Preventing Osteoporosis with Dr. John Neustadt: Rational Wellness Podcast 323

Dr. John Neustadt discusses How to Prevent and Reverse Osteoporosis with Dr. Ben Weitz.

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Podcast Highlights

3:08  Epidemic of osteoporosis.  Today we have an epidemic of bone loss termed osteopenia and osteoporosis in the US and one reason is because our society is getting older.  In fact around the globe, there are now more people over age 65 than younger than five.  About 80% of osteoporosis cases are women and the fastest rate of bone loss is as women go through menopause and the ten years after menopause.

4:03  Women more at risk.  The main reason why women are more at risk for osteoporosis has to do with their loss of estrogen as they get older.  Another risk factor for women is the use of antidepressant medications that artificially raise serotonin levels and there are serotonin receptors in the bones that stimulate increased osteoclastic activity, leading to more bone breakdown.  As people get older they also tend to have more inflammation such as autoimmune diseases and they tend to have more insomnia, etc., which are both associated with poor bone health. The average American woman also only gets about 800 mg of calcium per day from their diet, which is below the recommendation. They are also not getting enough of the micronutrients found in fruits and vegetables, which puts them not only at increased risk of osteoporosis but also for cardiovascular disease, dementia, etc.  Have less muscle mass also puts post-menopausal women at risk as well and partially due to not getting enough protein in their diet and also due to not doing enough exercise, esp. resistance exercise. Osteoporosis is a chronic disease, so it doesn’t just have one cause.

7:54  Medications.  There are a number of other common medications that result in a loss of bone mass.  Proton pump inhibitors, acid blocking medication often prescribed for reflux and other gastrointestinal complaints, such as Prilosec, damage bone and increase fracture risk.  PPIs block calcium, magnesium, and other minerals from being digested and absorbed from our food.  Taking a PPI for four years results in a 60% increased risk of a hip fracture. As mentioned, SSRIs, antidepressants, increased bone loss and for every 19 people taking an SSRI, we would expect one to break a bone.  There is also a long list of other medications that increase bone loss, including anticonvulsants like Phenytoin, prednisolone and other glucocorticoids, and aromatase inhibitors.

12:28  Detecting and assessing bone health.  The standard of care is a bone density test through a type of x-ray called dual x-ray absorptiometry test, a DEXA test, and that detects the quantity of bone and that’s used to diagnose bone.  A T-score of -2.5 or lower is diagnostic of osteoporosis.  While bone density is an important marker to look at, the most important factor is fracture risk, which depends upon a number of factors, only one of which is bone density.  Bone density only predicts 44% of women who will break a bone and only 21% of men. There are various factors that can affect the accuracy of the bone density test, including which mean is used, how they are positioned including that the hips are internally rotated 15 degrees or if they are very thin or obese or have arterial calcifications or bad arthritis in their spine of if they are taking strontium. 

17:10   Bone Turnover tests.  There are tests that measure whether you are losing or gaining bone, including the C-Telopeptide test, which is a breakdown product of collagen in bone.  If CTX is high it means you’re breaking down collagen and that has been associated with an increase in fracture risk.  The most consistent predictor of fractures in gait or mobility.  Can you get up from a seated position on a chair or the floor to standing?  What is your balance like?  Can you stand on one leg for 30 seconds? 

20:45  Medications for improving bone strength.  The bisphosphonates like Fosamax, Boniva, and Actonel are the most commonly prescribed drugs for osteoporosis.  If you have post-menopausal osteoporosis but you haven’t broken a bone since you’ve had the diagnosis, none of the oral bisphosphonates are effective at reducing both vertebral and hip fracture risks.  The only bisphosphonate that has been shown to be effective for primary prevention of fracture is intravenous Zometa.  To get benefits from any of these medications you have to take it 70-80% of the time for years to reverse bone loss.  Dr. Neustadt prefers Prolia, which also reduces osteoclast activity but which works by a different mechanism than the bisphosphonates and which is better at reducing fractures in secondary prevention of fractures and Forteo, which stimulates the osteoblasts and is also better at reducing fractures.  Both these drugs must be injected.

26:12  Exercise for Bone.  Dr. Neustadt says that we do not have enough good studies looking at fracture risk for which form of exercise is best for bones.  He is not convinced that we need to do heavy weight training or that you need to go to a gym but he feels that it is important that whatever exercise you do be done safely and certain types of movements, such as too much flexion type exercises might be dangerous and cause injury.  There are a number of studies that show increased bone density but few that show fracture risk.  Dr. Neustadt also recommends the stork exercise, where you stand on one foot while brushing your teeth.  You stand on one leg while brushing your bottom teeth and then switch feet and brush your top teeth.  He likes the vibration plates. He does not feel that Osteostrong has enough research to support it, though theoretically it makes sense.

34:20  Diet for Bone Health.  Dr. Neustadt does not feel that consuming milk and dairy are necessary to having healthy bones.  A lot of people have immune reactions to dairy and they can become phlegmy and congested.  A lot of people have a difficult time digesting dairy and they could be lactose intolerant.  Yes, consuming calcium in the diet is important, but milk is not necessary. Sardines are one of the best sources of calcium and almonds and swiss chard are good non-dairy sources of calcium.  It’s the overall dietary eating pattern that is the most important factor and not just one food that is eaten.  The Mediterranean-style of diet is best and has been studied for over 70 years and shows a 20% reduction in hip fracture, the most dangerous type of fracture.  While eating a more plant forward diet is healthy, eating an alkaline forming diet will not make much difference because this concept that eating an acidic diet will pull calcium from the bones has been pretty much debunked as a valid concept. 


Dr. John Neustadt is a Naturopathic doctor and he has published over 100 research review articles and four books, the most recent of which is Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis in 2022. He is also the founder and President of Nutritional Biochemistry Inc. (NBI) and NBI Pharmaceuticals. The website is NBIHealth.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.



Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field, to bring you the latest in cutting edge health information.  Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more check out my website, DrWeitz.com. Thanks for joining me and let’s jump into the podcast.

                                                Hello, Rational Wellness listeners. Our topic for today is osteoporosis and what we can do to prevent and reverse it, with Dr. John Neustadt.  Osteoporosis literally means porous bones, and it refers to a condition in which the bones become fragile and the risk of fracture is increased.  In fact, according to the National Osteoporosis Foundation, 1 out of 2 women and 1 out of 4 men over the age of 50 will break a bone due to osteoporosis. And that’s actually, I think an older statistic, so it’s probably worse now.  The most common sites of fracture are at the hip, the spine, and the wrist. If you have osteoporosis and you break your hip, there is up to a 40% chance that you’ll actually die within the next year.  When you look at a bone density scan, if there is a T-score of -2.5 or worse, this is generally defined as osteoporosis and a T-score of -1 to -2.5 is termed osteopenia, which is a loss of bone though not as severe as osteoporosis.  As I understand it, the way we should understand osteoporosis is that throughout our lives we have a balance of both cells that build new bone, osteoblasts, and cells that clear out old junky bone, osteoclasts.  When we’re younger, there’s a tendency for the osteoblast to dominate over the osteoclast, and when we get older, there’s a tendency for the osteoclast to dominate over the osteoblast.

                                                Dr. John Neustadt is a naturopathic doctor, researcher and frequent speaker. He’s published over 100 research review articles and four books, the most recent of which is Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis, and he just published this last year. He’s also the founder and president of Nutritional Biochemistry Inc., and NBI Pharmaceuticals.  Dr. Neustadt, thank you so much for joining us.

Dr. Neustadt:                     Thank you for inviting me to share what I’ve learned with your audience. This is a topic that is near and dear to my heart that I’m very passionate about.

Dr. Weitz:                            Good, and near to your bones too. Why do you think we have such an epidemic of osteoporosis and osteopenia in the US?

Dr. Neustadt:                     Well, part of it is simply because we’re getting older. The average age in the United States is getting older, and in fact there are more people over the age of 65 now globally than there are younger than five. The baby boom generation is aging out, and this is a disease that commonly affects people as they get older.  About 80% of osteoporosis cases are in women and about 20% in men, and it’s through menopause and the 10 years after menopause when women have the fastest rate of bone loss. And so not surprisingly, as they get older, as we all get older, we’re at increased risk for osteoporosis.

Dr. Weitz:                            What do you think is the main reason why women are so much more at risk? Is it mainly because of the hormones or does it have to do with less muscle mass or?

Dr. Neustadt:                     So the current thinking is that it has to do directly with estrogen, and even maintaining bone health in men is due to the conversion of testosterone to estrogen. Men do have some estrogen, and we don’t get the declines in testosterone in men or the declines in estrogen in men that we see in women.  In estrogen is what’s called anabolic, it helps build bone but it’s more than that. As we get older, we’re all at higher risk for chronic diseases. One of the common causes of osteoporosis now in women is antidepressant medications. So the selective serotonin reuptake inhibitors like Prozac, SSRIs or SNRIs, anything that artificially increases serotonin. People probably know serotonin as the happy hormone and it helps elevate our mood.  But there are serotonin receptors in the cells in bones, and when we artificially raise that serotonin and increase it, what happens is it creates an imbalance, as you put it very well, where you get higher osteoclast activity, that is the bone breakdown is happening faster than we can build up new bone, and that’s because we’re artificially increasing the amount of serotonin in the bone.

                                                So there are secondary causes beyond just estrogen that are more common in people as they get older. Medications is one of them. Comorbidities, meaning other diseases, as we get older, people are more likely to have other diagnoses. Diseases that create chronic inflammation cause osteoporosis like autoimmune diseases or inflammatory bowel disease.  People, as we get older, are less likely to get a full night’s sleep, so have problems with insomnia, and that’s also been associated with poor bone health and poor outcomes in osteoporosis.  Chronic poor diet, 80% of women only get about… Or I should say the average American woman only gets about 800 milligrams of calcium per day from their diet, which is below the recommendation. And then all the other micronutrients found in fruits and vegetables, most people are not getting enough of that, not only just to maintain bone health over time, but also it puts people at risk for cardiovascular disease, dementia, and the list goes on and on.

                                                Muscle mass is an issue, not getting enough protein despite how popular the high-protein diets are. The US recommended amount of protein that the government thinks we should get as we get older is not adequate for maintaining muscle and bone.  In fact, research has shown if you’re just getting the amount of protein recommended by the government, you’re going to be losing muscle mass and losing about two to 4% of bone.   So it’s important that people have that foundation of diet. People have a sedentary lifestyle, they’re not exercising a lot. This is a chronic disease, it’s a chronic condition. So very rarely, like all chronic conditions, does it just boil down to one variable or one thing. There are risk factors for that, and it’s important to understand what those are and control what we can control to improve and grow stronger bones and reduce our fracture risk.

Dr. Weitz:                           What are some of the other common medications that also negatively affect bone?

Dr. Neustadt:                     One of the more popular ones are the acid-blocking medications. So proton pump inhibitors or PPIs, half of those in the US are prescribed for only one condition, which is reflux, acid reflux.  First of all, the FDA, all the way back in 2010, put out a warning that the PPI category of acid-blocking medications, the proton pump inhibitors like Prilosec, they damage bone and increase fracture risk. So we’ve known this for a long time. Subsequently, research has come out-

Dr. Weitz:                           And is that mainly because they block the absorption of calcium?

Dr. Neustadt:                     So it’s multifactorial. There are different issues. The mechanism of action, when you look at it, it is blocking calcium but it’s other minerals as well. People who are stopping their production of acid also then put themselves at risk for other deficiencies of other minerals like iron and magnesium and difficulty digesting and absorbing nutrients from their food, and put themselves at risk for dysbiosis and intestinal infections.  And so there are multiple ways that this can affect bone, and we do now know that there is a very strong gut-bone connection. The health of the intestine and chronic inflammation and gut dysbiosis, directly and indirectly affect bone. So if that’s not balanced, if that’s not healthy because you’re stopping the digestive process right where it begins in the stomach, then you’re stopping the acid from helping to sterilize the food, you’re stopping the acid from activating your natural digestive enzymes, then you’re creating a whole cascade of potential problems down the road, and osteoporosis is one of them.  We know now after four years of continually taking PPIs, there’s about a 60% increased risk in hip fracture. And with the SSRIs, the antidepressants, just briefly, we now know there’ve been multiple studies that have come out and looked at this, that it’s estimated now that for every 19 people taking an SSRI, we would expect one of them to break a bone.  And that’s just two of a very long list of medications. Anticonvulsant medication like Phenytoin, anti-inflammatories like glucocorticoids, prednisone, [inaudible].

Dr. Weitz:                            What about Neurontin? That’s an anticonvulsant medication that now is being used more and more commonly for pain, because doctors are trying to avoid using opioids.

Dr. Neustadt:                     Great question. I don’t know of any relationship of Neurontin and fractures, which is great to understand that it’s not all medications have been associated with bone damage and fractures. If you need to take a medication, even in the same class of medications, there often can be a safer one.   So for example, if you have to take an acid-blocking medication, it appears that the histamine-2 receptor antagonist or what’s called H2RA are safer than the PPIs. So it’s just a matter of education. There’s a whole chapter in my book called Medication Induced Osteoporosis looking at that topic, where people should take a look in your medicine cabinet because again, that could be one thing that you may… in your doctor, it’s often a blind spot. Conventionally doctors don’t know which medications they’re prescribing are actually damaging bone and increasing fractures.

Dr. Weitz:                            And if you listen to the podcast I just recently did with Dr. Steven Sandberg-Lewis on reflux, only about 20% of patients who have reflux actually have hyperchlorhydria.

Dr. Neustadt:                     I believe it, yeah. In fact, the problem might be people aren’t producing enough stomach acid. You may have talked about that. They may have hypochlorhydria and in fact, simple dietary changes may be effective. There are about five common foods that commonly cause acid reflux in people, citrus and raw onion and raw garlic, chocolate, coffee. And so just making some simple dietary changes, working with an integratively-minded or a nutritionally-minded doctor, like yourself or others, can actually go a long ways to helping people get off those medications.

Dr. Weitz:                           So how do we best detect and assess bone health?

Dr. Neustadt:                     That’s a great question. So the standard of care is doing a bone density test through a type of x-ray called a dual x-ray absorptiometry test, a DEXA test, and that detects the quantity of bone and that’s used to diagnose bone. You mentioned a T-score of -2.5 or lower being diagnostic of osteoporosis, that value is derived from that x-ray test, that DEXA test.  Now with any test, it’s only as helpful as it can predict fractures. And similar with any recommendation somebody’s going to give you, the question, the most important question… I go through in my book over and over like, here’s the questions to ask your doctor, these are the most important questions. When it comes to osteoporosis, the most important question is, okay, you’re recommending I do a test? Well, has it been validated? How well will it actually predict my fractures?

                                                Okay, now you’re recommending an intervention. You’re recommending I do something, whether it’s a medication or diet or extradite. How well has that been shown? Has it been shown even to reduce fractures, not just change a number on a test?  So that T-score, it’s a number on a test. It’s what we call a surrogate marker. Clinically, the most dangerous thing about osteoporosis is breaking a bone, as you put so well at the beginning of this podcast. And so a T-score, a bone density test, only predicts 44% of women who will break a bone and only 21% of men.  National associations that have looked at the body of the research at osteoporosis and fractures have correctly concluded that fracture risk depends on factors largely other than bone density. And people get so scared because too often they go to their doctor, they get their test result, and the only thing the doctor focuses on is that number on the test.

                                                And it is a scary diagnosis. And what I counsel people is take a breath, let’s put the test in its proper context. Fracture risk is largely dependent on things other than the bone density. It’s only one piece of the puzzle and only one small piece of the puzzle. Most of the things that you can do to reduce your fracture risk actually have nothing to do with a test.  And I know people love tests, they want to see the number spit out, they want the quantitative evaluation but that’s just not how fracture risk works. It’s largely due to other things. Now, bone density test is important because it’s one piece of the puzzle, but it should not be overemphasized.

Dr. Weitz:                            And as I understand it, there’s some issues with the testing that if the test is done properly, and my understanding is a lot of labs don’t necessarily put the patients in the exact same position. The hips need to be slightly rotated in 15 degrees. The knees are supposed to be bent, it’s supposed to flatten the spine. If all those things are not done properly, then you could get a different result.  If patient has scoliosis and they have a curvature, you’re not necessarily going to see the proper density of the spine. If they go to a different lab that uses a GE machine versus some other machine, you can get different results as well. Isn’t that right?

Dr. Neustadt:                     That’s all true. If they’re too thin or if they have arterial calcifications or if they’re obese, all of that. If they have bad arthritis in their spine, all of that can change results. If they’re taking strontium as a dietary supplement, that will create false bone density test results. And that is all true.  And so it’s important to go to the same testing center and ask for the same machine and getting that done repeatedly at the same place can be helpful for mitigating any of that variation that may occur.   And I think it goes back to the point I was mentioning earlier that it is a test, it’s a surrogate marker. I do believe people should get tested. That’s one piece of the puzzle. But exactly what you’re saying, there can be errors on the test. It shouldn’t be over relied upon. It’s just one piece of the puzzle.

Dr. Weitz:                           When we get to the part of the discussion where we talk about supplements, I’m going to challenge you a little bit about the strontium thing.

Dr. Neustadt:                     Sure, I love it.

Dr. Weitz:                           So are there any other tests that you feel are important for assessing bone health? Blood tests? Any other tests?

Dr. Neustadt:                     So there are. There are some tests that can be helpful for giving a general idea. You can get what’s called a CTX test. It’s a C-telopeptide test. It’s a breakdown product of collagen in bone. So bone is not just its minerals. A bone density test only measures the mineral component of bone. And so when you look at the tissue, bone is a tissue, it’s a complex mixture of different things. It’s not just the minerals. Minerals give the quantity to bone, but it’s the collagen or the proteins that give bone its quality in its ultimate strength.  So when CTX is high, it means you’re breaking down collagen and that’s been associated with increase in fracture risk and it is a marker that’s recommended for compliance with treatment to be tested for by the… The National Osteoporosis Foundation actually rebranded last year, it’s now the Bone Health and Osteoporosis Foundation. I’m on their corporate advisory round table and also the International Federation for Laboratory and Clinical Chemistry. So that’s one of the bone turnover markers.  But the challenge with the bone turnover markers is similar to the challenge… and I think even worse when it comes to what you mentioned with the bone density test. There is a lack of understanding among clinicians about when to test, how to test… The CTX and other bone turnover markers are very sensitive to changes.   If someone were to eat a few hours before, so they need to be done fasting. If they exercise within the 24 hours, if a woman is still getting her period, depending on the phase within her cycle, that can change the bone turnover markers. If you did break a bone, bone turnover markers can be elevated for up to year afterwards. There’s seasonal variation, summer versus winter.

                                                Again, there’s just limited utility to testing those. The biggest predictor, the most consistent predictor of fractures is gait or mobility. So how well does somebody walk? It’s called about a six-second walking test. Can they walk unaided? How fast can they walk for six meters?   Can you get up from a standing position from a chair without using your arms? Can you get up from the floor unassisted? What is your balance like? Can you stand on one leg for 20 seconds or 30 seconds?   Things like that are going to be more helpful in determining fracture risk because 95% of fractures occur because somebody falls. In terms of looking at bone quality, making sure that you’re taking things out of your life that are damaging bone. And feeding bone and giving bone as much of a leg up, so to speak, as much nutrients and lifestyle and the environment to flourish and to do its job, then you definitely can grow stronger bones. You can increase bone density, you can improve bone strength and quality.

Dr. Weitz:                            In terms of the medications that are available, the bisphosphonates are among the most popular but there’s some real issues with those. What’s your take on the current bone medications and are there any of them that you would prefer over others?

Dr. Neustadt:                     So the bottom line and the most important question, I alluded to previously, is have they been shown to reduce fractures? So there’s a chapter in my book on osteoporosis medications and questions for people to take to their doctors. So has a medication that’s being recommended been shown to reduce fractures in someone with my diagnosis and my medical history? So those are two important questions.  So when it comes to post-menopausal osteoporosis, which is the most common cause of osteoporosis, the question is have you broken a bone before with osteoporosis or have you not? And that’s important because not all medications are equally effective in both situations.  So what we know is that if you have not broken a bone before with osteoporosis, you have post-menopausal osteoporosis, you haven’t broken a bone since you’ve had the diagnosis, or around the time you got the diagnosis, none of the oral bisphosphonates are effective at reducing both vertebral and hip fracture risks.  They can be effective at reducing vertebral fracture risk, but that’s not the most dangerous type of fracture. It’s hip fractures which are the most dangerous.  So I’m not sure why any doctor would only want to reduce the risk of fracture in one area of the body and not the most dangerous types of fractures, not both areas.  The only bisphosphonate medication that’s been shown to do both for what’s called the primary fracture prevention, that is you haven’t had a fracture before, is intravenous Zometa. So that’s both hip fracture and vertebral fracture prevention. It is effective. None of the other medications are.  If you have already had an osteoporosis fracture, then the other medications are more effective. I’m not so thrilled with all of them as a category of medications though. I think that if you do want to take a medication, if there is a strong argument to take a medication, there are better medications.

                                                I mean, first of all, in order to get the benefits of a medication, you have to take it 70 to 80% of the time. For the oral bisphosphonates and any of the medications, you have to be taking it consistently for years. Up to 50 to 70% of people stop taking their osteoporosis medications within a year of being prescribed because of side effects, because of compliance issues.  And so it is a big commitment that people need to educate themselves about and say, okay, if I’m going to do this, I’m committing to it. And of course if there are side effects and there can be quite uncomfortable side effects with some of the medications, some people are going to want to discontinue them.  But in terms of fracture risk, there are more effective medications than the bisphosphonates. Prolia is better at reducing fractures in secondary osteoporosis for secondary fracture prevention for both the hip and the spine. Forteo also better at reducing fractures. The challenge is those are both by injection.

Dr. Weitz:                            And those are both drugs, my understanding is, that stimulate the osteoblasts versus suppressing the osteoclast as the bisphosphonates do.

Dr. Neustadt:                     Correct, correct. And so part of the challenge becomes, and some of the side effects with the bisphosphonates in terms of they can actually create… in a minority of patients, but it’s statistically significant, it does happen… They can actually create new bone that’s weaker, that increases somebody’s fracture risk because it’s… You’re correct… poisoning the osteoclast. And so the osteoclast isn’t breaking down old bone, which we need it to do.  There’s a phenomenon bone called bone remodeling, where you’ve got osteoclast breaking down old bone that’s been used up and osteoblasts that are building and creating new bone, and it’s that healthy balance that creates strong healthy bone. And so when you’re not getting the old worn out bone removed and you just get new bone put on there, it can actually create areas of the bone that are weaker.  And in fact, in a dynamic system, a living system, which is our bones, about every 10 years with the healthy bone remodeling, your bones are all brand new again. There’s bone turnover constantly happening.

Dr. Weitz:                            So that’s why we see some fractures of the femur and certain other fractures associated with some of these bisphosphonates.

Dr. Neustadt:                     Correct. And when it does happen, it actually is more difficult for the fracture to heal unfortunately. And that’s also why you end up seeing osteonecrosis of the jaw, which there is a risk also with Prolia of osteonecrosis the jaw as well. It’s a very small risk, but it is there. All the drugs have some risk.  So it’s a matter of educating ourselves about the potential risks and the potential benefits, and making the best decision possible. And that comes down to making sure you’re asking the right questions so you can get the right information in the full picture, so you can make an informed choice.

Dr. Weitz:                            Now when it comes to exercise, what do you recommend for preventing and reversing osteoporosis? And there’s an argument that’s been made that we really need some sort of high-impact exercise to really load the bone sufficiently to create improvements in bone strength.

Dr. Neustadt:                     So the challenge is that it would take about 7,000 patients to do a controlled clinical trial on exercise with the fracture risk as the outcome, and that just hasn’t been done.  So when you’re looking at loading the bone and DEXA scans and all of that, there are studies that have been showing that doing resistance training can improve bone density, but they haven’t looked at fracture risk as an outcome.  There was one study many years ago that looked at some exercises as an outcome. It was a small study and it gave four different exercises to women. One was doing some sit-ups, one was doing kind of superman move where they’re on their back and stretched out. The other was a combination. Two were sitting in chairs, two were lying down. The bottom line was the flexion exercises where they were doing sit-ups and putting that pressure on the front of their spine, they were at an increased risk for fractures.  So when it comes to fractures and osteoporosis, to me, it’s not just a question of should we do weightbearing exercise? Should we not do weight-bearing exercise? Weight-bearing exercise is important, but we can just use our body weight.  But it’s also a matter of doing it safely because even with weightbearing exercise, even with your own body weight, if you have osteoporosis, you can actually be increasing your risk for fractures.  And so there are different types of exercises that can be done safely and there are ways to move to improve balance and improve strength to reduce fractures by reducing your risk of falling. But you don’t have to necessarily go to a gym. Yoga is great, but if you’ve got osteoporosis and you do certain moves in yoga, it can put a lot of pressure on your pelvis and potentially increase your risk for fractures down there. So it’s not a one-size-fits-all type of answer.

Dr. Weitz:                            Yeah, there was a study… I forgot the name of it, I was trying to come up with it. I think it was an Australian study that showed an improvement in bone density and one of the exercises, I think it involved maybe deadlifts and a couple of exercises like that and it involved them jumping up and onto a pull-up bar and then dropping down. So it added what might be seen as maybe a safer way of having some ballistic impact.  

Dr. Neustadt:                     That’s fascinating and I love that. I’d love to see that study. So this is where my mind goes when I hear that. So I would say, I would ask the questions, well, who is included in that study? Did they have osteoporosis already? Did they have a history of a fracture? It depends on their fracture risk if that could be safe for them or not.  The other thing I would say is, that’s great if it’s safe to do for somebody and somebody’s interested in doing it. What I’ve learned is that if it doesn’t interest people, these are like taking the medications to get the benefits from exercise, it’s something that needs to be part of somebody’s life. It’s longterm, it’s not a one-and-done kind of thing.  So I like to meet people where they’re at and say, look, you don’t have to go into a gym. It’s okay if you don’t like that. There’s tons of other things that you can do. Just going for a walk, walking 7,000 to 7,500 steps a day. Multiple studies have shown that’s been associated with the reduction in all-cause mortality of 50 to 70%, which is amazing. That includes death from all causes, including osteoporosis.

                                                I also love teaching the stork exercise, which is, you stand on one foot while you brush your bottom teeth for about a minute. If you need to steady yourself by holding the sink with one hand you can, and then when you switch to the top teeth, you switch legs and you do that twice a day. And even that will start working a little bit of your core, a little bit of your legs, your balance muscles, help improve your balance.  Park further away from the entrance to the store, take the stairs instead of the escalator or elevator. It’s all cumulative. Gardening can be phenomenal. So if you love going to the gym, I’m all for it. I just think it’s really important if you have osteoporosis or you want to do Pilates or you want to do yoga, whatever it is, that you make sure that you’re working with somebody who understands how to do it safely with somebody who has osteoporosis.

Dr. Weitz:                            What do you think about OsteoStrong?

Dr. Neustadt:                     I get that question a lot, it’s become very popular. So I met with one of the franchise owners a while ago and I asked for the studies and I looked at it.

Dr. Weitz:                           Is it John Jaquish?

Dr. Neustadt:                     I don’t remember. It was just a local, one of the local ones here that was [inaudible]-

Dr. Weitz:                           Oh, okay.

Dr. Neustadt:                     … I can’t remember his name. And what I learned at the time, so similar to many studies out there, there’s no fracture outcome data. So there are some studies showing improvement in bone density. But I do believe that the vibrational plate… And again, anything that can improve balance and working on a vibrational plate and they’ve got exercises where you’re strengthening muscles, I’ve got to believe it’s helpful, it’s good for you. So I don’t have a problem with it.

Dr. Weitz:                           Yeah, OsteoStrong is based on this concept that supposedly they can load your bones to something like 200 times your body weight or something.

Dr. Neustadt:                     And theoretically it sounds amazing. I think the concept is sound and it makes sense. Again, I ask the question, has it been shown in studies to reduce fractures. Now if there’s a lack of data… There’s a saying that a lack of evidence does not mean that that is evidence that it’s ineffective. It just means maybe it hasn’t been studied. It’s very expensive to do a study with fractures as an outcome. It’s much easier to do a study and less expensive where you’re just looking at a test result from a bone density test or a blood test. It’s cheaper and faster to do.  But that said, then I look at, we want to ask the question, well, does it actually make sense? So yes, if you’re reducing somebody’s risk of falling, you’re reducing their risk of fractures. And if you’re loading the bone and you’re improving bone density, that all sounds like great stuff.

Dr. Weitz:                            Yeah, from my perspective, I think it’s important that the exercise must A, load the bones in some significant manner. So there’s got to be some weight involved and it can’t be super light. B, there’s got to be some balance training involved, and you’ve got to make sure you’re strengthening the legs, which is what helps right you and reduces your risk of falling.

Dr. Neustadt:                     So I am in love with a new exercise that my wife Romy actually discovered, and she said I got to come with her to do these classes. It’s called Pvolve, and it started in LA. Kind of up in your neck of the woods, so I don’t know if you’ve heard of it. It’s a studio-based class, I do have some online classes, but the studio, I get a better workout. It’s amazing.  It’s functional training, and it’s working the muscles in your hips and your legs, your internal rotators and external rotators. And it’s resistance and it is flexibility and it’s strength and it is one of the best workouts that I’ve ever gotten in a class. And it can be done in a way that’s safe for, I believe almost anyone. Phenomenal.

Dr. Weitz:                           So what’s the most effective type of diet for improving bone density? Should we be consuming milk or dairy?

Dr. Neustadt:                     So milk and dairy are not necessary. So it’s really about-

Dr. Weitz:                           Are they bad, are they good, are they neutral? What’s the story on milk?

Dr. Neustadt:                     So I have a blog about dairy and milk and I think it’s called What’s in your Milk, or It’s Time to Ditch Dairy. I’m not a fan, I avoid it, I rarely eat it. Yes, I’ll have a little cheese now and then, every once in a while I’ll have a little ice cream, but you don’t have to consume dairy in order to have strong bones.  And it comes down to what I mentioned before, it’s the overall pattern. Just saying, okay, eat this one food and you’re going to have strong bones, that’s not reality. That’s not how the body works, it’s somebody’s overall dietary pattern.  I’m not a fan of dairy because a lot of people have immune reactions to dairy. They can become phlegmy and congested. Some people have a hard time digesting dairy, they could be lactose intolerant. But also in dairy, it’s a cocktail of hormones that’s from pregnant cows, and you’re putting those hormones in your body.  And research has shown there are a lot of other contaminants also that could be in dairy, including viruses and including other chemicals that accumulate in the dairy. And from a nutritional standpoint, it’s just not necessary.

                                                Yes, consuming calcium and having calcium as part of your diet is fantastic, but there are other amazing ways to get it that also give you other healthy nutrients. Sardines is one of the best ways to get it.  In fact, there’s a blog I have which are the top 10 non-dairy sources of calcium. Almonds and Swiss chard, there are lots of non-dairy sources of calcium, but it’s the overall dietary pattern that is most important.  And the research is clear that it’s the Mediterranean-style diet. It’s been studied for over 70 years. I’ve never seen any negative studies on it. It’s been shown to reduce the risk for osteoporosis, cancer, death from cancer, all-cause mortality, diabetes, obesity, dementia. I mean, the list just goes on and on and on.  And that’s primarily a plant-forward diet. In my chapter on diet, I walk people through how to transition into eating this way, making sure they’re getting enough plants and making sure they’re getting enough protein, which I mentioned before, how important protein is.  But that way of eating, that pattern of eating, has been associated with about a 20% reduction in hip fracture, the most dangerous type of fracture and better bone density. So that is the diet that has been shown to be the dietary pattern most effective. And it’s not a diet like, oh, I’m going on this fad weight-loss diet. This is really understanding and learning how you can eat to promote your health for the rest of your life.

Dr. Weitz:                            What about the concept of an alkaline-forming diet or acidic diet, does that make much difference? It’s a common thought out there that if you have a diet that’s more acidic, then the body’s going to pull calcium from the bones to alkalinize the system.

Dr. Neustadt:                     Nope. I mean, again, it’s the overall dietary pattern. If all you’re eating is… acid foods tend to be more animal proteins. And so if you’re eating just primarily an animal-type diet, you’re not getting the other nutrients required to feed your bones, you’re setting yourself for a problem. But is it because of the acid? There’s lots of studies that have been done, and it’s been debunked.  Now where it’s important to understand is if you’re eating a more alkaline diet or more balanced diet, you’re eating a more plant-forward diet, you’ll be eating more of that Mediterranean-style diet.  But again, it’s a complex condition and it’s a complex issue… It’s a chronic issue. So boiling it down to just one element of the diet, say, oh, it’s the pH of the diet, that’s the golden nugget of information that we all have to focus on. That’s just not how the body works, nor is it what’s supported by the research. It’s the overall dietary pattern.

Dr. Weitz:                            So let’s get into nutritional supplements for bone health, and I guess maybe we should start with vitamin D.

Dr. Neustadt:                     Okay, you got a specific question or do you want me to just go for it?

Dr. Weitz:                            We know vitamin D is super important, vitamin D is responsible for taking the calcium and bringing it to the bones. There’s some question as to what’s the ideal level of vitamin D we want in the body? What are your thoughts about this?   There’s the normal level which is over 30. There’s the moderate optimal range, 50 to 70. Some doctors like pushing it higher than that. What do you think is optimal for patients who want to have the best bone health?

Dr. Neustadt:                     Love it. Great setup. So first of all, I want to frame it with the most fundamental question when it comes to bone health and osteoporosis. Has vitamin D been shown to reduce fractures? If it hasn’t, that’ll change how I want to discuss it.  And the answer is yes. Calcium and vitamin D have been shown to reduce fractures. Now you asked the perfect question, what’s the optimal level of vitamin D for fracture reduction? What the researchers show is a vitamin D level between 30 and 44 nanograms per milliliter… That’s the units that are used in the United States. Canada and Europe, it’s different units… but 30 to 44 nanograms per milliliter is associated with the biggest reduction in hip fracture risk and the biggest reduction in fall risk, about 20% reduction in hip fracture risk.

                                                Now interestingly, back to that bone density study or bone density story, when you get to a level of vitamin D from nine to 30, nine to just below 30, right around that range, you see improvements in bone density, but they don’t find the reduction in fractures until you get higher than that. That 30 or 33 to 40 nanograms per milliliter range, that’s for bones.  You mentioned a higher level, 50 to 70. Now we’re getting more into immune system health and what the research shows is healthy for immune system. Vitamin D activates over 200 genes in the body. It has an incredible amount of activities in the body, beyond just helping with bone health or regulating calcium absorption.    And so for immune system function, the research does support at 50 or higher in terms of a blood level. I do recommend people get their vitamin D tested and track it that way.

                                                So vitamin D with calcium is the combination shown to work. Calcium by itself has not been. And when you look at the combination of calcium and vitamin D together, it’s associated and in clinical trials been shown to reduce fractures by about 18 to 23%. That’s supplemental calcium, supplementing. The US RDA for calcium is 1,200 to 1,500 milligrams per day.  And when people look at the recommendation from the government, the recommended daily allowance, that’s from all sorts of diet and dietary supplement. The average American woman consumes about 800 milligrams of calcium in her diet. So maybe supplementing if you need it with 400 milligrams, maybe a little bit more of calcium is appropriate to get you in that range.

Dr. Weitz:                            Some patients are afraid to take calcium, or a few studies that showed that calcium would increase heart disease. Some patients go to the doctor and he measures the serum calcium level and he says, “Well, you don’t need more calcium.”  What form of calcium do you recommend? Does it matter? Should it be calcium citrate, hydroxyapatite, carbonate? What form of calcium is best? Is calcium safe? Does it increase the risk of heart disease?

Dr. Neustadt:                     Great question. So the majority of the studies have done use calcium carbonate, which is a very poorly absorbed form of calcium, and you actually need stomach acid to break that apart.  So a mineral when you take it as a supplement, is not just a mineral, it’s connected to a carrier molecule carbonate in this instant, or citrate or malate. I believe you mentioned both of those as well. Those are the different forms that calcium can come in in supplements.  And what happens is as people get older, they’re at greater risk for having low stomach acid. And then if there are autoimmune conditions or if they’re taking acid-blocking medications, their stomach acid is going to be lower as well, they’re not going to be producing enough.  So your ability to actually digest and absorb the calcium from calcium carbonate is compromised. There is no indication that one form of calcium is better than another when it comes to reducing fractures. Zero. Zero evidence that one form is better than another.  I personally prefer the calcium citrate form because you don’t need stomach acid to be present in order to break that apart and absorb it. You actually absorb it in the small intestines and it disassociates. When there’s less stomach acid present, you can still absorb it. So that’s why I prefer calcium citrate. It also is relatively inexpensive to buy on the market and as a commodity in dietary supplements. And the reality is hydroxyapatite, coral calcium, whatever it is, there is zero indication that one is better than the other for reducing fractures.

Dr. Weitz:                            So how many times a day? With meals? At night? How do you like patients to supplement their calcium?

Dr. Neustadt:                     So the research points to the ability to absorb about 500 milligrams of calcium per serving at a time. So I personally, if you’re just taking calcium and vitamin D and all you need is 200 milligrams or 400 milligrams, you could take it once a day. You can spread it out twice a day. I think it’s personal preference.   This kind of segues into a conversation about the safety, is one way of taking it safer than the other? There’s no indication of that. Currently, the Bone Health and Osteoporosis Foundation and the American College for Preventative Cardiology have the position statement, having looked at all the research, that as long as somebody is not getting more than the safe upper limit of calcium as set by the National Academies of Medicine from all sources, diet and dietary supplements… And that amount is 2,000 to 2,500 milligrams per day of calcium.

                                                As long as people aren’t getting more than that, that it is considered safe from a cardiovascular standpoint. And there are studies, cohort studies and clinical trials, that have shown taking up to 1,000 milligrams per day has no effect on cardiovascular disease outcomes, and that means heart attacks.  So I think that the current state of knowledge right now is taking up to 1,000 milligrams is safe, but the reality is most people don’t need that amount. Most people only need maybe 400 milligrams of calcium.

Dr. Weitz:                            How do you decide how much calcium someone should take?

Dr. Neustadt:                     I look at their diet. In my book in the section on calcium or in my book, the chapter on diet, it talks about calcium, and then there’s in the appendix, a list of calcium-containing foods in helping people transition into eating this healthy way, this Mediterranean style. This osteoporosis-type diet that I teach and have walked thousands and thousands of patients through transitioning into.  I ask people don’t make any changes for a couple of days because first of all, you don’t want to make any huge changes overnight because those tend not to be sustainable, and just write down what you’re eating for a couple of days. People tend to eat the same foods day in and day out.  So just make a list without making any changes and then try an estimate. It doesn’t have to be perfect. It’s not an exact science. How many milligrams of calcium are you’re getting? How many grams of total fiber, how many grams of protein? And that’ll give you kind of a general idea. It’s not an exact science. People don’t have to be super particular about it. Get a general idea.

Dr. Weitz:                           With meals? In between meals? At night? Is there a best time to take your calcium?

Dr. Neustadt:                     I want to step back for a second because it’s really a question for me of what else is there in the formula? So if there’s vitamin D in the formula, then you want to be taking it with food because vitamin D is fat-soluble. So the fat-soluble vitamins like vitamin E, vitamin A, vitamin D, vitamin K, those are fat-soluble and those are absorbed better when there’s some fat there. And so you want to take that with meals because they’re probably going to be some fat with your meal. Plus it’s a good way to remember, it’s like I’m sitting down to my meal, create a habit around taking your supplements. It’ll just be easier to remember that way.

Dr. Weitz:                           Okay, let’s get into vitamin K.

Dr. Neustadt:                     Okay. I’ve loved the research on it.

Dr. Weitz:                           We’ve learned in recent years the importance of vitamin K, because vitamin K seems to reduce the potential for arterial calcification. It’s one criticism of some of the studies that seem to show that calcium might be a problem in terms of increasing heart disease risks that they didn’t include vitamin K.

Dr. Neustadt:                     So vitamin K is a phenomenal topic. So let me just start a little bit of the big picture because when people talk about vitamin K, they tend to think of it as just one thing, and that’s not the case. Vitamin K is a category, so there’s different-

Dr. Weitz:                           Right. So there’s K1, K2, MK4, MK7… I did a whole podcast on vitamin K actually.

Dr. Neustadt:                     Oh, phenomenal. It’s going to be fun talking to you about this then because you’re obviously up on the research. So the vitamin K1 and vitamin K2 are the two sort of big categories. Vitamin K1 is in plants, green leafy vegetables, and there is an association with a diet of eating more green leafy vegetables and a reduction in osteoporosis and fracture risk.  And then with vitamin K2, there are subtypes of vitamin K2. The most popular ones that you see in dietary supplements are MK7 and MK4. They’re designated by those numbers, but they are different molecules, they have different names, they have different chemical structures. They have similar effects in the body, it’s been shown, but they also have different effects in the body.  And when you look at outcomes trials, when you look at fractures, the only form of vitamin K2… the MK4, MK7… that’s ever been shown in any clinical trials to maintain or improve bone density, but most important, maintain strong bones as indicated by fewer fractures in clinical trials. The only form of vitamin K2 shown to do that is MK4, 45 milligrams a day.  In fact, if you do a search for MK7 on the National Library of Medicine database and you look for MK7 and osteoporosis, MK7 and fractures, and you look at all the clinical trials… there were only a few… there are no outcome study of MK7 fractures showing that it reduces fractures.  But even when it comes to bone density, the research shows those clinical trials in the National Library of Medicine database show that it only slows how fast somebody loses bone. It hasn’t been shown to actually increase bone density, but most importantly, it’s never been shown to reduce fractures. Only MK4, only in the amount of 45 milligrams per day.

                                                And it’s been so well studied that since 1995, it’s been approved by the Ministry of Health in Japan for bone health. And as a full disclosure, that’s why, because of that research and the decades of clinical trials, over 7,000 volunteers in clinical trials lasting for years, that I created my products. I needed it for my patients. Osteo-K and Osteo-K minis that have the clinical dose of MK4 in it, shown then to promote healthy bone density and maintain strong bones with calcium and vitamin D in those products.  So I don’t use the MK7 because it hasn’t been shown to work for the most important thing that we want to try and help when it comes to bone, which is maintaining strong bones.

Dr. Weitz:                            I think one of the issues with vitamin MK7 is it’s 100 times more expensive, and there’s more marketing behind it, and it seems to stick around in the bloodstream longer. It has a longer half-life. So they market it as being more effective because it lasts longer in the bloodstream, but the mere fact that it lasts longer in the bloodstream doesn’t necessarily mean that it’s being absorbed into the tissues. In fact, it may mean that it’s not getting absorbed into the tissues and it’s still sticking around in the bloodstream.

Dr. Neustadt:                     You’re exactly right. I mean, looking at just because it’s in the bloodstream, again, that’s not clinically the most important thing. That’s another surrogate marker. It’s just a number on a test. And our body has the machinery to actually create MK4 in small amounts. So MK7 is not produced produced by humans, it’s produced by bacteria, and when it’s absorbed in the body, the physiologically active form that accumulates in tissues around the body, the brain, the testes, the pancreas, the intestines, the breast, throughout the body, the form of vitamin K that accumulates is MK, which also points-

Dr. Weitz:                           The one exception is the liver. Apparently the liver stores vitamin K as MK7.

Dr. Neustadt:                     I’m not familiar with that. I will have to take a look at that, that’s not my understanding.

Dr. Weitz:                           But I think all the other tissues store the vitamin K, and if you consume K1 from green leafy vegetables, it ends up getting converted and stored in most of the tissues as MK4.

Dr. Neustadt:                     Well, and the reality also is, okay, what about clinical trials? That’s great, and that can give you some clues about where is it helpful. When you’re talking about liver health, there are no outcome trials with MK7 in liver health. There are outcome studies with MK4 in liver health.  There’s a published clinical trial, I believe it was published in the Journal of American Medical Association, looking at people who had hepatitis C. Hepatitis C increases somebody’s risk for liver cancer. When they took the MK4, 45 milligrams per day in this clinical trial, it significantly reduced the risk that it would go on and progress to liver cancer. And so we have outcomes data for liver health.  Look, it’s a dietary supplement. So I need to say that it’s not approved by the FDA, it’s not a drug. It’s not approved to diagnose, treat, cure, or prevent any disease.

                                                I’m talking about the research on this nutrient. It’s been shown to powerfully promote health in different areas of the body. Similarly, when it comes to bone health, bone is more than just minerals and collagen. Our bone also produces platelets for healthy blood clotting, our red blood cells and our white blood cells.  MK4 has been used in up to phase II clinical trials in people with acute myeloid leukemia and myelodysplastic syndrome and shown to promote healthy platelet production, kill blast cells… Those are the cancerous or pre-cancerous cells in blood… without harming healthy cells and improve red blood cells, numbers on tests.  So those are up to phase II clinical trials. Again, it’s not a drug. It’s not approved to treat any of those things, but MK7 has not been shown to have any of those health benefits either.

Dr. Weitz:                            Now, most experts on osteoporosis recommend consuming magnesium along with the calcium, is often recommended that you take them in a 2:1 ratio, but I understand from talking to you previously that you don’t feel that there’s enough data to justify magnesium.

Dr. Neustadt:                     So I keep asking, I’ve been asking… I’ve been doing this for nearly 20 years now… please send me studies that I can review that shows why this is actually important, not just a theoretical consideration.  Now, I love magnesium, don’t get me wrong. Magnesium is important. It has many different activities in the body, it’s a phenomenal nutrient. Magnesium has never been shown to reduce fractures.  And in the clinical trials using MK4, 45 milligrams per day for bone health, the only other nutrients that were given were calcium and vitamin D to get that over 70% reduction in fractures in those volunteers, they didn’t use magnesium.  Now, don’t get me wrong, I love magnesium and some people should probably supplement it, but there are no clinical data. There are no outcomes studies showing that it’s actually required when it comes to this goal of maintaining strong bones. To take it required, I’m talking about taking it as a dietary supplement, nor is there any indication that it has to be taken in a specific ratio.

Dr. Weitz:                            Okay. Strontium. So I know you’re not a believer of strontium and-

Dr. Neustadt:                      No, I am a believer in strontium. No, no, no. I am a believer in it. There is research on it. I just don’t recommend it for different reasons. When I say I’m a believer in it, what’s the most important question? The question is, has strontium been shown to reduce fractures? The answer is yes, I believe in that. That is good research, but that’s on strontium ranelate.  Strontium ranelate is a medication that was approved in Europe for osteoporosis. It’s not available in the US. It was actually taken off the market in Europe because of risks and health concerns. In the US is strontium citrate. There are no clinical trials on strontium citrate, either outcome studies or safety studies. And so I just want to be honest about what the research shows.  Strontium citrate may be helpful. It may reduce fractures the same as strontium ranelate. We just don’t have the data supporting it, the data doesn’t exist. Now, that’s just an honest assessment of the research. With strontium citrate… Or if you looked at the research on strontium ranelate, there are six large clinical trials on strontium ranelate in Europe. Five of the six studies showed that it only reduced vertebral fractures. It didn’t reduce hip fractures. Only one study showed hip fracture reduction and the studies that showed vertebral fracture reduction, it was about 45%. So similar to Fosamax.  And so it gives false bone density test results. It competes with calcium for absorption, so you can’t take it at the same time. There’s some safety concerns potentially around strontium that it may increase the risk for blood clots that can cause heart attacks and strokes. And for those reasons, that’s why I don’t typically recommend it.

Dr. Weitz:                           Another nutrient that you don’t recommend is boron?

Dr. Neustadt:                     Correct.

Dr. Weitz:                           So boron has been shown to prevent bone loss. It’s been shown to slow down the activation of the enzyme that breaks down estrogen and testosterone. Boron seems to have a lot of benefits. It’s even been shown to be beneficial for osteoarthritis. It seems to make sense to add boron to the mix for osteoporosis prevention or reversal.

Dr. Neustadt:                     So here’s my philosophy on which I base formulate. Has it been shown… I’m going to sound like a broken record. Has it been shown to reduce fractures? No, it hasn’t. Does it mean it’s unimportant? No, it has important physiological functions. But when somebody comes to me and says, “Doc, I have a diagnosis of osteoporosis,” or, “I have this, what can I do nutritionally to help?” Hopefully people aren’t just taking one dietary supplement. This is a holistic approach with diet and exercise.  So I’m looking at what are the clinical trials shown to promote bone density, but more importantly than that, reduce fractures. Now, most people also are likely going to be looking at a multivitamin and mineral formula. Well, a good formula is going to have some boron in it. It’s just a trace mineral, you don’t need a lot. Right?   But even when we’re talking about whether you should take it or shouldn’t take it, the study showing more than 70% reduction in fractures with the MK4, didn’t use boron. It wasn’t there, it’s not necessary.  If we get a little boron, can we get that up to 75 or 80%? I don’t know. It’s theoretical, but you’re going to be getting boron trace. If you’re eating a plant-forward diet, that’s where it’s found. You’re going to be getting those trace minerals. You’re going to be getting enough vitamin C. You’re going to be getting enough boron and then supplement with a good multivitamin mineral formula if you want a little bit of an insurance policy. But when it comes to bone health, I’m very focused on what can we do to reduce people’s risks of breaking a bone, and based on clinical trials.

Dr. Weitz:                           And since bone is built on a matrix of collagen, does it make sense to add collagen to the supplements?

Dr. Neustadt:                     It’s not my first line. There are no outcome studies looking at collagen and fractures. There’s one study looking at collagen and CTX where somebody took supplemental collagen or volunteers did, and their CTX… that’s that laboratory marker I talked about earlier… did significantly decrease. And maybe there’s also rationale for taking melatonin. There was a study in osteopenia that looked at melatonin, a dose-response study where one or three milligrams and taking three milligrams of melatonin also improved bone density if somebody’s having a difficult time sleeping.  But those are not my first line. I think, yes, if you want to be more aggressive, collagen may be good to take. But also, I think more importantly than that is getting the nutrients from food, eating enough protein, making sure you’re getting an adequate amount of dietary protein, to me, is more important than taking the supplement.

Dr. Weitz:                           Okay. Have you looked into any of the peptides?

Dr. Neustadt:                     I have not.

Dr. Weitz:                           Okay. All right. I think those are the questions. Any final thoughts you want to leave our listeners and viewers about bone health, osteoporosis?

Dr. Neustadt:                     Yeah. The first thing is it’s a scary diagnosis for sure, and it is a serious situation. But when somebody gets the diagnosis of osteoporosis, just to take a deep breath and realize this isn’t an emergency, that I have time to educate myself so I can make the best decisions for me. I have time to put together a holistic plan for myself, which is what my book Fracture-Proof Your Bones does. It walks people through how to create a holistic plan for themselves.   And so that’s the take-home message, that it’s not just about a number on a test, it’s what can you do to reduce your risk for fractures? What can you do to actually maintain strong bones and improve your bone strength?          And take a deep breath. There’s time to educate yourself, get the resources together so you feel comfortable that you’re not being pressured into making a decision to taking a drug, or doing something that you’re not really sure that you want to be doing.

Dr. Weitz:                           How can listeners find out about your products?

Dr. Neustadt:                     They can find everything on the website, NBIHealth.com… NBIHealth.com. There are links also to all the research studies. There’s a blog on there on MK4 or MK7. What’s better for bones? There’s blogs on diet and exercise. My products that I formulated for my patients, this all started back in my medical clinic because I needed the dose in combination of nutrients shown in clinical trials to work for my patients, and they didn’t exist.  So I created the company to provide those products to my patients. And now we’ve shipped into over 35 countries around the world. So NBIHealth.com is where they can find that information and they can reach me through there as well. And also all our links to social media are on the website.

Dr. Weitz:                           Okay. Sounds good. Excellent. Thank you, doctor.

Dr. Neustadt:                     Thank you.

Dr. Weitz:                            Okay. Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way more people will discover the Rational Wellness Podcast.  And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions. Or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective.   So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.


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