Readers Summary
- What medical conditions predispose to bad bone?
- What drugs are associated with bad bone?
- What commonly used drugs may need to be discussed if bone loss is present?
What are some of the medical conditions that are associated with osteopenia or osteoporosis?
- Excessive alcohol intake – greater than two drinks a day consistently will do it.
- Tobacco use – This causes a 100 fold increase in bone loss. Oral tobacco is worse than inhaled smoke
- Stress – any cause be it emotional, physical, mental, psychic all raise cortisol chronically and kill bone
- Lack of physical activity increases obesity risk, which increases cortisol from leptin resistance
- Low calcium intake or absorption from gastrectomy or low acid production from any reason
- Reduced strength and activity due to a chronic illness or a sedentary life (checked with a grip test)
- Small build or leanness naturally – correlates with BMI below 19 for women and men.
- Asian women have a particular propensity to osteopenia genetically and from their diet.
- Drug therapy, for example, long-term use of corticosteroids such as prednisone-used to treat rheumatoid arthritis, asthma, celiac disease, autoimmune diseases, Crohn’s disease, IBD, and ulcerative colitis.
- Low: Magnesium, strontium, boron, Vitamin D3, Vitamin K2, elevated PTH levels, low sex steroid levels, high insulin levels, low progesterone levels, any cause of a leaky gut.
- Menopause
- Andropause
- Any cause of chronic inflammation (perimenopause can cause severe acute bone loss)
- Disuse atrophy from any cause (space travel)
- Paralysis
- High carbohydrate diets
- Veganism or a plant based diet
- A diet high in whole grain (carbohydrates) is especially risky due to mineral malabsorption in gut
- A diet lacking in animal protein and animal fat and cholesterol.
- Excessive use of statins and thyroid hormone can cause osteoporosis
- Age and sex – the older one is predisposes to osteopenia. Women lose 1-3{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} of their bone density ever year after their last period.
- Chronic endurance athletics of any type cause severe bone loss due to chronic cortisol elevations
- Gastric bypass patients carry enormous osteopenic risks.
- Severe liver or kidney disease; Renal insufficiency can lead to osteodystrophy.
- Diabetes
- People with scoliosis of unknown cause (idiopathic scoliosis) also have a higher risk of osteoporosis. I believe this is because most of these children have severe underlying Vitamin D deficiency and a leaky gut, but this has never been studied in the spine literature. Any time I see a scolisosi patient, I always screen for low sex steroid hormones, low Vitamin D levels, and low Carboxylated osteocalcin levels. Bone loss can be a feature of complex regional pain syndromes.as they develop over time. It is also more frequent in people with Parkinson’s disease and chronic obstructive pulmonary disease as well.
What are some of the common drugs that can cause osteoporosis:
- Drugs used to treat seizures, called anticonvulsants, cause osteoporosis when used chronically
- Certain medications used to treat cancer, called cytotoxic medications, also cause osteoporosis
- Drugs called corticosteroids, which are used to treat many illnesses, including rheumatoid arthritis, asthma, and autoimmune conditions. Studies show that within the first year after starting corticosteroid therapy, patients lose an average 14 percent of their bone mineral content. Also, some medications given to men or women to help get pregnant. Taking even low doses of oral prednisone (cortisone, prednisone, hydrocortisone, dexamethasone, and methylprednisolone), even less than 2.5 mg per day, are associated with a 20{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} to 200{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} increase in risk of vertebral fractures. For each 10 mg increase in dosage between patients, there is a 62{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} increase in risk for bone fracture. Drugs that “calm” your immune system, used after organ transplantation and to treat conditions like rheumatoid arthritis. METHOTREXATE and cyclosporin cause osteopenia/osteoporosis.
- A drug called Lithium, which you may take for a condition known as manic depression. Lithium is used to treat patients with a bipolar disorder- a condition marked by periods of euphoria and high energy alternating with depression. One of its side effects is the increased production of parathyroid hormone, which in turn increases the breakdown of bone.
- A drug called heparin, which thins your blood, can also cause osteopenia but it is rarely used long enough to do so.
- Coumadin causes severe osteoporosis when it is used chronically by depleting Vitamin K2 stores.
- An injection called Depo Provera, which helps prevent pregnancy, also causes osteopenia when used chronically.
- Thyroxine, a drug you may take chronically if your thyroid gland isn’t working properly. This one is very commonly missed by many.
- A drug called Anastrozole, which is used to treat breast cancer is an anti-estrogen.
- Chronic use of antidepressants (Prozac, Paxil, Zoloft) cause osteoporosis. SSRIs (selective serotonin reuptake inhibitors), Clozapine use in schizophrenia
- Insulin (as a tx for diabetes) also increases fracture risk in people with diabetes, as shown in a 2001 study in the journal Diabetes Care. Actos and Avandia increase the risk of fractures after just one year of use by 57{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} in all women, and 72{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} in women sixty-five years or older (inhibitors of PPARγ, have been linked with an increased risk of osteoporosis and fracture). Sulphonylurea also cause osteoporosis with chronic use.
- Heavy metals, a strong association between cadmium, lead and bone disease has been established. Low level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in the elderly and in females. Higher cadmium exposure results in osteomalacia.
- Soft drinks — some studies indicate that soft drinks (many of which contain phosphoric acid) may increase risk of osteoporosis. Others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis.
Antacids with aluminum
These medications are used to treat heartburn, acid reflux, indigestion, excess stomach acid and ulcers. Some of these antacids are salts derived from mineral sources, including aluminum which impedes the absorption of calcium in the gut.
Popular aluminum-based antacids include:
- Aludros
- Amphojel
- Gaviscon
- Gelusil
- Kolantyl
- Maalox
- Mylanta
- Riopan
Non-aluminum-based antacids include:
- Alka-Seltzer
- Bisodol
- Mylicon
- Rolaids*
- Titralac*
- Tums*
Proton pump inhibitors (PPIs)
Proton pump inhibitors (or PPIs) are a group of drugs designed to reduce gastric acid. According to an article published in the Journal of the American Medical Association (JAMA), after just two years of taking acid blocking medications (Prilosec, Prevacid, Nexium, Protonix, Aciphex, Zantac) can increase the risk of fracture by 41{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6}, and by nearly 60{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} after four years! Often people are kept on these drugs for decades without stopping their use and switching to Betaine HCL for a period of time. They are among the most widely sold drugs in the world, and are used in the treatment of conditions such as acid reflux (GERD), stress gastritis, and peptic ulcers. They are very profitable and until recently, few people knew about their major side effect of impeding calcium absorption in the gut due to low acid production. There is a growing amount of research suggesting that prolonged use of these drugs can inhibit calcium absorption and cause osteoporosis. If you have reflux, instead of blocking normal acid production you would be wiser to eliminate dietary omega 6 content which is what really causes GERD. High O6/3 ratios inactivate the muscular contration of the lower esophageal sphincter by altering series two prostaglandin levels in the smooth muscle. This allows normal gastric acids into the distal esophagus due to poor muscle tone. The best way to reduce this risk is to reduce all industrial seed oils in your diet and avoid all processed foods from grocery stores and restaurants. Begin by cooking your own real primal foods at home.
Diuretics for HTN
Diuretics, or “water pills,” increase the volume of urine and are used to treat high blood pressure and congestive heart failure. Loop diuretics are a particular problem for bone development as they cause the kidneys to excrete excess calcium. The most popular forms of this drug are Lasix, Aldactone, Dyazide, Bumes, Diamox and Edecrin.
On the other hand, the thiazide diuretics actually help you to preserve calcium because they decrease the urinary excretion of calcium. Hyrodiuril and hyrochlorothiazide are diuretics of this class commonly prescribed for mild high blood pressure, for water retention and sometimes along with other high blood pressure medications. You might ask your doc to consider a drug change if you have co morbid metabolic bone disease.
Drugs used for hair loss
All deplete the sex steroid hormones (testosterone) which protect your bone. Consider the loss of bone and libido before taking these drugs. Hypogonadal states can cause secondary osteoporosis. These include Turner syndrome, Klinefelter syndrome, Kallmann syndrome, anorexia nervosa, andropause, menopause hypothalamic amenorrhea or hyperprolactinemia from pituitary tumor, and lack of growth hormone production in women over the age of 40 and men over the age of 55.
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Additional Resources
Cites
- Scottish Intercollegiate Guidelines Network.Management of osteoporosis.June 2003. Guideline 71. Available at http://www.sign.ac.uk/guidelines/fulltext/71/ (accessed on 19 July 2011).
- National Osteoporosis Foundation.Clinician’s guide to prevention and treatment of osteoporosis.January 2010. Available at http://www.natap.org/2008/HIV/070708_01.htm (accessed on 19 July 2011).
- Kerstetter, J. E.; Kenny, A. M.; Insogna, K. L. (2011). “Dietary protein and skeletal health: A review of recent human research”. Current Opinion in Lipidology 22 (1): 16-20. doi:10.1097/MOL.0b013e3283419441. PMID 21102327. edit
- Bonjour, J. P. (2005). “Dietary protein: An essential nutrient for bone health”. Journal of the American College of Nutrition 24 (6 Suppl): 526S-536S. PMID 16373952. edit
- Shapses SA, Riedt CS (1 June 2006). “Bone, body weight, and weight reduction: what are the concerns?”. J. Nutr. 136 (6): 1453-6. PMID 16702302.
- Pollock, N.; Grogan, C.; Perry, M.; Pedlar, C.; Cooke, K.; Morrissey, D.; Dimitriou, L. (2010). “Bone-mineral density and other features of the female athlete triad in elite endurance runners: A longitudinal and cross-sectional observational study”. International journal of sport nutrition and exercise metabolism 20 (5): 418-426. PMID 20975110. edit
- Gibson, J.; Mitchell, A.; Harries, M.; Reeve, J. (2004). “Nutritional and exercise-related determinants of bone density in elite female runners”. Osteoporosis International 15 (8): 611-618. doi:10.1007/s00198-004-1589-2. PMID 15048548. edit
- Hetland, M. L.; Haarbo, J.; Christiansen, C. (1993). “Low bone mass and high bone turnover in male long distance runners”. The Journal of clinical endocrinology and metabolism 77 (3): 770-775. PMID 8370698. edit
- Brahm, H.; Ström, H.; Piehl-Aulin, K.; Mallmin, H.; Ljunghall, S. (1997). “Bone metabolism in endurance trained athletes: A comparison to population-based controls based on DXA, SXA, quantitative ultrasound, and biochemical markers”. Calcified tissue international 61 (6): 448-454. PMID 9383270. edit
- MacKelvie, K. J.; Taunton, J. E.; McKay, H. A.; Khan, K. M. (2000). “Bone mineral density and serum testosterone in chronically trained, high mileage 40-55 year old male runners”. British journal of sports medicine 34 (4): 273-278. PMC 1724199. PMID 10953900.
- Iketani, T; Kiriike N, B. Stein M (2003). “Effect of menatetrenone (vitamin K2) treatment on bone loss in patients with anorexia nervosa”. Psychiatry Research 117 (3): 259-269.
- Iwamoto, J; Takeda T, Ichimura S (2000). “Effect of combined administration of vitamin D3 and vitamin K2 on bone mineral density of the lumbar spine in postmenopausal women with osteoporosis”. Journal of Orthopaedic Science 5 (6): 546-551.
- Yonemura, K; Fukasawa H, Fujigaki Y, Hishida A. (2004). “Protective effect of vitamins K2 and D3 on prednisolone-induced loss of bone mineral density in the lumbar spine”. American Journal of Kidney Diseases : the Official Journal of the National Kidney
- DIPART (vitamin D Individual Patient Analysis of Randomized Trials (2010). “Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe”. BMJ 340: b5463
First, thank you so much for all the work you've done, and made freely available here. I only just found your blog yesterday; I'll be busy reading for a long time! I was wanting to ask you about the risks associated with thryoid replacement therapy, and here you've told me. I'm at risk of osteoporosis. I take both T4 and T3; total thyroidectomy in 1986. I take fermented cod liver oil with butter oil, fish oil, magnesium, selenium, CoQ10, B's, C, iodine; and iron and 10mg progesterone after anemia caused by uterine hyperplasia (fixed earlier this year). I've been following the GAPS diet for almost 2 years, but have decided to go paleo. Is there something I can add to reduce my risk of osteoporosis?
@Kiera stay tuned…….the next blog in this series is the Osteoporosis Rx.
hi again,
http://www.webmd.com/osteoporosis/news/20101130/b…
why would apple shapes be correlated with less dense bone? even though i lost 15 to 20 lbs on paleo, i am an apple!!! i'm hoping some of the apple i have left is just extra subcutaneous fat and being stretched out from having big babies.
i can't believe that multivitamin might have messed up my blood test- i'm so annoyed at myself!!! i took that multi more than 12 hours before the test, so how will i know if it interfered with the test? if some vitamin values are on the lower side and some are super high, might that be an indication that the multi did not interfere with the test?? have you had that experience before where a patient took a multi more than 12 hours before a fasting test and it messed with the results?? thxxx as always!
@V this should be easy to understand. Apple shaped women are usually LR. Remember that leptin also controls where fat is deposited in the human body and this is why women and men look quite different from one another. If one is LR this leads to over abundance of energy from the diet to the mitochondria and this depletes Magnesium intracellularly and eventually causes insulin resistance. Once this occurs chronically more fat is dumped in places it should not be and this is because there is chronic cortisol release from the inflammatory cytokines released from adipocytes and the liver. Go back and re read my hormone 101 blog now…….LR leads to IR the leads to Cortisol elevation and classic body type of central obesity and an apple shape.
Good checklist, well organized. I've shared this with my parents just now.
@John. A High Intake of Saturated Fatty Acids Strengthens the Association between the Fat Mass and Obesity-Associated Gene and BMI.
AuthorsCorella D, et al. Show all Journal
J Nutr. 2011 Nov 2. [Epub ahead of print]
Affiliation
Nutrition and Genomics Laboratory, Jean Mayer-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA.
thx. i will go back and reread that blog. since you advocate testing so we don't fly blindly in trying to get better, which i agree with, how about more in-depth advice on how to prepare for blood work? i never heard that one should stop taking a multivitamin more than 12 hours before a blood test. i've also seen differing recommendations for a lipid panel: 8 to 10 or 12 or 14 hours of fasting. also i never knew that A1c results were unreliable if one was anemic until after i went digging around the internet. also, when i have my CBC done, I try to have it done at the same time in my cycle for every test so i can better compare results from test to test. otherwise i may be comparing a say when my iron "n the tank
was relatively full at day 20 of my cycle to an emptier tank at day 1.
@V I tell my patients nothing by mouth and I mean it. Testing is expensive and it must be drawn in optimal fashion to draw good inferences from it. Most Multi's we have no real idea what is in it unless it is consumerlab.com tested.
Thanks Jack! Looking forward to reading the Osteoporosis Rx as I am 57 and hypothyroid…been taking Levothyroxine for almost 30 years.
How does one define "excessive" with respect to thyroid hormones? Labs don't tell the whole story and ask 10 different docs as to what the normal levels are and you'll get 10 different answers.
I'm under 19 BMI and strict paleo — no dairy at all — so low calcium intake and I've taken armour + cytomel for years. With menopause approaching, I don't want bones to crumble but I truly like being dairy-free and definitely look leaner. My skin and hair look better. Nails grow fast. Once I start with dairy, I start to binge. Plus the high calcium makes absorbtion of thyroid meds inconsistent as I take my thyroid meds twice a day.
Maybe it's a catch 22 — I want bone health but don't want all the unnecessary IGF-1 and hormones, growth factors found in dairy especially as I approach menopause.
@Alexandra……you wont like this reply. I am no fan of any synthetic hormone. If you want to know precisely why go watch Matt Lalonde's AHS talk. I love hormone replacement but must be bioidentical or you are better off on nothing.
One other comment about dairy — it blocks all the benefits from cocao/dark chocolate and any antioxidants in berries/veggies as well as supplements. So no point in supplementing if you eat dairy. Waiting 4 hours after dairy may help but there is no way to know how fast an individual digests food so results will never be consistent due to stomach acid levels, thyroid function, gastric emptying rate, caffeine, certain herbs, medications etc etc etc which all impact rate of digestion.
Dr. Kruse,I've been reading your blog for almost six months now, it is just amazing, thank you so much for the information, it feels so right to me, the way John Lee's book did twenty,no, thirty years ago, hard to believe it's been that long. And thank you for reading all the studies, I try, but I find my eyelids drooping after the first one.
I've read that narcotics can affect the HPA axis, but most of the research seems to be done on methadone treatment in addicts, who have multiple reasons for BMD loss, and mostly the men are studied, the women seem to be too complicated. I take methadone for chronic pain (neck injury, discs),I've been on it for about seven years now, except for one year off with MS Contin, and while I have a degree of osteopenia, it has not progressed in ten years per DEXA, I have no height loss, the rest of my joints seem normal and no broken bones, ever. Have you seen anything in the literature that is conclusive for methadone or narcotics causing bad bone?
I follow your supplementation advice, actually I've been taking most of the supplements for years, including progesterone cream. I use lots of Magnesium malate, for the pain, and a degree of fatigue, also benfotiamine for the neuropathic pain. I've supplemented with calcium since my late 20's, but now, reading your blog posts and other advice, I've stopped that.
I am gluten intolerant and of course, dairy intolerant, to my regret, I love full fat yogurt and raw cheeses and cream. I've followed a mostly paleo diet for the last two years, but strictly no gluten, although I occasionally cheat with dairy. I've taken K2 for at least two years, mostly the 5 mg dose. My saliva hormone levels are all normal, except for cortisol, which is all over the map, but high at night. I'm taking phosphatidylserine (at night) for that, and I'm sleeping better, along with the leptin reset (for a FBS of over a hundred, and creeping up). (I'm 5'4" and 120). Thyroid, of course, is normal. My D levels range from 60 to 80 with supplementation, it's a bit chilly here on the coast to wear shorts for most of the year.
I've used only progesterone for years, but now I'm thinking of looking into a more complete hormone replacement, if I can find a doctor to work with, although in our rural setting, while lovely, the medical care is very old school.
But now I've had a total hysterectomy for cancer (and radiation for five weeks, no chemo, thank god) at age 63 on top of the narcotic use.
Can you help me figure out if I'm going to have a lot more bone issues from the hysterectomy and the methadone? And would it be a good idea to add back some calcium?
And, sorry for the long post and all the questions, but would you think that some forty foot sprints on the beach,(or as much as I can do)would be okay? I lift as much as my neck lets me, which is about ten pounds. Oh, I keep forgetting, I've read your cancer post, and I love the green tea mouthwash idea! Thanks, Jean
I'm falling outta my chair, JK!
My guy's mother is 64. Her husband of 40 years died of a heart attack 2 years ago. They had really an excellent marriage, very devoted, never a harsh word between them. She was an active gardener, with a beautiful large collection of azalea. She worked as a research librarian, a low stress but intellectually curious life.
Her 1 bad health habit however was 3 cigarettes a day. She also always drank white wine with dinner.
Her husband's death just destroyed her. She's naturally quite petite (5'1") and slender, a sylph. As a child, she did have slight scoliosis, which was corrected with a back brace.
After his death, however, depression overwhelmed her. She couldn't work, she couldn't garden. She couldn't get out of bed, barely ate, and started smoking more. She took early retirement but the lack of social interaction only deepened her depression.
Naturally she was given large amounts of Paxil. The doctors told her to stop drinking wine, so she switched to apple juice. After about 6 months, she began to improve mentally, but her physical health fell apart. She still struggled to eat and sipped apple juice all day. Then last month she fell down the stairs and cracked her ankle bone.
She's gone from an active middle age (60 is the new middle age now, I'd say) to being a frail 80-year-old, health-wise.
That fall led to a full physical – where it was discovered she had osteoporosis, and NAFLD, despite being only 93 pounds. We were all shocked! How could she have developed bone problems in just 1-1/2 years? How could she have NAFLD when she is underweight?
But now I guess you've told me why. Her history of scoliosis, smoking, and Paxil have done her bone in, plus her generally under-nourished state. The NAFLD must come from the constant apple juice.
@morepork This is why this info needs to be out there. ten years ago it made no sense to me until I decided to look closely at my clinical experience was incongruent with what I was taught
Dr. K, I've been on Plaquenil for RA for about 10 years. While you don't mention it, I was wondering if it had any negative effects. I know it can damage my vision, but I have my eyes checked 2x yearly with no ill effects yet.
@Chris W I do mention autoimmune diseases. All are associate with inflammatory cytokines and high cortisol levels and risks for bad bone. Many of the drugs used to clinically treat autoimmune diseases also cause osteoporosis. A good paleo diet is the best defense. Tomorrow you will read it in the Osteoporosis RX.
Among drugs that can cause osteoporosis you list Anastrozole (Arimidex).
Does Anastrozole causes bone lose directly, or it is low estradiol due to use of Anastrozole that is causing bone loss.
Number of men have high estradiol either naturally, do to high body fat or use of supplemental testosterone.
They would use Anastrozole to control but not suppress their estradiol.
Usually the aim is for E2(15-30)pg/mL
Currently I am using 1mg/E5D for that reason.
….
Thanks, I'm so looking forward to it!
Thanks Jack. I like all of your replies – may not agree with them all — but I absolutely appreciate the time you take out of your busy schedule to reply.
I respect Lalonde but respect the late great Broda Barnes and the brilliant Mark Starr more with respect to thyroid issues. Armour is not a synthetic although it does not contain "bioidentical" amounts of t3, t4 found in human thyroid gland. I agree with you completely about the Cytomel which is a synthetic and although I was on a tiny amount to start with 5 mcg — I've cut this in half so it's only an additional 2.5mcg per day. I want to wean off this under a doc's care but my endo (soon to be ex-endo when new insurance kicks in) doesn't want to mess with things because my numbers are "perfect." I could just experiment by cutting back myself but I would like to find an endo who can help monitor etc. I started thyroid hormone years ago while still just lowcarbing — not yet paleo. The ditching of grains, legumes and dairy appears to have increased my metabolism over time. I believe that strict paleo and implementing several of your strategies such as early to bed, ditch the caffeine monster — big breakfast — and meditation etc have made my metabolism work even more efficiently and I simply do not think I need any Cytomel and may be able to eventually wean off the Armour. Bio-identicals with respect to thyroid hormone are synthetics that are supposedly in the amounts of t3 and t4 one would find in a human — Armour (pig thyroid) is not but has 100 years of decent track record and changed my life. I'm comfortable with it (open to weaning off if possible) but respect your differing opinion. I am determined to get off the tiny amount of Cytomel. I am not open to bioidenticals for progesterone, estrogen, dhea etc for me at this time. As I approach the half century mark, I do not want the sex hormones of a fertile 20 year old. But that's just me. If I was feeling brainfog or unable to orgasm etc — perhaps I would change my mind. But for now, I want to keep it simple. Titration takes an expert and this is tough to find in NYC and even tougher to afford. Anyway, my comments really had to do with dairy and the fact that there seems to be a little contradiction — dairy is supposed to be ditched for those with autoimmune yet recommended for bones. I struggle with the dairy issue and have for years — I go back and forth. I do not miss it or crave it. I would only consider adding back if I could be convinced that it would help and not harm my health. Even if it arguably helps bones, increased bone density is associated with risk of cancer. So one has to pick their poisons… I still believe in the value of antioxidants found in plants/cocoa/berries/coffee etc and the absorption of these things is definitely impacted by dairy. Why swallow expensive resveratrol supplements only to have the dairy casein and or fat bind it and render it useless?
@Alexandra My belief is that most thyroid conditions will respond to a leptin reset. The real issue is can the patient wait for it to happen. People who are metabolically train wreckish usually wont wait. But it works. If you choose to use the hormones you do I have no real problem with it as a physician as long as you the patient know where I stand on it and you understand why I am making the statements and treatment decisions I do. That is the core of the doctor patient relationship. I would hope that most of my readers will begin to realize this is precisely how you get your doc to slowly adapt. Build the relationship you want to see and become the patient they can not stop thinking about. Eventually they will see the light unless their dogma blinds them to your optimal results. I would hope Colleen Coble would chime in here. She is a perfect example of someone who did this long ago.
dr. kruse, I know the nothing by mouth part. my question was how long to hold off on a multi or any supplement for that matter if you are having vitamin levels checked. next time i'll play super conservative with no supplements of any kind for 2 weeks before labwork.
@V My rule is no supplements 24 hrs prior to testing.
Alexandra said:
"…I do not want the sex hormones of a fertile 20 year old."
AMEN!
Alexandra, if you knew what how great you would feel by supplementing hormones you might change your mind. LOL About 4 years ago I switched from Premarin to bioidenticals and it has been a life changing! I have so much energy and feel terrific.
Dr. K asked that I weigh in here on my experience. About 15 years ago I was that train wreck he mentioned. Fibromyalgia, massive leaky gut–I was allergic to everything under the sun. I had bad blood work that indicated I was heading for a diagnosis of lupus or MS. I was determined to turn that train around. I read about Dr. Wilson's protocol and then extensively on http://www.drlowe.com site about thyroid resistance and fibro. I took all that information to my doctor and asked to try Cytomel. He said it couldn't hurt to try it–that I would soon know if it was working or not. I started low, about 50 mcg of Cytomel, and titered it up to 150 mcg which ended up being my magic number. I think I took about a month doing that.
Then POOF. Fibro was gone, never to return. So that was the first piece that fell into place. But it took MASSIVE doses of cytomel. That was a dose that would have put a normal person in the hospital. It's what I needed though. I've talked to many others who have followed that advice and gotten rid of fibro the same way.
Then I found a naturopath who addressed my leaky gut. that took about 3 years to heal. I was still plagued by migraines though. I read a book called The Migraine Cure by Dr. Dzugan. Reading about it, I could tell this was me. I tried to dose the bioidentical hormones with my regular doctor who was willing but my migraines got worse not better. Still, that was an encouragement to me because it showed me for sure that the migraines WERE connected to hormonal issues. I went to the Dzugan clinic and that was another huge piece for me. I had a complete hysterectomy at 23 and had been on Premarin for decades. That stuff is of the devil! 🙁 I started on the bioidenticals and what a difference! I am human again!
Then I found HCG and was finally able to lose the weight. I lost 75 pounds on it and after my final round my labs were awesome, better than they'd been since I was in my 20s. I think I was close to leptin sensitive because of the timing of the eating I was doing on the protocol.
but I still had some final issues. That's when I found Dr. K. He provided the piece that tied it all together. I read his Hormones 101 and saw myself in every paragraph. 🙂 I followed his protocol and will continue to do so because I feel great. I can actually eat some carbs now without gaining too which hasn't happened in decades. That timing issue is so important!
And BONUS!! After 3 weeks of 15 mg of K2, my turkey neck is gone! GONE!!! Oh my goodness, it was so exciting this morning to realize it. My neck looks like that of a 35 year old. AMAZING!! I love Dr. K for that alone. LOL
But it all boils down to the fact that YOU must take charge of your health. No one else is going to do it for you. Research your particular issues. Take information to your doctor. If he won't help you, find another doctor who will. There is so much more information out there now than there was when I first started my journey.
You say you're having trouble finding a doctor in NY. Look for an anti-aging clinic. They are everywhere now. Or find a doctor who will listen to you. I'm fortunate that I live in a small town and my doctor LISTENS. He has let me follow every rabbit trail known to man in search of health. So you can find out. They are out there. but you have to be diligent and search them out. Don't settle for less!
Um, girls if you could see me, you might change your mind about not wanting the hormones of a 20 year old. 🙂 I am almost 60. If you go to my website at http://www.colleencoble.com you will see I don't look 60. I don't color my hair if you're wondering. LOL Most people do not believe me when I tell them my age.
I have those wonderful hormones to thank. 🙂 I will NEVER give them up. I want to feel like snorkeling when I'm 80.
I forgot to mention that I am now on compounded thyroid. I was reluctant to give up my cytomel because I was afraid the cytomel would come back. But nope, it's stayed gone. 🙂
What kind of compounded thyroid Colleen? I am wanting to get off of cytomel now that RT3 is gone, but have heard many sad stories about the new Armour.
Also, is there a special time to take the k2 each day?
@Michele It depends why your taking it. If you are doing it as a palliative treatment once a day in the AM is OK. If youre trying to reverse atherosclerosis or treat leaky aggressive the type of K2 you use and the frequency of dose will change. This is something your doctor must help you with depending upon why they suggested you take it.
Dr. Kruse,
As I've mentioned before, I have epilepsy and have been on phenobarbital therapy for 40 years. Attempts to switch to other AEDs have been unsuccessful. In addition to causing problems with Vitamin D, phenobarbital catabolizes testosterone, raises SHBG and induces the liver to produce more aromatase, thereby increasing estrogen and decreasing bioavailable T.
So to offest the effects of phenobarbital, I take high dose Vitamin D, testosterone and anastrazole. Without the anastrozole, the estrogen levels skyrocket.
Any advice?
@Paul if you can only be on Phenobarb then you have to consider things that you can do to modify your response. I would go strict ketogenic paleo and would eat almost exclusively MCT and see if you could then switch to something else. If not then you must do simultaneous HRT, keep your gut and liver optimal because of all the drugs your on and I would consider adding Zn and ECCG (green tea and green tea extract) because both are great aromatizer inhibitors. I also consider curcumin as a must supplement, with NAC, sillymarin and alpha lipoic acid. You need to do everything you can to keep the liver and gut functioning optimally with your set of circumstances.
Sorry, Michelle, I've been traveling and we just hit the hotel. 🙂 I get mine at a compounding lab. It's basically dessicated pig thyroid like Armour but it's in a capsule so no fillers. The problem with the new Armour is the fillers. I take 2 grains daily, split into 2 doses. But I have hashi's, just FYI.
Don't forget about Fosomax and its ilk! My MIL took it for years to prevent her mother's osteoporosis, and while making dinner one day BAM! thigh fracture. The kind of fracture, from what I read in Pubmed, is rare in nature, but not at all uncommon in those taking these "anti-osteoporosis" drugs, esp. when in combination with PPIs and one other kind of drug I forget that she was also on.
It took over a year of therapy, getting off the drug, and eating a more traditional foods diet (naturally higher bone-building animal fats) to be able to walk again. (She tried once too early and fractured the other leg.) She's been debating whether to join the class action lawsuit ever since.
These drugs say they work by stopping the body from reabsorbing old bone. My suspicion is that they provide the illusion of real bone density by letting the trash build up, instead of taking out the trash and bringing in new growth.
@Michelle
My labs and my response to the Armour were identical with the current version and the previous. Only difference in formula is more fiber and less sugar. The biggest issue from the change was for many who liked to dissolve the Armour under the tongue for quicker /better absorption and no need to wait an hour to eat. The new formula does not dissolve under the tongue easily — it's not designed to. That's a shame. But I love Armour and noticed no difference at all between the old and new version. May be an issue for someone with insufficient stomach acid but I think I still have plenty of stomach acid but in any event, every person will respond differently to different formulas. My doc feels best on Synthroid — so ymmv.
@Colleen — what a terrific personal story! You look amazing and your enthusiasm and zest for life is inspiring. You do look very youthful but more importantly, you seem to have found the perfect protocol for you. Different strokes for different folks.
Thanks, Dr. Kruse.
How much MCT should I include in the diet? Also, with regard to HRT, I currently inject testosterone cypionate which contains cottonseed oil. Is this oil a problem? I tried topical compounded testosterone for over 4 years and my levels were always below normal.
@Paul If you're eating paleo 06 should be low so a little cottonseed oil in the testosterone is not a deal breaker. AS far as the MCT amounts my answer is simple…..as much as ou can stomach and fit in. I have zero rules on limits for CO.
Thanks Alexandra! I also meant to say I don't want to live forever. 🙂 I look forward to stepping into heaven. But while I'm here, I want to be the best me I can be–to enjoy life and experience things. We were created to live longer and healthier than we currently do. So the anti-aging movement is helping us get back to what our Designer had in mind!
Dr. Kruse,
What are your thoughts on Calcium D-Glucarate for helping control estrogen? I am currently taking .5 mg of Arimidex EOD and my estradiol as measured by the Quest estradiol, ultra-sensitive test remains high (45 pg/mL with < or = 29 normal range). I really do not like using Arimidex but phenobarbital induces the liver to produce more aromatase. As you suggested earlier, I am taking the following supplements: Zn , green tea and green tea extract, curcumin, NAC,milk thistle and alpha lipoic acid.
Paul, first off this may be unnecessary because your level of estradiol is not that high. Levels in the forties dont get me fired up for using drugs……now if your level is in the forties on arimidex I get why youre asking me. I am not clear on this. As for Ca-D glucarate here is all I know. Its a great detox drug people use for phase two detox pathways in the liver. Calcium-D-glucarate is the calcium salt of D-glucaric acid produced naturally in human and found in many fruits and vegetables.
Oral supplementation of Calcium-D-glucarate has been shown to inhibit an enzyme call beta-glucuronidase which results in a more efficient and effective phase II liver detoxification process.Calcium-D-glucarate's detoxifying and anticarcinogenic properties are attributed to its ability to increase glucuronidation and excretion of potentially toxic compounds. During Phase II detoxification, chemical carcinogens, steroid hormones (like estrogen), and other lipid-soluble toxins are conjugated with glucuronic acid in the liver (glucuronidation), and excreted through the biliary tract. Beta-glucuronidase is capable of deconjugating these potential toxins, making it possible for them to be reabsorbed rather than excreted. D glucaro-1,4-lactone is the metabolite from Calcium-D-glucarate that has been shown to inhibit beta-glucuronidase activity, increasing excretion of conjugated xenobiotic compounds and decreasing activity of harmful substances that are most active in their de-conjugated state. So Paul, this little-known supplement not only helps eliminate excess estrogen, it also detoxifying other toxic chemicals and substance in our body. So yes I do like it…
Dr. K, My latest DEXA showed my lumbar BMD has declined at L2-4 from .822g/cm2 to 0.782 g/cm2. -3.48 SD below young adults. Femur BMD has declined at the femoral neck from 0.7776 g/cm2 to 0.721 g/cm2. -2.16 SD below young adults. My doc's recs are: increase calcium, exercice, Vit d 400 IU/day and Fosamax. I started doing the Leptin Rx last Novemeber (ketogenic due to Leaky Gut Syndrome). Per your blog, I am taking 45 mg of K2, 800 mg of mag, 10,000 of Vit D (in addition to the other Top Ten recs for vitamins). Is there anything else I can do to speed up healing? Thanks so much for any input.
@pamela 400 IU of D3? what is your D level?
Dr. Kruse,
I am currently taking 0.5 mg. of Arimidex every other day and my last level was measured at 45 pg/mL on the Quest estradiol, ultra-sensitive test.
If I start taking Calcium-D-glucarate, should I continue with the Arimidex? I wonder, given the mechanism, if it decreases the effectiveness of phenobarbital?
Vit D level was 37.4, I was taking 1000 iu of vitamin D for years but that was before I came to your blog, I have been taking 10,000 IU of Vit D since Nov, BTW, when you said, "People with scoliosis of unknown cause (idiopathic scoliosis) also have a higher risk of osteoporosis. I believe this is because most of these children have severe underlying Vitamin D deficiency and a leaky gut but this has never been studied in the spine literature." That really indicated to me. I was not diagnosed with scoliosis until I was in 30's. So, it went w/o any treatment. Just a note, the leaky gut treatment is my own self-diagnosis. I believe I have had it since I was a child due to my gut issues. Thank you for all this data. I am so grateful! All my doc had to offer was Fosamax.
Dr. Kruse,
Given our exchange in posts #30 & 31 above, would you also recommend fish oil or krill oil?
@Paul I dont know enough to say honestly.
Dr. K, what are your thoughts on Fortical, Injection or Intranasal spray, for post menopausal osteoporosis?
@DrJackebner Calcitonin is used often by modern medicine …….I do not use or advocate its use for osteoporosis.