Editor’s Note: See part 1 of this article in the November 2024 issue, which introduces “Tommy’s” case and the potential cause of his symptoms. The web version of this article includes a sample workout program not featured in the print version.
A Foods-First Approach
Acid-promoting diets increase excretion of both calcium and bone matrix protein (BMP), a urine marker used to estimate the rate of bone loss. Only when calcium intake is low does calcium loss caused by animal protein become a problem.8
- Eat plenty of organic vegetables to maintain a slightly alkaline pH.
- Get enough protein (1.2g/ k body weight) and adequate calcium (1,200 mg daily).
- Stop eating lunch meats because the excess salt in processed foods leaches calcium from our bones.
- Avoid refined carbs (sodas, sugary juices, high-fructose corn syrup) because these increase the amount of calcium in urine.
- Avoid or limit refined breads, crackers, bagels, potato or corn chips, pretzels, white rice and cereals.
- Avoid processed and other SAD foods like cookies, cakes, and other baked goods; French fries and other fried foods; non-dairy creamers and anything containing hydrogenated oils.
- Introduce more omega-3 fatty acids by enjoying nuts and seeds, such as flaxseed and chia seeds. Remember, though, that Tommy has G6PH and is sensitive to peanuts and other nuts.
- Aim for fat to make up a maximum of 25% to 35% of calories.
- Add beans, root vegetables like carrots, yams, and potatoes; whole fruits like apples, peaches, plums; and whole grains like old-fashioned rolled oats, millet, and quinoa.
Supplement Recommendations
I started Tommy on a good multivitamin with minerals (calcium lactate, etc.), vitamin C (not ascorbic acid), vitamin D with K2. I also recommended whole vitamin D complex from real cod liver oil. Nutrient insufficiencies and supplements that could potentially be used to treat bone health include:
- Vitamin D: 25(OH)D. Blood levels should be checked twice a year, in late winter and late summer, and dosage adjusted. Optimal ranges of 60-80 ng/mL. Some popular doctors like Mercola and Gundry are pushing even higher D levels toward 100 ng/mL.9
- Vitamin K2: The appropriate dosage of vitamin K2 can vary based on individual health needs and specific conditions being addressed. For general health and bone support, typical dosages range from 90-120 micrograms (mcg) per day. For individuals with osteoporosis or those at high risk for bone fractures, higher doses, such as 45 milligrams (mg) per day, have been used in some clinical studies, particularly in Japan. Vitamin K2 comes in several forms, primarily MK-4 and MK-7. MK-7 is more commonly used in supplements due to its longer half-life, allowing for once-daily dosing. Typical dosages for MK-7 range from 90-200 mcg per day.1
Blood levels should fall within the lab ranges for vitamin A (serum retinol), magnesium (RBC), selenium (RBC), B vitamins, homocysteine (if elevated, may indicate folate, B6, or B12 deficiency), RBC folate, serum B11, methylmalonic acid (MMA), and essential fatty acids (EPA and DHA).
Weight-Bearing Exercise
Tommy’s exercise is basketball and weightlifting, hours every day. For most patients I need them to put strong, heavier-than-you-think weight-bearing stress on bones for 45-60 minutes every 5-6 days. If a patient is not working out already, I provide in-office training (~4-5 sessions) to teach them a DIY, at-home free-weight lifting program. This is something they can do for the rest of their life. Tommy has an excellent trainer and was working out “hard’.”
The National Osteoporosis Foundation says there are two types of exercise for building and maintaining bone strength and density:
- Weight-bearing exercises: These are activities in which you’re moving against gravity. They include walking, jogging, dancing, playing tennis, climbing stairs, etc.
- Muscle-strengthening exercises: These include lifting weights or using resistance bands; but you can also do certain exercises without weights. These include pushups, pullups, and squats.10
Treatment Goals: reducing, then eliminating joint pain; increased “play all out” and confidence on the court; and drugless therapy.
Best Exercises for Low Bone Density
Based on experience, some of the best exercises for preventing and managing bone loss include:
- Weight-bearing exercises: brisk walking, jogging/running, dancing, stair climbing, tennis and other racquet sports, or hiking
- Resistance/strength training exercises: weight lifting, resistance bands, bodyweight exercises like pushups and squats
- Balance and coordination exercises: Barre classes, ballet, yoga, standing
- on one leg
- High-impact exercises: jumping, skipping rope, step aerobics
Key points about exercising for bone health include the following:
- Aim for 30-40 minutes of exercise 3-4 times per week.
- Include a mix of weight-bearing, resistance, and balance exercises.
- Focus on exercises that stress bones and muscles against gravity.
- If your patient has osteoporosis, avoid exercises with high fall risk or that involve bending/twisting the spine.
A Sample Weight-Lifting Workout
Here’s is an example of a weight-lifting workout for a young adult to focus on exercises that enhance bone density, improve muscle strength, and reduce the risk of fractures. It incorporates resistance training, weight-bearing exercises, and balance exercises.
Frequency
- Resistance training: 2-3 times per week
- Weight-bearing aerobic exercise: 30 minutes most days of the week
- Balance exercises: daily
Warm-Up (5-10 minutes)
- Light cardio (e.g., march in place, brisk walking or stationary cycling)
- Dynamic stretches (e.g., leg swings, arm circles)
Resistance Training (2-3 times per week)
Upper Body
1. Chest Press
- Equipment: dumbbells or resistance machine
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
2. Seated Row
- Equipment: Resistance machine or resistance bands
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
3. Shoulder Press
- Equipment: dumbbells
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
4. Biceps Curls
- Equipment: dumbbells
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
5. Triceps Extensions
- Equipment: dumbbells
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
Lower Body
1. Leg Press
- Equipment: leg press machine
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
2. Squats
- Equipment: bodyweight or dumbbells
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
3. Lunges
- Equipment: bodyweight or dumbbells
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
4. Calf Raises
- Equipment: bodyweight or dumbbells
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
5. Hip Abduction
- Equipment: resistance bands
- Sets/reps: 2-3 sets of 8-12 reps
- Intensity: 50-70% of 1RM
Weight-Bearing Aerobic Exercise (Most Days)
- Options: brisk walking, jogging, stair climbing, or dancing (add in one-minute bouts of jump rope every 10 minutes)
- Duration: 30 minutes
Balance Exercises (Daily)
1. Single-Leg Stand (knee locked out and knee bent)
- Duration: hold for 30 seconds on each leg
- Reps: three times per leg
2. Heel-to-Toe Walk
- Duration: walk in a straight line, placing the heel of one foot directly in front of the toe of the other foot
- Reps: 10 steps forward and backward
3. Tai Chi or Yoga
- Duration: 20-30 minutes once or twice per week
Cooldown (5-10 minutes)
- Light stretching focusing on major muscle groups
- Deep breathing exercises
Look for Underlying Causes
Taking antacids for many years for GERD or indigestion is a fast track to osteoporosis. These drugs are not compatible with good gut health. The reduced stomach acid will prevent your body from digesting and utilizing the very nutrition your skeleton needs to stay strong.
Most people with GERD and heartburn are actually suffering from insufficient stomach acid. Instead of taking acid stoppers, they need supplemental digestive acids and enzymes. So, indigestion and GERD from too little digestive enzymes, bizarre combinations of foods, processed and artificial foods, too much wheat, a flexible hiatal hernia, or something else gets symptom treatment with antacids instead of treatment of the cause.
Where does this lead to? Malabsorption of minerals and essentials for your joints; arthritis and osteoporosis; symptom treatment with painkillers and/or bisphosphonate drugs; and treatment that leaves the underlying cause ignored while causing a weakened skeleton, perhaps spontaneous femur fracture or osteonecrosis of the jaw, and maybe even Barrett’s esophagus. These could even lead to invalidism, drug addition, a nursing home, cancer, and death.
Discussion Points
Bone health (loss) is just one more thing we must worry about as we get older. Our goal is to help people know what to do at every stage of life to build and maintain strong bones and prevent fractures. Chiropractors often represent people throughout their lifespan, sorting out patients with comorbidities.
By the time Medicare covers the cost of a DEXA, it’s late in life and a difficult challenge to increase bone density. The cost of screenings, which is now under $90 for private pay in Los Angeles, is worth it for all ages – even starting in the age range of 20-30. If you exercise properly and use real nutrition, your bones will begin to strengthen. In fact, you get a brand-new skeleton every 10 years!
Tommy is headed back to college to continue his basketball career and will follow up.
References
- Dawson-Hughes B, et al. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr, 2002 Apr;75(4):773-9.
- Live 2024 lectures by Drs. Gundry / Mercola.
- https://www.osteoporosis.foundation/patients/prevention/exercise.
