Osteoporosis - Fracture-Proof Your Bones with Dr. John Neustadt and Linda Kreter
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Good morning and welcome to Wise Health for Women Radio. I'm Linda Crater. We're going to be talking today to Dr. John Neustadt, who is a naturopathic physician. He works in nutritional biochemistry. In fact, his company is called Nutritional Biochemistry, Inc. And naturopathic medicine looks for root causes, looks for ways for wellness, looks

that honestly works integratively, functional medicine. These are terms you may have heard, but they get to the root cause of things. And we're going to be touching on a topic near and dear to many of us, which is osteoporosis. And John has written an amazing book called Fracture Proof Your Bones. And if there's one thing we've all heard is that you don't want to break a hip.

You don't want to fall down the stairs. You don't want to have any of these injuries, especially later in life. We become a little more fragile. But in order to avoid becoming fragile, John's going to talk to us today about how we can take care of our bones, stay healthy longer, have richer lives. So, John, I'm so excited to welcome you to the program.

Me too. Thank you. You're very welcome. It was a pleasure reading your book, and I highly recommend it to people. Found wherever you find your books called Fracture-Proof Your Bones, and it's a comprehensive guide to osteoporosis. Some of the information I knew. Much of the information I did not know or I didn't know the why behind it. And I think that a whole person look...

at reversing osteoporosis or reducing fracture risk is really important. I, for example, did not know that meds were used to stop spinal fractures, but maybe not limb fractures. So these little details are good to know if you're told you have low numbers, osteopenia, and

And, you know, we'll take it from there. So will you talk first about how common osteoporosis is and how bad it can be, but that there is hope if you take a more holistic look at your lifestyle?

It's not only more common than I think a lot of people know, but it's becoming this epidemic because the population is getting older and old, getting older is a major risk factor for osteoporosis and fractures. There are now

about over 50 million Americans with osteoporosis or at risk of the disease because they've already started to lose bone density. And I think that's an underestimate because there are so many medications that cause osteoporosis that doctors don't know about and they're unwittingly curable.

creating this problem in their patients. And those numbers, that 50, over 50 million person number doesn't capture that trend. For example, one of the most common medications out there, especially among women, are antidepressants, the selective serotonin reuptake inhibitors or anything that artificially increases serotonin.

like Prozac, uh, duloxetine, those types of medications, they, uh, damage bone so severely that several studies have looked at, um,

the research on this and concluded that for every 19, about 19 women taking it for one to five years, one of them is going to break a bone. And even less than taking it for less than one year increases the risk of osteoporosis and fractures. And that's just one of the long list of medications. As you mentioned, you know, nobody wants to break a hip. If you do and you have osteoporosis,

osteoporosis, there's up to a 36% chance that you're going to die within the year. And half of those people who survive never regain their pre fracture, you know, pain free life level of mobility, enjoyment of the active lifestyle they used to have before the fracture. And in fact, for women, their risk of an osteoporosis fracture

is equal to their combined risk of breast, uterine, and ovarian cancer. And osteoporosis causes more days spent in the hospital than other diseases like heart attacks and diabetes and breast cancer. So it's a major growing issue out there that is even despite

the recommendations for testing and screening. It's under tested for, it's under screened for. Absolutely. And doctors are not trained to provide the evidence-based recommendations to help people reduce their fracture risk as much as possible. Well, it's funny. I think as we get older, we start to make choices on activity and

risks. It makes a difference. For example, I have worn heels my entire life, but now I take my heels downstairs before I put them on because I do not want to trip on the stairs. It's just a small thing that makes a difference. Or I wear Pilates socks at night with the little rubbery things on the

Because I'm trying to reduce any fall risks, mostly because of distraction, not because of a lack of balance or a lack of strength. But I think we're all pretty distracted after the last four or five years. And I think people's habits went sideways. I would add to your comments about the mental health drugs. Not only do they cause stress,

as you said, an increase in osteoporosis, but they often cause weight gain, which puts more strain on those very bones. There's so many unrecognized problems out there within the medical community that

are creating more of an issue than there needs to be. One of them you touched on, which is just practical. 95% of fractures occur because somebody falls. So anything we can do to prevent somebody from falling is necessarily going to

prevent fall-related injuries like fractures or concussions, getting bruised. And those are great solutions. You mentioned incredible solutions that I hadn't thought of before. I'm very simple. It's wonderful. Well, they're bloody socks. So it's not like kids, but it makes sense because if you have hardwood or carpet, it doesn't matter. You need the grippers just to give you a little extra help.

Yeah. And there's a whole chapter called fracture proof or the whole section of fracture proof your home, you know, in my in my book of what people can do to reduce their risk, because that is where most of the falls and fractures occur.

And with respect to these medications and the last, you know, four years and the stress everybody's, you know, under, it's not only, it's not only the increase in, in the prescription of these and other medications that are creating a worse problem than we had before, but it's also that people's diet, uh,

has, I think, deteriorated. People maybe are not exercising as much either. You know, their emotional eating and that standard American diet that promotes inflammation and increases the risk for nutritional deficiencies and doesn't give people the raw materials their body needs

to function, let alone their bones, is contributing to this problem. In fact, the standard American diet is associated with increased osteoporosis risk. So simple things people can do to change their diet and start moving in a healthier direction isn't only going to improve their bone health and reduce their fracture risk, but it'll just help people feel better. I mean, slim down, get to a healthier weight, have more energy, feel more vital.

Well, vigor is so important. And I think that we find that...

Yes, the last four years were extremely stressful on every level. And I think people went one of two ways. They either went to the comfort food because they thought this was a short-term problem and then it fell into bad habits, or they went and got into good shape. And now we're not willing to relinquish that good nutrition and exercise, etc. But you and I before the show were mentioning that food is,

can be joyful. It can be wonderful. But I'm of the era where we were told, switch to margarine. That's bad for you. Don't eat too much meat. Bad for your heart and cholesterol. Avocado is fatty and bad. I now have great joy in eating because I use a lot of butter. I eat avocados. I love sweet potatoes, a complex carb.

And I'm eating grass-fed beef. I'd rather scrimp elsewhere and go with organic food and enjoy it. And it's very interesting because if you don't eat processed food, you really are eating healthy. So what I call single ingredient foods. It's true. And then more naturally, somebody can eat the healthier. And the research shows this, the dietary pattern that's associated with

20% reduction in osteoporosis and a 21% reduction in hip fracture risk, as well as reducing the risk for diabetes, cardiovascular disease, cancer, death from cancer, and all cause mortality that's dying from anything is the Mediterranean diet. And it's essentially a plant forward, whole foods, omnivore diet, not a vegetarian or vegan diet. In fact, the research shows that

vegetarian and vegan diets are associated with an increased risk for osteoporosis. And even if you're eating that

plant forward, Mediterranean style diet, which is rich in whole fruits and vegetables, whole grains, lean proteins like salmon and chicken. I mean, I guess salmon's not lean, but good healthy proteins like salmon and chicken, very low relative to the American diet in red meat and processed foods. You are giving your body what it needs to be healthy. But one of the

missing components that people are not getting enough of. We talked about this before we went on the air that I keep seeing over and over. And it's speculated that it's the problem with vegan and vegetarian diets. I mean, we know that eating plants are healthy for bones. So why is it that vegan and vegetarians don't have healthier bones overall?

And the answer is they're probably not getting enough protein. And I see that time and time again in people when I consult with them and my patients. They're just not eating enough protein to support their bones. Well, let's put this stat out there. It is recommended, and correct me if I'm incorrect, that you eat one gram of protein for every pound you weigh every day.

So that is, that would be sufficient. The direct, the U S recommended daily allowance for protein is actually in kilograms per pound, a body weight, which is tough for Americans. It's, you know, 0.8 to 1.2 grams of protein per kilogram. Don't make me do that on air. Okay. You just take your body weight and divide it by 2.2, but that is insufficient. So, you know, one pound of

one gram of protein per pound body weight is above that US recommended daily allowance, which is sufficient. That would be sufficient to maintain bone health. That would be considered a high protein diet.

And if you have kidney disease, chronic kidney disease or on dialysis, that may be too much for you to want to talk with your doctor. But for the general population, it's considered safe. But the U.S. recommended daily allowance is not safe.

sufficient as we get older to maintain bone and muscle. In fact, the amount of protein that people eat can account for two to 4% of bone mineral density because there are over 200 proteins in bone and the major protein is collagen. And that's what the minerals bind to. So when you're giving your body that protein raw material to build collagen, it necessarily helps maintain that bone

density. So I recommend people, you know, one gram of protein per pound body weight can be a lot. It is a lot for many people. Based on the research, I recommend people get a minimum of 0.65 grams. Okay, slightly less than that.

Yeah. Grams of protein per pound body weight, which comes out to the, just above that, that higher end of the U S recommended daily allowance. And that's based on, you know, clinical trials showing that that amount, uh, can maintain, uh, muscle mass. There is though they can get more than that. So if you just take your body weight and multiply it by 0.65 or one, you know, keep it at one that that's the number of grams, uh,

of protein that people should be striving for. Now, I'm going to ask a question about collagen because one of my family members is a physician and said, don't bother with collagen. It gets eaten up in the gut and it never gets absorbed. Now, contrast that with taking...

amino acids, already broken down protein. So it's more highly absorbable, fewer calories, et cetera. What do you feel about those two comments? So the first comment that he says that it basically saying it doesn't work, don't bother, save your money. It doesn't get absorbed. It gets broken down. When I hear statements like that, my initial question that I want to ask is, can you show me that research?

Do you have a study that shows that it doesn't get absorbed? Well, my next question was, how many nutrition courses did you take in med school? And the answer was zero. Right. Medical doctors tend not to get any nutrition classes. No, they don't.

- Right, but to give them the benefit of the doubt, there are many physicians out there who do take an interest in nutritional medicine and will start to read and do some research. So that's what I teach people in my book, the questions to ask of their doctors and of themselves so they can create a holistic plan

that works for them. And you mentioned the medications, and I hope we have time to delve in a little deeper about the medications, but questions around the medications and the research around the medications and what's being recommended to a patient are important to ask the doctor. So that's the first thing that comes to my mind with your statement about collagen and hearing that. The second is he's just wrong. The research, first of all,

First of all, collagen dietary supplement is already broken down. So it's hydrolyzed. Hydrolyzed collagen protein is protein broken down already into small peptides, which are chains of three to five amino acids. Amino acids are the building blocks to proteins. Like in alphabet, they get put together in all different ways. And there are about over 500,000 different proteins in our body.

Collagen being one of them, and there are many different types of collagen. The predominant form of collagen in bone is type 1 collagen, and that's actually what gives bone its ultimate strength. It's tougher

basically than steel. And if you take a chicken bone, for example, and you take all of the minerals out of it by soaking it in vinegar, all you're left with is the collagen, the protein. You can bend it, twist it, stomp on it. It doesn't break. It's that strength. Ah, so that's the trick with the turkey pinky thing.

Exactly. And if all the collagen goes away and you're left with just the minerals, it's brittle like a column of chalk. So when you're looking at collagen dietary supplements, the collagen powder,

for example, it's already broken down and it can be absorbed. There are studies looking at the absorption of collagen powder and collagen dietary supplements. It absolutely is absorbed. But more than that, there are clinical trials, you know, and I would say even better than that, you know, the clinical trial with the outcome that people want to experience, you know, those are the most important studies. You know, is something absorbed? Yeah, I guess that's important from a, from a, uh,

laboratory point of view or a pharma, what's called a bioavailability study. But that's not what's most important to a customer, a consumer, a patient. Am I going to get results? That's the bottom line.

So collagen is absorbed and the research shows that it does promote a healthy bone density. It does promote healthy joints and healthy skin. It had their studies showing that it reduces visible lines and wrinkles in the skin because collagen is made up. Skin is made up of a lot of collagen. Right. And so it gives skin its elasticity to spring back and it improves skin hydration. Right.

So, collagen is a great dietary supplement if people are interested for bones, joints, and skin. It's not my first line though, if we're on the subject of dietary supplements. I think it's important if people want to take it. But there are other nutrients that have been studied

And with the outcome, not just a bone density, because that's a number on a test, but the most important outcome is does it maintain strong bones as indicated by reducing fractures. So what's your number one?

So I look at what are the nutrients shown to reduce fractures in clinical trials. That's the ultimate indicator that it maintains bone strength. My number one is MK4. It's a specific form of vitamin K2 in the dose of 45 milligrams per day with calcium and vitamin D.

That nutrient has been shown not only to promote healthy bone density, but maintain strong bones as indicated by more than 70% fewer fractures in clinical trials. That's huge.

Not only that, it's been studied and shown to maintain strong bones in people taking medications that are known to destroy bones and reduce bone density. And it maintains bone density with those medications as well, not just in people with postmenopausal osteoporosis. Not only that, but you mentioned D and K2 together, they're powerful.

And so D3 and K2 are extremely important. I'm not surprised that that works there. I want to give you an opportunity to talk about the meds because you mentioned that.

And I also want to mention that the book is divided into chapters, but it's also got pages where you can write in, as you said, the questions for the doctors or your concerns or where you want to do more research or keynotes from the chapter that you want to maintain. So it's a combination, very informative, easy to read and absorb book.

No pun intended. But it also gives you the opportunity to take notes, which I did, by the way. And I find that that's very helpful because when you go in for your annual physical, if you're blessed enough not to be ill and going to the doctors all the time, you may forget unless you write your questions down. And it's such an invisible thing.

osteoporosis that you don't want to find out when you break your leg or your back. Which is typically when people discover they have it when they break a bone. But quick note on the K2-D3 combination. Okay. Yes, that's a great combination. But I want everybody to understand that vitamin K2 is a category of molecules. There are different forms of vitamin K2. Every standalone vitamin D3 and K2 supplement has

has K2 as MK7, not MK4. I specifically mentioned the MK4 form of vitamin K2. MK7 has never been shown to improve bone density in clinical trials, only slow down how fast somebody loses bone. But more importantly, it's never been shown in any clinical trial to maintain strong bones. I address this in the dietary supplement chapter of my book. And in fact,

I created the only clinical dose MK4 product, 45 milligrams per day with calcium and vitamin D back in 2006. It's still on the market because of the research and it didn't exist in the US. The research on the MK4 nutrient showing that that is actually the form of vitamin K2 that is most effective. Interesting. Not the MK7-4.

form. But MK7 is really cheap. They've got amazing marketing. And that's why it's more popular in dietary supplements. It's in the microgram, you know, thousands of times lower dose than what's found with the MK4. And it's a different molecule. It's got a different rate of atoms. Well, that's the key, it says to me. And you have a wonderful array of supplements on your website, nbihealth.com. And I presume that's one of them.

Yes, there are two versions, one with less calcium and one with more because not everybody needs a huge dose of calcium as a dietary supplement. Hopefully, they're getting most of it from food. Interesting. I mean, I find all of this fascinating because – and I do want to go further to the meds because –

Maybe America's become a lot more aware now after the last four years and doing some research on their own. My own background is in clinical trials. So I read eagerly not just the trials themselves, but when I look at a supplement or something, you want to make sure that it's a quality supplement. So I did not know the difference between a 4 and a 7 supplement.

And so that makes a difference because if you're going to spend money on supplements and, you know, organic eating and healthy diets and strong exercise, you want to be

doing it right the first time. So I think that's important. But go further into the meds, because I know that's an area you wanted to talk about. But I think there's less trust these days on just taking anything somebody tells you to take. You go into the research, or I do. I mean, I'll take a look. I'm blessedly not on any medications, which is always a surprise to

when you fill out that medical form, but I'd like to keep going that way. Thank you. Supplements, yes. Medications, no. So the antidepressants, the anti-axolytics, the anti-anxiety meds, those kinds of things are so commonly given out these days. They're given out because it's an easy solution and frankly, patients are asking for it.

You know, lifestyle changes take a lot more energy, but it doesn't take as much energy to pop a capsule or a tablet. And so talk about this and what questions to ask and what are holistic alternatives? Because there usually are holistic alternatives, but they may take more effort.

So one of the challenges, conventional doctors are not trained in nutritional medicine. They're not trained to understand, you know, beyond just saying, oh, go for therapy, go for, you know, counseling, exercise, you know, maybe get more sleep. They're not

educated to understand that there are specific nutritional deficiencies that can contribute to anxiety and depression, hormonal imbalances, and they're testing that can be run for those sorts of things to look at that, which is one of the reasons why I advocate people

do get a good naturopathic doctor or functional medicine doctor on their team. But with respect to the osteoporosis medications, I think you're going to really find this fascinating, given your clinical trials background. Which is a blessing and a curse, but okay. When I started looking at the clinical trials on the osteoporosis medications, I was shocked.

For your listeners, when a clinical trial is designed, there is what is called inclusion criteria. That is, who do they select? Eligibility, right. That's right. You looked at these clinical trials on the osteoporosis medications. They already enrolled women with postmenopausal osteoporosis who had already broken bones. So these are high risk for another fracture.

And what we found when researchers looked at prevention of fractures in osteoporosis, there is a difference between what's called primary prevention, if you have osteoporosis and have never broken a bone before, and secondary prevention, that is if you've had one fracture, can we prevent you from getting a second fracture or third fracture? If you've never had a fracture before,

Only one of the medications actually will prevent you from having your first fracture, both in the spine and non, that's called vertebral fractures and non-vertebral fractures, which include your hip.

So the vast majority of the medications, all the first-line therapies like Fosamax, which is alendronate, the oral bisphosphonates, they only prevent a vertebral fracture, not a hip fracture if you've never had one before. That surprised me. And you have a chart in the book that shows that there's only one that does both. Zometa. Yeah, it's IV. It's intravenous zometa. Correct. Correct.

And so people and doctors don't know this information either, which is why the book is so important. And writing down the questions, as you mentioned, is so important because doctors really aren't aware of this information either. And I think that, you know, if they were, it would make a difference. I feel sorry for our primary care internists these days. They're given, what, 10 minutes with you, right?

There's not much time, so you better come prepared.

to ask certain questions or about your concerns because otherwise you really get the standardized, especially if you are older and they need to ask you specific governmental type questions. So I have a friend who's on Medicare and they have to spend time each visit for a physical and ask standard questions that go into some giant database somewhere. And that takes up time.

So the meds are, so I encourage everyone, read this book, but also go through it and see how many categories that you fall into. Another thing that I always find so interesting, you know, reduce stress. Easier said than done, but you can intentionally make choices that reduce

will reduce the stress, will reduce the cortisol that will not wake you up in the middle of the night. If you mind your technology, darker rooms. I actually replaced my bedroom nightstand light with a red light bulb because it doesn't disturb your night vision. Well, I'm a sailor, and so when you're on boats at night...

The lighting is red, and so it does not destroy your night vision, but it also, I find, calms you way down. And so while I go along with the jokes about it's a red light district, it's not. And it has truly helped me to fall asleep faster, stay asleep longer.

So these are practical things that we're all mentioning today. You're mentioning what I am, but sleep is so hard when there's so many stressors and distractors in the world. It's true, and it's part of an important piece of this bone health and osteoporosis puzzle that also is not being talked about in appointments with doctors. And if you're not getting enough adequate sleep,

what the research has shown is that, you know, bone, you lose bone density faster and it increases your risk for, for fractures and falls and other mistakes. In fact, it's, it's sleep deprivation is such a danger that it, people can, uh,

it's equated to drunk driving. That's how much it can decrease coordination and reaction time. But just in general, getting sleep, you feel better. I mean, the day is brighter, you're interacting more, life is better. No question. And I think that we're running out of time, of course. We can come back and do more another time. But one of the things that surprised me was your final chapter on social support. Talk about that.

I've never seen that talked about before in the context of osteoporosis. But the research is clear that when people have a strong social support network, and it doesn't have to be a ton of friends. Researchers looked at this. If you just have three people that you reach out to, that you connect with, that you do things with, that's a strong social support network, which is associated with a reduction in

in all cause mortality, that's death from any cause, including osteoporosis. But when that's in place, if you unfortunately do happen to break a bone and fracture your hip, it's also associated with a faster healing time, a better ability to heal and get back on your feet. So many benefits to just interacting with other people and getting out there. Well, and you've become more active again.

You tend to go do things with people as opposed to just being in touch. Well, that's very positive and supportive. Even just attending an event together or taking a walk together. It really does increase your activity. And I do have to applaud whatever marketer pulled out the physics. A body in motion stays in motion because it's true.

And so by moving and exercising our, our choice about movement is a blessing. And so is nature. I mean, I think those who walk dogs would be the first to tell you that, sure, it's hard on days that rain, but I'm out every day in nature and that helps. Absolutely. No doubt about it. The research is clear, but you know,

Forget the research for a second. You just feel better. Don't we all want to feel better? Well, I definitely believe that all of our listeners do, and so do I. So I'm going to make another recommendation that you either go to nbihealth.com, which stands for Nutritional Biochemistry, Inc. So nbihealth.

B-I-Health.com. And you'll find out more information about Dr. Neustadt. But his book, Fracture-Proof Your Bones, and I'll put this in the show notes and click to where you can get it, is actually a very easy read. I've written all over his book because while I thought I knew a lot, there's so much I didn't know.

And so I think, you know, here's a tiny thing. I'm just thumbing through the book right now that I underlined. Going to bed at the same time every night is the best predictor of healthy sleep.

And I mean, I do that religiously because sleep is like gold to me. So I'm just laughing because I have all my underlines. I should probably tell you what my underlines are. But I thank you for this book and giving it to me in time to read it for this interview because it's so helpful to actually understand sleep.

what it is you were going to talk about. And we all want to stay as healthy and vibrant and vigorous as we can for as long as possible. Is there anything I missed that you would like to go over before we end our show today?

I think you hit all the high points. The most important thing, I think, for people to understand is that when they get a diagnosis of osteoporosis, it can be really scary and overwhelming. And there tends to be a lot of pressure from the doctor immediately to start a medication. What I write in the book and what I teach people is take a deep breath.

This is not a medical emergency. Yes, it's serious, but there is time for you to educate yourself, to learn more and create a holistic plan that makes sense for you. That's going to allow you to improve your bone health and reduce your fracture risk. And that's what the, what I walk people through in my book of how to create that plan. I love it.

I love it. Thank you so much for your time, your wisdom, your patience today, as I had a lot of questions. And I really do appreciate the discussion. Again, you would go to nbihealth.com. And Dr. Neustadt, thank you for your time today. It was wonderful. Thank you for the opportunity. I loved it. My pleasure. Thank you for tuning in today. You can find more shows at wisehealthforwomenradio.com.