what happens?

Dr. Mark Hyman:
Their bones-

Dr. Todd LePine:
Their lead is coming out of their bones massively and they’re starting getting problems related to lead toxicity from osteoporosis. That’s a clinical paroll that most doctors, including functional medicine doctors do not know.

Dr. Mark Hyman:
I did notice that. I paid attention.

Dr. Todd LePine:
Absolutely. Yeah.

Dr. Mark Hyman:
I remember this study I read once where they had to move some old church in Europe and they had to dig up this graveyard and there was 300 years old. And when they dug up all these bones and to rebury them, they actually ran them through DEXA machines to see their bone density. And then they compared them to modern day humans. And they looked at lead levels as well. We found obviously the bones are far more dense but the lead levels were 300% higher in modern humans than those who were from 300 years ago. And so, it’s everywhere. We had leaded gas, leaded paint. It’s in our food.

Dr. Mark Hyman:
I mean, if you have a garden in the city and you’re not importing the soil, you probably had coal burning in that city and the soil is contaminated with lead, it doesn’t go away. So, I think we often miss these really subtle things in patients. And that’s the beauty about functional medicine that we really address these things comprehensively. And I think if you’d have suffered from osteoporosis or bone loss, do you really want a comprehensive view? We’re here to help you at the UltraWellness Center. We’re in Lennox, Massachusetts but we do virtual consultations.

Dr. Mark Hyman:
Now, at telemedicine, you go to ultrawellnesscenter.com to learn more about what we’re doing. And we’d love to help you here. We are really excited to be able to offer a type of medicine that really just is unusual but it’s the future of healthcare. And it really is a comprehensive systems approach. And Todd, you have been at the forefront of this forever and I’m just so glad you were able to be on The Doctor’s Farmacy again on a special episode of the house call. If you love this podcast, please share with your friends and your family. Subscribe wherever you get your podcasts. Leave a comment about maybe how you’ve dealt with your osteoporosis and we’ll see you next time on the Doctor’s Farmacy.

Dr. Todd LePine:
Thanks Mark.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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