Osteoporosis with Dr. Lani Simpson: Rational Wellness Podcast 355
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Dr. Lani Simpson discusses How to Test for and Manage Osteoporosis with Dr. Ben Weitz.
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Podcast Highlights
5:01 Osteoporosis. We are seeing more osteoporosis among younger people today due to the fact that so many people in the US are eating an unhealthy diet and are leading a sedentary lifestyle. The bone density scan is a good way to diagnose osteoporosis but people rarely get one early enough. Ideally it would be a good idea to get a bone density on women who are at risk before menopause. That might help them to decide whether or not to go on hormones. Any patient who is at risk for osteoporosis, such as that they are small and thin or smoke or drink alcohol, should have their bone density measured.
8:16 Trabecular bone score. Dr. Simpson explains that with the bone density scan, we should also have the trabecular bone score test done, if the lab offers it, which can give us a sense of how resilient the bones are, which can better help to determine fracture risk, which is really what we should be focused on. Dr. Simpson has osteoporosis, but she has a good trabecular bone score, which is why she has not had a fracture yet.
11:42 Bone density test. A DEXA (dual-energy X-ray absorptiometry) scan reports on the hip and the spine and sometimes also the forearm. It measures our bone density as compared to an average 30 year old, which is the T score. Peak bone mass typically occurs at around age 30. It would be ideal to be eating a healthy diet and doing weight training during our teenage years as we are increasing our bone mass. One bone density test does not tell us whether we are actively losing bone mass. We need to compare tests to see if there is a trend.
Dr. Lani Simpson is a Doctor of Chiropractic who has established herself as an expert at bone health and women’s health over the last 35 years. She is a Certified Clinical Densitometrist, which means she is an expert at reading bone density tests, and she was the first alternative doctor to be awarded this certification. She produced Down to the Bone, a CEU course for practitioners and she has been presenting the Heat is on, Menopause and PMS seminars for chiropractors, acupuncturists, and other practitioners for the last 35 years as well. She is the cofounder of the East Bay Menopause and PMS center and of the East Bay Osteoporosis Diagnostic Center. Her website is LaniSimpson.com. Dr. Simpson will be teaching an advanced course on Osteoporosis starting on April 20, 2024: Ultimate Osteoporosis Course.
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.
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. To learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.
Hello, Rational Wellness podcasters. Our topic for today is osteoporosis; how to diagnose it and how to manage it with Dr. Lani Simpson. Osteoporosis literally means porous bones and it refers to a condition in which the bones become fragile and the risk of fractures increased. According to the National Osteoporosis Foundation, one out of two women and one out of four men over the age of 50 will break a bone due to osteoporosis. What’s actually worse, and that’s actually, I think, an older statistic, so it’s probably worse now. The most common sites of fracture are the hip, the spine, and the wrist. If you have osteoporosis and you break your hip, there’s up to a 40% chance that you’ll die within the next year. When you look at a bone density scan, if there’s a T score of minus 2.5 or worse, this is generally defined as osteoporosis, and a T score of one to minus 2.4 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 osteoblasts to dominate over the osteoclasts and when we get older, there’s a tendency for the osteoclasts to dominate over the osteoblasts.
Dr. Lani Simpson is a doctor of chiropractic who has established herself as an expert in bone health and women’s health over the last 35 years. She’s a certified clinical densitometrist, which means she’s an expert at reading bone density tests and she was the first alternative doctor, meaning non-MD to be awarded this certification. She produced the Down to the BONE course for practitioners and she’s been presenting The Heat is On: Menopause & PMS seminars for chiropractors, acupuncturists, and other practitioners for the last 35 years. She’s the co-founder of the East Bay Menopause and PMS Center and of the East Bay Osteoporosis Diagnostic Center. Most importantly for us, Dr. Simpson is the most knowledgeable doctor I know about bone health and osteoporosis. Dr. Simpson, thank you so much for joining us.
Dr. Simpson: Thank you for having me. I always enjoy talking about bones with you.
Dr. Weitz: Let’s pick some bones. Let’s start right in with, how do we test and diagnose our bone health and when should such testing occur?
Dr. Simpson: A lot of times what happens in the alternative world is, someone will come into a doctor’s office with a bone density test. What they have is the report. In the 90s, the first bone density machine came on board. In fact, I had one in 1990, I don’t know, 1994, 1995. You didn’t hear as much about osteoporosis until then. Prior to that, there was a way to test bone density, but it wasn’t good. But at that time also, there wasn’t any way to treat it. The nursing homes were full of people who had broken hips, mostly women. But one fourth of all hip fractures also occur in men. Men, by the way, don’t come back from that as well as women do. But when we hear that statistic that you said about 40% don’t make it after they get a hip fracture. That’s probably much older people. If we really looked at what the age range is, if somebody’s 60 or 70, in pretty good health fractures their hip, they’ll probably do okay. But those that aren’t, they’re doing the horrible diets. They’re not eating well. You and I know about that. We talk about it.
Dr. Weitz: That’s the typical American.
Dr. Simpson: Yeah. So we are seeing more osteoporosis and I really, really am concerned for the 30-somethings. My kid is 32, no, 33. I’m concerned about that generation. They’ve been the kids that were on computers, not exercising, not getting impact. My kid rides a bike, but that’s not impact. The food, a lot of young people don’t cook anymore. This is true across the board, but with each generation, we see certain things that are just plain bone depleting habits and they’re not good. So obviously, preventing osteoporosis is one thing, but it’s quite another once you’ve been diagnosed. Can you reverse it? Frankly, I just have to say to everybody, if somebody says, “You can reverse osteoporosis. Just take my supplements,” run the other way. Who are we talking about? Some people have very advanced osteoporosis, but when people hear osteoporosis, they think, “Oh, it’s osteoporosis. They’ll treat it however.” An alternative doctor might go, “Here. Here’s the supplement.” Or, the knee jerk for medical doctors, “Here’s Fosamax.” Is it even the right medication? Is it the right sequence to give somebody Fosamax before, say, an anabolic that actually builds bone. So we really have to understand, who are we talking about. My bones aren’t your bones. To lump everybody together makes no sense. Then I’ll have a couple other pet peeves. You asked when should somebody get a bone density. You look at someone like me. I’m thin. That’s just who I am. I weigh 115 pounds wet. I’m five foot five. So thin people are at more risk. Now mind you, I’ve been an athlete all my life, so that’s been helpful to me. But you want to get a bone density on women who are at risk before menopause. Who’s at risk? Women. People who have a background of smoking, alcohol, doing that now. There’s so many things that impact the health of our bones. It’s mind spinning. People who are too flexible can have EDS, Ehlers-Danlos syndrome. A lot of the people that we watch, go to Cirque du Soleil or whatever, they’re doing great things, but there’s a condition there that they have.
Dr. Weitz: Wait a minute. Being more flexible means you’re at higher risk for fractures?
Dr. Simpson: No, no. Thank you for asking that.
Dr. Weitz: They’re less at risk?
Dr. Simpson: No, no. If they have a condition where they’re hypermobile, they can take their thumb and put it on their, can you do that? Can you take your thumb and put it on your-
Dr. Weitz: Oh, of course not. No.
Dr. Simpson: Exactly. They can do that.
Dr. Weitz: No, I know that.
Dr. Simpson: You put their arm up and it’s like, you know.
Dr. Weitz: Absolutely, yeah. People with that condition, it also leads to a lot of gut problems.
Dr. Simpson: Yes. That’s exactly right. Makes you wonder how much is which. I’ve had Marfans folks, patients over the years. It’s interesting. There’s a lot of ways to think about how I assess bone. But in Marfans, these are really tall people and they have a long femur neck. They’re more at risk because they have a longer femur neck, because it’s more of a lever. I always look at how long, because in Caucasians, sometimes we have a longer femur neck. Whereas you look at Asians, though they get it, too, but it’s more compact. Also, shorter people have less distance to fall. It’s lots of ways I think about things that make sense about what’s the fracture risk? Honestly, Ben, that’s what we should be talking about. What is a person’s fracture risk? The bone density’s not everything. You and I were talking before we went on about a test called the trabecular bone score. That gives us a sense, you’ve got bone density. You want to have dense bones, like a piece of oak wood versus pine. Oak is really strong wood. It’s dense. Pine, not so much. But also, you want whatever you have in terms of bone to also be resilient. I’ve had people who have osteoporosis, I have osteoporosis. But my trabecular bone score is good, which is why I haven’t fractured yet. I’m going to be 75 next month. I haven’t fractured and I’d like to say to you, “It’s because I’ve done everything perfectly.” No. I think I lucked out genetically because I did a lot of bad things. So genetically, I think I came into this world with pretty good bone quality genetics. We can test that kind of stuff now.
But also, I get a sense about that. When someone says to me, “I’ve been an athlete all my life. I have never broken a bone, but I just got this diagnosis of osteoporosis.” If they’ve broken a major bone, that for me, is time to do serious workup. If they’ve broken their humorous or their femur or their wrist. Then also, I want to know what happened. Okay, you fell over. I had this one woman who was on a tennis court and she fell backward on both hands, so she equaled that weight. 52 years olds, shattered both wrists. That’s not normal. Well, it turned out that yes, she had osteoporosis, but she was also going through menopause, so that probably tipped things over a bit because number one cause of osteoporosis is estrogen loss. That is primary osteoporosis, which is why it drives me nuts that women, especially who are at risk, are not given a bone density prior to menopause. Because by the time they’re 60, they come to me and now they have full-blown osteoporosis with fractures. I know I kind of went off in a couple of directions there. Maybe you can bring me back.
Dr. Weitz: Okay. Let’s get back. Let’s put a little detail on the picture. Let’s go into a little bit about the DEXA scan and then also maybe explain a little more exactly what a trabecular bone score is. A DEXA scan reports on the hip and the spine, and sometimes the forearm as well. It’s giving a rating of the density of the bone in the T scores compared to a younger person with the Z score as compared to somebody equivalent age.
Dr. Simpson: Yeah. We’re measured up against, the database is average 30 year old. We actually want to do that. Some people say, “I don’t want to be measured up against them. I want to be measured up to my own age.” No, you don’t. You want to be close to a 30-year-old, average 30-year-old. The further you move away from that age group. By the time we’re 30, peak bone mass, the bulk of it is done by the time we’re 18. So 80% of our peak bone mass that we were destined to potentially lay down, and hopefully we did nutrition well and exercised during those years, is laid down at that time. By the time we’re 30, we don’t have all that help of the extra hormones. We just don’t. So that would be the time, if people understood that, to increase their weight training. We know weight training works, in terms of stabilizing bone and in terms of sarcopenia, resisting that as we’re aging because the people who have the worst osteoporosis as they age are people who have muscle wasting and osteoporosis. But the one thing I want to say is that one bone density test, and this is really critical, does not mean active loss is occurring. You can have osteoporosis diagnosis, but maybe that happened, and I like to use this word so people think about it, historically. We know eating disorders, for instance, a lot of things like that. But also, maybe there was a period of time you decided to be a vegan. When people do an extreme diet, and vegan is one of them, some of them have the worst bones I have seen. I’m not saying they can’t be vegan and have good bones. But I am saying when I hear the word vegan, it’s a risk factor. Big one for me. So any kind of big change that’s going to eliminate food, those are, and frankly, a lot of people had eating disorders going to these diets. The intermittent diet. Okay, you can do some of it.
Dr. Weitz: It’s interesting. Vegans tend to perk up when they hear about somebody with a fracture and right away say, “That’s because you eat meat. That’s why you have a fracture.”
Dr. Simpson: And it’s nonsense, absolute, utter nonsense. I don’t eat meat. I don’t eat anything with four legs. I do eat chicken. I eat turkey. I eat fish. I wish I could do dairy, but I can’t for other reasons. The protein thing is so critical. You could take all the calcium and vitamin D and vitamin K and all that kind of stuff. If you don’t have enough protein, and I see that over, and over, and over again in my patients. Most of them are women. I got men, too. But protein is critical. You can’t build bone if you don’t have good protein.
Dr. Weitz: But of course, the vegan argument is all that animal protein is acidic and it’ll leech calcium out of your bones to balance out your pH.
Dr. Simpson: But here’s the interesting thing about that. There’s always a kernel of truth. Yes, if somebody is on a strict paleo diet and they’re just slugging down a lot of meat, yes, it’s acidic. I’m talking about a little more of a balanced approach and not missing the forest for the trees. I talk about this a lot. We also saw, for many years, and it’s still going on, doctors recommending 10,000 a day of vitamin D. Have they tested the vitamin D? Have they tested the serum calcium? Have they tested the parathyroid? You can’t do that. That’s a hormone and for some people, especially those who have primary hyperparathyroidism. That is not a good thing. Also, some people are sensitive to high levels of vitamin D. My second book is on, a lot of it is around vitamin D. Some people, even if they’re 40 nanograms per milliliter or 50. I’d say 50 nanograms per milliliter. My sweet spot’s about 45. I don’t care how much vitamin D you take. I want to see the blood level. You have to respect it this way. You have to test.
Dr. Weitz: We test all the time.
Dr. Simpson: Yeah.
Dr. Weitz: We’re in Southern California and I’m amazed at how many patients in Southern California who regularly go out in the sun still have low vitamin D.
Dr. Simpson: Yeah. Australia’s the same thing. We were talking about that the other day. People are told to stay out of the sun from 10:00 to 4:00. You can’t make vitamin D unless the sun’s pretty much directly overhead. If the sun is at an angle from time of day or season, you don’t make vitamin D. Then you’ve got people slathering on sunscreen. Here’s the thing. I support that to some degree. The reason I wrote my second book is because I’ve had 25 rounds of skin cancer. Three months after that book came out, the vitamin D book, sun book, rather, with a lot about vitamin D, I found my first melanoma. It was literally, it was like freckle that had darkened. I’d had so many skin cancers because why. Because I abused the sun. I had so many sunburns as a kid, horrific sunburns. You’ve got some doctors out there say, “Oh, no. You don’t get it from,” of course, you do. If you abuse anything, that’s not good. However, I don’t always put, my face. I don’t need any more sun on my face, but I will expose my skin for five minutes here, five minutes there, but I take vitamin D. Vitamin D is very important, as you know. It increases absorption of calcium, magnesium, phosphorus, and it does so many other things in the body. But the problem was, is that absurd study that came out, and I’m sure you’re probably aware of it, a couple of years ago, that was not about vitamin D, but they went in and looked at some vitamin D stuff. They said, “Oh, vitamin D doesn’t do anything for osteoporosis, doesn’t reduce fractures.” Then they said, “By the way, don’t test.”
I was so upset about that because it’s wrong. I don’t care. Sometimes studies come out, they can be large. This was an epidemiological large retrospective study. What does that mean? People don’t know how to read studies. It meant nothing because all you have to do is understand basic physiology that, what does vitamin D do? It increases calcium, magnesium, phosphorus, all of which we need for our bone. So of course, it helps bone be strong. Studies, I can tell by hearing about it if it makes any sense to me physiologically. Since we’re on calcium, let me just say this. I’d like to get rid of these stupid ideas that are out there. When you hear a generalized statement that is supposed to be for everybody like, “Get all your calcium from food,” I could scream. Who do they get this on? Who are those people? They’re average Americans who are eating pizza, who are obese. They’re not me, for God sakes. I’m not going to eat as much, I don’t eat as much food as a lot of people. It is harder for me to get the calories I need in, and certainly calcium, and I don’t eat dairy. And then plus, let me just throw in the vegan thing again. Vegans, who eat a lot of greens, a lot of oxalates. We see more kidney stones now because you’ve got to have calcium, actually, to make sure the oxalates are going to go out in the stool rather than go into the kidneys. I got off track there. Okay. Here’s the-
Dr. Weitz: Let’s point out a couple of important things about getting-
Dr. Simpson: Wait, wait, wait. Let me just finish that one thought, Ben.
Dr. Weitz: Okay.
Dr. Simpson: So the main thing is, really be careful about generalized statements because it doesn’t apply to everyone. When I’m dealing with osteoporosis, most of those people are taking maybe 600 a day of calcium citrate malate in divided doses and some are taking as much as 4,000. Why? Because they had part of their colon removed or whatever, I mean or their intestines removed. Now we have more and more people who are getting gastric bypass. Their bones are in bad shape. I just get my soapbox going here.
Dr. Weitz: Yeah. No. Any sort of gastrointestinal condition, the majority of them are going to decrease the ability to absorb nutrients. Even a simple condition like small intestinal bacterial overgrowth means you’ve got too many bacteria lining your small intestine where the bulk of absorption of nutrients takes place.
Dr. Simpson: Yup. Exactly. Digestion’s key.
Dr. Weitz: Let’s go over some of the important things about a DEXA scan and why some places, some DEXA scan centers get it wrong in terms of the things that need to be done. For example, the positioning of the patient.
Dr. Simpson: Well, another pet peeve that I had hoped, over the years, I’d have some influence on, but I haven’t. I’m still going to work on that as I’m moving into retirement because it’s just outrageous. It’s not required that anyone be trained who writes the report or signs their name to the report of the bone density and the technicians don’t have to be trained, so we see errors. People send me their bone densities. I find errors almost on every one of them, one way or another, but I’m really picky. Those errors, say for instance, let’s say you had a perfect bone density test. They did it right. Then the following year, the person was sloppy and they didn’t rotate your hip properly. That can be a 7% gain or loss. If it’s a loss, that’s going to trigger a medical doctor to give you a medication.
Dr. Weitz: So let’s describe the positioning. A patient’s on their back. Do they have something under their knees?
Dr. Simpson: That’s the best way, but are they doing that? No. In my book, by the way-
Dr. Weitz: That would flatten the spine.
Dr. Simpson: It would be better to have the knees up so that it’s down. But now, let’s say the first time you had a bone density, your legs were straight. Then you’re getting smarter and you decide you’re going to go in and say, “You know what? Make my back flat.” You don’t want to do that.
Dr. Weitz: Because it’s got to compare to another scan.
Dr. Simpson: Right. Now in my clinic-
Dr. Weitz: You’re supposed to be rotated in 15 degrees, right?
Dr. Simpson: That’s right. They put you in a little thing. So the GE Lunar equipment typically, they have both legs out at the same time and pretty much all logic’s doing the same thing. It’s faster. Is it the best way? No. When you have the back flat, as you know, you’re not going to have any overlapping. It’s just going to be better to analyze.
Dr. Weitz: And if the patient’s had scoliosis, that’s going to affect the results.
Dr. Simpson: If the patient has scoliosis, I had a case in the other day. Woman had 45 degree scoliosis. This center, and it was, it was Mayo or one of the big places, did the bone density of her spine every year and she had a lot of rotation. When you have rotation, let’s say … I can’t really say this part. Okay. When they’re doing a bone density, it’s straight through, P to A. When there’s scoliosis with rotation, now what do you get? You get some of the transfer processes and so forth, you’re going to get a false reading. It’s going to show a better bone density than it is. Now, if you have two vertebrae that don’t have rotation, or very, very little, you can’t use one vertebrae in the spine for diagnosis. You can use two. You can use three and better four so that we can look at all four. The spine is typically going to be lower than the femur. That’s the discordance. People have arthritis, it’s going to falsely elevate the density. So I always, by the way, and this is me, I always order the four because it gives me additional data to look at. There’s only one diagnostic place in the mid-forearm. It’s the mid-forearm. That’s compact bone. So the spine is mostly trabecular bone. What’s good about what we call the ultra distal radius is that it’s mostly trabecular bone, so it gives me another area to get a sense about trabecular bone and I like that. The more, like I say, I have these data points, the better.
Dr. Weitz: If the patients have osteoarthritis-
Dr. Simpson: That’s going to falsely elevate. I had a case where the person had spondylolisthesis, a forward slippage of L4 onto L5. Well, L4 was all messed up. See, if they were trained, they were delete L4 and then only include L1 through three. So in the bone course that you and I have talked about that I’m starting on April 20, I’m going into detail about how to look at bone density because all doctors who are entertaining helping people with their bones should get the full bone density, not just the report. You want the images. So you either want to get the CD or ask the center to print out the images from the computer. You don’t want them to go into a file and make a copy of it because it’s going to look like blobs. If you get my book, y’all, it’s still good, look in the back. They look like sharp little X-rays. I can glean a lot from that information.
Dr. Weitz: If the patient gets a conventional X-ray, not a bone densitometer, and that shows bone loss, what does that mean?
Dr. Simpson: First of all, it doesn’t show bone loss. What it does, it shows density. Remembering for everybody, a single bone density doesn’t mean there’s active loss. We’re after that question to answer, but on an X-ray, if an X-ray says osteopenia, it’s actually osteoporosis. Because the word osteopenia means low bone density. That’s all that it means. But in order to see that on an X-ray, you have to have about 40%, note how I’m saying this, less bone density in that spine for that to be real. That would mean that it would be, from a T score perspective, about a negative 3.5 or negative four. Each standard deviation’s 12%. If I have a negative four, it’s 48%. A lot of times, yes, that is visible on an X-ray. They can see it and they can see it in an MRI. But what the report will say, it won’t say osteoporosis. It’ll say osteopenia because that’s how they do it in radiology. But don’t expect a radiologist actually to still write a good report. I’m just saying.
Dr. Weitz: I’ve seen where they write “slight bone demineralization.”
Dr. Simpson: That’s a good term, too. When they’re seeing that, that person has osteoporosis. It’s low bone density. We have to think about it. Mostly what we’re looking at, especially in the spine, you’re losing that nice lattice infrastructure. So you can imagine if you lose that, how are you going to build that back up. You going to take some supplement to start growing these? You have to think this through and understand bone. But I also say that we can build bone quality at any time and I have seen people like you, Ben, who can increase bone density with the right program. It happens. It’s just not as common. Let’s say I did bone turnover markers on you or someone. Not you, because you really work out and all that. But I do bone turnover markers and I can see that bone turnover is high. That should not be happening. That means bone loss is occurring. Here’s the interesting thing. My top two bone turnover markers are the C-telopeptide. That’s CTX, the P1NP, which is the pro-collagen type one. So the CTX is a peptide. It gives us information about osteoclastic activity.
Dr. Weitz: So these are [inaudible 00:31:34] that can tell us about whether or not the person is losing-
Dr. Simpson: Actively. Actively losing. It could be stable. Let’s say that CTX comes in at 700. Okay, now that’s giving me a hint, notice the words I’m using, everyone, a hint that bone loss is occurring. But I ordered two bone turnover markers at least, and now the P1NP, which is a marker of osteoblastic activity, is high. You would think that would be good. It’s not. So in this case, let’s say the CTX was 750, P1NP was 120. They are turning over bone and losing. I want to see the P1NP around 30. I want to see the CTX around 200 or 250. Then I think they’re pretty stable. But if those are high, they are losing. The P1NP should only be high in one case and that’s if somebody’s on an anabolic medication. Now, the other thing I’m doing because, again, I’m doing this course that’s coming up is, I’m reviewing all the data on people like you who work out a lot and bone turnover markers because you may be the exception. But that said, even people who work out and do all the right things, because people say this to me, they come in to me, they have a bone density, they’ve got osteoporosis. They just fractured something. They were walking across their lawn and fell on their hip and fractured it. “I can’t have osteoporosis. I’ve been doing blah, blah, blah, blah.” No, you can. So a lot of different things, a lot of prongs in this wheel of bone that have to be illuminated, but it’s very individual, which is why I don’t think this is ever really going to be handled that way. But you and I both know, when you evaluate somebody, it’s an individual.
Dr. Weitz: So let’s go over some of the other tests. Osteocalcin and then Genova offers an uncarboxylated osteocalcin.
Dr. Simpson: Now, the under carboxylated is kind of a no. Where this all comes from is, Kate, I think her last name starts with an R, a vitamin K book. I’ve interviewed her myself many times. She’s super smart. I don’t think it’s really holding up, but here’s what we do know from physiological perspective. Vitamin K2 does stimulate osteocalcin. Osteocalcin stimulates osteoblasts. To what degree? Is it going to help? I’ve never seen any evidence that, that alone as a treatment that, that would work. I wish I could.
Dr. Weitz: Now, could that be because very few people are taking the proper form and the proper amount of vitamin K?
Dr. Simpson: Okay. We’ve got K2, we’ve got MK4 and MK7. The proper would be the MK4.
Dr. Weitz: Correct.
Dr. Simpson: If we were really looking at it.
Dr. Weitz: And the proper dosage-
Dr. Simpson: Well, wait a minute.
Dr. Weitz: … 45 milligrams, which-
Dr. Simpson: And that’s a hell of a lot, so you better hope that, that’s right. That was first on the scene, Japanese studies. It was actually used as a treatment for osteoporosis.
Dr. Weitz: Correct.
Dr. Simpson: I’m just saying, it’s weak as a treatment program. It didn’t pan out. So what about MK7? MK7 comes along in lower doses, milligrams. You only take maybe 120 micrograms versus the 45 milligrams because as Dr. R, again, do you know her name? I can’t remember her name.
Dr. Weitz: Who are you thinking about?
Dr. Simpson: The woman who wrote the vitamin K book. Kate. Anyway. That’s where it really got launched, the MK7. That we find, of course, in foods. We find MK4 in foods, but it’s going to be more animal sources. MK4 is in animal sources like dairy, and meats, and so forth. By the way, our large intestines, if they’re healthy, actually make some MK4. So MK7 comes from fermented foods. The reason that took off and that book was written, and why she thought vitamin MK7 was better, it has a longer tail so it lasts longer in the blood. MK4, you would have to take throughout the day so that it would be available throughout the day.
I’m looking into this again, Ben, because I want it to be true, but I’m pretty critical now. It was interesting because a couple of weeks ago, my doctor’s group, there was a woman who, I can’t think of her name right now, she’s a researcher on nutrition. I thought, “Oh, great. Here we go again.” Because the typical people, the doctors in my group are phenomenal. I see them save lives every day. They bring the most complex cases I get to learn from. Nutrition? It’s ridiculous. In fact, one person came a few months ago to give a little nutrition thing. You can eat peanut butter and white bread and you’ll still get enough protein. I’m screaming. But I learned a long time ago, they don’t know nutrition and I don’t bother with that part because I get to learn all the other stuff from them in terms of diagnosis and so forth. But the foundation of every treatment program should include obvious digestion, nutrition, all that stuff. But anyway, this woman came on and I was kind of blown away. She was a real critical thinking researcher on nutrition. I asked her about the vitamin K. I said, “I’m just not seeing that much in terms of real, solid evidence.” But here’s the thing. Do I think people should get vitamin K? Yes. I don’t even do MK4. I think it’s fine if you do it. I don’t think necessarily it’s hurting. I don’t know how much good it’s really doing.
Dr. Weitz: Weren’t there more studies on MK4 than there were on MK7?
Dr. Simpson: Early on, yeah. Yeah. That’s true. I’m in the process of looking at all that again with a little more critical eye, once again.
Dr. Weitz: If you look at the different organs in the body, for the most part, vitamin K is stored as MK4 in most of the organs. The liver is the exception, where it tends to store it as MK7. But you ingest K1 and the body converts it and stores it as MK4.
Dr. Simpson: Well, not all of it. It’s a smaller percentage than you would think, but yes, it does do that. Like I said, I’m in the process of going through those studies again. I’ve been at this for 35 years or so and my ability to look at things changes as I learn more and I develop a wider lens with how I’m looking at things. So I don’t know. I just have to look at it again because I’m not so sure.
Dr. Weitz: Okay.
Dr. Simpson: I do have one little tip.
Dr. Weitz: Yeah.
Dr. Simpson: She also did a study on blueberries, which was really fascinating, where they did the equivalent maybe to 3/4 of a cup of blueberries. I can’t remember how they used it, was it powder, blah, blah, blah. Then a larger amount of blueberries, and then really high blueberry content. These are with animal studies. They found in the study, which was really surprising to her, that the middle amount actually was supporting the bone turnover markers in a better way than the high or the low. Whether or not that turns out to be really true with further studies, we know the polyphenols and all that kind of stuff and how powerful they are. People get really wound up and then they’ll do five cups of blueberries and miss the point. Or they’ll do prunes. I never bought into the whole prune thing, but to this level, I do. Which is, if people want to eat four or five prunes a day for bone health, fine. I don’t recommend 10 or 12 prunes, which was in those studies. But I do believe that the polyphenols and the boron that is in prunes is helpful.
Dr. Weitz: Trabecular bone score. What is that exactly looking at? Is that measuring the trabecular bone versus the cancellous bone?
Dr. Simpson: It’s measuring, yeah. That’s the same thing, trabecular and cancellous is the same.
Dr. Weitz: Oh, okay.
Dr. Simpson: You’ve got trabecular and compact.
Dr. Weitz: Compact, okay.
Dr. Simpson: The trabecular bone score, first of all, the bone density’s volumetric, centimeters squared in terms of how they view that. Then the trabecular bone score is looking at structure. Structure is the resilience. That’s what we’re looking at is that resilience. I have a video that’s on YouTube, that I interviewed Dr. Didier Hans. You can just look me up, bone quality. He really explains it. It’s an hour when we’re talking about it, but understanding how important that bone quality is to our bone health. That’s why we can have some people with a negative five, meaning 65% of their bone density’s gone and they’re not fracturing. Is that true for most people? No. We always have these extremes people like to point to, but I’m telling you, I’ve seen it and it blows my mind. It just tells you that bone quality’s really important.
When you get a trabecular bone score, it is separate software that the company or the imaging center has to have purchased for about $10,000. So because no doctors know about it, or don’t know what to think about it, no one’s asking for it, so they’re not putting it in because they’re not going to be able to recoup their money. You have to have a bone density test of the spine and then they apply the trabecular bone score. They push a button to run the trabecular bone score test. Then you get a nice little printout and the higher, the better. One point four something is really, really good. Let’s say I have somebody with normal bone density, but that trabecular bone score comes in as a 1.080. That’s not good and that person often will come to me because they’ve already had a fracture that didn’t make sense. So it’s really important, this bone quality. Of course, again, there’s genetics involved there. But also, what else would affect bone quality? All the things you and I know and do with patients; nutrition, gastrointestinal health.
Dr. Weitz: Sleep, exercise, on and on.
Dr. Simpson: I have people-
Dr. Weitz: Smoking, drinking.
Dr. Simpson: Over exercising. We’ve had people with what we call now, and there’s an article on my website called Anorexia Athletica. There are people out there that exercise, I know this one woman, she runs a marathon a month. Very, very thin. I’m trying to get to her a little bit because I’m around her some. I’ve given her my book and so forth. I’m sure she’s going to be in deep doo-doo when she gets to menopause. She’s right there now and if she doesn’t do something, she’s going to start fracturing. She already has had stress fractures. Are stress fractures a clue? They certainly can be. A wrist fracture can be the first heads up, there may be something wrong with these bones.
Dr. Weitz: In general, running marathons, triathlons is increasing your risk of having risk of osteoporosis or fracture.
Dr. Simpson: Keith McCormick is a good example of that. He’s a chiropractor. He’s written a book on osteoporosis. Super smart guy. When I met him, I wrote about him in my first book. He had, had 14 fractures.
Dr. Weitz: Wow.
Dr. Simpson: He’s the 100 marathon guy.
Dr. Weitz: Oh, wow.
Dr. Simpson: He ended up doing Forteo, which is an anabolic and saving his life, I believe. He still was out there doing that kind of stuff. That’s my opinion. Again, the hundred marathon thing, it’s got to be so tough on the body. So one day I said to him after he got better and stopped fracturing thanks to Forteo, I said, “So Keith, what are you doing now for exercise?” He said, “I just did the Tough Mudder.” I said, “You did what?” You know what the Tough Mudder is?
Dr. Weitz: Yeah, I think so.
Dr. Simpson: It’s that really intense, it’s a really intense athletic event. Throwing yourself over here and over there. You’re wafting through the mud. I said, “What did you do that for?” He said, “I wanted to see if I broke a bone.” We all think differently about things. That’s his thing.
Dr. Weitz: That’s better than, I ran into some patients who have osteoporosis, who’ve had fracture, and now they won’t do anything where they could ever fall or have to balance or anything. That’s not the right approach, either, because you need to work on your balance. You need to put yourself in situation where you can be safe, where you work on improving your ability to balance, and load, and things like that.
Dr. Simpson: I always say, it’s so true, walk in the world with awareness. But what’s happening in the example you just gave, they’re so fearful. I have a background of mindfulness practice, sitting for three months in silence in India and so forth. I’m out there doing pickle ball and doing my sports and stuff like that. I fell a few weeks ago, but I think the fear is worse than the fracture. The other thing I say to people, fractures are part of life. They just are. They can happen. We want to avoid them. Obviously, most fractures occur because people fall, pure and simple.
Dr. Weitz: So exercise for bone health. It looks like, from the studies I’ve been reading about, that the most effective exercises are involving heavy weight training exercises, things where you load the bones, like doing squats, dead lifts. It looks like there’s some special benefit to doing, if you can do it in a safe way, some high impact ballistic exercises. I’m sure you’re familiar with the LIFTMOR trial from Australia.
Dr. Simpson: Yeah, Belinda Beck. Belinda Beck, yeah.
Dr. Weitz: They have people jump onto a pull up bar and then drop down.
Dr. Simpson: Here’s the thing. When they first came out, I went up against them because they were showing people with rounded backs doing, just this really bad, I’m a former yoga teacher, so I’m very big on the mechanics of the body. But even something like OsteoStrong, which I did a whole video on that, I’m very against that program and it’s ridiculous and dangerous for a lot of people. You say, “Oh, you can’t fracture.” Of course, you can. If you sit there and strain and you have severe osteoporosis, and you know this, if you increase your intrathecal pressure, you can then, you think different about Schmorl’s nodes as we get older, you can end up with a Schmorl’s node, which is what? A fracture, partial.
Dr. Weitz: Right, but I think the reason why they feel that it’s safe is, you don’t sit there and suddenly get a big load on you. It’s based on how much you’re pushing or pulling.
Dr. Simpson: You’re straining.
Dr. Weitz: So you don’t start out with the heaviest load.
Dr. Simpson: No, but it’s B.S., period. Their claims are wrong. He got his PhD in Cayman Islands. I could go on about this guy. You don’t want to support him in any way. I did an hour long, he’s with, you know Anthony Robbins. I did an hour long video on him. It’s over on YouTube. I have 65,000 views on that, making no money on it, but I just got so tired of these people. They make these claims, “Oh, you just have to do it 10 minutes, 20 minutes, once or twice a week.” It doesn’t happen. They claim 14% increase in six months. It does not happen.
Dr. Weitz: Well, they’re claiming that you have to load your body weight, you have to put a load of more than your body weight. I forgot if it’s two or four times your body weight to really cause new bone formation.
Dr. Simpson: They have 150 studies. Have you watched that video I did of them?
Dr. Weitz: No, I haven’t.
Dr. Simpson: I was warned. The Canadian group-
Dr. Weitz: I have interviewed John [inaudible 00:51:11] before, though.
Dr. Simpson: Yeah. John? Yeah, I know John. I said to John, I said, “Bring me over five cases,” early on because of course, he would like me to support him. He shows them to me. He doesn’t even know how to look at bone densities. I said, “First of all, John, this one you’re showing me, you’re comparing the right femur to the left. Then this one,” I said, “Oh, this person’s 80 years old. They have osteoarthritis, John.” None of them were correct.
Dr. Weitz: Okay.
Dr. Simpson: I was warned not to put that up because they would come after me. No one, none of their attorneys, do you think they would if I was wrong? Yeah. And then there’s another one that Laura, I can’t think of her last name, out of Canada, who’s one of the top exercise experts in the world. She put up one about them, as well, because we’re all tired of hearing about them.
Dr. Weitz: What about vibration platforms?
Dr. Simpson: The original big hoo-ha came from Clinton Rubin. Back in the day when I was involved, people gave me stuff. I’ve got the Jufit. I’ve got the Marodyne. Because they wanted me to sell things. I sell nothing. I never have, but I would support something if I thought it worked. So what do I think? When you stand on a Jufit or you stand on the Marodyne, and all this stuff about NASA, this is where people have to start putting their thinking caps on. NASA did the studies. On what machine? And did they continue to use it? The answer to that’s no, it didn’t work. It was done on the one and only machine was the Jufit. The Jufit, I have to say, which goes for around $6,000 or $7,000 is a very solid piece of machinery. It feels like a hum when you stand on it. Who would I maybe recommend this to? I would recommend it to people who can’t exercise because it has a .05 vertical displacement. The idea is that by doing that hundreds of times in a short period of time, your body’s going to think you’re jogging. I would do it with people who have had lower limb fractures, people who just can’t exercise. That’s who I’d go for. Forearms, they can lean on it. They have to be able to afford it. But I would not recommend it for you. I would not recommend it for me. I can exercise. Now, what about the more intense-
Dr. Weitz: I’ve been using one for the last several months.
Dr. Simpson: Yeah. You may have another reason to do that and that could make sense. But the Power Plate, which is more intense, and I’ve used one of those, and I have to say absolutely, my balance is crazy good after that. But it’s so violent and I’m concerned with retinal detachment, which definitely has been, that’s a big concern. Also, a lot of these vibration machines don’t have vertical displacement. They have horizontal. Horizontal, in the world, we don’t have horizontal vibration. So I’m concerned about the health of the joints with that kind of thing. So you have to be really careful if you’re getting into that stuff. Do we really all need now to buy vibration equipment?
Dr. Weitz: Best diet for preventing fracture, increasing bone density.
Dr. Simpson: A balanced one. In my book, I talk about it, although I’d up the protein now. But yeah, it’s about having that balance. Really, when I say to people, “Here’s the diet you should do. Dump the junk. Do you not know what the junk is?” If they’re at that level and they’re still drinking a six-pack of Coke a day, I don’t know how far you’re going to get with them. But people know what junk food is. We had a vegan restaurant, not a restaurant, but a store around the corner from us and it was just a bunch of junk food. You want to eat three good meals a day. I always eat a really, really good breakfast every day. I have protein. I’ve got eggs. I might have a piece of turkey bacon with that or two. I might add some hemp seed. Actually, I like to do a tablespoon of hemp hearts and a tablespoon of pumpkin seeds in the morning. Right there, I’ve added about eight grams of protein. And I do avocado because I want to have the fat. I do all that. I just can’t eat as much as you, Ben.
Dr. Weitz: I do have a big breakfast. I think this morning I had a container of egg whites with chopped up kale, onions, mushrooms. I had avocado and I think chicken sausage in there.
Dr. Simpson: Oh, that’s my favorite. I like to put together mushrooms, kale, and onion. It’s kind of my go-to.
Dr. Weitz: What about including soy? There’s isoflavones in soy. Some studies have shown some benefit with those.
Dr. Simpson: You mean like genistein?
Dr. Weitz: Dietine and then there’s one called ipriflavone that some people are selling.
Dr. Simpson: Ipriflavone is, it’s not from soy. It’s actually just chemically made.
Dr. Weitz: Okay.
Dr. Simpson: The question is, and I talked about all this in my book. Would I take it? No, I don’t think there’s enough evidence. I think there’s evidence for eating a really good, solid diet. You have to get enough calcium, got to get enough vitamin D, magnesium, B12.
Dr. Weitz: Is [inaudible 00:57:49] a good idea?
Dr. Simpson: What’s that?
Dr. Weitz: Dairy?
Dr. Simpson: If I could, dairy, it is true that dairy’s inflammatory, but then you hear people say if you eat dairy, you’re going to lose bone. That is just so asinine. I’m sorry. It just is. I cringe when I hear this kind of ridiculous global statement. Then you’ve got people, every few months you hear the same kind of thing go out there, or get all your calcium from food, like that’s going to work for everybody. You’ve got to be really careful about buying into these things.
Dr. Weitz: Let’s go into nutritional supplements now. You talked a little bit about calcium and you said maybe on the average 500 to 800 milligrams a day.
Dr. Simpson: Depending. Again, it’s very individual. I always want to look at their metabolic panel, get a sense, especially if they had three or four of those, because then you can really look at the total protein and the calcium over time. But I like to see, again, it’s about blood level for me. I like to see it around 9.3. 9.5 would be really nice. But when you’re on the low end of normal, it’s not good. When you’re on the high end of normal, it’s not good. I talk about, when I’m teaching lab techs, to note when you’re looking at high end and low end normals. B12’s another one. We used to think-
Dr. Weitz: Let me stop you on the calcium. Serum calcium is probably not a great measure of the body’s need for calcium, though. Isn’t that right?
Dr. Simpson: Say that again.
Dr. Weitz: Serum calcium, in my estimation, I don’t think is a particularly good marker for the amount of calcium the body really needs. I don’t think it indicates tissue levels.
Dr. Simpson: It’s the best we’ve got. It gives us an idea. That goes along with, by the way, if I’m evaluating somebody, I’m going to be doing a 24-hour urine. The interesting thing about a 24-hour urine, high end of normal, low end of normal matters also. When you do a 24-hour urine for calcium, let’s say it’s low or on the low end of normal, they’re not getting enough calcium, at least on that day. I’m going to do another. I always redo tests. I’m going to do another one, but there’s also a whole way. I can’t explain it in this thing, but you’ve got to do it right and I’ll test it again. This is a really important point. When somebody comes to me and, I’m not taking new patients now, but when my older patients come back and I’ll still work with them, I never change anything. You want to do lab work first. I think a lot of doctors of any persuasion immediately want to start messing with stuff, when they don’t even know what they’re dealing with. Are they actively losing? What do the CTX say? Because then, if you have that groundwork done, then you’ll be able to see if whatever you do is helping. If it’s a woman, her CTX is 600, 700. She’s year two of menopause. You might help her a little bit with nutrition, but boy, put low dose estrogen in there and get it up to 50 in the blood, it’s going to bring that down to about 250. I’m not a big fan, by the way, of gels and all that kind of stuff. That’s a whole other topic. But all these things matter.
Dr. Weitz: What do you think about AlgaeCal?
Dr. Simpson: Oh, God. That’s another company. Don’t support them. They make claims, “You’re going to gain blah, blah, blah in six months.” Of course, you’re going to gain because you’re going to be doing strontium and strontium does what?
Dr. Weitz: Improves absorption of calcium.
Dr. Simpson: No, it replaces calcium in the bone. Now, because of where it is in the periodic table, is going to show a higher bone density that’s not real.
Dr. Weitz: You don’t think there’s any benefit to strontium citrate?
Dr. Simpson: No studies on that one. Strontium ranelate’s where the studies are. Now, is it worth doing if somebody cannot do anabolic medications, they have very serious osteoporosis? I would consider it. I just know the anabolics do a much better job. But to have these people out there willy-nilly just taking strontium, again, when a doctor has not actually evaluated this person fully, is just not right. I don’t really like the AlgaeCal company. I’m careful with companies that I recommend or I’ll work with. The other thing, too, is what is AlgaeCal? They call it plant calcium. It’s calcium carbonate.
Dr. Weitz: I heard-
Dr. Simpson: Oral calcium is calcium carbonate.
Dr. Weitz: You sure of that?
Dr. Simpson: Yeah.
Dr. Weitz: Okay.
Dr. Simpson: But e-mail me if I’m wrong.
Dr. Weitz: I tried to check that and I couldn’t find any data from the company’s website.
Dr. Simpson: Where does the plant get it from? It absorbs the nutrient. It absorbs it from what? The soil. Because a lot of times people say, “Calcium carbonate, it’s rocks.” Of course, it’s rocks, but that doesn’t mean it’s also bad, by the way. There are some people now that I would give calcium carbonate. If they really do have an acid problem, calcium carbonate may be the way to go until I get other things going, but overall, citrate’s the way to go. Kidneys love citrate. I mean kidneys … Yeah, go ahead.
Dr. Weitz: Magnesium?
Dr. Simpson: Glycinate.
Dr. Weitz: Should we be two to one calcium magnesium?
Dr. Simpson: No. It depends. Some people can do that much. Others can’t. It depends on their digestion. It depends on their sensitivity to magnesium. It’s a bit of a balancing act and understanding their stools and all that kind of stuff.
Dr. Weitz: We do an RBC magnesium and try to make sure it’s above 5.5.
Dr. Simpson: I stopped doing that because I didn’t see that much difference with it, but I know. A lot of docs still order that.
Dr. Weitz: Okay. And your target level for optimal vitamin D?
Dr. Simpson: 45 nanograms per milliliter. That can change if somebody’s on medications and so forth, with especially the PTH analogs. Yeah, that’s a good number.
Dr. Weitz: It seems a little low to me. I’ve seen data showing that 60 is a good target to decrease breast cancer risk.
Dr. Simpson: I thought so, but no. There’s too many risks when you do it. When you have too much vitamin D, what is it going to do? What’s going to happen to parathyroid? I’m asking you.
Dr. Weitz: Oh. It’s going to grab the vitamin D and bring it into the bone. If you have enough vitamin K, it’ll make sure-
Dr. Simpson: No.
Dr. Weitz: … soft tissues.
Dr. Simpson: No. It’s going to decrease your PTH, parathyroid hormone. The kidneys and the parathyroid glands and vitamin D all work together. That’s in my second book because we need the parathyroid gland to, if it’s too suppressed, you’re not going to get what we need from it, which is that the osteoclasts clean up old bone, right? In the body, the parathyroid hormone, that’s what it does. Interestingly, the parathyroid analogs, the Forteo, teriparatide and abaloparatide, the Tymlos work differently. They build bone, but they also increase osteoclastic activity, especially Forteo. It’s interesting. There’s a lot of complexity with all of this. But the point is, if you look at people in Hawaii who are out all day not wearing sunscreen, their level’s about 30. So what you’re doing is a big, fat experiment right now, bringing people up to 60. Nobody did that. Nobody had 60. Who has 60 in just normal, normal life? I think that’s too high.
Dr. Weitz: People who are out in the sun all day.
Dr. Simpson: And you run the risk of losing bone when you get too high, for certain individuals.
Dr. Weitz: Yeah, I’m not sure if that level’s 60, though.
Dr. Simpson: I wrote the book. You can think what you want, but I’m saying I think it’s better to be a little more cautious. It is a hormone.
Dr. Weitz: 45. What about boron?
Dr. Simpson: And then I need to stop.
Dr. Weitz: Okay.
Dr. Simpson: This is another good one. I’m glad you brought this up because boron, I don’t even know the name of the guy. He was recommending high doses of boron that was going to do this. This is what I’m talking about. We see this kind of stuff. Do you know who I’m talking about?
Dr. Weitz: I interviewed Laura Pizzorno and she has an article-
Dr. Simpson: Right, the AlgaeCal. And she has an article and who cares. Is boron, no, really. Is boron helpful to bone? Is protein helpful to bone? Yeah, but to do high levels, there is no evidence over time that’s safe or a good idea. When you start doing that, it’s really interesting because alternative doctors love to do high doses. Let’s do 10,000 vitamin D. Now let’s do 20 milligrams of this or that. But that’s kind of extreme.
Dr. Weitz: So what do you consider high? What do you consider a safe level?
Dr. Simpson: I think if somebody’s eating a good diet, eating apples, things like that, and maybe prunes, and they’re getting enough, I’ve reeled it in. I have to tell you, Ben, I’ve reeled it in over the years because I don’t know. I’ve just seen too many things now and I would rather be in a real safe zone because we really don’t know long term. Or the blueberry example I gave you. Somebody ate two cups of blueberries a day. Is that going to be beneficial or is it really just one cup?
Dr. Weitz: Let me ask you just one more quick question. Fluoride. Is that good or bad for bone?
Dr. Simpson: Well, fluoride is bad, but is it bad in small amounts because it’s in soil. It’s in everything, and especially now. They use the waste product fluoride. They’re watering everything with that water. I don’t think they’re filtering the water.
Dr. Weitz: Of course not.
Dr. Simpson: The question is, is there a way to really test? It’s interesting. I look at bone density, bone quality. I don’t know that I would associate high fluoride drinking water with that. My bones are good. I drink a lot of water. I don’t know. But back in the ’80s, that was one of the main treatments they were going after because when they gave people fluoride and they looked at X-rays, the X-rays were really dense, so they were really excited because it did increase density. But what happened over time was that these people on the fluoride started fracturing. These nice dense looking bones started fracturing because the quality was terrible. The thing is, I guess as I’ve gotten older, I worry less with the more I know. I just try to keep myself on a good, even keel and do the best I can and get through this life. I’m careful about articles I read and things that people say because people just say stuff. They do. They just say shit. I’m sorry. They just do, Ben. They say stuff all the time. I used to be one of those people, but now I’m a little more, I don’t know. Maybe a little older and wiser, I’m not sure.
Dr. Weitz: Okay. You are definitely wiser. So tell everybody about where they can find out about your books and tell us about this upcoming course that you have.
Dr. Simpson: On April 20, I’m starting a course, may be the only time I do it live. It’s 20 hours plus. I take people through the basics of what you need to know in terms of reading bone density tests. Honestly, this is also for people who may want a different career or add to their, they may want to get into really helping people. So how I frame my work, and I have for years is, I’m an educator. I don’t take insurance and I charge good money to see me. Right now, the only thing people can really get online is the bone density second opinions. But it’s needed and I really feel, I’ve always felt, actually, that chiropractors should have their hands in this. But what I keep learning is that they just don’t want to. I’ve been teaching for years. People, they didn’t really want a mentor. That’s what I’m creating with this. I’ve even got some doctors from Peru that have joined the course, which is great. It starts on April 20 and it’ll start on a Saturday for four hours. I’ve got it in four hour blocks.
Dr. Weitz: And how do they find out about it?
Dr. Simpson: Go to my website. It says bone course right at the top.
Dr. Weitz: And website address is what?
Dr. Simpson: Lani, L-A-N-I, Simpson, S-I-M-P-S-O-N .com.
Dr. Weitz: Great.
Dr. Simpson: And they can find out about my books there and they’re sold other places. They’re in libraries.
Dr. Weitz: Excellent. Thank you so much, Lani.
Dr. Simpson: You’re welcome, Ben. Very nice working with you and I’m really glad that you’re learning about it and helping people the way you do because it’s so important.
Dr. Weitz: Thank you.
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 appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, autoimmune diseases, cardio metabolic 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. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we’ll set you up for a new consultation for functional medicine. I look forward to speaking to everybody next week.
