Great Bones with Dr. Keith McCormick: Rational Wellness Podcast 393

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Dr. Keith McCormick discusses Great Bones with Dr. Ben Weitz.

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Podcast Highlights

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Dr. Keith McCormick is a Doctor of Chiropractic in Belchertown, Massachusetts who has come to specialize in consulting with patients about their bone health.  He has written two books on this topic, including The Whole-Body Approach to Osteoporosis, released by New Harbinger Publications in May 2009, and his new 2023 book Great Bones – Taking Control of Your Osteoporosis, which is by far the most comprehensive book on the topic.  You can book a consultation with Dr. McCormick: GreatBonesConsulting.com.  His nutritional supplement company is OsteoNaturals.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.

 

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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 Podcasters. Our topic for today is how to improve bone health and prevent fractures with Dr. Keith McCormick. Osteoporosis, according to the International Osteoporosis Foundation, literally means porous bone. It’s a disease in which the density and the quality of the bone are reduced.  As bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone often occurs silently and progressively, and there may be no symptoms until the first fracture occurs. Osteoporotic fractures can lead to significant decrease in quality of life, with a significant increase in morbidity, mortality, and disability.  Over 50 percent of post menopausal white women will have an osteoporotic related fracture, and only 33 percent of senior women who have a hip fracture will be able to return to independent living. In white men, the risk of an osteoporotic fracture is about 20%, And the one year mortality in men who have a hip fracture is significantly higher than that of women.  Women sustaining a hip fracture of a five fold increase, and men almost an eight fold increase in relative likelihood of death within the first three months. Dr. Keith McCormick is a doctor of chiropractic in Belchertown, Massachusetts, who has come to specialize on consulting with patients about their bone health.  He has written two books on this topic, including The Whole Body Approach to Osteoporosis, published in 2009, and his new book, Great Bones Taking Control of Your Osteoporosis. Published last year is by far the most comprehensive book on the topic and I now consider it a crucial reference guide for treating patients with bone loss.  So, Dr. McCormick, thank you so much for joining [00:05:00] us. Thanks a lot for inviting me on your show. Absolutely. So, perhaps you can tell us a little bit about your story for our viewers who haven’t heard from you before.

Dr. McCormick: Well, I’m an athlete and a long time ago when I was 45 years old, I was just doing a run workout.  My hips started hurting a lot and I couldn’t finish the run workout and the pain never went away. And so I ended up getting x rays and, MRI and everything. And finally got a bone density and come to found out, find out that I had really severe osteoporosis. And then I, over the next five years, I had a lot of fractures just from not doing very much at all.  You know, just even leaning up against something, I could break a rib or something. So it was kind of, devastating to say the least. I was only 45 years old and I hadn’t really had, you know, major traumas before.  So it just kind of to me came out of the blue. And for that reason I talked to five different endocrinologists.  Everybody just wanted to put me on drugs. And I said, boy, I got to figure this out myself. And so I just immersed myself in the study of osteoporosis and figured it out. And now I work with patients, other people to help them too.

Dr. Weitz: I have to say my own personal experience. I’m also passionate about this topic because last Halloween I fell and fractured my hip, had surgery the next day after four months was diagnosed as a non union, because there was a gap between the bones after the surgery.  And I, it was recommended to me to get another surgery, take the hardware out and start all over. And I was not wanting to do that, so I figured out a way to get my nonunion to heal by way of using a ultrasound bone stimulator. Taking daily injections of Forteo and Human Growth Hormone for 5 months and got it to heal.  So, that’s my own personal story about this topic.

Dr. McCormick: That’s a full immersion of learning how to deal with an issue. 

Dr. Weitz: Yes, and I have spent quite a bit of time reading in the last year about bone health as well, so. 

Dr. McCormick: And that’s what you really have to do, to be honest. Exactly what you did, and that’s exactly what I did, you know. And I, like I said, I work with people every day and I think they’re incredibly disappointed when they go see a specialist in osteoporosis and the person sits down with them for five minutes and says, here’s your drug list, choose one.  And then they’re out the door. And that’s why I wrote my book, Great Bones, because I wanted to educate people to say, not only that this is [00:08:00] a way more complicated issue, this disease process than is. It’s given, you know, credit for, this is not just about calcium and taking vitamin D. It’s way more complex, and so I wrote the book so people could understand that and say that, and not only understand that more, but have a language, have an understanding that when they do go to see their medical doctor, or an endocrinologist, or rheumatologist, or whoever that specialist is, that they’ll be able to have a much better, productive conversation with them because they know the language, they know the ins and outs of bone physiology, and it will just have a better outcome.

Dr. Weitz: Absolutely. It’s way more complicated than just take this drug, or even in a functional medicine world, just take this calcium and vitamin D supplement. It’s there’s a lot of detail into understanding the different [00:09:00] Types of bone loss, how to figure out what’s going on in more detail, testing that’s not normally done, and a way to understand what’s going on, and then being able to strategize to use a range of diet, lifestyle nutraceuticals, and then sometimes medications when necessary.

Dr. McCormick: And that is incredibly important. What you just said about the strategizing you do because there’s so many ins and outs to this thing. You do have to get plans of figuring out different ways to approach it, but also be ready to change those plans if you come up against something that’s not improving.  And, but that’s why you’re always analyzing, always trying to figure out through lab tests and bone densities. What’s going on, and then figure out a plan, but be ready to change that plan if what you’ve decided upon isn’t working.

Dr. Weitz: I gotta say, there’s very few people like yourself, going into the depth of analysis of understanding this condition.  It’s not being done very often.

Dr. McCormick: No, unfortunately it’s not, but we need to change things.

Dr. Weitz: Yes, absolutely. So, let’s start talking about testing for bone health and then also go into all the bone biomarkers that we need to look at for being able to understand what’s going on.

Dr. McCormick: Well, the first thing people need to do is get a bone density.  And a lot of times doctors will not even order a bone density for somebody until they either for a woman reach 55 or 60, which is really terrible, or for a male, they might not ever order a bone density. So I really recommend to people that they ask their doctor Even at age 45 or 50 to, if they could schedule a bone density.  So that’s the first thing a bone density is, it’s noninvasive. It takes about [00:11:00] 10 minutes to have it done. There’s minimal radiation. They’re pretty good. There’s some problems with them as far as accuracy but it’s the best we really have right now. And so that’s the first step, getting a bone density and figuring out exactly if you do have a problem and how big of a problem that is.

Dr. Weitz: And for the clinician, you go into really good detail about how to read the bone densitometer report. And it’s really important as a clinician that you not just get the summary of what the T score, and maybe the Z score is, but you get the full report with the diagram showing the part of the spine and the hip that they looked at.  And you mentioned in your book that 90 percent of the reports have at least one error. And like 40 percent of the errors are really significant.

Dr. McCormick: Significant. Yes. And that’s exactly right. You have [00:12:00] to get the printout. It’s called the bone density printout, not the report. So, the report is just from the radiologist, and that’s just a very brief one or two page report that just gives the bone density T score and Z score, and that’s it.  But yes, you have to get the full printout, it’s usually about four pages, has thumbnail pictures of the hip and the spine on it and the forearm if that was done, but it gives a lot of different information that’s way beyond just the T score and the Z score. And, as you mentioned, In chapter five in my book, you can I show some of the things that are pretty common mistakes.

And even the lay person can look at those things that I bring up in the book. And then they look at their own bone density. If they have that bone density printout and they can say, wow, you know, was this done right? Or was this done wrong? Or Oh this doesn’t look right now. And then they can bring that up with their doctor.[00:13:00]

Dr. Weitz: Yeah, sometimes they don’t columnate exactly which part of the spine they’re looking at. You show a couple of diagrams where they’re supposed to be looking at L1 to L5, and then instead they’re looking at T12 to L4. And then the second time they did it the right way. And the first time they didn’t.  So you can’t compare those if the patient has severe osteoarthritis or they have scoliosis or they have the, you could have a compression fracture that’s not severe, that gets missed. All these things will affect the amount of bone density.

Dr. McCormick: And you can’t tell that if you just get the radiologist report without the dexaprint out.

Dr. Weitz: Right. And and then if the patient needs to be positioned in the machine, the right way. And

Dr. McCormick: that’s the hard thing to really correct because, you know, it’s the technician that’s doing it and you, the layperson, you don’t really understand that, you know, the feet have to be turned [00:14:00] in a certain amount.  So that’s a hard really correct. Right. 

Dr. Weitz: The feet are supposed to be 15 degrees internally rotated, right?

Dr. McCormick: Yes. And, but, and they should put you on this little foam little foam block and hold your feet against that foam block. And then it’s done the same way patient after patient after patient.

It needs to be you know, consistent in the way that the technician does this. The problem is there’s lots of different technicians at each hospital and they do them a little bit different each time.

Dr. Weitz: And if they do it on a different machine, if they have multiple machines, that can affect the results too.  Yes. And in addition to getting the DEXA, you also need to get the trabecular bone score if that’s available.

Dr. McCormick: If that’s available, there’s, that’s not available in most hospitals, but if it is, the person, the patient has to ask their doctor who did the, [00:15:00] prescription to put on there, you want to bone density and the TBS and the trabecular bone score.  So I encourage people to call around, see what, see what’s available at that hospital, and you might have to call up some other hospital and say, Can I speak to radiology? Can and then when you get to radiology, say, do you have TBS or tubercular bone score capability with your bone density exam? And that’s the way to ask it.  And sometimes you might have to call five different hospitals before you find one, but they are out there. And yes, that TBS gives you a quality indices of that bone density. So the TBS is a, way to, it’s a computer analysis of the bone density itself. It’s not actually another test, but, and that’s why that TBS has to be coordinated with that DEXA machine.  So you couldn’t take your bone density from one [00:16:00] hospital and then go to a different hospital that has TBS and have them analyze that bone density. You can’t do that. But so you have to have that bone density. done at a place where they do actually have the TBS computer program attached to the bone density itself.

Dr. Weitz: So, just out of curiosity, by the way, where I am in Los Angeles, in Santa Monica very close at St. John’s Tower Imaging, they offer the trabecular bone score, so I’ve been having patients get it. But, let’s say it doesn’t get ordered, And they get a DEXA at the, at that facility. Can you call up and then add in the TBS if they have the software?

Dr. McCormick: Yes. Cause it can be done retroactively. Yeah.

Dr. Weitz: Okay, and that gives you information about the quality of the bone, which significantly can affect the fracture risk, correct?

Dr. McCormick: So, inside, in the inner aspect of bone is trabecula. [00:17:00] It’s kind of like the inside of an airplane wing, or it’s the honeycomb area that struts and bars that give, the airplane wing and your bone strength, but make it light.  And if those little struts and bars are not connected, and those struts and bars are called trabecula, if they’re not connected, if they’re disconnected, if they’re broken inside, then it doesn’t give the bone any strength. I don’t care how thick the trabecula are, if they’re disconnected. the strength isn’t there.  So that’s what this is doing. It’s the trabecular bone score. It’s the score of how many of these trabecular are connected or disconnected. And the more you have disconnected, the worse the score is and the higher the person’s fracture risk is.

Dr. Weitz: Okay, so let’s talk about some of the most important lab tests, starting with the bone turnover markers.

Dr. McCormick: So lab testing is crucial for trying to figure out why a person has bone loss to begin with. It’s also crucial for being able to follow that person and their progress, their either good or bad. So the most important are what’s called the bone turnover markers and it’s the bone resorption and bone formation markers.  So the bone resorption markers, the one I use mostly is C Telopeptide or CTX. Some doctors like the N TX and you can get NTX or N Telopeptide as a urine or as a through blood. Blood is the better way to go or a serum. So the serum NTX you can get, but I like the blood and CTX the most. So that’s your bone resorption marker, or an indices of how much activity the osteoclasts are having. So, if the osteoclasts, they’re the [00:19:00] cells that break down bone, if they’re really ramped up and cranking and breaking down way too much bone than they should be doing, that number will be high. And the higher that number is, Not only says the faster their bone loss is, but it actually increases their risk.  So the higher that CTX is, it increases the risk for fracture. And what do you consider a high number? Anything about over or around 400, a person is probably losing bone. I mean, I’ve seen people lose bone 350, 450, but, you know, as a general statement, around 375 to 400, if it’s over that, they’re probably losing some bone.

Dr. Weitz: And can that number be too low?

Dr. McCormick: Yeah, I think so. Typically not if a person’s not on a medication, but you’re usually not going to see somebody lower than 2. 50 or so, unless they’re on a medication. The [00:20:00] bisphosphonates and Prolia and we’ll get to those in the future. They’re the anti-resorptive drugs and they can really bring that CTX down to 50 or lower, you know?  So, and that’s okay to have in it for a year, but it’s not okay to have for five years because it makes your bones really old and more brittle. The second marker is the bone formation marker. And there’s two major Ones for that, and that’s osteocalcin, but that does, that’s doesn’t really, it’s not that accurate, so I don’t use that one much at all.

The one I use is called P one NP. or Procollagen Type 1 N Terminal Propeptide. And that is an index, indices of osteoblastic activity. How much activity that they’re doing. They’re the cells that form bone. So there’s three bone cells. The osteoclast, the tear down bone. [00:21:00] The osteoblast, the form bone. And then the osteocytes.

And the osteocytes kind of run the whole show. They kind of organize things and they’re the general managers of the whole bone remodeling system. So we don’t really measure their activity. We just measure the osteocytes at the osteoclast with the CTX. and the Osteoblast with the P1NP.

Dr. Weitz: And you also note, I think, in your book that it’s important when you do the CTX test that you test it in the morning and that you not have taken Biotin or Collagen in the last day or two.

Dr. McCormick: That is crucial for the accuracy of this test. It’s worse to get a test and do it incorrectly and get, you get a bogus number than to not do it at all. So yes, if anybody’s asking their doctor for a CTX and P1NP, they need to be done fasting. They [00:22:00] need to be done first thing in the morning as you recommended.  And then stop all supplemental biotin and collagen for 48 hours before. The P1NP is not as finicky of a test, but the C Telopeptide is incredibly finicky. You have to do it really exactly right to get a good number.

Dr. Weitz: And is this a high dosage of biotin or even the amount of biotin that’s in a multi?

Dr. McCormick: They say 10 milligrams, but I’ve seen it with three milligrams change, change a person. And I recommend 48 hours, but in truth, you could probably it really probably only has to be 12 or 24 hours, but better to be safe and not take it for 24 hours, for 48 hours.

Dr. Weitz: Okay. So those are really important tests to gauge where you’re at, how well you’re doing, whether the type of bone loss, if you do have bone loss, is more related to turnover as opposed to anabolic [00:23:00] activity.

Dr. McCormick: That’s, yeah, people think that bone loss is just because the osteoclasts are, you know, breaking down too much bone. But it might be because the osteoblasts are really not doing their job, too. And when we talk about the the bisphosphonate drugs, the antiresorptives drugs that are given, this is a really important Part of the diagnosis and the figuring out what we’re going to do for this person, because if that person has a baseline CTX before they take any medication or nutrition changes, supplements, or anything, if their baseline CTX is already low and their P1NP is really low, they have a low bone tone or osteoporosis.  Taking an antiresorptive is not going to help them that much. So, it really matters to do these bone turnover markers first before any treatment is taken.

Dr. Weitz: This is really what we call personalized, individualized medicine. [00:24:00] And, in conventional medicine they would say, well, that drug just didn’t work.  No, that drug was not going to work for you in your specific condition.

Dr. McCormick: And the other thing I want to say is, and there’s other lab tests too, besides the turnover markers that are really important to make sure that there’s not something else going on like hypophosphatasia or diabetes, or you know, there’s many different disorders that can cause a person to have thyroid problems.  And these things have to be ruled out because you can’t just say, Oh, you have low bone density. Here’s your drug. No, we have to rule these things out. Like you said, with like for the comprehensive metabolic profiles CBC, they’ll tell us. What a person’s blood level of calcium is. Getting a 24 hour urine calcium to see if they’re losing calcium in their urine.  Get a PTH. 

Dr. Weitz: Do you do the 24 hour [00:25:00] urine calcium on all your patients or? 

Dr. McCormick: 99 percent of them, yeah. Okay.  If they don’t have huge bone loss and they’re 60 years old and their bone density is a You know, negative 1. 5, then I probably wouldn’t, but almost everybody else I would.

Dr. Weitz: And then how does that affect the way you treat the patient?

Dr. McCormick: Well, if it’s high, most medical doctors would give them a a medication to to decrease that calcium loss the, through their urine. But the problem with those meds is. They can also increase their loss of, they might decrease the calcium loss in the urine, but they might increase the loss of some of the other trace minerals.  And it really can change a person’s hemodynamics of their blood and cause dizziness. So you wouldn’t

Dr. Weitz: What kind of medication blocks the calcium loss?

Dr. McCormick: Well, [00:26:00] you can have hydrochlorothiazides. Oh, diuretics. Diuretics right. And and these can, like I said, they can cause dizziness in people, and you don’t want dizziness, because dizziness causes people to fall, and the number one reason why people fall break something is because they fall.  They also don’t really work that well past maybe two years or so, then they lose their effectiveness. So they’re just, I mean, sometimes people patients need a hydrochlorothiazide, a diuretic, but most of the time they don’t. And speaking of that test, the 24 hour urine calcium, it’s really important to not be taking high doses of supplemental calcium when you do that test.

When they figured out the reference range for the 24 hour. They didn’t pick a lot of people from, in the world who was taking supplemental calcium. They were making this reference range from people who were just on a [00:27:00] standard American diet. That’s the reference range it comes from. So you wouldn’t want to now be taking a thousand milligrams of calcium while you’re collecting that urine because that calcium is going to spill over into the urine and now it’s going to look like you have high loss of calcium in your urine, which is not true. So do the 24 hour urine calcium just from what your regular diet is. And if your diet includes dairy products, that’s okay.  I mean, it’s whatever you eat regularly, but just stop to supplemental calcium.

Dr. Weitz: Okay. What is some of the other important biomarkers you like to test for? I know you like to look at gluten sensitivity.

Dr. McCormick: Right. So gluten is one of them. So gluten. Sensitivity and or celiac disease. A person can have actually where they’re so sensitive to gluten that they have this [00:28:00] disorder called celiac disease and that can cause them to have less absorption of nutrients.  There are nutrients from their intestinal tract, but people can also have just gluten sensitivity where they don’t really have celiac disease, but that gluten sensitivity can increase your antibodies to gluten or increase your immune system activity, and when the immune system is ramped up because of gluten, It also ramps up osteoclastic activity.  And the reason why is because osteoclasts are a form of a white blood cell. They’re kind of really related to the immune system. In any race of immunological activity, Raises these signaling molecules called cytokines, pro inflammatory cytokines. Interleukin 1, Interleukin 6, Tumor Necrosis Factor.

And these, when they [00:29:00] are released by the body, the osteocytes hear that, they see that they smell those cytokines. And they say, Oh, I’m all excited. And they have one response when they get excited, and that’s to eat up bone. So, if you can calm down the immune system for whatever that reason is, and the gluten is one way, and it’s not that everybody needs to be gluten free, that’s not true, but if you are sensitive to gluten, even if you’re not celiac, but if you’re sensitive to gluten, and you can tell that by the anti gliadin antibodies, IgA and IgG, then you should stop gluten.

 

Dr. Weitz: The one test that people… do you run one of those sophisticated gluten panels like the Cyrex Array4 or the the Wheat Zoomer?

Dr. McCormick: I think those are really, really good. I typically don’t run those, but I run anti tissue transglutaminase IgA, a total IgA, and anti gliadin or deamidated antibodies IgA and IgG.  They’re the four tests that I run, but yes, [00:30:00] there, If a person has a major bone loss and we suspect, you know, something else going on and all those markers come back, either I’ll just say, listen, you got to go gluten free, or we test for the, you know, do a wheat zoomer or something like that. Yeah. Okay.  Another one is parathyroid hormone because if that serum calcium in the comprehensive metabolic profile, if that’s high, 10 or 10, 10. 1, 10. 2, I would always get a parathyroid hormone because they might have a benign parathyroid tumor that’s causing their bone loss. I mentioned before a condition called hypophosphatasia and that if a person’s 

Dr. Weitz: So that’s low phosphorus?

Dr. McCormick: Alkaline phosphatase, right? And that’s way more common than people would really understand. And that can cause not only lower bone density, but an increased fracture risk. I had a patient the other [00:31:00] day and And she had hypophosphatase, she has hypophosphatase, and she was put on Perlea, and we’ll talk about Perlea in the future in a couple minutes, but Perlea is an antiresorptive, and it didn’t work on her, and the reason why it didn’t work was because the alkaline phosphatase is so low, she’s not having bone turnover, she, alkaline phosphatase is from the osteoblast, so her whole bone turnover wasn’t high, She didn’t need an anti resorptive, and that’s why the Pilea just did not work at all, and actually

Dr. Weitz: What does the low alkaline phosphatase mean?  What, what is exactly are we talking about?

Dr. McCormick: The osteoblasts need they release this alkaline phosphatase, and that’s the way That’s one of the steps that they need to do to form bone. And if a person is not capable of producing that [00:32:00] alkaline phosphatase, then their bone, then their osteoblasts are not going to build.

Dr. Weitz: Okay. So it’s an indication that the osteoblasts are not working effectively to create new

Dr. McCormick: bone. That’s right. And so the osteoblasts and the osteoclasts talk to each other. If there’s no community, if there’s no osteoblastic activity, then they can’t really talk to the osteoclasts. Her whole bone remodeling, and I probably had at least 10 people now with this they’re all, their bone remodeling is just tamped down.  It’s just, it’s not happening. So they’re not having increased What, what causes that? That’s a genetic issue. Okay. Genetic disorder, and you can get genetic testing for that. But, what’s the problem is, because doctors miss that, and then they just reflexively see, oh, this person has low bone density, here’s your bisphosphonate, here’s your [00:33:00] pralea or something, and they don’t diagnose them properly, they can actually hurt that person by giving these medications.

Dr. Weitz: And you pick that up by having low alkaline phosphatase. So, for that type of patient, an anabolic drug is going to be more effective to stimulate the osteoblast. Way better. Yeah.

Dr. McCormick: Way more.

Dr. Weitz: Um, you talk about the importance of healthy lipids and the ability to have healthy red blood cells and blood flow being a factor.

Dr. McCormick: So inside your bone, there’s blood vessels and those blood vessels carry in nutrients, carry in oxygen. And that’s the way the osteoblasts can survive. through this nutrition. So if you have arteriosclerosis and you have [00:34:00] less poor vascular supply of blood into an area, You’re going to have bone loss.  And so, yes, you need to test. Not only just do a lipid panel for cholesterol and triglycerides and stuff. If they have high triglycerides, maybe they have non alcoholic fatty liver disease that can also contribute to bone loss. Maybe they have high cholesterol and high LDL’s cholesterol.

If they have high LDL cholesterol, That can cause an increase in what’s called p par gamma. And Ppar Gamma directly stimulates the osteoclast to break down bone. So you would need to work with that person’s cholesterol and LDL to bring that down, to help bring the Ppar Gamma down, to help bring down the osteoclast activity.  So, lipids are really important.

Dr. Weitz: Homocysteine, I know is an I read in your book is an important factor.

Dr. McCormick: So homocysteine is a metabolite from protein. So every time you eat protein and specifically the amino acid [00:35:00] methionine, it’s broken down into homocysteine. Well, your body has enzymes to Either reconvert that homocysteine back into methionine, use that homocysteine as an energy source, or just get rid of it somehow.

But it’s kind of like a poison in our body. So we need to get rid of that homocysteine. It not only isn’t good for your heart, it’s not good for your bones. It makes those cross links in collagen molecules really stiff and hard. And we want your collagen to be nice and flexible. So a homocysteine makes those cross links really stiff.

Anything above like an 8 or 9 for the homocysteine, then you’re starting to affect the bone quality of a person. So research shows that if we have a normal of 8 for homocysteine, we’ll say, if a person has a 15, they might have a 2 or 2. 5 times risk for fracture. And that’s because of a collagen issue with that.

So yeah, [00:36:00] that’s one of the tests I almost always do is a homocysteine.

Dr. Weitz: And we know by using methylated B vitamins, trimethylglycine, we can lower homocysteine.

Dr. McCormick: Yeah it’s pretty easy to, what you’re doing with these vitamin Bs and trimethylglycine and serine and things is you’re pushing that enzyme, those enzymes, to do their job.

You’re not fixing anything, you’re just pushing them to do their job, and then it really works to do that. Right. Vitamin D, super important, right? Super important. I usually recommend 40 I’m not one of these people who says you should do 80, 90, 100. I think it’s easy to get toxic on that, and I think it’s not good for your bones when you get up to 80, 90, 100.

So, but 40 to ml, and that might be that you need to be a thousand I use a vitamin D a day. It might mean you need to do 3, 000 or 5, 000 or 7, 000. Some people don’t need any. [00:37:00] Depending on where you live, depending on what your system is doing, but that’s why you don’t just tell somebody take 3, 000, you do a blood test, you see where they’re at, you do usually do them, I usually like to do the blood test in March because that’s the lowest that they’re going to be in the year because there’s less sun, at least up in here in New England where I live.

And if they’re, you know, Let’s say there are 20, well, you start them off with maybe 000, then test them 3 months, 4 months later, and if it’s up to 30, well, that’s not enough, you might have to go up to 5, 000, but, you know, we test, and then we change what we’re going to do, and we test, and we change what we’re going to do, but it’s all by the book, it’s all looking at labs and figuring it out,

Dr. Weitz: Personalized, individualized care.

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Dr. Weitz:   Yeah, you’re a little more conservative than I am. I’m in Southern sunny Southern California. People get a lot of sun. I still see a lot of people who are low and you know, they go to their primary care doctor and they have a 30 and they tell ’em, yep, that’s good.  And we know that’s not good. So I usually start people on 5,000, sometimes go to 10,000. Sometimes somebody will shoot up to 90 or a hundred and we’ll back it off. But I often find that they have a recommendation to take a thousand. And my experience that usually doesn’t move the needle very much.

Dr. McCormick: Well, even though you live in Southern [00:40:00] California, a lot of people use the sunscreen, you know, really, and they wear a big hat, which I’m not against, I’m just saying, didn’t benefit from the sun at all.

Dr. Weitz: Right. And, and your body converts cholesterol into vitamin D. So if you’re taking cholesterol lowering medication, you’re going to be less likely to produce vitamin D as well.

Dr. McCormick: Right. Right. I’ll say do I usually do. Hormones, Thyroid, Yep, and like on thyroid I look at the TSH and a lot of people are on too high a dose if they have hypothyroid and they’re put on some medication Levo or whatever, and their TSH is driven down below 5 It can really affect the bone density.

Dr. Weitz: Even .5 is kind of low.

Dr. McCormick: Even .5 is a little bit, but typically, you can get away with that, you know? [00:41:00] Maybe even .4, but certainly not .3, .2, .1 And then anything above 5.5, 6.0, then I start getting nervous the other way. There’s actually TSH receptors on osteoblasts so, you need TSH to stimulate those osteoblasts.

Dr. Weitz: Not, not T3, you need TSH? You need the TSH. Interesting. We got male and

Dr. McCormick: female hormones. The hormones need to be there for women. I’m I’m very positive on recommending hormone replacement therapy and women over, you know, in the menopause. And I like to see their, They’re estradiol levels somewhere between 25 and 35, maybe 40 max but they can do that with HRT, with hormone replacement therapy.  For males, it’s really important to have that testosterone and looking at [00:42:00] the free testosterone and their sex hormone binding globulin. Sometimes their SHBG is so high. That you know, giving a an estrogen for a woman or testosterone to men isn’t gonna help as much it, because there’s sex hormone binding globulin is grabbing all that testosterone or estrogen binding it up.

And then you need the hormone in a free state to work in a free state to do its job with the bone cells. But what’s all bound up on with the H-H-S-H-B-G it doesn’t. And a lot of women are too thin. If they’re too thin and anything below 127 pounds is considered a risk factor for osteoporosis.

And if you have a person that’s five foot eight and they’re 105 pounds, That’s a problem. And one of the reasons why it’s a problem is not only it changes their hormone levels, but it also [00:43:00] changes leptin. And leptin is produced by your fat cells, and when a person’s too thin, They don’t have the leptin in them and that’s a neurotransmitter from in the brain and it’s produced by fat cells.

But it almost acts like a co receptor, or it actually does, with the estrogen on the bone cells. So, if you get, if a person is, postmenopausal, and they want to go on HRT, hormone replacement therapy, but they’re really too thin, and they don’t have any leptin, that hormone replacement therapy won’t work as well.  So just having them gain 5 pounds can make that HRT work better. So, you know, that’s just another lab test that’s, we might want to get on somebody, but we might not depending on the situation. Great.

Dr. Weitz: So let’s go into what do we do for people who have poor bone health and let’s start with [00:44:00] exercise.

Dr. McCormick: Let me, before you Oh yeah,

Dr. Weitz: what

Dr. McCormick: else? Go ahead. One last, one last lab

Dr. Weitz: test. Sure, yeah, we can talk more about labs. I, I also, you know, you said something interesting in one of your discussions about, Low red blood cells being a factor.

Dr. McCormick: That’s exactly, that’s one of the things I wanted to talk about.  Okay. Low red blood cells is not definitive, but it, it’s a

Dr. Weitz: And by the way, labs are like, some labs say under 4, some labs say 4. 2. So you’re talking about really low, right? I’m talking about below

Dr. McCormick: 4,

Dr. Weitz: yeah. Okay.

Dr. McCormick: Yeah, usually. I mean, if I see somebody at 1, you know, I, I kind of look at that, but what happens is when a person has osteoporosis, their bone marrow can fill up with fat.  I don’t care how skinny you are subcutaneous wise, but you can have zero subcutaneous fat, but in their bone marrow [00:45:00] can fill up with fat.

Dr. Weitz: Why does that happen? I don’t know.

Dr. McCormick: It’s a way they think, okay, that we don’t know exactly, but it’s a way that the body is trying to get ready for disaster. So if, you know, in times of plenty, We’re good in times of no food.  We have one thing we need to do, and that is survive. And so the body stores that fat in, because the person doesn’t have any subcutaneous fat, so the body is saying, geez, we got to store some food. some place so that if they’re really desperate, if their body is really desperate and going to crash and die, we need to have some food, some nutrition.  And that’s why the body throws that fat into the bone marrow. And so that bone marrow is their savior, really you know, the fat in there. But the problem is that that [00:46:00] fat is a lot of it is palmitic acid and it’s poisonous to osteoblasts. Number one. So the osteoblasts can’t work well when you have all that fat there, but number two, it crowds out the mesenchymal stem cells that produce your osteoblasts.

So, so we can’t have good bone cell formation when we have all that fat in there and it crowds out the cells that make the osteoblasts. the red blood cells too, the hematopoietic stem cells. And that’s why we don’t have red blood cells. That’s why the person’s red blood cell count in their CBC goes down because there’s so much fat in the bone marrow.

So yes, for a cheap 5 test, you know, that comprehensive metabolic profile can give you a lot of information. In my book, I go through all the different things on that CBC and it really is, for five bucks it’s a really important, but you [00:47:00] need to know how to look at it. Right. And I want to say, I want to back up a little bit and talk about that.

I know I’m going all over the place, but that’s okay. I get incredibly excited about the subject of lab tests because you can do so much for a person, help a person so much by doing it. I love labs too. But when we go back to the whole thing of perfusion, of making sure the person has good Blood flow to an area.

If a person has preclinical cardiovascular disease, that, you need to look at that, too. Um, and a nice test that I like to do is called ADMA or asymmetric dimethyl arginine. And that is a really nice, simple, you know, not that expensive test for looking at the onset of cardiovascular disease. So we want to, because you can do stuff about that, and if we can do stuff about that, then we know that we’re going to prevent disaster [00:48:00] five years, ten years, ten years down the road for a person.

Dr. Weitz: Yeah, that’s measuring nitric oxide, right?

Dr. McCormick: Yeah,

Dr. Weitz: yeah. Which is crucial for the health of the endothelium, and then there are specific supplements that can help stimulate nitric oxide production.

Dr. McCormick: Yes. And so we want to get ahead of this whole game and not only for your whole body, but you know, for me specifically for a person’s bones.

Right.

Dr. Weitz: Small, dense LDL, oxidized LDL. Those, those are also things that are telling us that you’re not going to be getting proper blood flow. Right.

Dr. McCormick: Right. Right. So you, so you asked about the exercise. Yes, you can do, you know, all the nutrition you want, but exercise is vital to this whole game. And the exercise stimulates your muscles.  Your muscles release myokines, they’re little signaling molecules to the bones to say, Hey, you guys are still needed. You bones, you’re still needed, so you better do your job and [00:49:00] be strong. Because me, the muscle, is, needs you to be strong. Because if you’re working a muscle, Then that bone is being put under stress a lot more, and so they need to step up to the plate and get, you know, do their job to make that bone healthy and strong.

So, so working your muscles does that, just from the muscle bone connection. But there’s also that when you stimulate, when you put stress on a bone, you then stimulate these bone cells to do their job too. So they’re getting the message in two ways. They’re getting it from the muscles and they’re getting it directly by the stress and strain that a bone is put under when you do exercise.

Dr. Weitz: When it comes to exercise, I think a lot of people are confused about what is really needed to strengthen your bones. And I talk to a lot of patients [00:50:00] who say, well, I walk, I go for a walk, I use these two pound dumbbells. And the reality is studies that look at exercise is pretty clear that that’s better than doing nothing.  But that’s not really going to put stress on your bones. You, you know, there, there haven’t been that many studies that have really shown increases in bone density and decrease in fracture risk. And one of the few sets of studies that have are the Lift More trial in Australia, and those use heavy weight training.  We’re talking about deadlifts, squats, overhead presses with five rep maximum. We’re not talking about two pound dumbbells.

Dr. McCormick: Well, they use 85 percent of one RM, which is 85 percent of one Rep Maximum. And yes, it’s crazy. I have patients, these little bitty [00:51:00] women, you know, and there’s, they’re squatting a hundred pounds and they’re dead lifting 130 pounds.

And I go, Oh my God, you know, because it is amazing to me. And it, and the study, you’re talking about the lift more study out of Australia and Belinda Beck was the main researcher from that. And yes, she showed that it does improve. Bone density and bone quality by doing these exercises. So

Dr. Weitz: now, and they also do, they have an element of ballistic impact training.

Dr. McCormick: Yes. They well, they do that. They mostly do like heel drops and things like that.

Dr. Weitz: Well, they have them jump up to a pull up bar and then drop down. Yeah.

Dr. McCormick: And, but that’s the, when you talk about high intensity and impact training, that’s, that’s what it’s called. That’s the impact part of it.

Dr. Weitz: Right.

Dr. McCormick: Right. So, they’re now starting an Onero program and there’s several Onero programs, probably 10 of them now in the United States.  [00:52:00] So you can go to this the bone clinics website, it’s called www. onero. academy. com, onero. academy. com. And they have a map of the world there and they show on there where all these Onero programs are in the world. Most are in Australia. You know, some in New Zealand and different around the world, but there are about 10 of them in the United States.

And those are really good programs for people to join and get proper training and guidance by physical therapists who it’s really important to, when you’re starting to do these, These intense exercises, you better have somebody watching you and not doing it on your own, but watching you to make sure you’re doing them correctly.

And that’s what makes it safe. It’s not safe to do this stuff on your own and and just hope for the best. It’s, it, I think it is easy to get hurt. And, but [00:53:00] that’s what’s so great about these Oneira programs. It helps guide people. What do you think about osteostromy? I’m not a big fan. I’ve had several people get some fractures from it.

I, whether it’s, it helps or not, I don’t want to say it does or doesn’t. The research is minimal. It, it may help. I don’t know, but I do, I would caution people, if they do it, that just be careful and cause I have seen some injuries.

Dr. Weitz: Do you like vibration plates?

Dr. McCormick: I think vibrations plates have a place for sure.  Uh, it, it, it doesn’t take the place of exercise, but it’s certainly an add on and it’s certainly a it does improve, especially if you do it, two or three times a day and it doesn’t, you don’t have to do, you know, 20 minutes, but even if you did it for like 10 minutes, 10 minutes and 10 minutes or 10 minutes, 10 minutes and five minutes or something like that, but you’re trying to [00:54:00] stimulate bones and then relax and then stimulate the bones and then relax.

But, but but yes, I think that the Vibration Plates, especially the Meridyne is a good choice and Clinton Rubin is the main researcher on that and I think he’s really shown that it, it does work and it’s not a miracle for sure. But there’s a lot of people who can’t go to the gym.

They have some issue. They have multiple sclerosis or, you know, something to where they, they can’t do the exercise that they, that they need to do. And they’re perfect for, for, you know, the vibration plate is perfect for them. But even, you know, people who are capable and can go to the gym, I think they would benefit from the vibration plate.  Also, if they have that time and the finances to do that, I think it’s a good choice. Yes.

Dr. Weitz: Yeah. I used the vibration plate early on in my rehab when I was still on the, you know, using a crutch and stuff. And I wasn’t able to do [00:55:00] squats and deadlifts yet. So let’s talk about diet for bone health.

Some people advocate an alkaline diet so that calcium won’t be leached out of the bones to balance the blood pH, and some people have advocated a vegetarian diet, but I know you’re also a big believer in getting adequate quality protein.

Dr. McCormick: The protein I put is number one, you know, you really need minimum.  You take your weight, you know, divide it in half and get a number. And that’s the minimum. So if I’m 150 pounds, 75 grams a day, but you know, I try to get, 75, 80, 90 grams a day. I honestly think, and I don’t know why I have osteoporosis completely. I am gluten sensitive, but for me, I do think that, you know, I was a really hardcore athlete for many, many, many years.  [00:56:00] And I guess still am, but, but I know that I didn’t get the protein. And I know that that was part of my problem. And I see so many people With getting 40 grams or 35 grams a day of protein. And that is just not enough. So yes, Now

Dr. Weitz: you were basically an endurance type athlete, right? And you still do endurance events, correct?

Yes,

Dr. McCormick: I do.

Dr. Weitz: Now having endurance exercise been associated with bone density problems.

Dr. McCormick: It is, and the reason why is because you’re flooding your body with pro inflammatory cytokines. You’re flooding your body with oxidative stress that, you’re really stressing the body tremendously. It’s hard to get all that nutrition and athletes tend to push the carbohydrates and not the protein.

So I think there’s lots of reasons for that and that the loss of weight, that the thinness, I now know leptin in women or marginally [00:57:00] or one or two, three level of leptin in women. So it’s changes their hormones a lot. So there’s lots of reasons why endurance athletics can cause people to get osteoporosis.

It doesn’t mean that endurance. Activity is wrong. You shouldn’t do it. I’m just saying you better be aware that there’s issues and you need to do it properly. You need to be really proactive on how to prevent that. And one of the ways is the protein intake.

Dr. Weitz: And the best way to get protein quality protein is with animal protein, correct?

Dr. McCormick: You know, I think it’s really difficult for people. We are not, Vegetarians, genetically speaking. We are omnivores, and you know, we’re not herbivores, we’re omnivores. And so I do think it’s difficult as a vegetarian to get that protein, and yes I, I don’t, I think you can get it from both. You get [00:58:00] from, from vegetable matter and from, from meat sources, but yeah, I think it’s, I think it is important to do both.

I think people can do it, but it’s pretty difficult to do it as a vegetarian.

Dr. Weitz: But it is important to try to have a lot of vegetables and fruits and things that are gonna make sure our diet is more on an alkaline side, right?

Dr. McCormick: Yes. I think if you eat this meat and potatoes all day long, you’re going to, you’re going to be acidic and yes, it’s your green vegetables that give you the four minerals that really help alkalinize you are calcium, magnesium, sodium, bio organic sodium, not salt, not sodium chloride, but sodium.

And what did I just say? Calcium, magnesium, sodium, and potassium. Calcium. So potassium is probably the number one. So in your bones, you have your [00:59:00] calcium, magnesium. On the outside of your bones, you have potassium and sodium, and that’s in what’s called a hydration membrane. And the first thing that your body does when it becomes acidic and when I say acidic, anything below seven on the pH scale is acidic.

But even if it gets to 7. 3, 7. 25. If your blood gets to 7. 25, your body goes, Oh, I don’t like this. And that’s, you know, it’s, it’s wanting to change that. It’s wanting to bring your blood pH back up to 7. 3 or 7. 4. And the first way it does that is it taps that hydration membrane around bones for the potassium and the sodium to release.

Um, to buffer those hydrogen ions and hydrogen ions are the acidic ions in your, in your body. So the body goes to the hydration membranes, get that, gets that potassium, sodium, alkanizes the blood. And if it’s not there, if you haven’t been eating your veggies and your fruits, then the [01:00:00] mind it, then it signals your parathyroid glands in your throat.

To pump out parathormone, that stimulates the osteoclast to break down bone, and now we can mine that calcium and magnesium in the bone to buffer those hydrogen ions.

Dr. Weitz: So maybe throw some green powder in with your protein powder, and maybe throw in some collagen as well, right?

Dr. McCormick: Well, I take a huge, almost every morning, I get this huge handful of greens, you know, all kinds of different greens.  I stuff them in my bullet blender, I put in my protein powder and I grind it up and that’s pretty much it. Pretty much my breakfast. So lots of greens and lots of protein. Right. What about dairy? I think it’s fine to have dairy if you’re not sensitive to it. Obviously, if you’re sensitive to dairy or gluten or eggs or soy or anything, you shouldn’t be taking it.  But if you’re not sensitive to dairy, it’s fine to use dairy. Use a lot of dairy. I think it’s acidic [01:01:00] in general, has a lot of phosphorus in it. So I wouldn’t recommend people saying, Oh, drink three glasses of milk for your calcium. I don’t think that’s a wise thing to do, but some dairy is fine. 

Dr. Weitz: Are there forms of dairy are better?  Like is, is yogurt better than milk?

Dr. McCormick: I like kefir because kefir is even better than yogurt because not only does kefir have calcium, has protein, and probiotics to help your gut health. So I’m a big kefir fan and you can get kefir that’s not, doesn’t have sugar in it. And so I all times get blueberries or raspberries or something and I pour kefir on it and that’s my dessert.

Dr. Weitz: Okay, cool. What do you think about soy? Soy contains isoflavones that have been associated with bone health.

Dr. McCormick: I think soy has gotten a bad name and because there are people who have sensitivity to it. So, yes, if you’re sensitive, don’t take it. Otherwise, I [01:02:00] think soy is a great protein product and with it, like you said, the isoflavones that do seem to help some people helps stimulate the osteoblasts.

Dr. Weitz: So let’s talk about nutraceuticals and let’s start with calcium.

Dr. McCormick: I always kind of recommend people take about 500 to 600 milligrams a day because you’re going to get 700, 800 from your diet. So you

Dr. Weitz: want to get say 1, 200 total between diet and supplements?

Dr. McCormick: Yup. And for magnesium, three to 400, probably.  I recommend that from, from your supplements because it is hard to get magnesium in your diet. But so I always encourage people to get three to 400 in addition as a supplement and not say, Magnesium Oxide, but I think the Magnesium Malate Chelate, Magnesium Bisglycinate, Magnesium Citrate, Magnesium Tartrate, [01:03:00] they’re all fine, but I just try to steer people away from the Magnesium Oxide as I don’t think you absorb as much of that.

And what form of calcium do you like? Anything, it doesn’t matter to me except not Calcium Carbonate, but once again, Calcium Malate Chelate, I think is the best, Calcium Bisglycinate, Calcium Citrate. But also the microcrystalline hydroxyapatite, the MCHA, I think that’s a good form. It’s a little bit less absorbed than the calcium malate chelate, but the MCHA, like I said, microcrystalline hydroxyapatite from bone, is a good form of calcium.

Dr. Weitz: Now some people are freaked out about consuming calcium because there’s been some studies linking calcium supplementation with the risk of atherosclerosis, even with the risk of arrhythmia, and I know in your book you compare the overreaction [01:04:00] to these studies to the overreaction to the Women’s Health Initiative studies when all the doctors stopped prescribing hormones.  So a lot of people are afraid to take calcium because of this and doctors are not sure what to do. And you have cardiologists out there telling patients, don’t ever take calcium.

Dr. McCormick: Yeah, I think they’re doing a disservice to people. And as you say, it’s exactly what happened in 2001 with the Women’s Health Initiative when that came out and with oral 0.625 estradiol was given and came up with a slight risk in cardiovascular disease and all that. And so all the doctors said, oh, no more estrogen for, for women. And that was a, Great disservice. And I think the same thing’s happening with this calcium. And, no, I don’t think people should take 1200 and 2000 milligrams of supplemental calcium every day.

I don’t, I [01:05:00] don’t think that. I do think that that’s a problem. But, when you say no supplemental calcium, And a person doesn’t eat dairy, they’re not going to get mg of calcium. So, you need to take supplemental calcium and, and, I recommend, you know, not taking 500 all at once, but taking 150 or 200. with each meal, making sure you, you know, chew it up slightly in your mouth, taste it a little bit.

That’s neurologically signals your brain that it’s coming. It acts more like food. It gets your body prepared for it. You’re not spiking your blood calcium that way by taking these small doses and you’re hedging your bets and saying, okay, I’m, I’m covering my basis. I know I’m going to get my thousand or 1200.  Because I don’t eat dairy, maybe, or I don’t eat sardines, or I don’t eat sesame. You know, if your diet is low in calcium, you need to [01:06:00] take supplemental calcium.

Dr. Weitz: And if that calcium is being consumed with the right amount of vitamin D and the right amount of vitamin K, it’s going to be utilized and not end up in the arteries.

Dr. McCormick: That’sright. Yeah, and that’s an incredibly important point. That, yeah, if you’re just taking calcium and not the magnesium, not the K, not the D, not the trace minerals. You know, then yeah, then that’s not balanced and that is probably a problem.

Dr. Weitz: And you point out in your book, not only did subsequent studies looking at whether there’s a correlation between calcium and atherosclerosis really show that there was a correlation, but there’s actually more of a correlation between osteoporosis and arterial plaque.

Dr. McCormick: Yes, and, you know, you can make a case for anything, and I think what happens with the media is they like to [01:07:00] make a story out of something, and I think that’s what happened with the studies that came out 10 years ago with the calcium as the media jumped on it and said, wow, you know, we never thought that calcium could be a big story, that it would be detrimental to health.

And the, and the media just jumped on it and made more out of it than they should have.

Dr. Weitz: So vitamin K is super important. And I have recently become convinced that the MK4 form at a higher dosage Is probably the most beneficial, especially for osteoporosis. So I’ve started recommending the 45 milligrams of MK four.

What do you think about vitamin K and what form and, and how much do you like?

Dr. McCormick: There’s two forms of vitamin K two. There’s MK four. Menoquinone 4, and MK 7. The MK [01:08:00] 7 lasts longer in your blood, probably a day and a half or so, half life. The MK 4 is much less of a half life. Even though these are fat soluble vitamins, they don’t last long in your blood.

So the MK 4 only lasts, you know, has a half life of 3 4 hours in your blood. So, that’s why I think it’s good to take a combination. of the two, but you’re right. I really think that the MK4 is the more important of the two. And I’ve seen people get heart palpitations when they take too much of the K2MK7.

And to me, that’s probably, oh, you know, more than a hundred micrograms. I wouldn’t take, I would take between 50 and a hundred micrograms of K2MK7 for the K2MK4. I usually recommend 500 to a thousand, although maybe up to 5, 000 or five milligrams can do a little bit better job than the 500 or a thousand.

I’m not sure it does a lot more. And I [01:09:00] don’t know. I don’t think the 45 milligrams It’s harmful to anybody. I think lots of people do that. There’s been several studies on that. It doesn’t show that it hurts anybody. Does it actually help? I’m not sure it does, but for sure up to five milligrams a day is perfectly fine and probably helps the person more.

You have to understand what the vitamin K does and it is incredibly important for bone health. When your osteoblasts are forming bone, They pump out this protein called osteocalcin. And osteocalcin needs to be activated or carboxylated by vitamin K. That’s the magic. So, the osteoblast might form the osteocalcin, but if that vitamin K is not there to activate that osteocalcin, you’re not going to get a bone crystal formation.

So, that calcium, that vitamin K [01:10:00] has to kind of be there 24 7. And, that’s why it’s important to take that, you know, if a person has low bone density, they should be taking vitamin K every day.

Dr. Weitz: What do you think about Strontium Citrate?

Dr. McCormick: I’m a little negative on Strontium. Okay. In my book, I talk, I write about two pages about it because I am not that passionate about it.  I’m passionate about it negatively instead of positively. And the reason why, I have a real reason that is important to look at that most people don’t. And that is, Number one, all the research for strontium, or most of the research out there, has been on strontium renolate from Europe, and that strontium renolate was taken off the market, and now we can only get, well actually put it back on the market, but you can still only get it in Europe.  In the United States, we can only get the strontium salts. [01:11:00] You know, and, and a lot of people talk about strontium and, and they cite the research for strontium, but that research they’re citing is from strontium renolate, not from a strontium salt. And I don’t think that’s, I don’t think we can do that. I don’t think there’s, Research that really shows that yes, Strontium does improve bone density.

No doubt about it, you know, it does improve bone density, but does it decrease fracture risk? We don’t know that, but I go even further than that. And my big beef is if you stop strontium, let’s say you take strontium for three, three years, and then you lose interest or for whatever reason, you stop strontium.  My concern is. But that strontium molecule leaves, that strontium [01:12:00] atom leaves the bone crystal quicker than calcium and may leave that bone crystal in a different state that makes it more Vulnerable to fracture that makes that bone more vulnerable to fracture. It’s because of the rapidness for which that person, those bone crystals lose that strontium.  Unlike the pace that calcium is lost from a bone crystal. Strontium is lost much faster and can change the strength of that bone crystal itself. So if you start strontium, I encourage people to stay on it. If they’ve been on it for three months, it doesn’t matter. But if they’ve been on it for three years, then I think people should just need to stay on it.

Dr. Weitz: Another controversial mineral is fluorite.

Dr. McCormick: You don’t want to be doing that. You make your bones more fragile. Okay,

Dr. Weitz: that’s where I’m at with that. [01:13:00] You know, one of my favorite nutraceuticals for so many things that I, I, I’ve been taking for years is berberine. And you talk about some of the bone effects, how it stimulates osteoblast formation.  That, that’s a new one for me. So that’s pretty fascinating.

Dr. McCormick: I really recommend berberine in not high doses, but, you know, 250 milligrams or so, but it does, it stimulates the osteoblast and it’s a cool herb because it calms down the osteoclast, yet stimulates the osteoblast, and it’s good for your gut in general, and your gut health is.  number one for improving bone health because in your gut is 70 percent of your immune system. And so you need that gut to not only be able to absorb things properly, but to not be rallying up your immune system, which is then going to route the osteoclast. So yeah, berberine is great for helping lots of things.

Dr. Weitz: Yeah. I know you like to look at [01:14:00] gut health and even do a stool test and make sure you get that gut improved as part of the program. Yes. Yeah.

Dr. McCormick: If a person has a gut issue that there’s a lot of stool, great stool tests out there to do. I happen to like the Diagnostic Solutions GI Map, but there’s other ones that are good too, but that’s the one I use.

Dr. Weitz: Just did an interview with Tom Fabian this morning talking about the GI Map. That’s a good, good, good tool to use. Yeah. Yeah. Yeah. I liked the GI map as well. So now let’s go into the pharmaceutical medications for osteoporosis.

Dr. McCormick: There’s only, there’s not very many, there’s only about 10 medications really.  Um, we’ll talk about, so there’s four bisphosphonates and, and like I said, there’s only really five that are anti resorptive. So there’s four bisphosphonates. There’s Fosamax, Actonel, Boneva, and Reclast, [01:15:00] and they are called anti resorptives because that’s what they do. They, they stop those osteoclasts from tearing down bone.

They stop that resorption by the osteoclasts. They don’t add bone quality to somebody’s bones. They just decrease bone loss and allow a sprinkling in of bone. calcium into that bone. So it makes the bone harder. It doesn’t make the bone quality better. It makes the bone density higher. And remember bone strength is a combination of bone density and bone quality.  And the bisphosphonates only add bone density to that bone. And then there’s the, the

Dr. Weitz: And, and, and the, one of the problems potentially with these drugs is by blocking that osteoclastic activity, which is essentially the cleaning crew [01:16:00] that cleans up the Bits of bone that get damaged from normal activity is you are likely to get an increased accumulation of less healthy bone.

Dr. McCormick: And the microfractures, you’re right. Right. If you do bisphosphonate for a year or two, that’s fine. It’s not going to hurt you. What’s going to hurt you is to be on it for 3, 4, 5, 6 years. Then, you’re right, then these microfractures I talk to patients who are on it for 15, 20 years. That’s, to me, that’s awful.  Yeah, it’s really sad. And because they have built up microfractures in there. Not only that, is When they exercise, the exercise doesn’t do them nearly as much good as if they had, you know, a bone turnover. Because if you have viable osteoclasts and blasts, then they can respond to that exercise that you’re doing.

So that fifth one, the anti resorptive is Prolia. [01:17:00] Prolia has lots of issues. I do recommend it sometimes though, and a person might need Prolia, especially if their hips are. are very, very low bone density because Prolia does do a way better job on hip bone density than episphosphonate does. So Prolia does have its place.

You know, I’m not, I, even though I push and encourage nutrition and supplements and exercise, I’m not against medications. What I’m against is when people use medications, number one, solely as their treatment for osteoporosis, and number two, when they use them long term. Medications can really help people get a person out of trouble.

But you usually only have to use a medication for two or three years and then you’re done. And then you rely solely on the nutrition and supplements and stuff. And sometimes people don’t need a medication at all, but sometimes it can be a lifesaver. So

Dr. Weitz: for patients who [01:18:00] are afraid to stop taking their medication, what you’re saying is, if you’re taking an anti resorptive drug, like a bisphosphonate, after two or three years, you’re not getting much benefit out of it.

Dr. McCormick: You’re not and you may have to go back on it in the future if depending and we’re gonna look at bone turnover markers and stuff But it’s that, that long term use of it backfires. And then the bones can become, you know, like we said, just much more vulnerable to, to breaking. Atypical femur fractures or osteonecrosis of the jaw or something like that.

But short term use is okay. And remember, all during that time of short term use, what are we doing to that person? We’re improving their whole body. through changing their, their nutrition, changing their supplements having them exercise more. So we’re kind of getting them ready, getting their body ready to [01:19:00] be able to go drug free in the future.  So it’s a time, it’s a, it’s a way to buy time too, personally.

Dr. Weitz: And then we have the anabolic medications.

Dr. McCormick: Anabolics, and there’s only three anabolics, and that’s Forteo, or Teriparitide, and Tymlos, or Abloparitide, and then there’s Evenity, or Romasomazab. And the Forteo and the Tymlos are pretty similar.  They’re the they’re analogs from a parathyroid hormone. And then the the Evenity or the Romasomazab, that’s an antibody against sclerostin. Sclerostin is this protein that’s produced by your osteocytes that, that shuts down or, or tempers osteoblastic activity. So your body doesn’t want to have osteoporosis and it doesn’t want to have osteopetrosis either.

Petrosis is too hard of bones, too thick of [01:20:00] bones, and that’s what would happen if your osteoblasts were allowed to just run amok and just build tons and tons of bone. So your body produces this sclerosin to, to bring back that osteoblastic activity. So the Evenity is an antibody against that sclerosin.

It gets rid of that sclerosin for a year because that’s how long the Avenidae is given. And during that whole year, those osteoblasts can go wild and crazy and just build lots and lots of bone. So you can actually get, you know, 12 to 14 percent of bone in one year by taking Avenidae. For the Forteo and Tymlose, you can get 8 10 percent in about a year and a half, well, a year and a half, two years.  So, so they both, you know, Forteo and Tym, Forteo or Tymlose and Evenity they’re, they’re great anabolic drugs that can really, add bone quality and bone density to somebody.

Dr. Weitz: But it can be difficult to get insurance to want to cover [01:21:00] these medications because they’re expensive. And in your book, you actually talk about how ideally there’s a lot of patients would benefit from starting with an anabolic medication building up some more bone and then following it with a Proleo or bisphosphonate so you can hold on to those gains. But insurance often doesn’t want to pay for the anabolic medication simply because it’s more expensive. So they force the patient to take a bisphosphonate to start with. And then if you do that, and then you do an anabolic medication, because the bisphosphonate is.  If it’s failed, it’s going to be less effective.  

Dr. McCormick: Unfortunately, those are, that’s a true situation. And it’s it’s unfortunate because you’re right. The, the anabolics don’t work as well if you take the anti resorptive first. So, and the anabolics, you have to follow them all with an anti [01:22:00] resorptive because there can be what’s called a rebound effect.  The same with Prolia. You have to follow Prolia up with, with Reclast or Zoledronic acid so there’s no rebound. But, yes. If a person’s bone density is really poor, their quality is poor, they need to do an anabolic first and then follow it up with an antiresorptive and not the other way around.

Dr. Weitz: So, I see ads now where they’re recommending Evenity followed by Prolia.  Does it need to be Evenity, then Prolia, then Reclast?

Dr. McCormick: That all comes down to a person’s hip, in my opinion. Okay. So let’s say a person’s hip is at negative 3. 6 and their spine is at negative 4. 8. They need a medication and Evenity would be great for that because Evenity is going to help that hip. way more than Forteo or Tymlos.  If the hip [01:23:00] is, you know, a negative 2. Tymlos are perfectly great drugs to, to help that spine because they’re not going to help the hip as much. But if the hip is really poor, like I said, negative 3. or even 3. 5, 3. 6, and the Avanity only improves them to maybe a negative 3. 4. then yes, I would say Prolia would be a better choice than doing Reclast.  And you might do that Prolia for like two years and then the Reclast after. You have to follow up Prolia with Reclast. And one of my pet peeves is seeing people on Prolia for three, four, five, six, seven years because it can be incredibly difficult to get them off of Prolia. and not have a rebound. And talk about that at length in my book and how awful the situation that is.  I’ve just seen way too many people who have been [01:24:00] put on Prolia and then They’ve stopped Prolia and they have a huge rebound and within three or four months they are fracturing like five, six, seven, eight vertebrae, just their spine just starts crumbling. Wow.

Dr. Weitz: So that’s pretty scary. People listening to this are probably thinking, I don’t want to go on that Prolea.

Dr. McCormick: Well, if you do, it has to be done properly. And unfortunately, some doctors don’t know how to do it properly.

Dr. Weitz: But you don’t want to just take Evenity and not follow it with something, right?

Dr. McCormick: No, all the, all the anabolics you need to follow up with at least a year of an, of a, of, of something, of an antiresorptive of some kind, yeah.

Dr. Weitz: Just because you won’t hold on to those gains and you’ll have like

Dr. McCormick: So, Evenity is a very interesting drug. It acts as an anabolic for the first eight months, and then it’s an antiresorptive for the next four months. And and it’s still, you can have, when it’s, when you stop Ibenity, there can still be a bit of a rebound, even though it becomes an anti resorptive, you can still have a rebound and lose, actually lose some density. And we want to. solidify that. We want to cement that bone density and bone quality in there. So by taking a bisphosphonate, you’re ensuring that those osteoclasts don’t start ramping up and breaking down that bone again.

Dr. Weitz: Okay. Great. I, this was a tour de force discussion of bone health. Thank you so much, Dr. McCormick.

Dr. McCormick: I love talking about this, as you can tell. I’m pretty passionate about it, so.

Dr. Weitz: Absolutely. So, everybody should pick up Great Bones. [01:26:00] It’s available through Amazon, right? And if people want to work with you.  Are you still available?

Dr. McCormick: Yeah, I do either telephone consults or in person. It doesn’t matter. So. So how do they get a hold of you? You can go to my website. I actually have a brand new website. I’m trying to think of the name of it. I mean, it just went up like three days ago. Okay. www. Great Bones consulting.com.  Okay. . But yeah. Well, I, I, I mean that’s sort of, you have to do the H-T-T-P-S.

Dr. Weitz: Yeah, yeah,

Dr. McCormick: yeah. Everybody knows that. Yep. Yeah, then, but GreatBonesConsulting. com or you can just put in Keith McCormick. I don’t know if you would come up with it that way anymore. You know, I’m a little bit flexed with this new website and how it works, but.

Dr. Weitz: It looks like your old website’s [01:27:00] still up there. Is it? Okay. Okay. That’s what I looked at. I didn’t see the new

Dr. McCormick: website. This is all happening this week, so. All right. What’s going on? But yes, they can go to just Keith McCormick. And Keith McCormick, D. C., and W. W. W. And, or my supplement company, which is osteonaturals.com. And you can get to my website that way too. So, so either osteonaturals. com or KeithMcCormick.com. 

Dr. Weitz: And practitioners, can they distribute your supplements? Is that something?

Dr. McCormick: Yeah, we give we have programs where they can do that. They can become an professional distributor.

Dr. Weitz:  Yeah. Okay. That’s great. Thank you so much.

Dr. McCormick:  You’re welcome. Thanks for having me on Dr. Weitz.

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Dr. Weitz: 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 very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review.  As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310 395 3111.  And we can set you up for a consultation for functional medicine. And I will talk to everybody next week.