Osteoporosis

Osteoporosis: two of my favorite self-help books by R. Keith McCormick DC (and some of my own story)

August 16, 2024 By Trudy Scott 3 Comments

In May 2023 I posted this on Facebook and it never made it on to the blog so here goes …. osteoporosis and two of my favorite self-help books by R. Keith McCormick DC:

Earlier this week I read this book, The Whole-Body Approach to Osteoporosis: How to Improve Bone Strength and Reduce Your Fracture Risk by R. Keith McCormick DC, and wow, I’m very impressed and learned a ton.

It actually consolidates and builds on what I learned from him at the in-depth and excellent interviews with him on the Osteoporosis Summit, hosted by my friend and colleague, Margie Bissinger, MS, PT, CHC (thanks Margie! – I’ve ordered his newest book too).

I really love how Dr. McCormicks walks us through him being a detective with clients (the cases are excellent). And his information and interpretation on advanced bone health tests (like CTX, P1NP), other basic blood work (CRP, homocysteine, fibrinogen, vitamin D etc.) and functional testing (celiac/gluten sensitivity labs) he does is invaluable.

I’m curious to see what updates he’s made (if any) in his newest book, Great Bones: Taking Control of Your Osteoporosis. Does he now prefer MK-4 to MK-7 (forms of vitamin K), if he addresses the tricky calcium-oxalate issues (I’m trying to figure this one out too) and if he also discusses Trabecular Bone Score (TBS) which can be included in the DXA.

I do like that he discusses prevention too – for younger women and men! He was in his 40s when he started to have osteoporotic fractures.

I’m in my early 60s and don’t have osteopenia or osteoporosis but I want to be proactive and do comprehensive testing. I do have concerns due to my dietary oxalate issues and calcium homeostasis as a result of this.

Read about both books below and more on my own osteoporosis story (yes, I do have osteoporosis after all!) and probable root causes.

The Whole-Body Approach to Osteoporosis

Here is the official blurb for this book:

No pill will cure you of osteoporosis. While medication can sometimes help, it won’t fully address the underlying causes of your osteoporosis or osteopenia. To restore bone health, you’ll need a targeted program combining the best bone-building strategies from traditional and holistic medicine. The Whole-Body Approach to Osteoporosis distills these complex strategies into a whole-body plan you can begin today to dramatically improve your bone strength and overall vitality.

This comprehensive guide includes information on:

- What to eat for stronger bones
- Choosing bone-building supplements and osteoporosis medications
- Foods and medications that may be contributing to bone loss
- Signs and symptoms that can help you monitor your bone health
- How lab tests can help you personalize your plan

It was published in 2009, and I found it to be eye-opening and a wonderful introduction to the comprehensive functional medicine, nutritional and lifestyle approach that needs to be considered when addressing bone health. It’s written for the layperson but is meaty enough for practitioners new to the mechanisms of bone building and bone breakdown, osteoporosis medication and the impacts of environmental toxins.

As I mentioned above, his information and interpretation on advanced bone health tests (like CTX, P1NP), and other labs that are important for bone health (CRP, homocysteine, fibrinogen, vitamin D etc.) is invaluable. He also covers the basics that I cover in my book/work – like eating real food, digestive health and celiac/gluten sensitivity.

It comes highly recommended and you can find it in bookstores and on Amazon here (my Amazon link).

Great Bones: Taking Control of Your Osteoporosis

Here is the official blurb for this book:

Dr. McCormick knows what potential dangers lurk for women and men who don’t understand the life cycle of bone, who don’t realize the role nutrition plays in bone health, who don’t know what can happen to bone even when they think they’re doing “everything right.”

In his mission to help readers — women and men, athletes and nonathletes, primary care physicians and specialists — Dr. McCormick explains not just the fundamentals of osteoporosis but also the pathophysiology of bone loss and what it takes to regain skeletal health.

If you’re a patient suffering from bone loss, Dr. McCormick helps you take control of your osteoporosis; if you’re a doctor, he lays out the most up-to date science so you can best serve your patients. Great Bones is a book everyone can use to achieve better skeletal health well into their 70s, 80s, and beyond.

This one was published in 2023 and is a hefty 714 pages (vs 200 pages for his first book). This book takes everything in his first book to the next level. And while it is more geared to practitioners it is easy enough to follow for the health-savvy layperson.

Every time I pick it up to search for something I learn so much more. Here are a few eye-opening gems:

Test CTX early morning and avoid biotin and collagen for 48 hours beforehand (I also heard him say this on the osteoporosis summits)
“Butyric acid can increase bone formation by lowering osteoclastic formation” (bone break down) “and stimulating the deposition of calcium into the collagen matrix”
“High concentration of lead are found in the cement lines – where mineralized bone meets non-mineralized collagen and where zinc concentration is highest” (and more information on how lead adversely affects our bones)
“Post-menopausal women excrete eight times more urinary zinc than women with normal bone density”

With regards to my questions I had before getting this book – he does use both forms of vitamin K (MK-4 and MK-7) and he also discusses Trabecular Bone Score (TBS) which is an add-on for the DXA and a good indicator of bone texture and quality.

Unfortunately he doesn’t address the tricky calcium-oxalate issues that I’m trying to figure out, other than a very brief mention on one page.

I’m eagerly waiting for a kindle version to come out so I can more easily search for advanced topics. My index is full of my scribbles as I find some topics buried within other topics, like some of the TBS information.

This book is also highly recommended and you can find it on Amazon here (my Amazon link).

My osteoporosis story (some of it anyway)

When I posted about these books in May 2023, I was planning to be proactive and do comprehensive testing to get a good baseline in my early 60s. After reading these books and two others, I had my first DXA in July that included a TBS and testing of my left forearm. I was shocked to find out I have osteoporosis, despite the fact I have exercised my entire life – running (road and trails), playing tennis and then squash, rock-climbing, doing weights to train for climbing, backpacking with heavy packs, mountain biking, skiing and wind-surfing.

Because of this I’m really passionate about getting the message out about testing early (for women and men) and being informed and proactive. Dr. McCormick suggests women do their first DXA at 50 and men at 55 (and earlier if they’ve had a fracture).

Given my many possible root causes, I now wonder if I should have tested myself at 40 years of age? As I mentioned above, my dietary oxalate issues and the disruption of calcium homeostasis is likely a major factor. I’ve added these as contributing factors too: my long-term gut issues (since childhood), gluten sensitivity, SIBO, my history and propensity for anxiety and panic attacks, my past exposure to toxic lead (in my 20s I worked in an oil refinery and was exposed to jet fuel at a small airport), the fact that I have pyroluria (the zinc and vitamin B6 connections – I’ll be publishing a blog post on this and osteoporosis) and my liver/bile issues (which play into the oxalate issues).

Dr. McCormick says this at the start of Great Bones … “you need to understand the causes” and I do so now I can work on all of this. I love that he also says: “In this book what you will find is hope – within realistic physiological limitations – that you can improve your bone health.”

Dr. Kim Millman’s healthier bones course

With these books and other reading I’m doing, I now have the knowledge and tools. I’ve seen some improvements in the last year and I’m ready to jump in and do further testing and additional adjustments to actually reverse my bone loss.

But I need more so I’ve just signed up to do Dr. Kim Millman, MD’s online Restore & Rebuild: 100 Days to Healthier Bones program. Dr. Millman was also a speaker on Margie’s osteoporosis summit and if you are also looking for support and expert guidance via an online program, this one is a no-brainer. There is also an opportunity to ask your questions. It’s really short notice and if you can’t make this cohort, I’ll share my feedback in case you make the 2025 class.

Dr. Millman shared this in one of her interviews with Margie: “I think that the most important thing to understand is that it is possible to reverse bone loss and drastically reduce your risk of fractures naturally. And in my 15 years of evaluating and treating the root causes of bone loss, my patients do not break bones, and they don’t feel fragile anymore. Their fear fades. They don’t feel vulnerable, and they return to living their most active lives and doing the things they love.”

Hearing this gives me even more hope and I’m excited!

And in case you’re wondering, I’m still glad I’ve read both these books and have them to refer back to again and again. Both are heavily referenced too and I love to look at the research.

Wrapping up and your feedback

Now I’d love to hear from you – do you have osteoporosis and have you read either of these books and have any gems to share?

Do you have another favorite book on bone health?

Have you done Dr. Millman’s program?

What age were you diagnosed with osteopenia or osteoporosis and were you surprised?

Have you been able to reverse your bone loss and drastically reduce your risk of fractures naturally?

What root causes do you feel play a role for you?

If you’re a practitioner working with clients/patients with osteopenia or osteoporosis I’d love your insights

Feel free to share and ask your questions below.

I have osteoporosis – within a week of starting collagen I experienced profound insomnia, was much more anxious and had tons of worrying thoughts

August 18, 2023 By Trudy Scott 10 Comments

Nancy shares her unpleasant experience when using collagen for her osteoporosis and asks how she can use tryptophan and possibly add the collagen back:

I have osteoporosis and recently started taking a collagen peptide product (Fortibone). At the same time, I started taking a bone support formula containing calcium, magnesium, vitamin D, vitamin K2, boron, etc.

Within a week I began experiencing such PROFOUND insomnia. I felt like I was wide awake and could not drift off till 4 am each morning. Also, when I laid down at night, I was much more anxious than I normally am and had tons of worrying thoughts flitting thru my mind.

Within a couple weeks of the insomnia starting, I thankfully caught your talk about collagen and folks who are susceptible to it, at the 2023 Osteoporosis Summit. The puzzle pieces clicked together; I’m a MAO-A. I immediately stopped the collagen and the bone support supplement.

I understand supplementing with tryptophan may be the fix for being able to reintroduce the collagen.

I appreciate her for sharing her experience on one of my collagen blogs and thanked her, saying how glad I was that she heard my interview about this.

Collagen and gelatin lower serotonin in susceptible individuals

Intake of collagen (and gelatin) can lower serotonin in susceptible individuals and cause these symptoms she experienced. I first blogged about this in 2017 but it’s still not common knowledge even amongst practitioners and companies selling collagen products.

The good news is that awareness is growing. Dr. R. Keith McCormick does mention the serotonin-collagen connection in his excellent book Great Bones – Taking Control of Your Osteoporosis (my Amazon link). He does not, however, offer tryptophan as a solution.

If this is new to you, this blog post describes why it happens (i.e. collagen does not contain any tryptophan), lists many of the tryptophan depletion studies and who may be more susceptible to this effect – Collagen and gelatin lower serotonin: does this increase your anxiety and depression?

Here is a more recent blog on the topic too: Collagen causes increased anxiety, low mood, irritability, insomnia, gut issues and an itchy skin: some questions and my answers

The causes of these symptoms can be due to the serotonin-lowering effects of collagen but also the dietary oxalate impact, a histamine reaction and/or a glutamate reaction to collagen.

Could supplementing with tryptophan be the fix for being able to reintroduce the collagen?

Nancy said “I understand supplementing with tryptophan may be the fix for being able to reintroduce the collagen.” Hearing her symptoms – profound insomnia, increased anxiety and worrying thoughts flitting through her mind – led me to the same conclusion, especially since they all started soon after starting collagen.

We know she has the MAOA (monoamine oxidase A) genetic polymorphism – this does make her more susceptible to the serotonin-lowering effects of collagen. Other factors that may make her more susceptible (explained in the 2017 blog above) are current or prior depression and/or OCD (obsessive compulsive disorder) or family history of these conditions and being a smoker. In addition to a MAOA defect is having a 5-HTTLPR genetic polymorphism.

To confirm the likely low serotonin connection, it would have been helpful to know if she also experienced other low serotonin symptoms: panic attacks and phobias, lack of confidence, depression, negativity, imposter syndrome, PMS, irritability, anger issues and afternoon/evening cravings.

It would also be helpful to know if her symptoms resolved when she stopped using the collagen.

But the best way to confirm is to do a trial of tryptophan and observe if these symptoms resolve when using collagen.

How to use tryptophan in a situation like this?

She asked these specific questions about using tryptophan:

I bought the Lidtke brand which is a 500 mg. capsule. How do I dose this? I realize you said to trial dose it but:

1) what time of day is best to take it?

2) is it taken on an empty stomach or can it be taken with food?

3) should I start taking the tryptophan BEFORE restarting the collagen and be watching for the night time anxiety/insomnia symptoms to reappear?

4) if the insomnia, anxiety do reappear, how much do I titrate up and is there a max dose of tryptophan? If I’m taking more than one capsule a day, should they be taken at one time or divided throughout the day?

Tryptophan is always taken midafternoon and evening on an empty stomach/away from protein and increased until there is symptom resolution.

For clients in a similar situation who have stopped the collagen but still have insomnia, anxiety and worry symptoms, I have them start on tryptophan before adding back collagen and adjust the tryptophan dose up if needed once collagen is reintroduced.

If symptoms resolved when the collagen was stopped, tryptophan would be trialed as soon as symptoms show up when collagen is reintroduced.

With tryptophan, 500 mg is a typical starting dose but less may work in a situation like this. I’ve had clients use up to 1500 mg tryptophan 2 x day. It’s really individualized with no one-size fits all.

I did mention my book, The Antianxiety Food Solution, as an excellent resource for Nancy. There is an entire chapter on the amino acids and how to use them. I recommend everyone read it before using any of the amino acids as supplements.

Resources if you are new to using amino acids as supplements

If you are new to using amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA, low serotonin, low dopamine, low blood sugar and low endorphins).

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, (as I mentioned above) I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms too). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

Thanks to Nancy for sharing her experience with collagen and asking this question.

Have you used collagen for bone health/osteoporosis or for other reasons? And have you experienced insomnia, and increased anxiety and worrying?

Were your symptoms due to low serotonin and did tryptophan allow you to continue with collagen or add it back if you stopped it?

Or were your symptoms caused by oxalates in collagen, a histamine reaction and/or a glutamate reaction?

Has Fortibone led to improvements in your bone health? If yes, how long have you been using it and which collagen product (a number of products contain Fortibone)?

If you have questions and feedback please share them here too.

Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia: anxiety, depression, anger, irritability, delusions and impaired cognition

July 7, 2023 By Trudy Scott 38 Comments

In samples of patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT), these disturbances have been identified at a rate of 43.1%–53.0% for anxiety, 33.0%–62.1% for depression, 22.0% for thoughts of death or suicide, 51.9% for anger and irritability, 5.0%–20.0% for hallucinations and delusions, and 37.3%–46.5% for impaired cognition.

In fact, it has been noted that there are more neuropsychiatric phenomena in PHPT than is often recognized and that these symptoms are easily missed, particularly in the elderly population.

This excerpt is from, Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia, published in Psychiatry Online.

I’ve recently been reading as much as I can about this condition, for personal and professional reasons. As soon as I learn about something new I go digging to see if there is an anxiety connection. And I must say I was very surprised to read these stats. It’s not something I’ve heard discussed or taught at mental health conferences.

The authors also state this about the condition:

The incidence of primary hyperparathyroidism (PHPT) is about 21 cases per 100,000 person-years, and the disorder is usually caused by a solitary parathyroid adenoma. PHPT has traditionally been recognized by its characteristic symptoms, including urolithiasis (“stones”); osteopenia and osteoporosis (“bones”); abdominal cramping, nausea, and peptic ulceration (“moans”); and depression, anxiety, cognitive dysfunction, insomnia, confusion, and personality changes (“psychiatric overtones”).

How do changes in serum calcium levels contribute to mental health and cognitive symptoms?

It’s always helpful to understand the mechanism and it was the first thought that went through my mind – how does hyperparathyroidism and changes in serum calcium levels cause these mental health and cognitive symptoms? The authors share this:

Although the pathogenesis [or cause] of psychiatric symptoms in primary hyperparathyroidism remains unclear, calcium is thought to figure prominently in determining changes in monoamine metabolism in the central nervous system(CNS), thereby modifying neurotransmission and resulting in alterations in mood and cognition.

I went digging and found this paper – Acute psychosis secondary to suspected hyperparathyroidism: A case report and literature review.

The authors also state that the mechanism isn’t known for certain. And although they are referring specifically to psychosis, the explanation could be applied to other symptoms too: “It is thought that the changes in serum calcium level slow down nerve function and neurotransmission rate, inducing psychosis (and other symptoms like anxiety, depression, anger, irritability and suicidal thoughts).

Understanding this possible mechanism helps us find a temporary solution for these symptoms until the hyperparathyroidism is addressed with surgery i.e. using amino acids as supplements.

Using amino acids to ease symptoms while you are seeking the root cause/s

If you’ve been following my work and have read my book The Antianxiety Food Solution, you’ll be familiar with using targeted amino acids as supplements to support low levels of neurotransmitters. These provide quick relief of symptoms (in a day or less) while you are seeking the root cause.

If we look at the above symptoms:

Anxiety can be a sign of low serotonin (worry type of anxiety) and/or low GABA (physical type of anxiety) – and tryptophan/5-HTP and/or GABA help ease symptoms.
Depression can be a sign of low serotonin (negativity), low dopamine (curl-up-in-bed depression) an/or low endorphins (weepy depression) – and tryptophan/5-HTP, tyrosine and/or DPA help ease symptoms.
Irritability and anger are common with low serotonin – and tryptophan/5-HTP helps to ease symptoms.
Low GABA can also be involved with anger and rage
Cognitive issues can be caused by low dopamine and low GABA – and tyrosine and/or GABA help ease symptoms

(You can find the symptoms questionnaire here. As always, amino acids are used based on symptom clusters and dosed according to your unique needs.)

If you find you have been using the amino acids long term and have explored all the possible root causes described in my book and summarized here, it may be worth investigating primary hyperthyroidism especially if you’re menopausal.

Case: “I had to have a parathyroid gland removed a few years ago… I literally felt better from the moment I came round from the surgery”

We always want to find the root cause when we have various symptoms. With this condition, it’s common to observe very quick resolution of symptoms after parathyroid surgery to remove the adenoma/s. Someone in our community shared this:

I had to have a parathyroid gland removed a few years ago … I literally felt better from the moment I came round from the surgery. It’s a miserable disease. I thought I was going to die! Lots of people get so low that they don’t feel like they can go on.

Bone pain was awful. Fatigue, depression etc.

I had had some dental issues around that time. One of my teeth crumbled. My Vitamin D went down to 9 so I am sure that was a large part of the puzzle.

I was actually diagnosed fairly quickly but was retested many times. I self-referred to a surgeon that was in-network in the end as my insurance wouldn’t cover various surgeons that my doctor wanted me to go too.

I had had breast cancer a few years ago and so had had weekly blood tests and, when I went back and looked, my calcium had been high for years. So important to read our own results.

The surgery was so easy.

What an amazing outcome for this woman and I appreciate her for sharing so we all get to learn and benefit from her journey. And yes, I agree, we need to advocate for ourselves and ask for and keep copies of all our labs. And get educated and ask questions. It’s really unfortunate that high calcium and hyperparathyroidism is so often missed.

Not everyone has all the listed symptoms of primary hyperparathyroidism. This woman did experience fatigue, depression and bone pain. She did not experience anxiety and didn’t have kidney stones. I do suspect dietary oxalate issues (without kidney stones) can be an issue for some folks because of the calcium disruption.

Some reasons why hyperparathyroidism is underdiagnosed

In the last few months I have learned that primary hyperparathyroidism is underdiagnosed. PTH (parathyroid hormone) is not routinely tested and I believe that it should be. Also, as you read above, elevated calcium levels are often ignored or brushed off as being a non-issue. And to complicate things further calcium is not always elevated. Hyperparathyroidism is also underdiagnosed and undertreated in the elderly.

For many women (and men) the discovery happens after they are diagnosed with osteoporosis and then calcium and PTH are tested, and/or past elevated calcium levels are “discovered.” If the hyperparathyroidism diagnosis happens first then osteoporosis screening is not always done and I believe it should be. And don’t get me started on when I believe osteoporosis screening should start (at 45 and not 65 or 70 years old) and issues with DEXA screening (more to come on this).

The good news is that primary hyperparathyroidism is a well-established cause of secondary osteoporosis which starts to resolve after the surgery too.

I’m still very much in learning mode

Primary hyperparathyroidism only recently appeared on my radar as a result of the 2023 osteoporosis summit, hosted by my friend and colleague, Margie Bissinger, Physical Therapist and osteoporosis coach. Dr. Deva Boone was a speaker on this condition on the summit and her site is a wealth of information. I appreciate them both.

As I mentioned above, I am also amazed it’s not something I’ve heard about at mental health or integrative health conferences and when doing continuing education.

I will admit I’m no expert and I’m still very much in learning mode – for myself and for you and this community. But, as you know, I like to share what I learn. As I continue to learn, I plan to share additional perspectives and the osteoporosis/menopause and oxalate links.

I am also in the process of creating a hyperparathyroidism questionnaire to use with my clients. Not everyone has all the above symptoms and not all the papers and resources list all the symptoms covered here today. For example, fatigue is listed on many sites but not in the above two papers and very few sites emphasize the mental health symptoms.

I’m also learning there are clues to look for – like forearm results on the DEXA scan and a good TBS/trabecular bone score has some significance. Stay tuned.

Resources if you are new to using amino acids as supplements

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues.

If you’ve been diagnosed with hyperparathyroidism (or a family member has been) you can likely relate to much of this. Please share your/their journey. I’d love to hear how long it took for a diagnosis and treatment and what symptoms resolved after surgery, and how quickly.

Did you find the amino acids helped anxiety, mood and cognition symptoms in the short term, and then were no longer needed after surgery?

If you’re new to hyperparathyroidism, feel free to ask your questions and share what you’d like to hear more about in the follow-up blog.

If you are a practitioner, is primary hyperparathyroidism on your radar and do you recommend PTH testing in addition to calcium testing? Have you found the amino acids to be a good short-term solution for your clients/patients?

And if hyperparathyroidism is your area of expertise, feel free to add to the discussion.

Feel free to post your feedback here in the comments.