The REAL Drivers of Osteoporosis and How to Restore your Bone Health

Lara Pizzorno, MDiv, MA, LMT

Thank you so much for this opportunity. I hope the information will be very helpful.

Dr. Sharon Stills

Oh, with your bio, I know that it will be.

Lara Pizzorno, MDiv, MA, LMT

I’ll do my best.

Dr. Sharon Stills

So maybe just, I mean, I read your impressive bio, but maybe just say hi to the listeners and tell them just how bone health and osteoporosis became one of your special interests.

Lara Pizzorno, MDiv, MA, LMT

Sure, well, I’m married to Dr. Joe Pizzorno, who’s the founding president of Bastyr University, and a leading clinician in natural medicine in the world. And when I was in my early 40s, we were at a medical conference, and typically they have an exhibit hall with medical conferences, or they used to when they weren’t Zoomed, and you go into the exhibit hall and look at all the new gadgets that doctors could have in their offices to evaluate patients. And so we’re at this medical conference, I think I was 43 years old, so well before menopause, and they had a piece of equipment there that doctors could have, that would analyze the bone density in your ankle, your tibia, your ankle. 

And I thought here I am married to one of the world’s leading doctors and I do everything for myself and I’m so healthy, and I went over there and I already had osteopenia, severe osteopenia. And this was frightening to me because every woman that I knew about in my family, going back to my great, great, great grandmother had developed severe osteoporosis and died after breaking her hip. So it was kind of like a message from the universe, figure this out or die. So that was what started me on my very deep dive into all the research about bone health. And fortunately for me, because most of friends are doctors, or they’re in medical research. And we knew people who even back then were starting the first genetic testing. And so they ran me through their genetic tests and I discovered that I’m the poster girl for osteoporosis. I have every possible SNP, that is single nucleotide polymorphism, that makes my enzymes not work properly. All the things that are connected that help you build bone. None of mine work. 

The worst thing that I have is very, very lousy vitamin D receptors. So there are four different SNPs that tell your body how to make your vitamin D receptors. And I have the very worst version of every single one of them. And so it is extremely hard for my cells to latch onto vitamin D. And if you can’t activate, if you can’t bind vitamin D, you do not absorb calcium well, for one thing, you need vitamin D to absorb about 85% of the calcium that you can absorb. And so that was a big problem. So that was kind of the first thing that we tackled. And then over the succeeding, well, I’m 73 now, 25 years or so, I have discovered more things that my body doesn’t do properly, that I’ve corrected. And as a result, I have fabulous bones. I mean, I have the bones of a 30 year old, very healthy woman. And so I know that anybody can deal with this. Having osteoporosis run in your family doesn’t mean that you have to have it. You just have to figure out what’s off for you. And I basically dedicated my life to providing that information, to helping people be able to do that for themselves because I lost my mother, I lost my aunts, I lost my grandmother, cousins, I didn’t have to lose them. And I don’t want anybody else to die from this completely preventable curable condition.

Dr. Sharon Stills

Well, taking a sad situation and turning it into something where you can help others is always a beautiful way to contribute and learn. So, yes, I’m sure there are so many women listening right now that are saying, oh my God, that’s me, that’s my family. So right off the bat, it’s like, you heard there is hope you can reverse it naturally. And we’re gonna get into that now. So for someone who is listening, who is like, yes, I have that genetic, it’s in my family. What do you recommend they start to do to explore and figure out what’s going on?

Lara Pizzorno, MDiv, MA, LMT

Well, vitamin D is one of the most common ones. Like I said, there was four different SNPs that can cause you to have problems with that. There are also enzymes that activate and deactivate, vitamin D and there are SNPs for those. So you can easily find out if you have those by running something like 23AndMe, it will check. And there are many doctors now that will run genomic tests for people and look at these SNPs. You can even do it yourself online, it’s not even that complicated anymore. But for vitamin D, you don’t even have to do that. All you have to do is have a blood test run, which actually should even be covered by your insurance to check your levels of 25-OH D, which is the form in which vitamin D circulates in your bloodstream. So that’s the form that’s checked. And you want to see what your levels are. 

You want optimal levels. So they tell people that the optimal level or an okay level is 30 nanograms per ML, 29 nanograms per ML is deficient. So 30 nanograms per ML is not optimal. And what we’ve discovered, particularly over the last couple of years with COVID, is one of the things that vitamin D does for us is it’s really important for immunity and immune function. And for good immune function, you need to be in the 60 to 80 nanogram per ML range. So you get the blood test run. If you’re not in that range, then you want to increase your intake of vitamin D3. And you can do that with the help of your doctor. Most people need around 5,000 IU daily of D3. And people who are overweight can need two to three times more than that, because vitamin D will be sequestered in fat. So it’s easy to check and you just alter what you’re taking until you’re in that optimal range.

Dr. Sharon Stills

Very, very important. And yes, a good point about the optimum range, ’cause I see patients all the time, they come in, they’re like I’m always told my vitamin D is fine. And I say, let me take a look at it. And it’s like 42 and no, no, no, no, that is not fine.

Lara Pizzorno, MDiv, MA, LMT

You’re not gonna die from rickets. But on the other hand, a few other things may be a problem.

Dr. Sharon Stills

Exactly, exactly. So we think vitamin D and we think calcium. could you speak about calcium and even AlgaeCal and what’s so specific about their support and just like let’s lay the foundation of what nutrients women should be thinking about for basic support.

Lara Pizzorno, MDiv, MA, LMT

Yeah, well certainly you need calcium for bone. And the average intake from the diet for women in the US of calcium is about 650 milligrams per day. And we need 1200 milligrams per day. And as we get older, some digestive function isn’t quite as good. And there are various things that interfere. So as we enter post menopause, we can need up to 1500 milligrams per day of calcium, and vitamin D will help you absorb calcium. That’s one of the primary things it does. Active absorption of calcium is made possible by vitamin D and it accounts for about 85% of the calcium that you’ll absorb, that you consume. However, after you’ve absorbed that calcium, you have to do something with it. And there are a bunch of other nutrients that are involved in you taking that calcium that you’ve absorbed and getting it into your bones and keeping it out of your arteries, your kidneys, your breasts, and your brain. And probably the most important nutrient for that is one called vitamin K2, which is really not available in the United States diet. 

The only food it’s really, really well provided by is Nattō which is a fermented soybean product that smells like dirty gym socks, and it’s kind of this stringy slimy stuff that trust me, I tried it, I’d really like to go the natural route, I tried it. You need a supplement, and unless that appeals to you, you need a supplement for vitamin K2. There are a couple of different forms of that that are available. The MK7 form is the most potent form, and you need to take it in the smallest amount. I don’t know how much detail you want me to get into here, but essentially you have to have vitamin K2. After the vitamin D helps you absorb calcium, you have to have vitamin K2 to activate the proteins that pull calcium into your bones. That one’s called osteocalcin. And also to activate the proteins that prevent calcium from depositing in your blood vessels. You really don’t want it to deposit there. That one is called Matrix Gla protein. And vitamin K2 is the co-factor for those proteins. And if you don’t have enough vitamin K2 around, you will not activate them. I think if you’re only gonna look at three things in terms of your bone health, those are the top three. Vitamin D, calcium and K2.

Dr. Sharon Stills

Yeah, I’m so glad you brought up the K2 because I think a lot of women know about vitamin D, but I find myself educating and adding K2 in so frequently because they’re not taking it and you’re missing the boat and potentially causing harm. So we’ve got calcium, we’ve got vitamin D, and we’ve got K2. What else?

Lara Pizzorno, MDiv, MA, LMT

Well, magnesium is really, really important. After calcium in your bones, magnesium is the next most important mineral that’s in bone. And the diet in the US is very deficient in magnesium. I think it’s one of the most deficient nutrients in the standard American diet is magnesium. And here’s a newsflash for people, stress depletes magnesium. And the last few years have been pretty stressful for most of us. And if you exercise, when you’re sweating and everything, you are losing magnesium. And when you get your period, you are losing estrogen, before your period, estrogen levels go up, and estrogen pulls magnesium into bone, which is really good for us, but it also takes magnesium away from everything else. And if you didn’t have a lot of magnesium, you get headaches, you get cramps, you get a massive craving for chocolate, which by the way, is rich in magnesium. So now you have one more reason to eat more chocolate. So magnesium is incredibly important. Vitamin C, you can’t make collagen properly without vitamin C. 

So we need that for our skin. We have collagen in our bones. So we need vitamin C. Vitamin A, which gets a really bad rap. People think it causes osteoporosis. No, when it is in balance with vitamin D, it actually promotes bone renewal very effectively. And very few people are getting enough vitamin A. We do not produce vitamin A, most of us, about 85% of us, back to the genetics stuff again, do not have versions of the enzymes that are supposed to convert beta-keratin, which is in orange, plant foods, carrots, and we’re supposed to be able to just convert that into vitamin A, about 85% of us do not do that effectively. I’ve written several review articles on that. They’re on “Longevity Medicine Review,” which is free access, a free access medical journal. If people wanna look at that. So people are not getting enough vitamin A. When they’ve looked at pregnant women like in Boston area, they’ve done some big studies there, and most of them were deficient in vitamin A. You have to have enough vitamin A for an infant’s brain to develop properly, so it’s quite important. And many people are deficient. Pretty much the only good food source of vitamin A is liver. And how many of us are eating liver frequently? And for heaven’s sake, if you do eat liver, please let it be organic liver. The liver is the garbage disposal, reclamation center of the body. And so you really want the liver, if you’re gonna eat liver, please make it organic.

Dr. Sharon Stills

Exactly, so going back to food sources, do you think food sources of vitamin D, are there ones you recommend? I mean, I just find everyone’s deficient in vitamin D whether they’re eating the sources or not, but I’m just curious what your thoughts are are for food sources.

Lara Pizzorno, MDiv, MA, LMT

Well, yeah, there are mushrooms that are irradiated, so they supposedly have a decent amount of vitamin D. Unfortunately the vitamin D they contain is ergocalciferol, which is vitamin D2. And you really need vitamin D3. Vitamin D3 is the form that’s in that we produce in our skin from sunlight, and fish, cold water fish, have vitamin D. I don’t think you can get enough vitamin D just from food. Interestingly, I used to think people who live in the southern latitudes could make enough vitamin D by getting half an hour to an hour sun exposure, most days in the summer, without sunscreen, without being totally covered up. However, the research that I’ve seen that was done on young people in Hawaii, who were outside 30 hours a week, like working at skateboard shops and things like that, and never wore sunscreen, most of them were not able to produce adequate vitamin D. 

So I’m not sure. I think there are a bunch of different SNPs that interfere with vitamin D production. I don’t know, maybe we weren’t supposed to live until we were 120. I don’t know about you, but I’m planning on it. I’m still waiting for my son to get married and produce grandchildren. So I wanna hang around here for a while and I wanna make sure I have enough vitamin D. So I recommend just taking a supplement, run your 25-OH D, see how much you need and supplement until you get optimal. We want optimal, right, we don’t just want, okay.

Dr. Sharon Stills

Absolutely, we are all about optimal here. And I always said I was gonna live to 120 because I think we really, if we take good care of ourselves, we’re biologically designed to, but then I started doing ProLon and some intermittent fasting and really inducing autophagy. And then I was like, you know what, I’m going 130 now. that I’ve had…

Lara Pizzorno, MDiv, MA, LMT

That’s great.

Dr. Sharon Stills

And what about I think calcium, that’s such a hot topic, so I’m real curious to know your thoughts on forms of calcium and what do you think about dairy products and what are your favorite forms of calcium and that whole conversation.

Lara Pizzorno, MDiv, MA, LMT

Well, for people who are not, well, even if you’re lactose intolerant, you can have cheeses and things, because the lactose has been used up by the bacteria that make the cheese. I do not think it’s a good idea to have more than one eight ounce glass of cows milk daily. And the reason for that is lactose. So lactose is composed of two sugars, glucose, and D-galactose. So when you consume lactose, your digestive system is gonna break it down into, unless you’re lactose intolerant and you can’t break it down at all, but for most people you’ll break it down into glucose and D-galactose. And D-galactose is the world’s most pro-inflammatory sugar. They actually use it in research studies to prematurely age the animals, very rapidly, so that they don’t have to wait around to look at aging problems. And you can comparable for a human to the amount of D-galactose that they use in these studies to prematurely age the animals, you can get that from two glasses of cows milk that has lactose in it. 

And when they do the lactose free, lactose reduced cows milk, you know what’s in that? they pre-digest the lactose for you. So they put the glucose and D-galactose there for you. So you don’t want that either. So just if you’re gonna drink cows milk, eight ounces is great. And then you can have yogurt and cheeses and cottage cheese, and kefir, and all these things where there’s not very much lactose. And then milk, I think is a fabulous source of many minerals, it’s a great source of calcium. If you’re vegan, or you don’t wanna have dairy products, there are many vegetables that are really excellent sources of calcium. Can I pitch my book here because I have… So my latest book, this is my latest book. And for every nutrient that your bones need, there is a table, there’s a workup of it, what it is, what it does for you, how much you need, what kind of lab tests you need to find out if you’re getting what you need. And then I also have, well, this was the one on omega-3s. but I have a table in the book, I’m not sure where the page is for calcium, but I have a page in the book where I have a table that shows how much, the best food sources of that nutrient. And I can’t find calcium, but here’s an example. This is the best food sources of vitamin K2. So I have a table like this for every nutrient and it’s in real life, serving sizes.

Dr. Sharon Stills

Awesome.

Lara Pizzorno, MDiv, MA, LMT

The kind of amount of food that you’d actually really eat and what the calories are and how much of the nutrient it gives you. And so you can easily look. There’s a pretty long list of, tofu is a good source of calcium, some nuts and seeds have calcium, many leafy greens have calcium. And certainly things like, if you eat fish, you can get sardines with their bones, they are a really great source of calcium. So it’s not that hard to get the calcium. I think people are just eating the standard American diet, which are all these little prepared, highly refined food products in little plastic boxes. And those don’t have a lot of, by the time they get done with them, they’re not really good sources of calcium. 

Oh, you can also get calcium in my favorite thing. One of my favorite things, Pellegrino, or other mineral water. It’s highly bio available in mineral water, which also has some other minerals in it, then you can get. I like the fizzy kind, which is you put a little lemon or orange juice in it, and it’s delicious. If you buy milk products like alternative milk products, like soy milk or orange juice, that’s been fortified with calcium, and often vitamin D. You just wanna make sure that you shake the container up really well before you pour out a glass for yourself, because what happens is the calcium precipitates out. And when you get to the bottom… Have you ever had a box of milk, like soy milk or whatever, or oak milk or whatever it is that has calcium added and you get to the bottom of the box and there’s this sludge down there? That’s calcium, Calcium will even precipitate out of calcium milk. Even if you’re drinking cows milk, it’s a good idea, just shake up the container a little bit and you’ll disperse it back into the solution.

Dr. Sharon Stills

So what about, and I love those tables you have, that’s very helpful. What about protein just in general? How much does protein contribute? And I know a lot of, I see it all the time, patients are eating protein, but they’re not absorbing their protein. And how does that relate to calcium and bone health?

Lara Pizzorno, MDiv, MA, LMT

Well, in part, it depends how old you are, because as people age, they actually need a little more protein. I’m not sure the general age of our audience, but until you get into your late 30s, early 40s, you only need about 0.8 grams of protein per kilogram of your body weight. But as you get older, our bodies develop what’s called anabolic resistance to being able to use protein to build muscle. And that’s really how protein is involved with bone. Muscles pull against bone, bones serve as levers for muscles. And when the muscles contract, they pull against the bone, and that signals, that turns on these cells in your bone, called osteocytes, which are actually the predominant type of cell in your bone. And those orchestrate the bone renewal process. So when you exercise or you contract your muscles, they contract, they pull against the bone, that wakes up osteocytes, and they start new bone formation for you.

So you have to have protein to build muscle, and we’re constantly breaking down muscle. Sarcopenia, that’s a term that means, it’s muscle wasting. It’s when muscle gets replaced by fat, which is a really nasty outcome. You do not wanna replace your muscle with fat. You wanna keep your muscle, and to keep your muscle, you have to have protein. So as people age, elders need 1.2 to 1.5 grams of protein per kilogram of body weight. And what that translates to, and something in sort of remotely understandable English, is about 25 to 35 grams of protein per meal for most people.

Dr. Sharon Stills

And what about for the vegans in the audience and protein intake? Do you have any…

Lara Pizzorno, MDiv, MA, LMT

You can still get plenty of protein as a vegan. Vegetables do have protein, beans and legumes are really great sources of protein. Diet tofu is very high in protein. Tempe is very high in protein. So I mean, you can totally do it. You do have to be more careful. I think the worst concerns for vegans are vitamin B12, ’cause you’re not gonna get, you just have to take a supplement for vitamin B12. And then also zinc, vegans need. So the foods that vegans are gonna get their protein from, like the beans and legumes and even some grains, they have compounds in them called phytates that bind to minerals, like calcium for example, and make an insoluble complex that ferries its way through your intestines and you poop it out, you do not absorb it. And so vegans have to have one and a half times as much zinc as someone who is an omnivore, or even a vegetarian.

Dr. Sharon Stills

Good point, good point, vegans listen up.

Lara Pizzorno, MDiv, MA, LMT

You can be a very healthy vegan though. And the other last thing is omega-3s. And you can get Alto omega-3s now, Directly from algae without the fish in the middle.

Dr. Sharon Stills

Right, exactly. So, all right, let’s talk about something that we don’t often, we’re talking about calcium and vitamin D, these are the things we always think about with bones, but what about environmental toxins and how do they play a role into bone health or non-health?

Lara Pizzorno, MDiv, MA, LMT

When I think about environmental toxins, well, there’s heavy metals and there’s like three of those that are biggies, lead, it’s lead, mercury, and cadmium. So lead, everybody thinks, well, that’s not a problem anymore because we have unleaded gasoline. Unfortunately, when we were all driving around with leaded gasoline, that lead spewed everywhere into the atmosphere and into the fields and into the soil. And so it’s still around. And then there’s lead in paints, and there’s still a lot of lead around. And anybody who is my age, certainly, when I was growing up, lead was in gasoline. And what we did was our bodies took that lead and we stuffed it away inside our bones to protect ourselves. And as we go through menopause, it starts coming out and it’s really nasty stuff. So it is an issue for many people. I have a list of labs that I run on people to see why they’re losing bone. When we can’t figure out why someone is losing bone, one of the things I always look at is heavy metal toxicity. And you can have labs, it’s easy to run them, there are urine tests, you can have labs, and there’s a couple of really good labs that do this. 

You can have that done to see if one of these heavy metals is a problem for you. Mercury, mercury amalgams, those silver dental fillings. Every time you chew, you shoot a little mercury into your body. That’s not good for you. We all know about the fish, there’s certain fish that we wanna avoid and there’s lists of fish that you can safely eat. And then there’s lists of fish that you really don’t wanna eat very often. And if you’re pregnant, you really never wanna eat them at all while you’re pregnant or breastfeeding. And then the last one, cadmium, which I think most people don’t know much about, but it’s a real problem for bone. It’s in cigarette smoke, which everybody knows that’s bad, but it’s also in the high phosphate fertilizers that they use to grow conventionally grown plants. And then the animals that eat that plants get the cadmium and then we eat the plants or the animals, and we get it. And cadmium is incredibly hard on bone. It destroys your kidneys. And they did a big study here in Seattle. I’ve lived in Seattle for 45, 50 years now, and it’s considered a very beautiful part, it’s a beautiful part of the country, and it’s considered very clean. Guess what? The women that were checked, they had really high, there’s a lot of farming in Washington state, and there’s a lot of cadmium here, and it’s also in the food. But conventionally grown foods are the primary source of cadmium in the United States, in the diet, for most people. 

So it’s making my pitch for, please eat organically grown food. Don’t put that stuff in your body, the conventionally grown foods in your body, they’re bad for you for many ways, but that’s one of them. So that was one environmental toxin group. Then the next are things like the bisphenols. And I think most people are aware of bisphenol A, not being a good thing. It’s in all the plastic water bottles, it’s a plasticizer. So it makes plastics more pliable, smoother. One place that I think people may not be aware that BPA is present is in those… You know all the receipts you get, the thermal paper. The stores that I go to, where I go every week to get my groceries, whatever. I’m in there mothering the people at the checkout stand. Because I like them. I said, please, if you have to touch 1000 of these receipts every day, would you please wear gloves? I mean, this stuff goes into your skin. I never take a receipt unless I absolutely have to have it anymore. I mean, I used to take lots of receipts. For one thing now we charge everything. 

It all goes through Amazon or it’s on a Visa card somehow, or some other card and you don’t need the receipt, they’ll email it to you. So you don’t have to take all those pieces of paper. But a final thing on the bisphenols, you’ll see many places now that are saying, ’cause awareness of bisphenol A and it’s endocrine disrupting activities is pretty widespread now. So you’ll see companies saying we don’t use bisphenol A anymore. We don’t use it in the lining of our cans, we don’t use it in our plastic water bottle and all that. They have replaced it with other bisphenols that are worse. The studies that have come out in the last year are showing that bisphenol F, bisphenol D, there’s like a whole list of them. And every single one that they have checked is an even more effective endocrine disruptor than bisphenol A. So just avoid plastic, get a stainless steel water bottle or glass or something else, just don’t drink outta plastic. All right, girl. Don’t store your food in plastic. As I mentioned, my husband is one of the world’s leading experts on environmental toxins. He lectures all over the world, he’s written several textbooks on it. And after he finished the last big one, about two years ago, we went through our house and we threw out everything that contained plastic. I mean, I took those great, big, huge trash bags, like several of them to recycling, unfortunately. But I don’t know what else to do with them. But I have no plastic in my house. For Christmas that year, I was given Pyrex glass storage dishes with glass tops, you can get them with glass tops and a silicone seal around the edge. And that’s what I use for everything now. We don’t have plastic in our house.

Dr. Sharon Stills

It’s plastic free, yes, absolutely.

Lara Pizzorno, MDiv, MA, LMT

I am plastic free. Although they’ve now found plastic in all of us, the fish get the plastic, there’s microplastic in the ocean. And then when you eat the fish, you get that, but you can minimize your exposure, do everything you can to minimize your exposure. And because plasticizers are endocrine disruptors. So the endocrine system, it’s hard to make this connection, you hear endocrine disruptor, well, what’s that? Well, your endocrine system is stuff like your thyroid, your thyroid hormones, your sex hormones, things that you need to run your body properly. And the plasticizers disrupt that function. They contribute to hypothyroidism. They contribute to Cushing’s Disease and adrenal malfunctions and all kinds of nasty things.

Dr. Sharon Stills

Yes.

Lara Pizzorno, MDiv, MA, LMT

That is my rant on plastic.

Dr. Sharon Stills

100% agree, yes, the more you can get plastic outta your life, the better. And I’m glad you brought up the receipts ’cause that’s not a commonly known one and it’s a big one. I always feel bad, ’cause they’re like, do you want the receipt? And I’m like, no, it’s toxic, right, and you shouldn’t be touching it either.

Lara Pizzorno, MDiv, MA, LMT

I think the next time I go to the grocery, I’m gonna bring a little box of gloves.

Dr. Sharon Stills

That’s good.

Lara Pizzorno, MDiv, MA, LMT

Gloves, for the people that work there. ‘Cause I like them, they’re young people, they’re gonna wanna have children.

Dr. Sharon Stills

Exactly, exactly. And what about pesticides? How do they?

Lara Pizzorno, MDiv, MA, LMT

Pesticides are also, well, they really destroy your nervous system. They’re carcinogenic and they cause a lot of inflammation in the body. And one way to think about bone health is anything that causes chronic inflammation, all the time, your body isn’t supposed to be inflamed all the time, it’s supposed to get inflamed when you have to nuke something, and then your immune system nukes it and clears it out and then you stop being inflamed. But in our modern world, we’re exposed to stuff that’s constantly triggering inflammation. And when inflammation gets triggered, one of the things that gets activated is this ligand in your cells, called the RANK ligand, RANKL, and RANKL activates osteoclasts, which are the cells that break down your bones. And sometimes we need to have RANKL, but we don’t want RANKL going crazy on us. And when you’re inflamed, when you’re exposed to things that are constantly causing inflammation, pesticides, being an important one, that RANKL gets activated too much. 

And when you renew your bones, it only takes a couple of weeks for your osteoclasts to break down old crummy bone or bone that needs to be replaced, it only takes them a couple of weeks to come in as a demolition crew and clear it out. It takes months, several months, for your osteoblasts to rebuild. I mean you can think about that, just like a house. So you have a house that that’s really old and it needs to be broken down, and the demolition crew comes in, and the house is gone in an afternoon. Well it takes months for the new house to be rebuilt. It’s the same kind of thing in your bones. And when there’s chronic inflammation, your osteoblasts just can’t, they can’t keep up. And so you lose bone.

Dr. Sharon Stills

Good point, so you mentioned lab testing and could you just go through for the listeners, what tests are good and what they should be asking their physicians for? And what is your thought on the standard DEXA scan?

Lara Pizzorno, MDiv, MA, LMT

Oh, the DEXAs.

Dr. Sharon Stills

Yeah.

Lara Pizzorno, MDiv, MA, LMT

Okay, well, okay, let me talk about DEXAs first. And then I will tell you the labs that I always run to get a systems overview, to kind to kind of see what’s driving bone loss.

Dr. Sharon Stills

Perfect.

Lara Pizzorno, MDiv, MA, LMT

Because any system that’s not working properly can promote bone loss. And so you have to figure out what’s off and then you correct it. But for the DEXA, DEXAs are extremely helpful. They tell you about your bone mineral density, which is the quantity of bone mineral that is present in your body. By themselves, they’re not optimal because you can have a bunch of stuff and it can be crummy. So you can have a lot of bone mineral and it can be brittle. DEXA isn’t gonna tell you what the health is of your bone mineral. It’s just gonna tell you, you have X amount. So you really need to also have, there’s another, sorry, my nose is itchy. You also really need to have another type of bone scan done, that’s called a trabecular bone scan, or a TBS. And I wrote about both in the book. There’s pictures of the reports that you get, and it explains what they mean. But essentially the trabecular bone, it’s the bone that’s the interior of your bones. And it’s held together by all these rods and struts. And if the rods and struts are well connected, you have bone that is resistant to fracture, it’s flexible, but it’s resistant to fracture. The exterior part of your bone is called cortical bone. And that’s the more brittle, hard, dense stuff. So the DEXA pretty much measures the hard, dense stuff. It measures the interior too as well, but it doesn’t tell you if it’s connected or not. And you need to know if it’s connected, and that’s what a trabecular bone score tells you. 

What is the health of the interior of your bones? And the interior of your bones is where all this stuff is happening. Like you’re producing your blood cells and your immune cells, immune cells get produced there. And probably the most important thing, mesenchymal stem cells are inside your bone marrow, your trabecular bone. And those are, depending upon the information they get from your environment and what you’re eating and what’s going on in your body, they will develop into osteoblasts for you. Or if things aren’t going well and you’re not being good to yourself, they will become fat cells. And we don’t want fat cells, we want osteoblasts. There’s a bunch of things that contribute to that, I explain it all in the book, that’s like an hour lecture. But anyway, for your trabecular bone, you need to know what what’s going on with that. So you really need, not just a DEXA, you need a DEXA and a TBS. And there are quite a few facilities across the US now that offer it, it’s approved. You may have a hard time locating it. But what can I say. The company that created trabecular bone score, it’s called Medimaps, and they have a website, where you can write them and they can tell you where the centers are in your state for trabecular bone. 

Or you can contact me somehow and I can look it up for you, ’cause I have all that information. I get a lot of requests for information about that. So after those two, the tests that I use to, and these should be covered easily by your insurance, and they’re easy to get, are a blood test, serum tests for two compounds. One is called CTX, it’s a marker that appears in your blood of bone breakdown. And then the other one is called P1NP, and that’s a marker of new bone formation. So you can get a blood draw and you can see how much bone breakdown and how much bone formation is showing up in my blood from these markers. And you want them to be in balance. The CTX should be 350 to 450. And for most postmenopausal women with osteoporosis, CTX is at least 500 and sometimes 1000. And one of the great things about running CTX and P1NP is after you’ve evaluated your life and you have your protocol that’s for rebuilding your bones, you can check to see if you are, because these markers will balance out and it’ll happen within three to six months. So you don’t have to wait for, I think it’s two years now to get another DEXA approved by your insurance. So this is just a blood draw, it’s easy to do, you can check within three to six months if what you’re doing is working.

Dr. Sharon Stills

And for the other, the range for the P1NP, what do you like?

Lara Pizzorno, MDiv, MA, LMT

It varies from lab to lab. It’s why I didn’t give you a specific number. You always have to know what lab you’re dealing with and they should provide the reference range. You want it in the middle of the range.

Dr. Sharon Stills

Gotcha, okay. And what about running things like N-telopeptide in the urine? Do you think those are worthwhile?

Lara Pizzorno, MDiv, MA, LMT

So N-telopeptide is NTX, it is not nearly as accurate as CTX, and urine is the worst. If you’re gonna do a urine test, you better run it three or four times, and average the results, because it can fluctuate so much from day to day, that the result is essentially meaningless. So just do CTX. That’s the marker that internationally is now being used by all the researchers, it’s valid, you only have to run it once, and you can trust the result that you get.

Dr. Sharon Stills

Perfect. So we talked about vitamin D levels, we’ve got these levels, the right kind of scan, anything else that the listeners should know about?

Lara Pizzorno, MDiv, MA, LMT

Well, if you wanna list of what things I look at, because any area that’s off, that’s putting you in a state of chronic inflammation, it will cause problems for your bones. So you really have to look at your body. The name of this book is “Healthy Bones Healthy You!” Because to have healthy bones, if you have healthy bones, you’re gonna have a healthy body, because all your systems interact. And I know doctors are still trained to, and they have to be, there’s just too much information, to just focus on one thing like your digestive tract or something, or you’re an endocrinologist or whatever. But unfortunately, the human body is all one thing, and it’s all interacting all the time. And so I always look at somebody’s, I’ll do the list, I look at vitamin D of course, I look at the lipid profile. Does somebody have a lot of really high levels of oxidized cholesterol? LDL? Is their HDL really low? Is their triglycerides really high? These things indicate things that cause inflammation, the cardiovascular system is being inflamed. 

So that’s something I look at. I look at homocysteine, that’s a blood draw, for that. It’s a marker of inflammation that’s related to problems with B vitamin, using the methylation and B vitamins. And can be pretty easily corrected. If you need a supplement, you can just take a supplement of activated B vitamins and lower your homocysteine levels. But homocysteine is highly inflammatory. When your methylation cycle isn’t working properly, for whatever reason, homocysteine will build up in your cells. And then it spills out into your bloodstream and it goes everywhere. And it’s like a terrorist with an acid spray gun. I mean, everything that comes into contact with gets destroyed, including bones, it causes a lot of inflammation. You wanna look at kidney function, and that’s a standard test on your estimated glomerular filtration rate, EGFR. Your kidneys are aware of vitamin D is finally activated into its hormonal form. And so if your kidneys aren’t working, you can’t activate vitamin D. 

And if you can’t activate vitamin D, you can take hundreds of thousands of IU of vitamin D and it is not gonna help you. So your kidneys have to be functional. Then there’s another very standard blood test just to check overall inflammation level, HSCRP, C-reactive protein. That will just give you an indication, hey, inflammation’s going on, I need my doctor’s help to let me figure out what’s causing this. Thyroid. There’s a lot of people have… So the test for that, you want your TSH run to see thyroid stimulating hormone. You wanna see what your free T4 is and your free T3 is to see if you’re producing the hormones, T4, and then you’re converting it to T3, which is the form that’s really active and runs your metabolism. If you are hyperthyroid, okay, everything’s gonna speed up including breaking down bone and your osteoblasts really won’t be able to keep up, it’s a huge factor for bone loss. On the other hand, if you’re hypothyroid, nothing’s gonna happen quickly enough. So that also contributes to bone loss. And many people get put on thyroid hormone replacement and they never check again for years. 

And our bodies are hummingbirds, we’re constantly fluctuating, and you should be checked once a year to see if your thyroid dosage is correct, because when they’ve looked at it, they’ve seen that probably a quarter of the prescriptions are wrong, they’re either too high or too low, and either one is gonna contribute to bone loss.. Plus you won’t feel good. You need to have that be right. Omega-3s, omega-3s are highly anti-inflammatory. Unless you eat fish pretty much once a day, of the cold water fish that are really high in omega-3s, you’re not gonna have enough omega-3s to balance the amount of omega-6 that’s in the diet, particularly people who eat meat. There’s a lot of omega-6 in meat and furthermore, it’s omega-6 in the form of arachidonic acid, which is highly inflammatory. 

That’s fine if you’re getting enough omega-3s to balance it, it’s just when you don’t have enough, then there’s too much inflammation. You can check your omega-3 status with a finger prick test. It’s very easy. You wanna check your serum calcium level. And if it’s too high or too low, then you wanna try to figure out why is that? One reason for that is problems with your parathyroid glands. And so you wanna run your PTH. They typically run serum calcium and ionized PTH together. And surprisingly, hyperparathyroidism is pretty common. In hyperparathyroidism often, you’ve developed a benign growth on your parathyroid glands and it’s making them overactive and that will cause bone loss. So you check for that. And then the last thing I check is magnesium. As I said, we’re pretty stressed out around here and you can only eat so much chocolate, no matter how wonderful it is. People’s magnesium often needs a boost. But the way to check for that is to run a red blood cell magnesium, not just a serum magnesium, which is often what they run. And the reason you need a red blood cell one is about 1% of the magnesium in your body is in serum. And by the time that’s low, you’re pretty much ready to go to the emergency room. So it’s not gonna tell you anything. Red blood cell magnesium tells you what’s in your cells, what’s been going on in your cells for the last three months, and do you have enough magnesium? So that’s the list, I always pretty much always run all of these on somebody. And often, they’ll already have had that done. I’m sure you run these on your patients.

Dr. Sharon Stills

Yes, and about 700 other levels.

Lara Pizzorno, MDiv, MA, LMT

Yeah, yeah, right.

Dr. Sharon Stills

But yeah, I mean, that’s a great comprehensive list.

Lara Pizzorno, MDiv, MA, LMT

It’s a start.

Dr. Sharon Stills

Yeah, it’s definitely. So I guess my last question is, you’re obviously bone savvy. So why AlgaeCal, what made you wanna to be on their advisory board? And could you just tell us a little bit about AlgaeCal, and why you love them and what makes them different, and just kind of give us a quick little tutorial,

Lara Pizzorno, MDiv, MA, LMT

Thank you for the opportunity, ’cause I really value AlgaeCal. So what happened for me, it was after I wrote my first book on bone health. and I read the first two hours of every day, I subscribe to hundreds of medical journals, we have lots of subscription things. And so every morning I go through, in my inbox, I get the breaking papers on bone health and I scan them. And back in, I think it was about 2009 or so, I saw two really interesting studies, they grabbed me, and they were on what became AlgaeCal. The first one was an in vitro study, which is just a cell study, where they used AlgaeCal basically, they put it in petridishes with osteoblasts, and the osteoblasts went nuts. I mean, they just did so much better, they built so much more, they were so much more activated. So that was one. Then after that they ran a six month study, a human study, to see what would happen when they gave people AlgaeCal. And they developed a couple of different kinds, versions of it. And so I saw those and both of them did something I had never seen before with any kind of bone health support supplement, which was, they actually improved bone mass. So what you see in the studies typically, you’ll see that you lose less bone than you would’ve lost otherwise, but you’re still losing. 

So with AlgaeCal these people not only stop losing bone, they added new bone, far beyond what they would’ve lost. We’re supposed to lose one to 2% of our bone mass every year after a certain age, like age 50 or so, it starts in the 50s. And for some people, it starts in the 40s, like yours truly. Through menopause, it’s about 2% a year, and then it drops back to about 1% a year. But every year, you’re supposed to lose bone. So most of the studies just say the rate of bone loss was slowed down and that’s all you get, you don’t get I added new bone. AlgaeCal added new bone. 

So I was blown away by this. And I contacted Dean Niles, who’s the owner of AlgaeCal, and I said, hey, this is really great research, I wanna learn more about this and what you’re doing. And he said, oh, we’re coming to Seattle, which is where I live, because we are running another study on about 2000 postmenopausal women with osteoporosis and we’re coming up to do DEXAs on everybody. And so I got to meet him and I was very interested in what they were doing. And then they developed the formulation that they now use for AlgaeCal products, which has every key nutrient necessary for healthy bones in it, in the amounts that are beneficial. For example, the calcium, you take it twice a day, and the amount of calcium that you get is about 350 milligrams each time you take it. And that’s the optimal amount for fractional calcium absorption. So if you take a huge bolus of calcium while at once, you’ll just poop and pee most of it away. But if you take about 350, you absorb most of the calcium that you possibly can when you take it. So that was one thing. Then it has vitamin D3, which is the better form of vitamin D, you don’t want vitamin D2. 

They have magnesium in an amount that balances calcium. You should be consuming approximately half as much magnesium as calcium. So if you wanna get 1200 milligrams of calcium in every day, you need 600 milligrams of magnesium to balance that. The AlgaeCal supplement balances it properly. So it’s half as much magnesium as calcium. They added boron, which is my favorite trace mineral, I’ve written many medical journal articles. My article on boron is entitled “Nothing Boring about Boron.” It’s on PubMed, and it has now been read by over 6,000 clinicians. I get letters from people from all over the world about that article. Boron is so cool, it does so many things for you. And one of the things that it does is it’s fabulous for bone. I mean, there there’s 15 different mechanisms through boron helps us build and renew healthy bone. So they have boron in it, and then all the trace minerals, which are a big problem. We do not have trace minerals in our food supply anymore. I mean, one example, do I have time to talk about all this? Or we running outta time? One example is manganese. 

So Roundup, glyphosate, the pesticide, glyphosate, it works by… It kills things, one of the things that it kills is plants’ ability to absorb manganese. So you have to have that, and it causes the plants to die. And if humans have absolutely no manganese, they’re not gonna be very happy either. You need manganese to produce a mitochondrial enzyme that prevents you from being killed by your own production of energy, among other things. So at any rate, AlgaeCal has it, naturally, it’s a ground up algae, looks like a little piece of coral, and it has all the trace minerals in it, naturally present, to build that bony coral structure. And they just grind it up and standardize it so that you get the same amount throughout. So it has all these trace minerals. Silicon, we need silicon for… Men, don’t need extra silicon, they drink it in beer, but women don’t usually drink that much beer. So we need all these trace minerals and they’re not in the soil anymore because of the way our foods are grown. So that was the next thing. And I started learning more, and I offered to write some articles for them about various things that were important for bone health. And I’m now on their scientific advisory board. And I asked them, because I was doing this interview with you. Let’s see if I can find the the note, okay. So I asked them, since I serve on AlgaeCal’s health advisory board, would they agree to people who are listening to this, going to the Mastering Menopause Summit, if they purchase some AlgaeCal product, they will get sent a free copy of my book along with it.

Dr. Sharon Stills

Woohoo.

Lara Pizzorno, MDiv, MA, LMT

And I think that offer is good through October 31st. And all they have to do is when they place the order for the AlgaeCal, they put the word summit when you fill out the form. But what I have to tell you about AlgaeCal, about two and a half years ago now, we started a group called the AlgaeCal Community, it’s a Facebook group. And there are now about close to 20,000 people on it. And they write in with questions for me. And there are other staff now who can support people with their questions and they just have to be using AlgaeCal to be a member of this.

Dr. Sharon Stills

I’m writing it down, I’m not a member of that.

Lara Pizzorno, MDiv, MA, LMT

Well, if you use any AlgaeCal product, Triple Power, which is the omega-3s, your curcumin and astaxanthin, or AlgaeCal Plus, and Strontium Boost, they only have three products. If you use any of them, you can become a member. And I have seen over the last two years, literally, hundreds of women who’ve sent me there before DEXAs and their after DEXAs. I mean, I get these notes. I cried when I got my DEXA, I gained 14% of bone, I mean, really just astounding results. And think the reason for it is our diet isn’t providing these nutrients for us anymore and our bones have to have them. And so AlgaeCal works.

Dr. Sharon Stills

I actually learned about AlgaeCal from a male patient of mine.

Lara Pizzorno, MDiv, MA, LMT

Oh, interesting.

Dr. Sharon Stills

Yeah, ’cause men get osteoporosis too.

Lara Pizzorno, MDiv, MA, LMT

They certainly do.

Dr. Sharon Stills

And that’s how I got turned onto it. And he just had phenomenal results with it. And I was like, ooh, I need to learn about this.

Lara Pizzorno, MDiv, MA, LMT

And if you wanna live to 130, you’d better be taking it.

Dr. Sharon Stills

That’s right, that is right. Well, this has just been amazing and wonderful and thorough and a total masterclass on bones.

Lara Pizzorno, MDiv, MA, LMT

I hope so.

Dr. Sharon Stills

And I’m gonna sign up, I wanna a copy of your book.

Lara Pizzorno, MDiv, MA, LMT

Absolutely, they didn’t send you one already? They should have.

Dr. Sharon Stills

I need one.

Lara Pizzorno, MDiv, MA, LMT

I’ve heard it’s a fun read. I tried to make osteoporosis fun, I hope I succeeded.

Dr. Sharon Stills

Well, you are doing so much good in the world and I’m so impressed that you wake up and for two hours read studies every morning. I wish that I had space in my life to do that. But that’s why we have researchers and clinicians and we all work together to bring it to you, to those of you listening so you can get the best support for your health, for your bones in this case.

Lara Pizzorno, MDiv, MA, LMT

You’re the one that you’re on the front lines, I’m reading.

Dr. Sharon Stills

We rely on people like you reading so we get the data. So thank you so much. And thank you to AlgaeCal for that generous offer and for being a part of the Summit, because this is such an important piece in mastering your menopause transition. We wanna grow old gracefully and have healthy bones to support us. So thank you for being here, thank you everyone for listening. You’re gonna wanna listen to this one again. There was like is a lot of data in there. Never too much information, but you’re gonna wanna take notes. Thank you and be well everyone.

Lara Pizzorno, MDiv, MA, LMT

It was lovely to meet you.

Dr. Sharon Stills

You too.

Lara Pizzorno, MDiv, MA, LMT

Be well.