Bone Health Program tailored to each patient
By Dr. Martin Gleixner, MSc, ND
Last month’s column was the first of two articles dedicated to bone health with a special focus on osteoporosis. A new, safer approach was discussed as mounting evidence is suggesting that the present first line treatment option of bisphosphonates drugs (including Actonel, Fosamax, Didronel and Aclasta) are associated with risky side-effects.
Osteoporosis is a chronic condition that is characterized by deterioration of bone strength and density. It is not a condition of normal aging. Rather, it is a result of the interplay between multiple causes including lifestyle factors, nutritional deficiencies, and metabolic/hormone imbalances.
At the moment, along with drug therapy, high doses of calcium (often in combination with vitamin D) are often recommended to treat osteoporosis. Although calcium and vitamin D are important nutrients for bone health, this approach falls short to address underlying causes of osteoporosis (other than calcium and vitamin D deficiencies) and because of drug side-effects does not provide a long-term solution for many patients.
To help fill this void in health care, I have devised a Bone Health Program that addresses both the prevention and treatment of osteoporosis. Part of this program incorporates the FOOT™ Plan (Fully-Optimized Osteoporosis Therapy Plan). The FOOT™ Plan is based on the work of Dr. Mark Swanson, a naturopathic doctor (ND), who through his practice in Washington (USA), dedicated time to devise clinically successful treatments that aim to not only stop, but also to reverse bone loss.
The Bone Health Program is an individualized approach that is tailored to each specific patient. Let’s now review my program’s unique 5-step approach:
Step 1: Obtaining an accurate diagnosis
The first step is to assess the stage of bone loss. Osteopenia (early stages) or osteoporosis can be diagnosed by a bone mineral density test (BMD), such as a dual-energy x-ray absorptiometry (DEXA) scan. A T-Score of –2.5 standard deviation below the young
adult mean is diagnostic for osteoporosis. Discuss these results with your medical doctor or naturopathic doctor so that you have a good understanding of the degree of overall bone loss and the progression of your bone density changes. It should be noted that on its own, DEXA scan measurements are not a very good measure of actual fracture risk and therefore each individual should be evaluated based on the totality of their symptoms and risk factors.
The following lab tests are also very helpful for the overall assessment:
1) 25-OH D3 is the indicated test for measuring vitamin D status. Insufficiency levels are less than 75-80 nmol/L. Optimal levels that prevent bone loss and build new bone are between 133–150 nmol/L. The 1–25-OH D3 test is not recommended.
2) Other useful adjuvant tests are: vitamin B12, folate, hormone levels (especially DHEA, testosterone, estrogen and progesterone), ferritin (iron storage), lipids/cholesterol, TSH (to evaluate thyroid function), and parathyroid values. ESR and CRP are also helpful to understand the degree of inflammation in the body.
3) A number of new tests are becoming available, although they are not widely used yet: a) urinary collagen cross-linked N-teleopeptides (NTx) measures the rate of bone resorption from osteoclast activity (and therefore assesses calcium urine loss); b) new bone formation from osteoblast activity can be measured by bone-specific alkaline phosphatase (BAP or BSAP); and c) decarboxylated osteocalcin which checks for vitamin K status which is helpful to determine vitamin K dosages. Please note that some of these are only available through private labs in the USA.
Step 2: Evaluate and address pertinent causes and risk factors
Evaluating the risk factors and addressing previous or on-going causes were discussed in my previous column. Please the article to review this comprehensive list.
Step 3: Evaluate and optimize organ and system function
Many of our organs have the main role of taking in what the body needs (water, nutrients, oxygen) and removing what it doesn't need (excess water, metabolic waste products, toxins and carbon dioxide). Since a healthy skeletal system is best obtained through a healthy body, improving the function of the lungs, kidneys, digestive tract and liver is also important. Through breathing, urination and bowel movements, these organ systems are consistently repairing and renovating our body.
Healing the digestive tract for example is essential for those diagnosed with nutrient deficiencies (e.g. low levels of iron, vitamin B12, and vitamin D). This is especially important in gastrointestinal disorders leading to malabsorption issues (e.g. celiac disease, Crohn’s disease or ulcerative colitis, etc…).
A properly balanced endocrine (aka hormonal) system is crucial for bone heath. Both low levels and excess levels of thyroid hormones (conditions called hypothyroidism and hyperthyroidism respectively) for example, can lead to bone loss. The thyroid gland, which is located in the throat area, produces hormones that controls how quickly the body burns energy (i.e. helps to control our metabolism). When treating osteoporosis, I pay close attention to my patient’s thyroid function. Helping patients achieve optimal levels of thyroid hormone production (aiming for a TSH of 1 to 2.5 rather than the broader range of 0.4 to 5 set by most laboratories) is especially important.
Step 4: Nutrition and exercise targeted to bone health
As an essential component of the Bone Health Program, the FOOD Plan (Fully-Optimized Osteoporosis Dietary Plan) has been developed with the goal of building strong bones while maximizing your overall health. It focused on real foods and eliminates foods that can contribute to osteoporosis. It incorporates my top 5 nutritional guidelines (as discussed in great detail in a previous column): 1) eat whole foods; 2) eat quality foods; 3) avoid food additives; 4) eat fermented foods; and 5) know your food allergies or intolerances and avoid them as best you can.
The FOOD Plan is a modern dietary lifestyle that aims to decrease inflammation, improve omega-3 status, balance the acid-alkaline metabolic profile, and increase nutrient intake targeting bone strengthening. The FOOD Plan incorporates dietary practices commonly found in the Mediterranean (especially Crete Mediterranean) and certain Asian cultures that have low incidences of chronic diseases.
This diet aims to restore the omega-6/omega-3 essential fatty acid (EFA) ratio by including more omega-3 foods such as locally caught fish/shellfish (low mercury choices are best), walnuts, freshly ground flax seeds, and hemp hearts. Essential fatty acids are necessary co-factors in bone formation and therefore help to ensure strong bones. The diet includes first cold-pressed extra-virgin olive oil for its nutritive value and because it regulates our appetite and helps to stabilize blood sugar levels.
The diet is a high alkaline diet (positive potassium/sodium ratio) by incorporating a large proportion of potassium rich plant foods, such as non-starchy vegetables, fruits, berries and herbs. The diet also includes foods high in vitamin K such as leafy greens (e.g. kale, chard, spinach, beet tops, dark coloured lettuce), broccoli, Brussel spouts, cabbage and asparagus. Please talk to your ND or MD before making such dietary changes because certain foods may be contraindicated with certain drugs (e.g. Warfarin/Coumadin with introducing more vitamin K rich foods).
Allowed in moderation are whole grains, starchy vegetables (yams, sweet potatoes, potatoes), soy (with emphasis on fermented types such as miso, tamari and tempeh), nuts/seeds, legumes, sheep and goat cheese (as long as you are not allergic to casein or lactose intolerant), and local organic eggs. Wild game, grass-fed beef/lamb and organic chicken/turkey should be eaten sparingly by comparison. Since protein is an important component of bone structure, such quality animal meats are good sources of protein, but if consumed in excess can disrupt the acid-alkaline balance in our bodies.
The recommend exercise regime should be conducted on a regular basis (daily for a minimum of 30 minutes is optimal), and includes a mix of both aerobic and weight bearing exercises. Walking, jogging/running, skiing, racket sports or team sports (e.g. soccer, hockey, etc…) are all great weight bearing exercises. Moving the body is an essential component of the Bone Health Program. Specifically tailored recommendations may be included depending on other outstanding conditions such as obesity or excess weight, arthritis, cardiovascular disease, etc…
Step 5: Individualized treatment plan
Using therapeutic doses of appropriate naturopathic medicines is crucial. As a naturopathic doctor, I have observed the limitations with using only calcium and vitamin D or supplements with multi-nutrients touted for bone support. Such treatments usually fell short of halting the progression of osteoporosis and many continued to have little or no improvement in bone density.
The recommended naturopathic treatments included in the FOOT™ Plan, as devised by Dr. Swanson, ND is based on an exhaustive review of the past and present scientific research. It emphasizes effective osteoporosis support based on optimizing bone density, quality, and micro-architecture. Certain examples of treatments include strontium citrate, melatonin, potassium citrate, calcium citrate, magnesium citrate, vitamin K2, vitamin D and omega-3 oils. Although it is beyond the scope of this article, adequate dosage and timing of each supplement at different times during the day is crucial to achieve therapeutic action. Please note that certain supplements in high dosages are contraindicated with certain conditions (e.g. kidney disease) and along side certain drugs (e.g. bisphosphonates). Your ND will be best to guide you to determine the best-suited treatment protocol.
As discussed by Dr. Swanson, this treatment plan “targets the interplay between acid-alkaline balance, osteoblast activity (bone formation), osteoclast activity (bone resorption), osteocalcin activity, calcium absorption, parathyroid function, a healthy inflammatory response, hormonal support, essential fatty acid (omega-3) balance, vitamin/mineral nutrition and antioxidant protection”.
The key to successful outcomes is to demonstrate efficacy in the patients who receive treatment. The Bone Health Program is designed to be a safe, yet effective alternative to bisphosphonate drugs. Start now, so that you can be added to the others who report improved bone density using the FOOT™ Plan.
Published by Dr. Gleixner on Thursday August 14th, 2012 in Times & Transcript.
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