ja_mageia

2009-06-05 R. Keith McCormick DC Bone Regeneration And Fracture Prevention

KIRK HAMILTON: Welcome to Staying Healthy Today, a health-oriented radio show committed to bringing you key experts in the fields of nutrition, prevention and integrative medicine. Hi. My name is Kirk Hamilton, your host of Staying Healthy Today. Our mission is simple: To provide you credible and usable health information from interviews and our educational resources to help you Stay and Be Well in the busy modern world.

Today's show topic is "How To Improve Bone Strength And Reduce Fracture Risk Using A Whole Body Approach To Osteoporosis." Our guest today is Dr. R. Keith McCormick, a chiropractic physician with a private practice in western Massachusetts, where he specializes in the nutritional management of patients with bone fragility and also in the treatment of sports injuries. Dr. McCormick studied human biology at Stanford University and earned his Doctorate at the National College of Chiropractic. He is a member of the American Society for Bone and Mineral Research, the International Society of Clinical Densitometry, and the Institute for Functional Medicine. Dr. McCormick is a certified chiropractic sports physician, with a membership in the ACA Counsel on Sports Injuries and Physical Fitness. Sports have played a vital role throughout Keith McCormick's life. At Stanford, he competed on the varsity cross-country and fencing teams. As a junior, he was a silver medalist in the Modern Pentathlon World Championships. In 1975, he won the North American Championship and the following year was a member of the Unites States Olympic team competing in the 21st Olympiad in Montreal. Dr. McCormick continues to compete in triathlons of all distances including ironmans, and is available online at www.mccormickdc.com. He is the author of an excellent review paper entitled "Osteoporosis: Integrating Biomarkers and Other Diagnostic Correlates into The Management of Bone Fragility" in Alternative Medicine Review, 2007;12(2)113-145. He has also published a recent book in 2008 by New Harbinger Publications entitled "The Whole Body Approach to Osteoporosis: How to Improve Bone Strength and Reduce Your Fracture Risk."

Welcome, Dr. McCormick. Thank you for taking the time to share with us your important work on optimizing bone health.

DR. R. McCORMICK: Thank you for inviting me, sir.

KIRK HAMILTON: So how serious is the frequency and consequences of bone loss and fracture risk as a public health issue in the United States?

DR. R. McCORMICK: I think it's becoming more known now, but I think most people don't really realize how many people have osteoporosis. In the United States there are 8,000,000 women and 2,000,000 men, with a direct cost of probably $18,000,000,000 to our society because there's 2,000,000 fractures that happen every year. And of those fractures, the most devastating to the people are fractures of the hip, and there's probably 300,000 of those each year and from those people who fracture, it creates quite a lot of morbidity and sometimes even a loss of life from complications, so it has a huge impact on our society.

KIRK HAMILTON: I've heard something like almost 50% of individuals who get a hip fracture and go into a facility don't come out again, or something like that. It's pretty astronomical.

DR. R. McCORMICK: That's a little high. I would say it's 20% or something.

KIRK HAMILTON: Twenty percent?

DR. R. McCORMICK: But probably 40% certainly never fully recover, or 50% never really recover their full use of their hip and a lot of times people are in these rehab centers for quite a long time.

KIRK HAMILTON: If you had to pick out the most frequent fracture area, would you say hip, lumbar spine?

DR. R. McCORMICK: The lumbar spine is definitely the most frequent, but a lot of times people don't even realize that they have a fracture. I've had several patients who come in here and they have some back pain, but it wasn't, you know, anything unusual for them, and you take an x-ray and you see that they've had a compression fracture.

KIRK HAMILTON: Is it true that bone is a dynamic entity and it turns over every seven years, or something like that, or your whole skeleton?

DR. R. McCORMICK: Some bone turns over every two years. That's what people tend to think of the spine and skeleton that hips, all the bones, it's just these static stays that kind of hold you up in the air, and that's all they are, but they're incredible dynamic organs and they are constantly undergoing changing. They are constantly being what's called remodeled, where old bone is taken away and resorbed by a cell called the osteoclast, and then new bone is being deposited by osteoblasts. This remodeling process is the way we get rid of the microfractures that happen as a result of all the daily stress we put them, the stresses and strains, and we get little bitty micro cracks. Well, if we don't get rid of them, then they'll build up and over time bone gets more fragile. And anytime we take up a new activity, say we've never played tennis before and now we decide to play tennis. The way our arms get stronger, the way our legs get stronger as we exercise doing a new thing, then the bone has to remodel and that's the way the bone, the skeleton, the hips, get stronger to take up that stress.

KIRK HAMILTON: I never knew we had little microfractures. That's interesting.

DR. R. McCORMICK: Lots of them. At any one moment throughout your spine and hips and throughout your skeleton, there are probably at least a million or more of these little bitty bone resorption sites taking place, constantly getting rid of all these microfractures. If your body senses these little micro cracks, it sets up what's called a basic multicellular unit where it funnels in these little osteoclasts and osteoblasts and they fix that bone and then they go on to someplace else to fix the bone.

KIRK HAMILTON: Can you tell me or share with the audience the terms osteopenia and osteoporosis and how are those determined?

DR. R. McCORMICK: Well, osteopenia and osteoporosis are a -- it's how we look at the fragility of the skeleton, how we look at it, how it becomes more easily breakable. We measure this through bone density exams, and they are called dual energy absorptiometry scans, and it's a measurement of how much actual mineral content is in the bone or how much density is there. That is measured in grams per centimeter squared, but it's kind of hard to work with that measurement and it's hard to compare grams per centimeter squared to everybody else's. The way we are able to compare ourselves to our neighbor and everybody else is we take those, that measurement, and we convert it into two different scoring systems. One's a T-scale and the other's a Z-scale. And a T-score of a bone density exam is compared to a person's bone density. It's taking your bone density and comparing it to that of a healthy white young woman. But a Z-score compares a person's bone density to a person of their own age and their own sex. And most of the time when we're talking about bone density, we actually just refer to T-scores, and a T-score in general, if it's a 1 or a 0 or a -1, that's normal. But if it's between -1 and -2.4, that's considered to be low bone density, or what people often refer to as osteopenia. And anything worse than a T-score of -2.5 is considered to be osteoporosis.

KIRK HAMILTON: So the goal is to be closer to youthful bone density levels?

DR. R. McCORMICK: Yes. It would be great if everybody was a -1 or a 0, or something like that.

KIRK HAMILTON: How did your own experiences with osteoporosis inspire and influence your work that you do now, and why did you commit so much of your professional life to optimizing bone health?

DR. R. McCORMICK: Well, I'm 54 now, and 10 years ago I was just doing -- I'm an athlete and I was on the ‘76 Olympic team and did a lot of things athletically all my life, and so even so even at 45 I was just training and I came up with a lot of hip pain. After doing a lot of different diagnostic tests we found out I had really severe osteoporosis. I had a T-score of -4.3 in my spine, so I had really severe osteoporosis. So I went to several endocrinologists and I just realized that what was available to me wasn't what I was after and the only thing that was available was medications. I was told to use a thiazide diuretic to reduce the calcium loss in my urine, and also to take a bisphosphonate, Fosamax, to harden my bones. I thought that seemed a little crazy to me because I was 45 years old and I am assuming I am going to live to be 85 or 90 or so, and I certainly want to keep training and doing ironmans until I'm 70 or 80. So, I couldn't imagine that I was going to be on a thiazide diuretic and a bisphosphonate for the next 45 years. It didn't make any sense. So I just delved into it. I am a chiropractic physician. I know the lingo of medicine and so I just thought I can figure this out, and I started exploring and learned a lot about osteoporosis and now I try to help other people who are in the same boat.

KIRK HAMILTON: Let me ask you this before we get into treatments and things. Looking back now, what were your risk factors?

DR. R. McCORMICK: Nothing.

KIRK HAMILTON: Well you had to do something to get the bone loss, because you changed it, or you had a lack of something.

DR. R. McCORMICK: Yes, but they did this one study. I can't remember the name of the study, but 37% of people in this study had absolutely no risk factors, but they had osteoporosis. One of my pet peeves is there's a lot of people out there who have osteoporosis and don't know it and don't find out until it's too late when they're 60 and 70 and 80 years old and they're starting to fracture a lot. And it would have been great to find out when they were 40 or 50 or 55 that they had low bone density and we could have done something about it, or more so.

KIRK HAMILTON: So you don't see anything looking in your past that would have set you up for it?

DR. R. McCORMICK: Not as far as the general criteria of what is considered to be a risk factor. Now, after doing a lot of searching of who I am biochemically and genetically, that I am sensitive to gluten, and wheat and barley and rye, the protein in gluten. People who are sensitive to gluten have celiac disease, and have a much greater risk of having osteoporosis. Also, because I am an athlete, I train really hard. I was on the ‘76 Olympic team, and I've done ironmans and triathlons, and I've put in quite a lot of miles and I've beat up my body a bit. And when you're an athlete, you're generating a lot of inflammation in your body. You're generating a lot of what's called pro-inflammatory cytokines, and these cytokines increase inflammation in your body and lead to bone loss. So unless you are taking care of that by taking antioxidants and making sure that you're absorbing the nutrients that you need, there's a high risk that you're going to fracture or that you're going to have osteoporosis or bone loss, but you don't know those things until you look into it.

KIRK HAMILTON: I understand the traditional risk factors, but looking back on what you know now, and the medicine you practice, you would say, well, I probably had a malabsorption issue because of the gluten sensitivity, and because I was under such oxidative stress and maybe - I don't know how great your diet was as far as having lots of antioxidants included.

DR. R. McCORMICK: Well, I certainly didn't eat enough vegetables, and most kids don't, and I don't think it was an absorption problem because I don't have celiac disease. I just have gluten sensitivity. But even gluten sensitivity can increase inflammation in your body enough to contribute to bone loss.

KIRK HAMILTON: Oh, I see. So you don't think that because you had gluten sensitivity there was altered intestinal permeability and things like that to cause malabsorption. You think it was because of increased inflammation. I see, I understand.

Let's talk about calcium for a minute, because, you know from traditional circles, if we took enough calcium, everything would be okay almost. I was reading about a calcium paradox from the World Health Organization that said something to the effect that the countries that have the highest intake of calcium have the highest rates of osteoporotic fracture, and I was wondering first if you can just comment on the rate of calcium and how important it is, and do you believe this comment at all?

DR. R. McCORMICK: That whole calcium paradox thing got started -- I don't really agree with it. It got started probably in the 1970s or even earlier when they were starting to do heart transplants and they would remove a heart and immerse it into a solution with no calcium, and then they put it into another solution with a lot of calcium and they noticed that it caused a lot of cell membrane damage. But what was actually happening in that situation was that the heart was contracting rapidly and then when it was perfused again in this calcium solution it broke the cell membranes and it leaked all these enzymes and it sucked in a lot of calcium, and so they called it a calcium paradox. And that's continued, that theory or that concept has continued because now we see that these calcium channel blockers that lower blood pressure work, yet when you take oral calcium or take calcium by mouth, it can also lower your blood pressure. So, that's how this whole thing of the calcium paradox has progressed, but now people are using those examples and they're applying it to the fact that we see more osteoporosis, more heart disease, more things like that that are related to calcium in places with high calcium and intake, the developed countries, and in places of under developed countries, or developing countries, where there's less calcium intake, we have less occurrence of osteoporosis. I think it's talking apples and oranges really.

KIRK HAMILTON: How would you just explain that difference then? In the countries?

DR. R. McCORMICK: Because the intake of protein is part of this problem. Because in all the developed countries, we have way too animal protein intake which decreases the body's pH and we have too much salt intake which also causes problems in electrolyte balance and when you have a low body pH, several things happen. Most of that is because people don't eat vegetables which are more alkaline and they eat too much animal protein which makes the body more acidic. What this does is that low pH causes an activation of what is called P2 receptors on cells and that allows calcium to actually enter the cell, and that's why we have this increase in intracellular calcium. The ratio between what's outside of the cell to what's inside of the cell should be like 10,000:1. So 10,000 parts of calcium outside of the cell to 1 part inside. And that's kind of what helps signaling mechanisms occur properly. When you have a low pH, it allows calcium to enter a cell and that ratio is offset. So when you have those P2 receptors stimulated by the low acidity, that stimulates the formation of osteoclasts from what's called hematopoietic stem cells. Hematopoietic stem cells can develop into either white blood cells, cells of the immune system, or into osteoclasts. And when you have a low pH and stimulation of these P2 receptors, then you have more formation of osteoclasts. You also, with that low pH, it also allows the enzyme that is released by osteoclasts that breaks down bone, it's an enzyme called cathepsin K, when you have low pH at that level of the bone, then cathepsin K has a much easier time resorbing this bone, breaking the bone down. If people would just reduce the animal protein, increase fruits and vegetables, and take vitamin K, that will help guide - and vitamin K is really important because the vitamin K guides the calcium towards the bone and away from the soft tissues, and that's one of the reasons why you see so much impregnation of calcium into the soft tissues. You see people with their abdominal aorta that's calcified or their costochondral rib cartilage being calcified, or smaller vessels in their legs and in their abdomen are being calcified. A lot of times it's because of this imbalance from low pH, the imbalance between intra and extracellular calcium, and because they don't have adequate vitamin K intake. And you get vitamin K from vegetables.

KIRK HAMILTON: Let me ask you, because I want to hang on the alkalinity thing for a second, then get to vitamin K, because you've got ---

DR. R. McCORMICK: Sorry, I was long-winded there.

KIRK HAMILTON: No, no, no. You've just got two good topics going and I just want to clarify. So, we have fruits and vegetables on one end that are more alkaline, beans are more alkaline, and legumes, correct?

DR. R. McCORMICK: Yes.

KIRK HAMILTON: And then, whole grains can be actually borderline acidic, correct?

DR. R. McCORMICK: Yes.

KIRK HAMILTON: Okay, and then are animal meats are little more acidic than whole grains?

DR. R. McCORMICK: Yes.

KIRK HAMILTON: And then dairy products are still like animal products, but I saw cheese was very acid.

DR. R. McCORMICK: Hard cheese is the worse probably. I rank that probably even maybe worse than red meat.

KIRK HAMILTON: I saw a graph that was way up there on acidity (cheese). Now, how does a person, an individual aside from knowing those food groups to eat, is there a way to measure urine pH, or is that accurate at all, or what?

DR. R. McCORMICK: That's a really, really complicated question. So, I will try to answer it briefly. But if people take their first morning urine pH and it should be at least 6.2 to 6.4 to 6.6, something like that, then that's not completely alkaline, but it's pretty good. And if it's 5.5 or 5.7 then they're too acidic. Even with that, you can look at the pH also by looking at several other things. Number one are their phosphates too low on what's called a comprehensive metabolic profile. Let's say they have a high loss of calcium in their urine. So you can get a 24-hour urine calcium test done, and if a woman has greater than 300 or 350 mg, then a lot of times they're going to be acidic. So you shouldn't just rely on the urine pH, but if that's all you have then I would go with that.

KIRK HAMILTON: Let's talk about vitamin K because it's also my pet things that I saw coming, because I do a lot of interviews of researchers and the connection between bone loss and coronary artery disease or atherosclerosis, low vitamin K is risk factor for both, and I think you kind of gave an explanation of why if you're low on vitamin K you might get deposits of calcium in the places you don't want it. So, there's an issue here. One is, how do you assess for vitamin K besides, I think what is it, decarboxylated osteocalcin, some - under carboxylated (undercarboxylated osteocalcin)?

DR. R. McCORMICK: Called UCOC.

KIRK HAMILTON: For the clinician I think that's relatively difficult, but I know Metametrix is just starting to do it.

DR. R. McCORMICK: They're the only commercial lab that does it in the country.

KIRK HAMILTON: Have you found it valuable?

DR. R. McCORMICK: Yes, I think if you don't know, it's a great way to really see on a person and I'm amazed how few vegetables people eat and that's where they get their vitamin K from.

KIRK HAMILTON: Right.

DR. R. McCORMICK: And not only that, but it's nice to push a person with vitamin K. And if you're just going to give them vitamin K anyhow, then maybe it's not worth doing the test, but I think what's so important and this is one of the things I really push in this concept in my book, is that it's okay to kind of give people lots of nutrients kind of in a shotgun effect and hope for the best, but wouldn't it be better if we really know that we have this or that problem. If we really know that, oh, going into this, their vitamin D was low and I know that I am going to affect that by giving them vitamin D. I'm going to be one up on this problem. And if we know that their vitamin K was too low, then we know that we're really going to affect them by increasing their K intake. But if you don't know, then I just think you're kind of walking blindly through this whole thing.

KIRK HAMILTON: I agree with you.

DR. R. McCORMICK: To find these therapeutic targets. We look for these things that are wrong, and then we attack.

KIRK HAMILTON: Tell me. When you ‘attack' with vitamin K, there's vitamin K1 and vitamin K2, which one do you use, or do you use a combination?

DR. R. McCORMICK: Yes, use a combination. K2 has been shown to be more effective for bone, and most products have K1 also, so K1 and K2, and then of K2 you're looking for MK4 and MK7. Those are components of the K2 and MK7 is a longer acting part of the K2 and seems to have the most benefits to bone.

KIRK HAMILTON: Let's stay, I guess, with some nutrients. What are your four, five favorite vitamins to help in bone health?

DR. McCORMICK: Well, it depends on what I tested, what we tested for. But, I mean, vitamin D, of course. Because vitamin D encourages the intake of calcium from the gut and if you don't have increased calcium then you can swallow as much calcium as you want. But if you're not absorbing it, it doesn't do you any good. And everybody should have their vitamin D tested and that's called 25-hydroxyvitamin D. There are two forms that you can test for. But the storage form is called 25-hydroxyvitamin D, and that's what should be tested, and everybody should be at least at 32 ng/ml, and preferably 40 or 45 or 50 ng/ml. And if you're lower than 32 then you are insufficient in your vitamin D. And it is amazing. I live in New England. You're in California, so you have a lot more sun that I do, Kirk, but 50% of the people here in New England are vitamin D deficient. Even in today's world where vitamin D is being pushed by everybody, and everybody's now talking about vitamin D, but still most people aren't tested for it and they take 400 IU because that's what their doctor told them to, and they're still going to be vitamin D deficient. In New England from November to May you can lie outside naked, stark naked in the snow, and you're not going to get any vitamin D from the sun. So as the winter goes on you get lower and lower and lower in your vitamin D stores. Vitamin D insufficiency is not just correlated to increased bone loss, but it's correlated to autoimmune disorders, cancer and tuberculosis and all kinds of things. I just have people not only test but then take 2000 IU a day of vitamin D, especially in the wintertime and if they're out in the sun then they can take less during the summer. So vitamin D is number one and vitamin K is number two.

KIRK HAMILTON: Well, I can attest, and I am a vitamin D freak, I guess. I measure everybody, and in California, there's still gross deficiency, trust me.

DR. McCORMICK: Isn't that amazing?

KIRK HAMILTON: And it doesn't really matter where they are. So many people are paranoid, they're inside or they lather on sunscreen and they just really avoid it, and the simplest way to get it is some gentle sunlight. But I agree with you. I have everybody -- I routinely start people on 4000 to 6000 IU/d because I know I am shooting for 50 ng/ml.

DR. McCORMICK: Right, and you put them on that for two months and then drop them back down.

KIRK HAMILTON: Alright. How about B12 and vitamin C? Doesn't B12 stimulate osteocalcin, which is important in bone health?

DR. McCORMICK: There's not a lot of research on that stuff, but yes, I think that B12 is really important. But I'm amazed at actually how many times I see people with really, really high levels of B12 in lab tests and I'm not sure why that is, but I've heard or talked to people who say they see that often when people aren't doing well. They say the body is changed but I'm not sure. I actually see quite a lot of people with elevated levels of B12.

KIRK HAMILTON: Well, are there any other vitamins that are usually at risk besides D and K, or those are the two big ones?

DR. McCORMICK: Well, if a person has high levels of homocysteine, then sure you're going to put them on vitamins B2, B6 and B12, and what happens is people don't think of homocysteine as being related to osteoporosis, but homocysteine is an inflammatory marker and when it increases, to say-- let's say normal was below 8 mcg/L, if it goes to 15 mcg, then the person's going to have a two and a half fold increase in fracture risk. So if a person has osteoporosis, it's nice to know what their homocysteine is, especially if what you're doing is -- Let's say a person has a -3.0 T-score and they don't have any other risk factors. And so we're trying to decide whether to put them on a medication or not to make sure they don't fracture. So let's get a homocysteine and if this is really elevated, then if we can't get that down, then they have a much higher risk of fracture than somebody else who has a -3.0. So it might sway our choice of whether to use the medication or not. And when you have a high homocysteine, you can bring it down with the B vitamins.

KIRK HAMILTON: Years ago I heard the story of Bill Walton having chronic foot fractures and it kind of put a rail on his career, and he saw Dr. Saltman, I think at UCSD, and he put him on zinc, copper and manganese after he found he was deficient. Let's talk about trace elements for a minute. Which ones do you see are important or frequently deficient between like zinc, copper, manganese, or boron, silica, and what do you do with those? (http://www.vitasearch.com/CP/experts/osteoporosis3.htm)

DR. McCORMICK: You mentioned Metametrix Laboratories and I use Metametrix Labs quite a lot, and I see zinc deficiency quite often. I mean everything should be balanced here, and I think to pick out one or the other doesn't do you a service unless you do a test and you come up with something that's really deficient. But boron certainly helps estrogen do its job. Silica has a high level in bone, so if a person has low bone density, they should probably have extra silica in their body. Even strontium is possibly needed in bones, in microdoses. Just like 1 to 5 mg or something like that. Not high doses of strontium. But we need to be conscious of all those and doing testing, mineral testing, is the easiest way with that. You don't want to be giving a person a lot of zinc unless they need a lot of zinc.

KIRK HAMILTON: So you use the RBC mineral test from Metametrix?

DR. McCORMICK: Yes.

KIRK HAMILTON: I do that, as well. I understand that you supplement to that. So let me ask you this then. If you are supplementing individually, then are you giving a lot of individual pills because you're testing for all these wide variety of parameters?

DR. McCORMICK: Well, I try not to, but unfortunately sometimes, yes.

KIRK HAMILTON: Let me talk about calcium and magnesium for a second. Do you believe in a 2:1 ratio or 1:1 ratio, or how do you put those two together for bone health?

DR. McCORMICK: If a person takes in dairy, uses dairy products, then I usually do a 1:1. If they don't do any dairy, then I do a 2:1. And I most of the time I don't like dairy because I think it probably causes more harm than good, and so I go with the 2:1.

KIRK HAMILTON: Do you think -- I was on actually a trip coming back from UCSD from a vitamin D conference and I happened to sit next to an orthopedist who was a bone specialist. He was a traditional guy, and he uses a lot of phosphorus in his mixture. And I'm wondering, you know, I've seen it in supplements, I don't use it a whole lot. What's your opinion of phosphorus?

DR. McCORMICK: I read something about that, too, on somebody who gave phosphorus and I didn't quite understand it, but for sure, there are those people who are phosphate losers and probably do need it. But, not only a few that are phosphate losers, but also there are people out there who have such a poor diet that they do need phosphorus. I mean I live in a very affluent part of Massachusetts and so I never use phosphorus. All my people, I'm sure, get way more phosphorus than they need because it's very plentiful in all foods. So if you have a good diet, you're going to take in plenty of phosphorus and I certainly don't think you need more.

KIRK HAMILTON: Let's talk about fatty acids because the first time I saw some data on fatty acids and their balance being important in bone loss really signified it's in an inflammatory condition, or you're trying to reduce inflammation. Can you tell me your opinion about using omega-3 and omega-6 fats and how fats play a role in bone loss?

DR. McCORMICK: Well you just want to increase the omega-3's because they're anti-inflammatory and omega-6's can, not always, but they can increase a person's - what's called arachidonic acid and that's going to lead to what's called prostaglandin formation and these prostaglandins they are inflammatory agents and they increase bone loss. So most times, most of the time, people have a ratio of like omega-6's and omega-3's of, I don't know, 10:1 or something like that, 20:1. And it should be very reverse. You should have a lot more omega-3 than omega-6's, but you should certainly increase your omega-3 intake, your fish oils and your flax seed, and reduce your omega-6s and that's from corn oils and meat and things like that. So, yes, it should be more like a 2:1 ratio, 3:1.

KIRK HAMILTON: Do you use the fatty acids analysis from Metametrix?

DR. McCORMICK: Well, what I do, and this is amazing to me, is, I do a lot of lab testing. I do a comprehensive metabolic profile, CBC, vitamin D, vitamin K, homocysteine, C-reactive protein, I do N-telopeptide or deoxypyridinoline, I do urine calcium. I do all these tests and sometimes everything is normal. And then I go and I do what's called -- a Metametrix test. It's a great profile called an ION profile, and it has fatty acids and amino acids, and red blood cell minerals and a lot of different things. It's amazing how I find so many things wrong on these tests, because they're functional tests. So it points me in the right direction as far as what to do with these people.

KIRK HAMILTON: You're preaching to the choir. I have a little smile on my face. I've been doing the ION profile for quite some time and, you know, ideally if it weren't that expensive. You know, the goal someday in our kind of medicine would be that everybody walks through the door and instead of getting a basic chem profile they can get that, but they would get an ION profile as well. Because that's really this medicine...before we had to shotgun 25 years ago. But now we have the sophistication thanks to labs like Metametrix where you can really assess the reasons why we give all this stuff. Unfortunately it's usually cash out of pocket, and that's limiting to some people.

DR. McCORMICK: When I was first diagnosed with osteoporosis, I went to the endocrinologist and every time I would go to him, he would just check off on a lab list, $2000.00 worth of lab tests. And I went, you know, five, six, seven, eight times, and every time, you know, doing the same thing, no matter whether it was normal the first and second and third and fourth times. He just did the same things over again, and I'm thinking -- well, at the time I didn't say anything because I was still learning about osteoporosis. But, now, I look back at that I and I say, "Man, he could have used those finances in such a smarter way," you know.

KIRK HAMILTON: No, I agree with you.

DR. McCORMICK: Functional testing.

KIRK HAMILTON: You know, and if that test was paid for by insurance it would be great.

I want to talk about three areas and then kind of tie it up here. First of all, tell me about bisphosphonates. Your opinion. The Fosamax type drugs, the anti-resorption drugs. Some holistic doctors say they're really terrible and may cause jaw necrosis, and traditional people seem to think that they're wonderful. What is your opinion?

DR. McCORMICK: I follow the middle of the road because my goal is to win. And I'm gonna win. When I say win, that means I am going to hopefully help my patients not fracture. Not fracture but stay healthy, and just because you don't fracture, it doesn't mean you're going to be healthy. So to follow a management process, a management protocol that pushes the nutritional aspect and lifestyle aspect of health first, and then medication second. In my book I say we should use medications in emergency situations, and then get away from it and then go back to the nutrition and lifestyle, which we never got away from, but you're continuing to do the nutrition, but then use the medications when you need to, when you're getting into trouble. I think bisphosphonates are fine when they're used properly. And when people just give a person bisphosphonates without, number one, checking bone resorption markers before, which you don't know whether they're losing bone rapidly or not, which is important to find that out beforehand. But when people just give a bisphosphonate without testing for other things, without trying to figure out really why this person's losing bone, it's a crime to me. And then they put these people on a bisphosphonate for four, five, ten years and their bones are getting older and older and older. They're getting harder, but they're also getting older because they don't have remodeling. So I'm not against bisphosphonates. I'm just against their poor use.

KIRK HAMILTON: Tell me about hormone replacement therapy, and we don't have to get into bioidentical or not, just the basics of hormone replacement therapy. Do you think things like testosterone, DHEA, estrogen and maybe even progesterone are of benefit in bone health?

DR. McCORMICK: Yes. You have to have hormonal balance. It's vital for skeletal health. Back in 2002, when the Women's Health Study was halted because they discovered that hormone replacement therapy increased the risk of stroke and heart disease, and thromboembolism, I think that really did a disservice to women because people got really afraid of using hormone replacement and I think that was not helpful. I think you shouldn't just give everybody estrogen or everybody testosterone, but you have to look at the individual. If a woman has just gone through menopause and they have lots of menopausal symptoms, then you should look at hormone replacement therapy because probably their estrogen, estradiol, is pretty low. And if it's really low, they will lose more bone density. If a man's testosterone is below 300, that's reason to give them testosterone. Not only will they feel better, they'll be able to sleep better and have more energy, but they're going to have better bone health. The problem is physicians have either shied away completely because it's just easier to give a person bisphosphonates. I don't want to get into this bioidentical versus artificial -- but they just give them an estrogen replacement therapy and they don't monitor them with testing. They'll just give them estrogen and maybe their estrogen levels go way up to a level that is harmful to them. We only need enough estrogen to limit the bone loss. We don't need so much that it puts them at risk for cancer and stroke and everything else. So estrogen is important for more than just its direct effect on bone. People think that estrogen is just important because it hits the receptor sites on the bone cells and changes bone density in that way. But estrogen is also important because it has an immunological effect. When a person goes through menopause, what do you often see? You often see that they have increase in allergies, they have increase in intestinal problems, and that's because they're having more inflammation in their body and that's because their immune system is not functioning as well. The estrogen maintains immune cells. It maintains the ability for the immune system to work. They've even done studies to where if you take away the estrogen all together, you won't have any bone loss at all because you have to have an increase in what's called reactive oxygen species within the osteoclasts and that's what creates the bone loss. And reactive oxygen species, it involves the immune system, because if the immune system is not functioning properly, because one of the immune system's jobs is to reduce those high levels of reactive oxygen. So, if the immune system isn't working well, you get increase of these reactive oxygens or pre-radicals, and then that increases inflammation and we have a chronically inflamed person and they become what's called catabolic, and that's when you get the bone loss. The immune system pumps out these chemicals, what's called pro-inflammatory cytokines, called interleukin-1, interleukin-6, and tumor necrosis factor, and those are produced to try to increase inflammation, but what it also does is it increases the osteoclastic activity and bone loss, and when you have low estrogen, then you start increasing these. Your body starts increasing these pro-inflammatory cytokines from the immune system. So, what I'm trying to get at is that instead of just pumping more estrogen in the person, if the estrogen and the immune system are closely tied in to bone loss, why not improve the function of the immune system? Why not reduce it's production of pro-inflammatory cytokines instead of just giving the estrogen? Because by doing that, by reducing that inflammation, you're going to do the same job but without subjecting a person to the increased risk of cancer and heart disease and thromboembolism.

KIRK HAMILTON: I hear the underlying theme, that anything that can increase inflammation, whether it be low hormones or you eat foods that inflame the gut, that cause more free radicals. Anything that can cause more inflammation is going to aggravate bone loss.

We know you obviously did a lot of weightbearing exercise during your athletic years and that didn't necessarily prevent bone loss, but I'm sure you encourage weightbearing exercise and do you also encourage some type of strength training in your patients?

DR. McCORMICK: Definitely, because if a person's 55 or 60 years old, what they have to realize is they're not -- I don't care how much strength training and exercise you do, you're not really going to build bone tissue. But what you are going to do is decrease the chance of the number one reason for fracture. And that's falling. And the stronger a person is, the more coordination they have, the more flexibility they have, the less chance they are of falling. And so I really push exercise, strength training and aerobics because that will substantially reduce the fracture risk by reducing falling.

KIRK HAMILTON: I just want to get into how you follow patients once you put them on whatever program. Now, do you do a DEXA test, let's say once a year or whatever your frequency is, and then you follow it by either the N-telopeptides or the other urinary markers? Is that what you do every few months or so until you see the urinary metabolites like the collagen metabolites that come from NTX testing go down?

DR. McCORMICK: The thing about just using bone density examination is that you really have to wait two years to see if what you're doing is working. And a lot of times -- And also, what you're seeing is the change in bone density. There's a lot more to increased bone fragility than just the density, and that is bone quality. And so you have to get away from just relying on bone density, just relying on a bone DEXA scan to see whether your management, your therapeutic protocol is working or not. So, yes, it's signs and symptoms, physical signs and symptoms we look at, and laboratory tests. And what we're doing is we're looking for therapeutic targets. We're looking to find something, to find whatever tests, I don't care, hopefully the more it relates to bone, the better, but we're looking for these tests that are abnormal and then we're trying to change them. And, yes, if a person has high calcium in their urine, then what we do is we do certain things like increase their intake of fruits and vegetables. Possibly give them potassium bicarbonate, vitamin K, boron, maybe taurine, and then three months later we check their urine calcium again and hopefully it's better. And if it's not, then you do something else. But we're constantly trying to monitor and figure out if we're winning this game or not, instead of having to just wait for two years and do nothing in between.

KIRK HAMILTON: We're talking to R. Keith McCormick, chiropractic physician and bone specialist, and he wrote the book "The Whole Body Approach to Osteoporosis: How to Improve Bone Strength and Reduce Your Fracture Risk," published by New Harbinger Publications. So, I'd like to tie this up. I know you might not want to do this without lab testing, but can you name between five and ten things that the average person who's not going to go get tested tomorrow can do to improve their bone health?

DR. McCORMICK: I think that's a really important thing to seek, because a lot of people don't have the financial capacity to do a lot of testing. And I totally respect that. I understand that, and I don't want people to feel frustrated that they can't do a lot to benefit their bone health, because they can. So I guess the number one thing is to reduce inflammation and oxidative stress. And the way you do that is you eliminate toxins from your body. You stop smoking, you stop drinking, you try to eat a lot of fruits and vegetables and that helps reduce inflammation. You try not to take in things that increase inflammation like a lot of, like I said before, meats. You make sure you take fish oil and flax seed because they reduce inflammation. You can also take certain nutrients like curcumin, which reduces inflammation. You want to also normalize your body pH, and that's a simple little test. You can buy pH tests for $10.00, and every morning you take a little inch-long strip of pH paper and you pee on it, and you see what your pH is. And you average it over a five or seven or ten day period and see what your pH is. And if it's too low 5.5, then you can change your diet. Even if you're not taking supplements. You can change your diet and if you just eat bok choy and kale with garlic and lemon on it, you'll really improve the pH of that urine, and increase the pH of your body and help reduce bone loss. Normalizing your gut function is also one of the most important things you can do because your gut not only is important for absorbing nutrients, but its also a huge source of inflammation. And when you inflame the gut what happens is you increase the levels of serotonin that's produced in the gut and the serotonin filters in through the blood to the bones and it shuts down the osteoblasts from forming bone. So normal gut function is really important, and by eating high fiber foods, taking probiotics which are like Lactobacillus and Acidophilus and Bifidobacterium, like probiotics are in yogurt. You can also take them in a capsule, and maybe using digestive enzymes to ensure a good digestion. Another thing would be to eat a gluten-free diet if you're sensitive to gluten. As far as supplements are concerned, everybody should take calcium, at least 1000 mg of calcium and 500 mg of magnesium at least. That would be a 2:1 ratio. Vitamin D, I would say take 2000 IU a day. Vitamin K take 1 to 5 mg a day. Alpha lipoic acid is a great antioxidant and you might want to take 200 or 300 mg of that. N-acetylcysteine is incredibly important especially in women who've gone through menopause because the estrogen levels are decreased and when you take N-acetylcysteine it helps improve what the antioxidant effects of estrogen on cells. So taking 500, 600, 1000 mg of N-acetylcysteine would be appropriate. And taking fish oil to reduce the inflammation. And finally you need enough protein to build bone. I recommended people taking whey protein shakes every day, 10 to 20 gm of whey protein. If you go exercise your body is craving to build bone, to build muscle right after you exercise. So if you drink a whey protein within 20 minutes after you exercise it has a much added benefit than just taking it in the middle of the afternoon when you've done nothing. So that would be the, I don't know, five or ten or whatever number of things I just said, that I would do to improve skeletal health.

KIRK HAMILTON: That was excellent. So, again, we're talking with Dr. R. Keith McCormick, chiropractic physician. The book is the "The Whole Body Approach to Osteoporosis: How to Improve Bone Strength and Reduce Your Fracture Risk."

I want to thank you, Dr. McCormick, for taking an hour of your day to speak with us, and we will talk to you soon.

DR. McCORMICK: Thank you very much for inviting me on.

KIRK HAMILTON: In conclusion, I want to again thank Dr. R. Keith McCormick. And if I can pull together some of his highlights, bone loss and bone health needs a total approach of assessment and then treatment according to what assessment tests tell you. And there is an inflammatory component to bone loss, and you need to create an anti-inflammatory situation or reduce inflammation to help with bone loss. That can be like increasing fruits and vegetables which are rich in powerful antioxidants, reducing meats, increasing fish or flax oil, increasing things like curcumin. Another step is you can help alkalize your body. And to do that, you can do your first morning urine pH, and you want it to be between 6.2 and 6.6. If it's in the high 5's, that's too acidic. If you get between 6.2 and 6.6, that alkalizes the urine and helps keep calcium from being pulled from bone (fruit, vegetables and beans are the most alkalizing foods). A third component is you want to normalize gut function because gut function, if it's abnormal, can increase inflammation in your total body, which is going to aggravate bone loss. It can also aggravate the absorption of important micronutrients. Things that are good for gut function are high-fiber diets, probiotics and sometimes digestive enzymes. A fourth thing you can do is to consider if you're gluten sensitive or grain sensitive to things like wheat, oat, barley and rye. Because again, if you have that issue of gluten sensitivity like Dr. McCormick had, you create an inflammatory condition that might aggravate bone loss and possibly increase malabsorption. Some important nutrients to take according to Dr. McCormick are calcium and magnesium 1000mg:500 mg if you're not on dairy products; vitamin D at least 2000 IU; vitamin K 1-5 mg; alpha lipoic acid 200 to 300 mg; N-acetylcysteine 500 to 1000 mg; some fish or flax oil; and a whey protein supplement usually best taken immediately after working out at 10 to 20 gm of protein.

So, again, I would like to thank Dr. McCormick for his timely interview on optimizing bone health. I want to thank you, the audience, for listening today on this edition of Staying Healthy Today Radio. And remember, until the next time, Stay and Be Well.

No part of this interview may be copied or reprinted in any form, electronic or print, without written permission from Prescription 2000, Inc.