Bone Health Myths and Truths · 2019-05-07 · Bone Health Myths and Truths, Part 2 4 individually....

Bone Health Myths and Truths Part 2

Bone Health Myths and Truths,

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Good evening and good afternoon to all of you. Welcome to the second webinar of our Bone Health Myths and Truths course.

I hope you have all been enjoying your time since the first webinar. Hopefully you have had an opportunity to review that recording at least once if you attended live and twice if you weren’t able to join us. The Q&A on the web site has been excellent in terms of exploring a variety of topics related to bone health.

Today we are going to pick up on some of the key themes from the last session and dive into detail about the nutrients and particular solutions that are needed to help our clients to retain good, strong bone density and also perhaps to recover it where it’s been lost.

Before we dive into our webinar, just a few gentle logistical reminders, especially for those of you for whom this may be your first SAFM Clinical course. A final version of the presentation slides as well as the stream-able video file and a downloadable mp3 file will all be available by early tomorrow morning. As always, I encourage you to take a look at it at least once again relatively soon within the next week. Repetition helps tremendously to lock in the concepts that you are learning. As we discussed in the first webinar these presentations are really designed to be information packed. They are designed not to be digestible or memorable after only one viewing. So please make sure you have some blocks in your schedule set aside to maximize your time and money investment in the course.

I encourage you to continue to use the online bulletin board to post file questions related to this course.

So this is part 2 of this Bone Health course. Tonight in particular we are going to cover a few key reminders from the first course just to provide linkage and then we are going to dive deeply into bone building blocks, especially into some of the nutrients I introduced in the first webinar. We are going to a particularly deep dive into the myth-riddled topic of calcium. I will do a case study that ties together a number of the puzzle pieces related to bone health in the case of Katrina, a woman who was diagnosed with both osteopenic and osteoporotic bone loss. Then we’ll summarize a second set of clinical pearls as well as additional resources for those of you who wish to do deeper dives into some of the concepts presented in the course.

As always, I want to remind you that your go-to webinar dashboard has a questions tab that I encourage you to use throughout the webinar in order to post live questions that I might be able to answer in real time as I am going through the material. We’ll use it to gather your input and your view of the interconnectedness for our case study Katrina this evening as well.

Without further ado, I want to start off with just a gentle reminder about our optimal health model. I’m sure as we go into this course you can see the role of maximizing what’s needed and minimizing what’s


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not needed, and prioritizing an environment of healing for bone health just as is the case for metabolic health or respiratory health or cardiovascular health. These three legs of the stool work synergistically in order to help our unique client bodies to heal themselves. Certainly we talked about the interconnectedness of things last time and getting away from some of the myths that vitamin D and some calcium supplements are all you need to have healthy bones. We certainly explored that it’s not true and bone health is indeed not that simple.

Let’s review some of the particular key pints from Part 1 of this course. First of all, bones are alive. I really enjoyed comments that a few of you sent me after the first webinar, admitting that you never really thought about the fact that bones were live tissue just like our skin or anything else is that is constantly regenerating itself. It also follows the principle of ‘use it or lose it’ that’s true for most of the body, where our tissue evolves, adapts and strengthen itself based on what we ask of it.

Healthy bones are not just strong and stiff. They also need to be strong and flexible and it’s not just a matter of having sufficient calcium or even just sufficient calcium and vitamin D, but a number of critical co-factor vitamins and minerals that we discussed; also, the importance of the collagen backbone and the importance of our ability to not only ingest but also absorb protein to keep bone mass density high.

We also talked about the importance of muscle strength, that the bones are not designed to be supporting all of our weight on their own. They are intended to be a framework for our muscles that do most of that, so musculoskeletal health is based on a partnership between the muscles and the skeletal system.

We also discussed a bit that it is normal to lose some bone mass density. I’m sure we have all had clients who have become upset, alarmed or even freaked out if they received a DEXA scan showing that they have lost some mineral density. I think unfortunately that there are some practitioners who fuel the flames of that alarm. I have worked with clients who have been on very heavy duty medications for osteoporosis for extremely mild osteopenic bone mass density loss. So it’s important to understand for us and to reassure our clients that some loss is completely normal and to be expected especially during menopause as a reflection of hormone changes. It doesn’t have to be alarming or predispose one to fracture in any way.

We talked about the dichotomy that bone density as we age is based on, first and foremost, making sure we maximize that peak bone density in early life, that we are creating the best bone density we can in the first few decades of life to get a good start and the certainly retaining what we have amassed as we age. Part of the challenge for individuals who have their first DEXA scan at age 60 is that they don’t know what they started from, and they don’t know what they are working with. We tend to believe that there’s been this rapid and large loss based on an osteopenic DEXA scan. In some instances individuals would be what we would be classifying as osteopenic in their 30s and 40s simply because they failed to achieve a good peak bone mass density early on.

As I always like to say, health is not so much about “you are what you eat”, it’s about “you are what you absorb”. We talked about the importance of good strong stomach acid and a good strong intestinal system to allow vitamin and mineral absorption.


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We reflected that bone mass density is affected by many different factors, especially hormone balance and a number of different factors. In fact, anything that increases systemic inflammation can have a negative effect on bone mass density. In particular I like to highlight that for women in premenopausal and menopausal years, progesterone has such a huge effect on creation of new osteoblasts which create new bone tissue. Progesterone is just as important as estrogen.

The conventional medical world tends to focus just on the importance of estrogen, but both are important. Progesterone as a hormone is often left out of the equation, and because progesterone secretion begins to decrease five or ten years before actual menopause this can be a huge mediator for early and aggressive bone mass density loss during the premenopausal years.

We discussed at length that it is not just about calcium, but in particular vitamin D, vitamin K and magnesium that are at least as important as calcium in ensuring good, dense bone tissue.

Chronic stress directly contributing to increased loss of bone mass density through the action of elevated cortisol which not only up regulates the breakdown of tissue but also impairs the osteoblasts from making amounts of new tissue, so yet another example across the broad family of modern inflammatory diseases about the role of stress.

That’s also the catch-22 of dairy foods for that reason. Certainly a very potent calcium source that is enjoyed and well digested by many people, but for others it can be a chronic source of inflammation that’s coming in at the same time. We are going to talk today quite a bit about alternative sources for calcium and the choice of supplementing with food versus supplementing with tablets as an external source. So just key points, to have at the back of your mind, as we are starting today.

In particular we talked about the acceleration bone mass density and the prevalence of it in this day and age and how much more aggressive it is now versus the 1950s, much less 1000 years ago. We reviewed a number of things that have changed and certainly the cornucopia of drivers for bone mass loss for each individual are going to be unique, but we can easily understand how most of these are quite pervasive in modern Western society. I’m not going to review them again, but I just want show them to you as a gentle reminder and an example of the need to treat each individual client as a unique person, as a unique opportunity to maximize, minimize and prioritize; not everyone needs more vitamin D, not everyone has low stomach acid, not everyone has hormone imbalance.

Each situation is unique and part of our unique opportunity as health coaches is to really spend enough time with clients and build wonderful rapport and good relationship and sharing so we can get a good sense for: “what are the full set of factors?”, and given an individual person’s lifestyle choices, how can I be creative in helping them as a unique person, and staying away from the tried and true copycat kind of solution for everyone that has similar symptoms?

Unfortunately, that’s what a lot of our clients may get in the conventional medical world because they just don’t spend enough time. An awful lot of today’s physicians, nurse practitioners and conventional medicine staff are simply not allotted enough time in their daily schedule to really get to know the full set of circumstances that are plaguing a client and the full set of solutions that can help them


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individually. So bone health is not clearly a matter of popping a Vitamin D pill and drinking three glasses of milk a day. That make work for some people but it’s clearly not that simple.

So let’s do a deeper dive into bone building blocks. I showed you a two page table in the first webinar highlighting the most critical nutrients with regard to building and retaining high bone mass density. In this webinar I’m going to do deeper dives into some of these, in particular vitamin D and vitamin K2, or as I had a client say, ”Vitamin what?” There are a lot of people who have never heard of vitamin K, much less vitamin K2.

We’re also going to talk about calcium and at length about magnesium and also strontium. These are all critical and good high leverage opportunities for helping our clients. I also do want to mention that these other minerals are also critical, of course. Phosphorus I ‘m not featuring primarily because it’s extremely abundant in both the sad standard American diet as well as the healthy whole food American diet. It’s an extremely uncommon deficiency.

Trace minerals such as manganese are really not that difficult to acquire in a healthy whole food diet because they are quite prevalent and they’re really only needed in trace quantities. Certainly someone who is eating highly processed fast–type foods, as a health coach you are going to be working with them anyway just to get some whole natural nutrient dense food in their diet and generally that’s going to take care of trace mineral requirements, but not necessarily some of these higher leverage essential minerals.

So let’s talk in particular about vitamin D, or as a ten yea year old called it, the “duh” vitamin. I asked a group of middle-schoolers if they knew anything about vitamin D and how important vitamin D was. One little precocious gentleman was quick enough to jump up and say, “Yeah, duh. Vitamin D should be called the ‘duh’ vitamin because we all need vitamin D. Anyone knows that.”

I love the spirit of that comment because I hope everyone does know that and I’d like to think that all of our clients know that, but perhaps you like me are still running into clients who are very much in the dark about the importance vitamin D. There are still a lot of clients who believe they are getting vitamin D from their food and as long as they’re drinking fortified milk, they are getting plenty. So it’s important for us not to take for granted what our clients seem to know even if they seem savvy about other topics.

Vitamin D is critical as we discussed in the first webinar for absorbing calcium from our diet and being able to marshal it into bone tissue, but what you might not know is that vitamin D as a hormone also controls the expression number of different genes in the body. It plays a very important role in strengthening and bolstering the immune system. A little tit bit; this is actually a clinical pearl here. It’s one of the most important nutrients for keeping really tight junctions between the micro-villi and our intestines so our clients don’t develop leaky gut or enhanced intestinal permeability, which is the primary condition that triggers food sensitivities. It’s also a key player in the vast, vast majority of auto-immune disorder activation. So vitamin D has been clinically shown repeatedly in multiple studies to reduce all cause mortality. It’s very critical.

What a lot of our clients don’t understand is that we are designed to get vitamin D from the sun. We are not designed to get it from food. The challenge is that we need to be spending time in the warm months in the sunshine with exposed skin. When I say exposed, I’m not just meaning without a shirt on with or


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bare are arms and legs- I’m also meaning without sunscreen; not only does sunscreen block a lot of UV rays that can cause a skin cancer but it also blocks vitamin D absorption.

It only takes about 30 minutes in the summer sun to generate, in our skin, more than 10,000 IU of vitamin D. Our body is quite effective and efficient in generating vitamin D. It is also made from a precursor to cholesterol in the body and is yet another wonderful example of how cholesterol is not an evil substance, but really critical as a hormone precursor for all of the steroid hormones in the human body.

Another fact you may not be aware of is the process of making vitamin D does not take place instantaneously. It actually takes many hours and is triggered to begin the process of sun exposure. For individuals who go and take a shower after sun exposure, especially taking a shower with soap, it completely derails the process of making vitamin D in our skin.

Certainly this doesn’t mean we can never shower if we have been on the beach or at the pool and it’s the peak time of day when the sun is at its brightest say in the middle of July, then yes, we probably did slather down with sunscreen and we are going to take a shower because we don’t want to leave it on our skin. It’s not so much the exception that matters, but more the ongoing, daily, or multiple-times-a-week sun exposure we need during the warm months. We want to make sure we are getting it at a time when we can leave it be where we aren’t always showering afterward.

It’s another fact that, what determines whether or not the sun is able to trigger vitamin D synthesis in our skin has to do with the height of the sun in the sky, the radiant angle of sun radiation on our bodies. The northern half of the United States is not able to achieve that radiation intensity for more than half of the year. So this means for individuals living in Chicago or Seattle or Boston, from approximately mid-May to September is the only time of the year where one is capable of making vitamin D from the sun.

I like to use humor for remembering key concepts with my clients, but people can be butt-naked and get a really good sunburn on the top of a ski slope and make no Vitamin D whatsoever during the middle of the winter. Most of our clients don’t know this. I am amazed how many believe that if they get sunburn, it must mean that they made some vitamin D.

There are some very few food sources. There are some natural food sources that I mentioned here, but they are not anywhere near the doses we can make in our skin. We’re talking about 100s of IUs per dose, rather than this multiple thousands of IUs that we really need on a daily basis for optimal benefits. So for individuals who struggle to retain sufficient levels of vitamin D a supplement is necessary and across the board, it is the supplement that I end up recommending the most.

I have a lot of clients who live in the northern half of the United States and I should also say I have had clients who lived in Key West and in Phoenix Arizona and in Bermuda who had wildly deficient levels of vitamin D, despite living in areas where they are capable of making it and in one case, an individual who didn’t wear sunscreen. I think that it was just evidence that she just had a hard time genetically metabolizing vitamin D. So it’s another great example of “test, don’t guess”. Just because someone gets in the sun often and they have a good tan, and just because they live in an area of the world that is warm throughout the year does not mean that vitamin D sufficiency.


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There are many different opinions and you’ll find hundreds and hundreds of different views on the internet. Even in clinical research you’re going to see varying views about optimal levels of vitamin D. I think what clinical research is beginning to show is that optimal levels vary by individual especially when one is trying to heal from a certain challenge such as osteoporosis or maybe cardiovascular disease or colon cancer, the level of vitamin D that has been shown to be most helpful in healing is going to be different for those varying challenges.

My read of the research is that if you are looking for a target for pretty much everyone it’s to achieve at least 50 nano grams per milliliter of vitamin D. I find that this is one of the easiest pieces of lab work to get. It’s pretty universally covered by insurance even to get it a couple of times a year. Certainly our ability to make it is going to vary throughout the year. I do like it that my clients get it checked a couple of times per year. Perhaps in late September, early October this is a good time to see what a client’s optimal vitamin D level is going to be. For those that live in the northern hemisphere, that’s at the end of the summer. It’s pretty much not going to get better than it is right then. That’s going to give you an idea of an individual’s maximum synthesis ability.

I also recommend checking it again, in perhaps late January. The half-life of vitamin D in the body is several weeks so by the time we have moved out of the optimal zone for a lot of the States and gone through the year-end holidays, January is a time when a lot of people become very deficient and it’s a good time to check, especially that whatever supplement they are using is keeping their levels at an adequate place.

In the supplement world of Vitamin D, form matters tremendously. Today you can get vitamin D in two different forms- D2 which is ergocalciferol or D3, which is cholecalciferol. It’s important to understand that the body can’t use either of those forms directly. We still have to convert it into the most active hormonal form of Vitamin D in order to use it, and that’s calcitriol. As we talked about in the first webinar, this is an example of the interconnectedness of nutrients because magnesium is required for this conversion, so magnesium is not only important in its own right but it enhances vitamin D’s ability to make a difference with regard to calcium absorption.

There is a huge difference in our body’s ability to absorb and make us of these different forms. In fact, I’ve given you the stats here for my favorite clinical study. D3 is 87 percent effective at raising serum vitamin D levels than vitamin D2. That’s not a small difference. That’s huge but here’s the clunker, unfortunately. Today, all prescription vitamin D that our clients may be able to get from their physicians is vitamin D2. Now that’s a bummer. I have to say that I am delighted we are moving in the direction of making these nutrients available to our clients with some level of insurance reimbursement. There’s nothing wrong with the typical vitamin D prescription; it is not for a daily dose. It’s prescribed for a single high weekly dose, typically for 50,000 IU once a week.

That’s certainly safe to do because vitamin D is a fat soluble vitamin that the body stores. Generally research shows it’s just as effective to take a high dose once a week as it is to take daily lower doses. I really encourage my clients to use vitamin D3 even if they can get a prescription for vitamin D2. Sometimes I negotiate with them to go back and check their levels after no more than two months of using the prescription just to make sure that it is aggressively bringing their levels up.


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I have actually worked with multiple clients over the years that have been using prescription vitamin D for more than year and never got a request to confirm whether their levels were up. In every case I can remember their levels were still quite low. I’m doing this from memory, but I think in every case their levels were still below 30. So the form is really critical.

There are a few questions here about vitamin D2. Generally all food supplementation with vitamin D is going to be vitamin D2 because it is cheap. It is inexpensive. If you want to talk about a travesty of processed foods, natural raw whole milk from a cow has natural vitamin D3 in it, but in the processing of our milk through pasteurization and homogenization, the vitamin D is removed and the D2 is added back. So unfortunately we make a trade-off between those two.

Across my client base, off season, in order to get that 50 nano grams per milliliter level, I find that most of my adult clients need between 2000 and 5000 IU per day. Some of them don’t need any; some of them might need only 1000. Some of them may need 10,000 or 15,000 IU a day. I don’t mind sharing that me as an unique individual that I don’t ever wear sunscreen and I need to take 10,000 IU a day every day of the year in order to have a hope of keeping my levels between 45 and 50. This seems to run in my family because my mother has a similar challenge. So nothing magic about me, just an example of the differences you can find in individuals.

There are a few questions here that are extraneous, which I’ll come back to.

The genetic component with regard to vitamin D metabolism or synthesis doesn’t necessarily relate to any other genetic issue. People have the genetic higher or lower ability to make or absorb pretty much anything. It goes back to this notion of what we refer to as the “average adult” or the average need. In fact, none of us are average. We’re all unique and there are a huge spectrum of needs but again, “test and don’t guess”.

When someone has started taking a vitamin D supplement I always like to recommend, especially if they were starting at a very low level, that they supplement for no more than three months before they go back in and get another check.

Vitamin D is a fat soluble vitamin and as long as it’s taken with food, it’s generally well absorbed. Individuals who have a deficiency in lipases, which is the digestive enzyme that breaks down fats, or individuals without a gall bladder who are not making use of bile salt supplements, may struggle to absorb vitamin D optimally. Just like those who have had various types of microbial craziness or dysbiosis in their intestines can also struggle with fat absorption.

I’ve seen it literally dozens of times. Those individuals with a parasite struggle with absorption overall, but in particular with fat absorption. For those who have a challenge with that type of thing I often recommend a sub-lingual form that they can hold under their tongue after meals and then swallow the rest of it so the hope is that between sub-lingual and intestinal they’re getting good absorption across multiple forms.

There’s a question about high vitamin D. Certainly all fat soluble vitamins can cause toxicity if they are too high. My experience in comparing the conventional view in society versus what science really shows is that there’s a big dichotomy between what toxic levels really are. I’ve has clients who completely


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freaked out when they find out their vitamin D level was 80. In truth clinical research shows that actual toxicity symptoms don’t manifest until vitamin D levels are approaching 200 nano grams per liter.

That is very difficult to do unless someone is really being negligent with supplement use or like anything else there have been examples of supplements that have been inappropriately formulated and despite labeling, people were getting very toxic levels of vitamin D. That can cause a wide variety of issues, one of which is too much mobilization of calcium not only from over-absorption from food, but mobilization of calcium from bones. We talked about that in the first webinar and there are a couple of references about that.

There are a few handouts that are posted for this particular course is a detailed vitamin D handout which will be informational for you but it’s probably one of the most common handouts that I give to my clients. In that hand out I give very specific supplement dosage recommendations depending on blood levels of vitamin D. I also talk about some of the contraindications which are also mentioned here. For kidney stones and sarcoidosis, these are all dynamics in the body where calcium is a problem, and so we want to be careful about not increasing that even further by not increasing with more vitamin D.

I really want to highlight for making sure that there is sufficient magnesium in your clients before they begin, in particular, high dose vitamin D. I‘ve actually seem some pretty scary examples where individual started taking 5000 or 10,000 IU a day when they were magnesium deficient already and that quickly exacerbated into cramps and spasms and headache, because the effect of increasing vitamin D is using up a lot of magnesium in the activation of that vitamin D into the active form. The body will prioritize that and leaves less magnesium available for other body functions, so something to be very cautious about. We are going to talk about magnesium in the ‘Supplements 101’ course for those of you in the semester program.

Magnesium is one of the top three American nutrient deficiencies and I’m going to come back to that in a moment, but it’s really key to understand this interconnectedness, this interdependency between nutrients.

Throughout this presentation I give you some photos of some supplements that I frequently recommend. There’s nothing magic about these. Please don’t feel these are the only good brands or good solutions out there. I’m just showing you what I personally use. If you have questions about brands or suitability or any concerns about the quality of a supplement brand, that’s a perfect question to put on the Q&A tool on the course page. I would be happy to address those.

There is a vitamin D3 liquid from Metagenics that I use quite a bit for individuals who struggle with swallowing pills and also for people who don’t need too much vitamin D and are looking to maintain a good level, especially if they live in a warm, sunny climate and generally don’t have trouble maintaining god levels. Cod liver oil, I think, is a wonderful way to minimize supplements by helping people to get D, A and K all at once, along with wonderful essential Omega 3 fats. I’m a very big fan of ‘Blue Ice’ cod liver oil, which is a fermented cod liver oil, but again, a number of different solutions.

Vitamin D is probably one of the most pervasive supplements available today. I want to give you a tip – lanolin is a common source of vitamin D3. It’s not the only source out there. There are definitely


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vegetarian sources, but lanolin would be the most common source and that is not a common, but existing allergen for some people. So you really want to make sure that you’re aware of that. Some brands also use soy bean oil as a dispersant agent for the vitamin D and oil cap. Of course, soy is a common food sensitivity, so this is something to be aware of when we‘re supporting our clients with food sensitivity. These are allergies. Don’t just think about food. You’ve got to think about supplements, too.

Vitamin who? Let’s talk about little known vitamin K2. It’s called K because K is the first letter of the word ‘coagulation’ in German, and that was because vitamin K was initially discovered as being the critical vitamin or co-factor for triggering effective blood clotting.

We think about blood clotting as being a negative thing, as a blood clot that breaks loose and causes stroke, but it’s important to remember that clotting is critical for our longevity. When we fall down and cut ourselves and begin bleeding, we need to be aggressively and effectively clot our blood to keep from bleeding to death. Certainly without our knowledge day in and day out, our body is using clotting proteins to stem all sorts of internal wear and tear in the body as well to prevent internal bleeding.

It’s important to understand that vitamin K1 and vitamin K2 (the two varieties of natural vitamin K) are very different and there’s a lot of literature, especially in the past five or seven years, that talks about the desire to name them different things because what they do in the body is so different. Vitamin K1 is primarily responsible for activating clotting proteins. It’s commonly found in plant foods, especially dark leafy greens. So when we are regularly partaking in our big servings of salad greens, kale or collards, it doesn’t matter if it’s cooked or raw because vitamin K is well preserved through cooking. That is where we are getting our K1.

However it is different from and not taken up in the body in the same way as K2, which for lack of a better title is a calcium ‘manager’ in our body. It is vitamin K2 that has been clinically shown to reverse arterial calcification. Let me say that again - vitamin K2 that has been clinically shown to reverse arterial calcification.

This is a fact that should make headlines in the medical media but alas, you cannot patent a nutrient that you get from egg yolks. I’m certain that some pharmaceutical company is working on some synthetic version of vitamin K2 that can be patented. I gave you some references. There are actually a number of them and this is a wonderful pearl for you to know for your clients who are struggling with cardiovascular disease. It’s a wonderful benefit of K2 in helping not only bone health, but heart health.

Food sources for vitamin K2 are very different from K1. Generally, K2 is found in the fat of conventional saturated fat food- butter, but it must be grass fed butter, fermented cheeses, especially hard cheeses, or soft cheeses as long as they are fermented and well cultured; egg yolks, salami, organ meats like chicken liver and naturally fermented vegetables like kimchee and sauerkraut and pickles.

It’s important that I’m talking about conventional ones, meaning raw cultured ones that do not have vinegar. It’s the fermentation process that creates the vitamin K2 in the food. It’s also a wonderful example of these vegetables, wonderful cultured food as an additional condiment to our client’s plates. We don’t really have to consume very much to get significant benefits. You are going to find those in the


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refrigerated section because they are perishable. Any kind of sauerkraut or pickles, for the most part that, you find on the room temperature shelf are going to have vinegar in them.

Certainly the highest known food source for vitamin K2 is natto, which is a traditional Japanese fermented soy product that is an acquired taste, most people would say ‘nasty, nasty natto’, but it is certainly something that is revered and really deeply appreciated in the Japanese culture which is wonderful for them. In fact one of the most common supplement forms of vitamin K2 is the MK7 form is primarily derived from natto.

Here are some questions here about fermented cheese. Pretty much all hard cheese is fermented and that’s part of how the proteins are denatured and that’s part of what gives cheese its taste, its sour flavor. So anything from cheddar to parmesan and in the soft cheese arena- it could be things like camembert or brie. What would not be fermented would be things like ricotta or cream cheese. Fresh soft cheeses have not been fermented, but the vast, vast majority of cheese has been fermented.

There’s a question about a liquid form of cod liver oil. There’s a liquid available from the same brand I mentioned earlier, the Blue Ice. Another liquid form I really value and recommend often because of the quality is Carlson’s. Nordic Naturals also makes good quality liquid cod liver oil.

Vitamin K2, as we discussed in the last webinar, is necessary for making sure that once calcium is absorbed that it is bound into the protein matrix of bone tissue and held there. It is necessary to do something called carboxylating osteocalcin. It is also necessary in our arteries for carboxylating a protein called MGP in order to prevent the calcification of arteries. These are the primary two places where vitamin K2 plays a role but that is critical from keeping calcium from going rogue and end up calcifying other tissues, like the thyroid gland or kidney stones or calcifying the thyroid gland, or calcifying the pineal gland.

In terms of supplements, there are two forms of K2 – MK-4 and MK-7, both of which have been shown to be effective, I think. You’re going to find all over the internet that people who are vehemently passionate about one form or another. In truth, if we look at the science realistically, both forms do work but I want you to make note of the fact that the typical effective dose of both of them is quite different in terms of dosage levels, so you want to make yourself aware of that.

I’ve shown a number of different supplements on this page that I might typically use. The one in the upper right hand corner is Jarrow MK-7, which I believe is a 90 microgram capsule of MK-7. Thorne sells liquid of vitamin MK-2. This is the MK-4 form and they also sell a combined vitamin D/vitamin K2 form which is really nice. I didn’t mention it there but Market America makes an isotonic form of \vitamin D with K2, a powder that can be dissolved in liquid and is quite good tasting and is effective for people that have strong gag reflexes to strongly flavored supplements or who can’t swallow pills.

Pure Encapsulations and Life Extensions both make K complexes that both include the MK-4 and the MK-7 form. Some of my clients based on their own research prefer, (as they put it, better to be safe than sorry) to use a combined supplement. There are certainly examples which I’ll show you later in the webinar of multi-nutrient formulas that include K2 along with vitamin D, calcium and other things. I’m just showing you the separate vitamin K options depending on what your unique clients need.


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A key tenet that you need to know about vitamin K is that the commonly prescribed medication Warfarin or the most common brand name is Coumadin, (which is a blood thinner) prevents the body’s conversion of K1 to K2. In a natural normal healthy human body we can convert K1 to K2 so if we are not eating it from K2, our body should be able to make the conversion if we are eating plenty, plenty of K1 and absorbing it well.

Like anything else, our body’s ability to absorb it and Warfarin increases arterial calcification. I find this to be a really discouraging catch-22 of using a medication like Coumadin for individuals who need it as triage in order to prevent blood clots. They are also damaging their arteries in the process if they are also not supplementing with some K2.

There are some handouts on vitamin K2 on the course page, both for clients and then an extremely detailed one just for you where you can read the research. In reading that you will learn that studies have shown that vitamin K2 deficiency as measured by insufficient carboxylation of osteocalcin or insufficient carboxylation of MGP, vitamin K2 insufficiency is pretty common.

I‘ll talk about the lab work for that in just a second, but I would really encourage your clients who are using Coumadin to chat to their doctor about supplementing with a fixed dose of K2. If their doctors push back, it is just because they are unaware of the differences of the forms of vitamin K and they may need to be educated. There are some resources in the last page of the webinar as well, some articles that your clients may be able to print out and take to their physicians.

It’s vitamin K1 that is primarily responsible in the liver for activating clotting proteins, so by blocking the K1 to K2 conversion, the Coumadin is really preventing the K2 that would keep the medication from being dangerous in a different way.

There are a couple of questions about kidney stones. I’m going to talk about that a little further on in the presentation.

There’s a question about miso: miso contains very small amounts of K2, unfortunately. It would be a really low level source, not any here near as high as natto. That’s a great question, though. They are obviously fermented versions of soy but they are different.

Theoretically we should be able to convert sufficient K1 to K2 but that ability can vary. A little tit bit for you. Several years ago there was an understanding in the medical world that it was really intestinal bacteria that contributed our supply of K2. We now understand that certainly the microbes in our gut do contribute to some K2 but they aren’t anywhere near the primary source. It’s really the body’s own primary conversion of K1 to K2 that should be prominent.

Now in terms of lab work, most physicians would be willing to run vitamin K. In fact, if someone is taking Coumadin they are going to want to run it because in their mind they need to be minimizing all vitamin K. The challenge is that it would be very unusual to find a physician who would be willing to run a K1 versus a K2 panel. What they are going to be running is a total vitamin K, which of course as you now well understand is not going to tell you about the breakdown between them.


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What I’m showing you on this page on the graphic is a fat soluble vitamin panel from Metametrics, now Genova. This is wonderful because you can see in one panel that you can get useful vitamin D and vitamin K and vitamin A markers all in the same place, keeping in mind that these three fat soluble vitamins are used in concert in the body, so supplementing heavily with one can cause you to go deficient in another one.

This is a wonderful panel because it does not measure serum vitamin. What it measures is uncarboxylated osteocalcin. This is a really hard marker to get from a conventional physician. A functional health practitioner would likely have access to it and certainly clients can order their own using the online resources. There’s several of them on this particular one I’ve flagged down here; Accesa Labs. There’s a link for this and these are the types of things client can order for themselves online.

This is the conclusive marker that lets you know that for this unique individual, regardless of what their serum levels are, whether they’re high or low, for their unique body are they getting enough vitamin K to carboxylate the osteocalcin that their body is trying to place, to put calcium back in bone tissue. If it is high, it means they are insufficient in vitamin K for their unique body.

So this is a really wonderful marker and very difficult to get. I’ve had some pretty comical replies from people returning from their physician, really not understanding what this marker is at all. But when we can get our hands on it it’s a really wonderful tool for clients to understand their status. And of course vitamin A and vitamin D - these levels are being looked at directly with regard to reference ranges.

There’s question here: “Is arterial calcification the image [you] used in the cardiovascular webinar?” This is a great question. Calcification in arteries and plaque in arteries are two different things. They may go hand in hand but they are two different things. Atherosclerosis is the buildup of plaque in the artery wall, which can eventually impinge on it and eventually cause a clot. Arteriosclerosis is hardening of the arteries or calcification of the arteries which may happen completely separate from atherosclerosis. It is very common to have both but people can have one and not the other. Hardening of the arteries makes the arteries very rigid and inflexible and is one of the contributors to hypertension. That’s a great question; they are two different things, and highlights the importance of both K vitamins. Again, ideally we get these from our food, from a nice, rich, diverse whole foods diet, but not everyone is willing or able to consume that and not everyone is able to make sufficient conversion.

Now let’s talk about magnesium. Again, a very common deficiency and the levels vary from year to year. Over two thirds of Americans are actually deficient in magnesium. It’s an extremely common challenge. Magnesium is responsible for a huge array of biochemical reactions in the body that control relaxation and tension. I see magnesium deficiency symptom in my clients all the time. This is a common cluster of symptoms you can look for in your symptom questionnaire; any sign of tightness or tension, so insomnia, muscle cramps, spasm, acid reflux, asthma, chronic coughing without any other explanation, heart palpitations, high blood pressure and atrial fibrillation. I have had no less than a half dozen clients who had atrial fibrillation that went away by repleting magnesium.

Magnesium is also a key mediator of inflammation. People who are deficient are one and a half and one and three quarters more likely to have elevated C-reactive protein; clearly see the impact of magnesium


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on cardiovascular health. Magnesium, like all minerals (we are going to talk about this in the lab work course) is best measured not in the blood in its entirety but in red blood cells.

If you think about it, this makes good sense because generally our blood nutrient status is a good reflection of what we have eaten in the past couple of days. If I generally didn’t eat a lot of magnesium, but in the last couple of days I‘ve been bingeing on almonds, my serum magnesium levels are going to show quite high because I have eaten and absorbed quite a lot of magnesium recently. That lab work may be confusing because I may have symptoms of deficiency but my lab work may show very high levels.

Red blood cells typically live in the body for a little more than three months so the average level of magnesium in the red blood cell is a much more useful marker if one’s ongoing diet, not just a binge of almonds but rather an ongoing marker is reflecting sufficiency in the diet.

An RBC magnesium or RBC zinc, these are markers that I find physicians are more willing to run, but they have to be requested, otherwise the standard measurement that is going to be done, if a client says to their doctor, “Hey, could you check my magnesium?”, is going to be serum magnesium. What serum magnesium will tell you is if the body is absorbing magnesium. That’s a reasonable reflection of stomach acid or intestinal absorption capability, but it’s not going to tell you much about nutrient sufficiency in the diet or what is being achieved with the supplement.

Generally, magnesium is pretty safe to explore dosages for most people. The only exception to that are those with kidney concerns. The primary reason is that magnesium is going to increase your urination and one of the reasons it does that is magnesium is a bit of a master electrolyte. Repleting with magnesium, one of the ways it lowers blood pressure is that it increases cellular absorption of potassium and that will increase urination.

So for those who have kidney disease, this is something we want to be cautious of. Outside of that, magnesium is a fairly safe supplement to experiment with. Taking way too much is simply going to cause diarrhea. If someone goes really, really crazy and overdoses – perhaps 10 times what is recommended, they are going to show signs of potassium toxicity or what would medically called hyperkalemia, which can cause all kinds of heart palpitations and heavy breathing and cardiovascular concerns, but someone would have to very negligent in order to do that.

Generally, I start with recommending 400 milligrams a day for individuals who need it but I have had clients who have needed to go up to 1000 milligrams or more a day just on their ability to absorb what was needed to get to healthy red blood cell levels, which really needs to be in the upper half of the typical reference range because mineral deficiencies are incredibly common.

The form of magnesium is something really important to consider. If constipation is a person’s major concern, the two forms of magnesium that have the most stimulation to the colon are going to be the salt forms, specifically sulfate and citrate. A product I show you here in the upper right hand corner is Natural Calm. I have probably had a hundred or more clients use this product and love it.

This is a powder and is a magnesium carbonate which is the only exception to using magnesium carbonate that I have in my practice. That’s because it’s magnesium carbonate mixed with citric acid


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which when you put it in water, it has a physical reaction that fizzes and bubbles that will create ionized magnesium citrate, so ultimately what is being consumed is citrate but what is in the canister is carbonate. Clients need a wide variety of dosages to achieve a good daily bowel movement but certainly taking magnesium at least to bowel tolerance is a really good marker to think of for sufficiency.

Magnesium sulfate is available in a capsule form and is also the form of magnesium in Epsom salts. For people who have poor overall GI absorption in terms of bringing on board magnesium or they can’t find a form that doesn’t irritate their stomach, soaking in an Epsom salt bath for 20 minutes is a wonderful way to absorb magnesium sulfate. You can also purchase what are called magnesium oils. They are actually not oils. They are water tinctures, water solutions that can be sprayed on the skin and can be well absorbed through the tissue. It is particularly good for spot relief of muscle spasms and cramps in the muscles. I have a number of athlete clients over the years that have used magnesium oil.

If bowel movements are of a good consistency and frequency or even loose, you do not, do not want to recommend magnesium salt and certainly not citrate or sulfate. Instead I recommend an amino acid chelate rather than a salt form. This is simply magnesium attached to an amino acid which most closely represents how we would get it in food. Magnesium glycinate or malate or what might be labeled as a mixed chelate are really quite common. I show you up here magnesium glycinate. Pure Encapsulations makes a nice form and is one of my favorite supplement companies because like Thorne, they don’t use any minerals or binders in any of their products.

For headaches and anxiety, for specifically calming the nervous system I recommend the taurate or theanine forms. Taurine and theanine are two amino acids that can be used for calming. I use it in my clients who have anxiety or who are withdrawing from anxiety medications, like Valium, or clients who have multiple sclerosis who are trying to calm spasm. These are examples of amino acid chelates. You have a number of different varieties of choices. It’s just a matter of knowing what to pick and choose from for each unique client. This Jarrow “MagMind” is actually an example of a magnesium threonate formula that’s fairly easy to find.

There’s a question here about magnesium chelates; “Is that something you would want to take away from food?” That is a great question. No, you want to take them with food because you actually want the body to break down any binders or the capsule that it’s in. You want it to be efficient at that and to be able to actually separate the mineral from the amino acid.

There is also a hand out that will be posted on the course page as well, so you will have that additional information for you and for your clients too.

There are a few questions here about the specific brands; I will post those under the Q&A section beyond what I have shown here. A couple of really detailed questions here, I promise I will get to those on the Q&A on the web site.

I’m going to keep going in the interests of time and I am going to give all of us just a three minute break. This is a good chance to stretch. I’m going to keep talking but I promise I’m not going to say anything important. Always a good reminder for our clients, especially if they spend a lot of their day sitting, to


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take the opportunity to stand, to bend the body the other way, to take a few deep breaths, to hydrate. So I encourage you to do that now.

A few deep breaths and a few stretches and we will move on.

I want to end up this section by talking about some food considerations. Our ability to absorb minerals depends on how well we are able to separate it from binding agents in our food and I find that my typical client is completely ignorant of, even basic things that I thought everyone understood. For example, you don’t take iron supplements with a calcium-heavy meal because calcium and iron compete for absorption and pretty much calcium always wins. I’m amazed how many clients I run into who are having a big ol’ bowl of yogurt for breakfast and that’s when they are taking all of their supplements, including their iron supplements. The combinations of things matters greatly and especially for minerals. We are going to echo this a little bit in later courses for those of you who are part of this semester.

There are a number of natural substances found in food and plant foods that bind minerals and therefore impair our ability to absorb them from the GI tract and in some instances these substances cause GI irritation as well, depending on how sensitive the individual is.

I want to talk just briefly about oxalates and phytates. We could do whole courses on any one of these so please, my apologies to those of you who are expert as it may be deeply dissatisfying to you. I appreciate that there is a lot of knowledge there.

Oxalates and phytates; are a number of natural substances found in food and plant foods that bind minerals. I want to talk first about oxalates. These are natural substances that are in a lot of plant foods and I give you a list here of the highest oxalates containing foods, every day healthy whole food like spinach and nuts. Nuts are particularly high in oxalates, but even things like chocolate and tea and bran from a variety of different whole grains, not just wheat; most dry beans and legumes as well. The challenge is that oxalate binds with calcium and when it does, it forms these molecular complexes that the body struggles to absorb through the intestinal wall and what that means is that depending on the combination of foods, we may ingest a lot of calcium but not necessarily absorb it. Again, we are not what we eat - we are what we absorb. So this points, I think, to the need to be aware of our clients who are consuming large amounts oxalate-containing food but not much calcium. We definitely have to get calcium from our diet.

It is not true that oxalate is not one of those substances that we ingest it and absorb and it goes scavenging to our bones like a Pac-Man and starts wildly eating our bones. There are a lot of myths on the internet. That does not happen, but it is true that oxalates can bind with calcium from a meal and impair the absorption of it. I think this speaks to the need to ensure that we eat a rich variety of foods in our diet. Maybe this is unique in my practice, but having people be careful about picking things like spinach as their primary dark leafy green and eating a giant spinach salad every single day.

All foods have unique nutrient profiles and whether it’s dark leafy greens or legumes or nuts or seeds, I’m always encouraging my clients to eat a rich variety. We’re very lucky to live in the modern world where a huge variety of foods are available, even within a season, even with seasonal foods. We have a whole range available to us and I encourage my clients to avoid getting stuck in ruts. It is especially


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important to ensure we are getting plenty of calcium from foods especially if we have a high oxalate containing diet.

These are not foods people need to be afraid of unless they actively have kidney stones, then there’s certainly reason for reducing it. This is not a course about kidney stones but most kidney stones are made of calcium oxalate and it is a great example of what happens to calcium when it goes rogue in the body and is not being well bound in the bone tissue and ends up in other places.

One of the things in the diet that helps to take care of this is citrate and it is one of the reasons copious consumption of citric acid from fresh lemon juice is a very effective old fashioned, cheap home remedy for naturally breaking up kidney stones. If people would get started on doing this rapidly enough, it’s very effective. Drinking plenty of fresh lemon juice along with taking vitamin K2 can be a very effective way of breaking down kidney stones along with copious water for flushing.

A good way to counter this for people who do consume a lot of oxalates in their diet is something a lot of our clients do is to put some freshly squeezed lemon juice into their water that they might sip on during their meals. We’ve talked a little bit about that we don’t want to be hydrating too much, so a half glass of water that has a half of a fresh lemon squeezed in it is a great source of citric acid. That will not only help prevent calcium oxalate crystallization in the kidneys, but it will help to break up those complexes in the intestines as well. So this is a nice simple solution for those who are worried about this.

To be honest, the bigger concern for calcium binding in the vast majority of foods is phytates or phytic acid. When I toss around these terms these are the same substances, it’s just that phytic acid is the acidic form and phytate is the salt form. It’s essentially the same substance. Phytates are found to varying levels in all plant foods that are seeds. I want to point out, like oxalates; these are normal expected substances in plants and is part of the plant’s defense mechanism to not be eaten. They have survival mechanisms like animals do. Phytates are actually what seeds use to bind minerals to prevent seeds from sprouting before they are supposed to.

If you think about it, seeds fall from plants typically in the autumn when there’s a shedding of leaves or at the end of the harvest. Those seeds do not want to sprout right away with the coming of the cold season. Instead they want to be held in suspension for a number of months until the appropriate combination of daylight and humidity triggers them to sprout the following spring. Part of what enables that whole magic of nature to happen is phytates, so while we might curse it sometimes for binding our minerals in our diet, it’s really a wonderful magical substance that allows our plant kingdom to flourish.

As a result, phytates are found in everything that is a seed in nature. That includes whole grains, which are the seed of grass plants, nuts, edible seeds like pepitas, sunflower seeds or sesame seeds and also beans, legumes which are also the seeds of plants. Soaking, sprouting and fermenting will deactivate the phytates. If you think about it that kind of mimics what happens to those seeds in the spring. This is a topic I am very passionate about actually because in my own personal kitchen I always soak nuts and seeds before I roast or dehydrate them for storage for consumption over a multi-week or multi-month period. It is a very easy process. There is a handout for this course that is attached.


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This is a somewhat advanced nutritional topic and it’s not something we want to introduce to clients who are wanting to try and stop eating McDonalds and Dunkin’ Donuts as their daily diet because it’s trying to get them to eat a handful of almonds instead of a chocolate glazed doughnut is a giant step in the right direction, and obviously they are not ready to take things to the next level, but for some of our clients it’s a very appropriate step to deactivate those phytates, and especially for our healthier clients, nuts are a very common snack. For our vegetarian and vegan clients, nuts and seeds are an important source of protein.

The other thing that surprises my clients is that the process of soaking takes the bitterness away from nuts and seeds and indeed to most animals, phytates taste bitter. Cooking in general also does reduce phytates but not nearly as much as these other mechanisms. You can achieve the same thing with the legume and the whole grains. It doesn’t have to be complicated. I encourage my clients to put the food in a little mixing bowl on the kitchen counter covered by a couple of inches of water and a splash of vinegar before they go to bed at night if they plan on cooking it the following day or maybe when they rise in the morning especially if it’s a small whole grain like quinoa. If they are planning on cooking it later on in the day, a very simple task and just a new habit for folks.

A key concept from a digestive perspective is that phytate binding to minerals is higher at high pHs, meaning more alkaline pHs. So this means those with low stomach acid are going to struggle even more with this dynamic. Really good strong stomach acid also helps to separate some phytate, not a lot, but some. So there are several mechanisms that are at play here and I’ve given you some references on some studies if you want further detail.

In the additional references section there is a huge online article about phytates levels, presence, how they are reduced with various levels of preparation. I actually show you just a little example here which will demonstrate the difference. This is phytate reduction in quinoa. You can get very complex with preparation; soak it for half a day and then germinate it and then lacto-ferment it with whey for another day and cook and then get rid of pretty much all the phytate.

It’s important, I think, for preventing our clients for getting too over the top, especially our clients who have orthorexia and obsessiveness about the nutritional value of their food. You cans see that soaking it overnight – “I‘m just going to throw it into a bowl before I go to bed, cover it in water with a splash of vinegar and then I’m going to cook it the following day for dinner”. That gets rid of two thirds or a quarter of it. That’s good enough and it’s not important that we try to get rid of a 100 percent of it because we don’t absorb 100 percent of our nutrition from our food anyway. That’s why we eat a lot and that’s why we eat a variety of foods, but it is interesting to look at it from a biochemistry perspective how preparation changes food.

To me this is a lot about the wisdom of the tradition for the preparation of food, whether it’s India with the making of dhal or dosa, where it’s a three day preparation making a legume dish. Or in Mexico where traditionally corn - masa is pounded and cultured for several days before it is turned into tortillas. A lot of modern day preparation of these foods really by-passes the traditional wisdom that made foods much more nutritious.


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There a couple of questions here. You can reduce the oxalates in greens by cooking them, if you cook them in water. You do need water to leach the oxalates away, steaming and boiling would be even more if you’re to remove the greens afterward.

There’s a statement here that “vegan diets are more likely to be high in oxalates”. That’s absolutely true.

So again, cooking does play a role for both of these but these are pretty strong molecular bonds because otherwise a really hot day would deactivate the binding in a seed and generally that’s possible but nature wants to be more resilient than that.

So I’m going to move on and dive into calcium because this is the mineral topic about which our clients have the most confusion. I’m sure you feel that way too; I field questions from coaches about that all the time. It’s one of the most popular supplement questions. You certainly don’t have to go very far in the media, whether it’s online or in a journal or in the newspaper, to find a headline that’s talking about the potential risk of calcium supplementation. I’m actually delighted to see this because in many ways I think it’s a wonderful reinforcement of getting as much of our nutrition from food as we can.

Nutrients come in food in a wide variety of chelates and salts and forms that we have evolved over millennia to well absorb. This doesn’t mean supplements are a bad thing. They can be incredibly valuable for making up for what we won’t or can’t get in our food and also for what we have genetically higher needs of, but as we all know we want to start first by maximizing what we can get from food. I think this is true perhaps more in the arena of calcium than any other nutrient.

Many, many studies have shown that supplemental calcium can actually be dangerous. On the other hand dietary calcium, especially at moderate intake levels, has been repeatedly shown not only to be safe but quite helpful in regard to a variety of illnesses like cardiovascular disease. I give you references here for a few specific studies that would be of interest for you. I’m not going to talk about them in detail but for those of you who are study junkies like me you can certainly find some great information in this list of references here.

Generally what these studies show in aggregate is that there is a higher risk of cardiovascular disease for individuals who use supplements, and there is a reduction in cardiovascular disease for people who get sufficient calcium in their diet. Now of course there are a lot of caveats around that and I’m sure you can start to see that. The level of calcium matters (I’ll just jump in here in the middle). This study showed that women had a 150 percent higher risk of heart attack if they used a 500 milligram a day supplement when it was paired with high dietary intake. I’m going to talk about that in a little more detail in just a moment.

Generally, people are taking in much, much more calcium than they think because (number one) most people don’t know that calcium is in a wide variety of foods. I have an astounding number of clients who think that calcium is only available in dairy products. Then on the other hand, because of our obsession and perhaps fear of bone mass density loss, a huge array of food products are fortified with calcium and most people don’t know that.

It’s also been shown in multiple studies that there’s something about the notion of having a sudden dumping of calcium in the body with a supplement that may be part of the problem with regard to


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increasing the calcification of soft tissue because the body cannot absorb it all at once. Certainly when calcium is bound to minerals and we are slowly eating a meal and our body has to slowly break it all down with enzymes over multiple hours, we get more of a slow steady state bleed-in of calcium, as opposed to people who might suddenly pop a 700 or 1000 milligram tablet of calcium.

Calcium supplementation has definitely been shown to increase the incidence of kidney stones, for sure, and in men: prostate disease. I quoted a couple of studies here where it’s a mixture of men and women. It’s important to understand that men need calcium as well but they are also vulnerable to cardiovascular risk as a result of superfluous calcium intake. Again, if our calcium intake outstrips our vitamin D and vitamin K and magnesium ability to snag it and put it in bones at a quick enough pace, the body is going to start sticking the calcium in other places where we don’t want it to be. The arteries are certainly vulnerable to that.

So let’s talk about where we can get our calcium. Certainly dairy is a good source of calcium. I give you a couple of stats here right at the top of our table. A three and half oz. serving of milk or yogurt has between 250 and 300 milligrams of calcium. It’s a great resource. Most people are shocked to find out just how much they can get from whole food dietary items. I think it’s an important consideration because in general when we think about putting together three good meals a day, most of us are not going to struggle to get a good 700 milligrams of calcium. We’re just not.

I want to go ahead and up front say that I generally do not recommend calcium supplements for my clients. Certainly I never recommend it as a matter of course just for women because they are approaching menopause. I don’t think that’s smart. I think it’s really a good example of trying to “do no harm” seriously. Unless people are completely unwilling to eat calcium rich foods and they also have a diagnosis of advanced osteopenia, not barely osteopenic, but advanced osteopenia or osteoporosis - and they have to be willing to take the co-factor supplements consistently as well - These are the only circumstances in which I would recommend it and I’ll give you some tips on the forms in just a second.

I really help my clients construct the mosaic of fish, nuts, seeds, leafy greens and whole grains and if they do well with them - dairy products, they will get enough calcium. That’s a lot of different food items. Even the whole sesame seed arena for my clients who are just beginning to eat healthier foods - simply encouraging them to take a rounded teaspoon of sesame seeds and sprinkle them on their salad. That’s few hundred milligrams of calcium right there, or tahini; making a salad dressing with some olive oil and a little vinegar and a tablespoon of tahini, which is ground sesame seeds. That’s a really easy way to get some natural calcium.

Let’s talk about the craziness of calcium in the modern food world. I do find that most people just have no idea just how much calcium they are getting because an amazing number of products are fortified with calcium. All sorts of breakfast cereals, breads, crackers, cookies, actually the other day I saw a calcium fortified cookie made for children. Alternative milks like almond milk or coconut milk or flax or rice milk are very often fortified with calcium. This one was new one on me - calcium-fortified white rice from ‘Uncle Ben’s’. A huge number of juices are calcium-fortified. Most of us are familiar with the orange juice but a variety of other fruit juices are fortified as well.


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A couple of funny examples. I find it comical that apparently there’s not enough calcium in regular milk that we need to have calcium-fortified, calcium-rich milk, which is a Smart Balance product. Milk and Granola is a granola bar that the Kraft company made for a while and is no longer available, but this was a granola bar that had fresh milk in it that needs to be refrigerated. The sales were initially very high and were sold in the refrigerated section. For a granola bar that people were used to being pretty shelf stable, it was too cumbersome to refrigerate a granola bar.

These are just great examples of the craziness in our community with regard to people desperate for calcium. Of course the problem is that all of this calcium supplementation is calcium carbonate. Calcium carbonate is a little like vitamin D2. It’s cheap and it’s the one that’s going to show up most often in products and it is a form that is very difficult to absorb. I’m going to talk about that in just a moment. Calcium carbonate requires very strong stomach acid in order to be absorbed. Studies have shown that calcium carbonate, for example, is much more poorly absorbed than calcium citrate, which is the salt form of calcium that I most frequently recommend.

So I think it’s important to do a rundown with a client who’s a bit freaked out about ‘must take’ calcium supplements when they feel they are not getting enough. Do a bit of a food inventory with them- maybe a two or three day food diary is in order to take a look at what they are really getting. Most people would be surprised at just how much calcium carbonate they might be getting, even from organic or high-end brands of foods. We are a little crazy about supplementing with calcium via food - not naturally, but as an added nutrient.

There’s a question here; “If a client’s diet consists of all the various foods I’ve listed here except maybe dairy, but has been diagnosed with osteoporosis, do I still recommend calcium supplementation?” That’s a great question. No, I don’t. In fact, I like to keep people away from calcium supplements if I can. I’ve had examples where I’ve had clients who had also an incident concern about cardiovascular disease, so we specifically decided not to talk about calcium supplements, but certainly they were on pretty high doses of vitamin K2, magnesium and vitamin D. They just weren’t taking supplemental calcium. So I think its dependent on your question about how many of these foods your client is able to routinely include in their diet. As we talked about before, the co-factor nutrients and hormone balance is really, really key for making sure that the calcium is actually used in making new bone tissue.

Let’s talk for a moment about calcium supplements. For those of you in the semester program, we are going to poke at this quite a bit in the supplements course. I like to do supplement sleuthing. There are a lot of people out there who buy a supplement based on the front label without actually taking a look at what they are getting. What I am showing you here are the two top selling calcium supplements in the United States as of the year 2010. This is a sad state of affairs, my friends, because here on the right we have Viactiv, which are chocolate flavored calcium chews. Indeed, this particular formula does have a mixture of nutrients. On the surface there’s some vitamin D, there’s some vitamin K and there’s 500 milligrams of calcium, but I want you to take a look at the ingredients.

First of all, we have the cheap poorly absorbed form of calcium which is carbonate, and we have corn syrup and sugar, which we would like to avoid in any product. I find it funny that one of the reasons people would take a calcium supplement is that they can’t or won’t eat dairy foods, yet this product


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includes milk in it so it makes it not an option for those who have dairy sensitivities, which is unfortunate.

The vitamin K form is vitamin K1, which is as we just discussed, is not the form that we want. We are picking up potentially allergenic things here such as artificial flavors, soy and corn starch, and of course, we have to throw in a couple of potentially inflammatory artificial colors. This, in my mind, is not a high quality supplement at all. It is not something I would recommend. Just to put the lid on the coffin - we have hydrogenated coconut oil. It does not say fully hydrogenated - you have to make the assumption that it could partially hydrogenated, which means this would actually be a source of trans fats, which are extremely toxic. So I definitely do not give this product a gold star and I would never recommend Viactiv to any of my clients.

On the left hand side you see Caltrate. There are a lot of varieties. This is the 600D form that includes minerals. Hopefully, you can see the list up here and this is the calcium carbonate form of calcium and then a huge variety of artificial colors- blue number two, red number forty, yellow number six. Keep in mind that they are all particular artificial colors that include aluminum. I would really like to recommend supplements to my clients that are not bringing in a potentially inflammatory toxic metal at the same time that they are supplementing.

On top of that we have potential allergens like soy and artificial flavors. We have poor forms of the various minerals - we’ve got magnesium oxide and zinc oxide. Zinc oxide, by the way, is that really thick cream that your mother spread on your cheeks to completely prevent sunburn when you were a child - completely non bio-available. Then we definitely have trans fats with partially hydrogenated soya bean oil, which would also include GMOs. Again, not a product I would ever recommend to my clients, but certainly a lot of people that we encounter are using. My heart goes out to them because they are trying to do the right thing, trying to get a good 600 milligrams of calcium and some other supportive minerals.

This is a challenge and an opportunity for us. When I saw my clients in person I often recommend on one day of our work together - usually not the first session, more typically the second or third - that they bring in a bag with all of their existing supplements and we go through and read the labels together. I think that’s a wonderful tool. Certainly if you can’t do that, if you’re working with your clients remotely, I think it’s an important exercise that you have them send you the brand names and dosages of everything they are taking because I am always amazed at how often they have chosen really cheap, non bio-available and potentially toxic versions.

If people do need a calcium supplement and do choose to take one, it certainly needs to be a well absorbed form and certainly one of the best ones is as a salt – calcium citrate. Remember from our first webinar that we don’t want to take more than 500 milligrams at once. If they are going to take more towards the maximum of 700 or 750, they want to do that in divided doses, but a mixed amino acid chelate for calcium, just like for magnesium, is a good form that is generally well absorbed in a healthy gut.

Microcrystalline hydroxyapatite, MCHC, we talked about briefly in the first webinar because this is the actual substance that is mineralized in our own bone tissue. It mimics the physiological ratios of


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calcium, phosphorus and magnesium so it’s going to bring in what people need specifically for their bones. This form of calcium is typically quite a bit more expensive so not something all of my clients are willing to spring for.

Similarly AlgaeCal is a natural plant based mixed amino acid chelate form of calcium – also more expensive but also a form I really like to recommend and very appropriate for individuals who are on a vegetarian or vegan diet.

Now, please write this down: You do not want your clients to take calcium carbonate or oxide. Because it’s not well absorbed and people can end up with a lot of expensive stool or expensive urine or kidney stones. Remember the exception to that is powdered forms that include citric acid because once it’s stirred into water it’s going to create citrate. The vast majority of calcium supplements that our clients are going to get when they purchase a supplement from a mainstream grocery store or a pharmacy or a big box store - so this could be CVS or Kroger or Costco – they are going to be calcium carbonate. That’s just the most commonly available form because it’s the cheapest. It’s also the form that is least vulnerable to moisture in packaging so it makes for cheap manufacturing.

Just to reiterate a few key concepts, it’s very important that your clients are aware of their vitamin D and their magnesium levels. For the typical person I recommend at least as much magnesium as calcium because magnesium is such a common deficiency. A lot of standard supplements will have two to three times as much magnesium in a formula and it’s not a good idea.

For those over the age of 35 who use more than 1000 IU of vitamin D3 a day, I recommend vitamin K2 regardless – just to make sure they are getting plenty.

There’s a question. “Do we want kid’s vitamin D levels to be at least 50 nano grams per milliliter as well?” Yes, we do.

There’s a question about Ceragenin. No, Ceragenin is a preservative, a seaweed extract; actually, it’s not algae. It’s used as a preservative and can be toxic for some people and that’s not what I’m talking about at all. A great question.

It’s also important to remember that minerals when our clients take them in supplement form are extremely alkaline so there’s no better way to shoot good digestion in the foot than to take a big handful of mineral supplements right at the end of the meal, because you had nice strong stomach acid and now it’s not so strong anymore. So this is important to keep in mind and another reason to spread out mineral supplements throughout the day because those with weak stomach acid are going to need some help to ensure that calcium supplements don’t tank their ability to digest that meal and to perhaps to break down that supplement. So that may be a place where a tablespoon or two of apple cider vinegar in a little water is a good thing to sip on or the lemon juice that we talked about earlier, or for people with more advanced needs, the hydrochloric betaine with pepsin, which is a pretty easy-to-find supplement for people who have more advanced lack of stomach acid - just something to keep in mind in terms of balance within a meal.

Then again, the pairing matters; don’t take calcium and iron-dense foods or supplements at the same time and be aware of the binding with other elements. I also recommend that clients don’t take


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medications with any mineral supplements, or for that matter, supplements period because unless they are using the very high quality brands that do not include binders like ‘Pure Encapsulations’ or ‘Thorne’, binders in a mineral or a supplement can just as easily bind up components of a medication. So we really want to make sure people are getting what they are trying to take.

I want to spend some time talking about a mineral that I haven’t focused on very much, which is strontium. Now this is a real gift, a real modern miracle discovery with regard to helping people who are truly osteoporotic or really advanced osteopenic.

Strontium is present in many, many foods in tiny trace amounts. It happens to be high in beets and Brazil nuts but it’s still present in trace amounts. Research around the turn of the century started to show that strontium did a really good job of stimulating the re-growth of lost bone tissue and most importantly, it did it quickly. There was another surge of research about strontium in the 1950s and early 1960s and there’s been a huge amount of it in the past 15 years.

Research shows that women who have quite a bit of bone mass density loss, especially those who are post-menopausal, cannot only arrest the loss of bone density, but actually grow back bone tissue and improve bone density, in a, relatively speaking, aggressive time frame. It’s important, as I said in the first webinar, to set client’s expectations that bone tissue does grow slowly, so you are not going to add some supplements and increase your bone density by ten percent in three months. That’s impossible, but could certainly be done over a few years and it’s definitely a worthy journey. It’s just going to take time. But as you can see here, there’s some very impressive data, not only in terms of increasing bone mass density but also reducing fracture incidence.

The good thing is that strontium is readily available in various supplements. If people take it consistently and responsibly it can make a huge difference, and my case study will show you a good example of that.

There’s a product made by the Garden of Life called Grow Bone, which is a really wonderful two-formula kit that I have used for many different clients that includes a calcium mineral, vitamin-rich formula alongside a strontium formula and it’s a natural strontium salt. Quite a bit of the research was done with a synthetic compound of strontium, which of course makes it patentable, which the pharmaceutical companies are very interested in terms of profits. I certainly feel much more comfortable with people using a natural strontium salt because that’s certainly what would be in our food, but this has to be done responsibly. No one should ever take more strontium than calcium in a day - ever. Ideally, it should be taken at opposite ends of the day.

Molecularly, strontium and calcium are very similar and if they are taken at the same time, they compete for absorption. If you take too much strontium it will cause abnormal bone tissue growth which could potentially result in bone spurs. It’s therefore important that people don’t take too much and even more importantly, that they never take more strontium than calcium. So most of these kinds of aggressive formulas may have something like 700 milligrams of calcium - which as we talked about in the first webinar, is about the maximum calcium intake that is recommended - and then a little less strontium to be on the safe side, maybe 500 or 600 milligrams.


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It’s important to educate our clients that they can’t be consistent in taking the strontium and really inconsistent in taking the calcium. They really have to be done consistently together because just to make sure the body gets a break from the bone growth stimulation properties of strontium. I usually recommend my clients use it for a cycle of five or six months and then take a few months off in between and then start another cycle.

Of course strontium would not be recommended for anyone with a history of bone spur, abnormal bone tissue growth, or for anyone taking calcium channel blocker medication because strontium could potentially interfere with the action of that medication.

There’s a question here; “Do I worry about food intake of strontium when balancing with the calcium?” No, I don’t because strontium in food is available in 100th or 1000ths level of a dose and is what you are going to be talking about in these supplements.

Another question here; “Magnesium and calcium need to be taken with food?” I always tell my clients that it doesn’t mean at the beginning of a meal –that means in the middle of a meal or immediately after a meal is finished, not over half an hour later either, when the dishes have been done. This is a very important consideration to maximize absorption.

1:50:54 Supplement Suggestions

So here, I want to give you some specific suggestions. Here’s “Grow Bone”. You can take a look for yourself at the ingredients. You can see it includes a raw calcium formula, which is a nice mix of D and K2 and calcium and magnesium and some co-factors. It’s really nice and actually and includes some other key nutrients that can be helpful. It even includes some phytase, which is a digestive enzyme that helps to break down phytate complexes that we were just talking about. This is a really comprehensive formula, really nice and some other enzymes just to help make sure we can get at the minerals in our food, too.

Then, a “Growth Factor” formula that is primarily strontium which is taken at a different time of day and separate from the calcium. ‘Grow Bone’ has been actually clinically researched itself and has been clinically demonstrated to promote bone density regrowth in pretty good clinical studies. The actual product itself has been studied, which is quite rare.

For people who don’t need the stimulation of strontium, one of the comprehensive formulas that I really like is Jarrows: “Ultra Bone-Up”, which again, includes calcium, K2, magnesium, manganese and lots of nice things here as well as some anti-inflammatories. A key caveat to be aware of is that a full dose, which is six tablets, which is 1200 milligrams of calcium and which is too much. So it’s important to remind clients that if they are going to be using it, they don’t want to be using more than a half dose or three tablets, and depending on the calcium in their diet, they may want to use even less than that.

In my practice I’m only going to be recommending this type of supplement to people who have formal diagnoses of osteoporosis or highly advanced osteopenia who just won’t eat calcium in their diet.

If you’re looking for strict calcium formulas, I’ve given you some here down at the bottom. Pure Encapsulations has a microcrystalline hydroxyapatite formula that’s just calcium on its own. For those


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who need a chewable, I think the best example is Metagenics chewable “Bone Builder, which is a calcium phosphorus blend and then Thorne again, with no binders or fillers, is particularly key for those with poor absorption ability in their gut. This is a calcium and magnesium citrate combination and a citrate supplement is also a good way to get citrate in the diet to help break up some of those oxalate formulas.

There’s a question about why the supplement company would recommend such a high amount. I think that has a lot to do with the fact that at least US government recommendations for calcium are still incredibly high and still recommending in some cases 1000, 1200, 1500, 2000 milligrams of calcium a day. A lot of people translate those numbers into supplements completely without regard to, number one, what they might be getting in their diet and I think we are just starting to learn more about the potential toxicity of calcium in the past five or seven years of research. I think we are going to see some of those recommendations change, but a lot of supplements carry that kind of recommended dosage. It’s not specific to Jarrow; it’s a problem with a lot of them.

Let’s get to the case study. I’m going to talk about Katrina. For those of you who haven’t been near the question tool, let me encourage you to pull it up because I’m going to give you an opportunity to share your insights here. Katrina is a client I worked with a few years ago. Female, post-menopausal and particularly of note - lives on a tropical island.

Her primary complaint in coming to work with me was that she had a diagnosis of osteopenia and osteoporosis, a mixed diagnosis in various assessment spots. Muscle pain and tightness, occasional restless leg, occasional headache, intermittent anxiety. She was taking Fosamax and a Citricalsupplement, but outside of that, the only thing she really took was Advil, normal dose but frequent use for the muscle pain.

Relevant history is hyperparathyroidism and three knee surgeries for torn cartilage not tied to a specific injury, which I thought was of note.

Generally a very healthy diet; lots and lots of vegetables, moderate animal protein. It was of note to me that she was actually of British descent and really enjoyed her good black tea, a few cups a day. She had a nice big bowl of oatmeal for breakfast every day and a glass of red wine most nights.

So if this is all the information that you had and you wanted to start thinking about this client, how you might support them and what you want to take a look at and what interconnectedness do you see? I’m going to give you just a minute to think about it and share with me on the question tool what comes to mind.

What is affecting what?

Almost immediately I get a dozen people saying ‘low magnesium’. Excellent! My hope is that you all get incredibly astute at recognizing magnesium insufficiency because I promise you; you are going to see it everywhere. That should be an overall clinical pearl for your private practice, period. Magnesium sufficiency is such an easy way to create a wildly satisfied client because magnesium insufficiency symptoms are particularly annoying and debilitating. Absolutely! Low magnesium is associated with every one of her symptoms. Every single one of them!


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What else do you see? Several folks talking about low vitamin D. Excellent! Three folks mentioning high tannins. Excellent! I didn’t call that out specifically on the food combination page, but it’s listed there for you. Both tea and red wine are extremely high in tannins which is another mineral binder that can prevent calcium absorption. I did inquire and she was taking her Citrical every day in the middle of breakfast, so my heart goes out to that poor little calcium supplement. The odds of it getting absorbed with a big giant bowl of non-soaked oatmeal with all of those phytates with a big mug of black tea was pretty much slim to nil.

Because she’s post-menopausal, a few folks are curious about her hormone levels, estrogen and progesterone in particular. I think that’s a great comment. Probably not soaking the oatmeal? Indeed she wasn’t.

A couple of folks commenting on her calcium values because of the prior hyperparathyroidism, which is a dysfunction in the parathyroid gland, which remember controls the acceleration of osteoclasts to break down bone tissue to put more calcium in the blood, usually when they are a little out of control and blood calcium goes a little crazy; there’s a need to remove one or more of the parathyroid glands - we have four of them.

There’s a question about sufficient vitamin B. Excellent. Here’s what I was waiting for. “Why does she have torn cartilage?” What does that tell you about her protein? What does that tell you about her stomach acid? She’s 62. We have to start thinking about stomach acid, and if she eats a lot of vegetables, why is she deficient in magnesium? Stomach acid could be playing a role. Definitely. When people have soft tissue damage and especially when it’s not related to acute injury, you have to start questioning what is happening with the protein matrix. What’s happening to the collagen? Why is the soft tissue falling apart? Why is it weak? I’m sure Advil is wreaking some havoc on her intestines and her ability to absorb both protein and minerals.

There are a couple of comments here. The parathyroid gland has nothing to do with the thyroid gland other than its location. The parathyroid gland does not need the same nutrients as the thyroid gland. It’s literally called the parathyroid gland because it’s ‘para-’ - ‘next to’ - the thyroid gland. It has a totally different function, so I appreciate the comments but it’s a good clarification to make. They have very different roles. I would say, by the way, that for clients who have had surgery often the parathyroid glands are damaged or inadvertently removed. I know that sounds crazy but I‘ve actually seen that twice in my practice. People end up with calcium dysfunction or problems because the parathyroid glands have been nicked or damaged in some way during thyroid surgery, so the connection is really a physical one, not a biochemical one.

You did a great job of targeting what came to mind for me. Indeed, I had a nice chat with her and made several suggestions about lab work she might turn around and request or start to explore with her physician.

I want to get your feedback about what jumps out at you from this lab work because we definitely found a lot of pearls here. Total protein 6.8. It’s within the range but it’s a little low. We’re going to talk about this in the lab work section, so for those of you for whom you don’t know what this means, this is a marker that is included in the complete metabolic panel, or the CMP, that is typically given in any


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annual physical, actually. Optimal levels are 7.0 or higher. It is not a 100 percent targeted marker for protein absorption but it’s a good place to start, a good dartboard, and an initial indication that protein absorption might be an issue. Definitely vitamin D. Good calcium function. I think the parathyroid gland removal is clearly working for her. The remaining glands are doing a good job of keeping her serum calcium in an important place. Absolutely way too low magnesium.

So with a reference range like this for red blood cell RBC, magnesium - as I said earlier, we want to at least be at the mid-point to that reference range. In this particular case we want it to be at least 5.5. - She’s sitting right at the end of it. We knew from serum hormone data that her overall progesterone level was pretty low even being post-menopausal. If total progesterone is low, odd are the free progesterone, which we are going to see in the salivary test, is also below and indeed it was rock bottom. Actually, she was using a progesterone cream when I first met her but the dosage of progesterone in the cream was only 2 milligrams per dose, clearly not anywhere near enough for her because with supplementation it should really be high up within that reference range.

Salivary Estradiol is a little low in the reference range for sure, but not deficient. Her salivary adrenal test results are attached, so you can take a look at her four sample (although in her case we only got three) data points and it’s a great example of being within the range so not being clinically low, but really being sub-optimal.

I included the data graph here. Her data points are these dots. The optimal zone is the dark green. The total reference range is the full shaded green. Her cortisol levels are way, way too low so definitely some evidence of some adrenal fatigue.

She probably has rock bottom progesterone as a result of cortisol steal for who knows how many years and definitely needing boosting with cortisol to make sure that all of her hormones are able to be stable on their own.

I also ended up running zinc for a different reason; she had another symptom that I didn’t want to cloud the issue with. Her zinc was clinically low and we do know that is a co-factor for the osteoclast/osteoblast balance, so that was something we also needed to address. So a lot of key findings here and obviously some core opportunities to help her.

I just want to share with you what I recommended for her. Not rocket science.

She was a great candidate for “Grow Bone”. She wanted to use it and give it a try, so we started in late autumn (I think it was around Halloween) beginning a six month cycle of using “Grow Bone". Because of her other symptoms, I did recommend an additional magnesium glycinate. We used a zinc/copper blend. She decided to switch from prescription progesterone cream to an over-the-counter, which had a standard dose of 20 milligrams – quite a bit higher than what she had.

She wanted to supplement her stomach acidity using apple cider vinegar. She actually enjoyed that quite a bit. She was willing to switch from black tea to green tea. Green tea has hardly any tannins in it and she was willing to cut back on the wine in the hope of improving her bone density. Certainly seeing an improvement in her bone density helped her to move away from having wine every day.


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We changed the breakfast and she was over-the-moon excited to be given permission to eat eggs every day. Two easy-over eggs on top of several handfuls of sautéed greens was a really nice breakfast for her. There was vitamin D in the “Grow Bone”, but we decided to add another 1000 IU addition just to see how quickly her levels came up. We supported her low cortisol with some boosting adrenal adaptagenic herbs, specifically in her case the Gaia “Energy Vitality” formula. She was taking that in the morning and at midday.

Bottom line, for the purposes of this course, what she was able to achieve for herself is what I have seen in a number of clients. I want to draw your attention to the data here. What you’re seeing here is the bone mass density in a couple of the lumbar vertebrae. You can see the improvement in bone mass density in a short period of time. This was in four months essentially from when she first started using “Grow Bone”.

Essentially her primary achievement was arresting the loss. It was not so much that there was significant regrowth between these, but you have to remember the first goal is to simply keep it from going down further. That alone is a big achievement. Then after a further additional year she started to get some further increases and was coming into a T-score of 1.6 and getting her back into the osteopenic range. She saw similar results in her hip as well.

So this is just an example of what can be achieved with the natural route. What I did not say was why she came to me - she didn’t like the “Fosamax” and the risk of it and she stopped taking “Fosamax” when we began doing our work together. I’m sorry I should have clarified that for you. She was specifically looking for a natural remedy.

So in this example we did a really good cornucopia of things that we talked about. Rebalancing hormones, addressing mineral binders, providing good bone building co-factors and then using that strontium kicker in order to boost growth.

On the other hand she had complete relief of her headaches. She reported about 80 percent improvement in her muscle pain and she started doing a much better job of absorbing the progesterone and getting it up to more therapeutic levels based on using supplementation, so I was very excited for her.

I have, since working with Katrina, worked with the husband and two of her neighbors so another example of a Wildly Satisfied client doing my marketing for me because she was so delighted. One of her neighbors was another woman who needed help with similar issues. So this is exciting to see what a Wildly Satisfied client can do for you in terms of helping you to build your business while you’re helping them to feel great.

To summarize for this course; we have talked about key bone builders, the importance of vitamin D, checking it, using the right amount, using the right kind.

We talked about the interactions between all the fat soluble vitamins and the criticality of checking all of them.

We talked about calcium craziness and not taking too much overall, realizing that we get a lot more than we think we are from food. The vast majority of our clients are absolutely getting over 700 milligrams a


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day. It’s not a problem. Calcium is not their issue. Hormones might be an issue. Vitamin K, vitamin D, magnesium might be an issue. Inflammation might be an issue. Stress might be an issue but for our average client, calcium is not so much of an issue.

The form of mineral supplements matters. We want to make sure our clients are not using the first cheapie first supplement they can grab, but something high quality, and then just paying attention to the interactions of food and nutrients so that we can ideally absorb as much as possible of what we are ingesting.

I just want to introduce one more thing to you before we close. This is a final testing consideration. I don’t want to focus on this too much because this test is not easy to find. It is something that has recently become available online. It’s urinary test so it’s easy to do at home. It is something now that individuals can get on their own from one or of the multiple online resources for kits. This is measuring in the urine substances that are used in the collagen, so in the protein matrix of cartilage tissue. These are called pyridinium cross links. There are two different kinds. There’s a pyridinoline and there’s a deoxypyridinoline. The first one is found in both bone and cartilage and the second one is found primarily just in bone.

Basically when bone is being broken down, these markers go up. It is a marker of re-absorption of bone tissue. It’s the kind of thing where when you assess it, it’s a good idea to get a baseline and then begin to check it often to see if the collection of remedies that are being used are succeeding in slowing the activity of the osteoclast. I hope that makes sense to everyone. It’s not telling you anything directly about the bone density. It’s letting you know whether the activity of the osteoclasts is more or less than it was before. So it’s a relative marker. For clients that are not interested in getting a DEXA on a regular basis or getting a DEXA at all. They actually prefer to do this (no radiation involved) in order to see if they are succeeding in slowing the breakdown of bone tissue, so just another possible testing option.

My final page here just summarizing for you the various potential types of testing that could be useful for supporting people with bone health as a particular goal.

As always, yet more information resources for those who want to do deep dives on certain topics.

That is what I have for you today and hope you have enjoyed this course so far. It is something about which I am particularly passionate because, as we discussed in the beginning, the incidence of bone fracture is rising rapidly in the Western world. This is another example of an inflammatory disease that is approaching epidemic proportions so whether or not our clients have actually had a fracture, the threat of it can be very scary and certainly something that is omnipresent for especially women in their late peri-menopausal and menopausal years.

My hope is that you enjoy continuing to review the material. There a lot of very detailed, dense handouts for this class, so I really encourage you to take the time to review all of them. There are a lot of pearls in them and a lot of them are appropriate for sharing with clients, but several of them are additional clinical depths that I really posted for you rather than for you to share with your clients, just to give you that extra bit of deep dive.


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So I thank you very much, and I encourage you to bring your additional questions to the Q&A board. I will do a download of the questions I did not get to from the Q&A tab today and I will follow up on those in the next few days.

I wish you well in future reviews of the course. Thank you so much for the opportunity.

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