Osteoporosis - A Holistic Approach
Dr. Paul Goldstein
732-271-0400

Introduction
Osteoporosis is not a normal consequence of aging. It is the end result of a chronic imbalance of nutrients, lack of physical activity, and disruption of hormones and neurotransmitters from the chronic overexposure of chemicals in our food, water, air, and modern way of life. It is estimated that there are 10 million Americans diagnosed with osteoporosis and an estimated 30-50% of women and 15-30% of men will sustain an osteoporosis related fracture in their lifetime. The Pharmaceutical industry does offer drugs for this problem, but they do have serious side effects and in my opinion a more comprehensive and holistic approach should be given greater consideration.

Bone is Dynamic
Within bone there are cells that build more bone called Osteoblasts. There are also cells that break down bone cells that are called Osteoclasts. This is an ongoing negative feedback process and occurs like it does in any other part of the body. Osteoporosis is the net loss of bone cells in relation to the net addition to new bone cells. This is called a catabolic state. If there were a net gain of new bone cells it would be called an anabolic state. Over time, this catabolic state that exists within bone results in osteoporosis and a lowered Bone Mineral Density (BMD).

Diagnosistic Testing
Most diagnosis’ of osteoporosis or BMD deficits are made from an extremely safe test called a DXA scan. The results are given in T and Z score. T compares your BMD to normal and Z compares your score to others in your age and gender group. The WHO (World Health Organization), says normal T scores are greater than or equal to -1.0. Low bone mass is between -2.5 and -1.0. Osteoporosis is a having a T score of -2.5 or less and severe osteoporosis is having a T score or BMD of -2.5 or less with a history of fragility fractures.

Some doctors will test to see if you have an elevated Bone Resorption Test which would contribute to the catabolic state mentioned above. If it is elevated then that measures an overactive osteoclastic situation and bone loss, and you now have a baseline to gauge improvement of therapy. One bone resorption test is N-Telopeptide (NTX) which measures small molecules of bone collagen being excreted through the urine. A reduction in NTX means a reduction in bone loss and less risk for fractures. Another bone resorption test is C-Telopeptide (CTX). This measures a different part of the collagen molecule and can be done through urine or blood. The last bone resorption test is Deoxypyridinoline (DPD). This is also tested through urine.

There are also Bone Formation Markers to test the osteoblasts ability to form bone. If the bone resorption tests are normal, then the problem in an abnormal T score could be from abnormal osteoblastic activity to build bone. The first test for bone formation is Osteocalcin. This is a protein produced by osteoblasts and is important for activating the mineralization of bone. It is dependant on vitamin K for its function. Another bone formation test is Bone Specific Alkaline Phosphatase (bsALP). This detects early signs of osteoblastic activity, and over suppression of bone resorption during bisphosphonate therapy. Taking bisphosphonates can over suppress osteoclastic activity and consequently by a disturbed negative feedback loop inhibit the osteoblastic process that you desire. Therefore if the bsALP falls to low, it may signal taking a break from the medication. The last test for bone formation is P1NP which is only used to test the amount of collagen in your blood and if a patient is considered to have severe osteoporosis and is considering the injectible medication Teriparatide (Forteo).

Aside from these specialized tests there are more common tests that are essential to see a bigger picture of what is happening in an osteoporosis patient. A mineral assessment such as Calcium, Magnesium, Phosphorus, and Potassium can easily be checked on a blood test. Vitamin D (25-hydroxy), and Vitamin K can also be checked along with Parathyroid hormone which helps maintain blood calcium and phosphorus levels. It is the active form of vitamin D (1,2-dihydroxy) that is converted into calcitriol in the kidneys in order to increase calcium absorption in the intestines which then activates a negative feedback loop to the thyroid to release Calcitonin (a thyroid hormone) to lower blood calcium. Measuring estrogen, progesterone, DHEA, and testosterone in both males and females is useful too because of the anabolic effects of these hormones. Conversely measuring cortisol which is a stress hormone produced by the adrenal glands would measure the catabolic effects.

Another important test is Insulin Growth Factor 1or (IGF-1). Very similar to Insulin, it acts to increase muscle mass and bone density. Protein intake stimulates IGF-1 production. 1.0-1.5 grams of protein for each kg (or 2.2 lbs) of body weight is a good measurement to remember. However, too much animal protein, and refined carbohydrates will make your body too acidic and your body will buffer the acidity with the release of alkalizing minerals like Calcium and Magnesium resulting in a net loss of minerals. Checking your oral and urine ph with a specialized ph paper can give you the feedback as to whether your diet is more acid forming or alkaline forming and this can reveal the consequences of your daily food intake.

There are other tests to consider that are not as well known. These tests fall into a category of testing for functional problems. One of the theories about the loss of bone is that since it is dynamic tissue it is prone to the same problems of other tissue in the body that might be under stress. For instance if someone has a food sensitivity the tissue in the gastrointestinal tract becomes inflamed and causes damage to the absorptive potential of the villi of the small intestine and alsothe lymph nodes (Peyers Patches) of the small intestine. Therefore it is easy to see how those same stresses to the immune system of intestinal system might also affect the immune system of the bone marrow too. Inflammation is likely to be a key factor in uncovering a holistic approach to improving BMD since there is evidence that inflammation causes the bone marrow to become more fatty, crowding out osteoblasts and decreasing
the production of red blood cells. This is why osteoporosis patients are also frequently anemic. The tests for inflammation might include a stool analysis to see if there are markers such as Lysozyme or Alpha Anti-Chymotrypsin causing inflammation in the small or large intestine. On blood tests sedimentation rate, C reactive protein, and Homocysteine would be tests that could be run to analyze inflammation as a problem. Tests like Interleukin 2, Interleukin 6 and Tumor Necrosis Factor (TNF) are considered inflammatory cytokines that also signal immune system stress and inflammation. Once any of these are identified as a problem, then the next step is to stop the inflammation through diet modification and through dietary supplements.

Drug Therapy and its consequences
The most common prescription for osteoporosis is Biphosphonates. Short term use of Biphosphonates does reduce bone fracture risk but it does not reduce inflammation and it has its associated side effects such as stomach pain, and joint pain. In essence it is like putting a fire retardant blanket over the embers of a campfire. The heat and inflammation are still there smoking under cover and the insidious inflammatory process is still at work.

Are you Catabolic or Anabolic?
This is the key question in understanding the risk you have for Osteoporosis. If your body has an acidic ph level, if you have markers for inflammation that are elevated, if you have cortisol imbalances due to high stress from work or other issues, if you have chronic stress to your immune system from various sources, if you have toxicity from a poor diet or environmental exposure, this will all contribute to inflammation and a Catabolic state and the breakdown of bone tissue. This breakdown is not normal and can be reversed. However the consequences of any of these factors took years to develop and it could take years to normalize.

How to become Anabolic
If you have an acidic ph you will want to incorporate more vegetables and fruits into your diet. An approach that is becoming more popular is juicing or blending your fruits and vegetables. It is easier to juice a few carrots, some celery and an apple for breakfast than it is to sit down and eat those foods. Without the fiber the nutrients from those foods will be rapidly absorbed and the benefits will accumulate over time. Blending some foods is beneficial but some foods like carrots can be difficult to blend completely. There are high speed blenders like the Vitamixer that can do a decent job of it but it might be most beneficial to do both. Eating a diet that is high in animal protein and carbohydrates is acid forming and will not alkalize you so those foods should be kept to a minimum.

Running lab tests to observe the changes in blood and urine*- chemistry for inflammation and repeating bone density testing is how you can observe improvement and hopefully get off medication for osteoporosis if you are on it.

The Gut Connection

Aside from the nervous system, the greatest link to the vast majority of chronic health issues is the connection between the dysfunctional digestive system and our overall health. The short list of problems that are associated with an inadequate functioning digestive tract is: Food Allergies, Asthma, skin problems such as Rosacea, hives, Psoriasis, Eczema, digestive problems such as Gastritis, Diverticulitis, Irritable Bowel Syndrome, Hepatitis, functional problems like Metabolic Syndrome or Syndrome X, Chronic Fatigue Syndrome, Fibromyalgia, Diabetes, inflammation problems like Arthritis, Rheumatoid Arthritis, Migraines, and other chronic autoimmune disorders such as Lupus, and Hashimoto’s Disease.

What follows is an attempt to take a complex subject and hopefully simplify it by attacking several myths, and presenting some interesting facts, so that a new appreciation for the gut connection to health is understood.

Myth 1:
We are what we eat. Not true!
We are what we eat and absorb!
Without adequate breakdown and assimiliation of the nutrients of the food we eat, we may develop health problems due to malabsorption issues. Absorption begins in the mouth. Proper chewing assists enzymes there in breaking down sugars. In the stomach the ph is extremely acidic, (in the range between 2-3 on a 1-14 scale). A slight alkaline shift in the ph of the stomach to 4-5 would indicate hypochlorhydria, (low amounts of hydrochloric acid) and incomplete digestion of protein and other food. The effect of stress, or zinc deficiency is often at the root of hypochlorhydria and would require supplementation with HCL (hydrochloric acid) and/or zinc to restore normal acidity levels to the stomach. Pancreatic enzymes and bile acids are also necessary for the proper breakdown of food. Not surprisingly, they too are often deficient in the chronically ill patient. Proper supplementation using Applied Kinesiology and functional laboratory tests can pinpoint the needs for each patient.

Myth 2:
Our immune system is separate from our gastrointestinal system. Not true!
Approximately 70% of our immune system is housed within the gastrointestinal tract!
Optimally the mucosa that lines the grastrointestinal tract has immunoglobulins that protect us from bacteria and viruses that we are exposed to on a constant basis. In fact, the mucosa often acts as our body’s first line of immune defense from disease. At the final part of the small intestine there are also concentrated areas of lymph tissue known as Peyer Patches. This tissue has a significant role in the protection against disease as they secrete both B and T cells just like peripheral lymph nodes. There are some who say that our immune system should be renamed “the microbial interaction system”.

Myth 3:
Germs make up a relatively small percentage of who we are. False! Admittedly, this is a trick question because by percentage the statement is false but by weight it would be true. The total mass of the bacteria in our body probably only weighs a few pounds, but by percentage there are more bacteria in us than we have of our own cells. The human adult has about 10 trillion cells, but we carry over 100 trillion cells that are made up of a variety of different bacterial species. Therefore we are only 10% human based on this percentage breakdown. These other bacteria cover our skin, hair and exist throughout our digestive system. Of course they are small so we fail to see that they are there. However if instead of eyes, we had Illumina HiSeq 2000 machines looking at ourselves we would instead see that we are not who we thought we were. What is an Illumina HiSeq 2000 machine? It is a machine that scientists are using to analyze the microbiome of humans. The research is in its earliest stages, but scientists are analyzing the microbiota of individuals and comparing it to the microbiome of different cultures and seeing if there might be a new way of treating diseases through symbionts, the microbacteria that we seem to have coevolved with. Where do all these bacteria come from? Well, the first dose is supposed to come as we exit through our mothers vaginal opening during birth. Mothers milk, being handled by the adults in our childhood and of course touching things, food and putting things in our mouths, eventually forms our individual microbiota. You should not find it that surprising that researchers are finding that the microbiome of people living in western civilized countries differ a bit from the microbiome of indiginous cultures around the world.

Myth 4:
All germs are bad for us. Not True! We couldn’t live without germs.
We have a symbiotic relationship to the germs we live with and without them we would die. We know that our microbiome produces B vitamins and Vitamin K, along with neurotransmitters such as serotonin. Most of us think of serotonin is a brain chemical but perhaps 90% of the serotonin in our body is made in the Gastrointestinal tract. Bacteria also produce signaling molecules to regulate our appetite, metabolism and mood. Bacteria also detoxify toxins and harmful chemicals that we are exposed to. How is it that we have become so dependent on microbes in order to survive? Because microbes reproduce so quickly, and in most cases a new generation can take as little as 20 minutes to an hour to occur, can respond and adapt to the introduction of any foreign food or microbe and determine whether to digest it or to fight it.

The Connections
So how does all this information tie together? How is it related to the specific conditions that I mentioned in the beginning of this paper?

To begin, if you don’t already know, approximately 75-90% of the antibiotics produced in the U.S. are given to chickens, cows, and pigs. Most would surmise they are given to treat infection if the animals are sick, or to prevent illness. That is only partly true. Instead, C.A.F.O.’s or (concentrated animal feeding operations), administer antibiotics regularly to animals to make them gain weight quicker so that they can reach their ideal weight for slaughter in the shortest time possible. Why this occurs was a mystery until recently, but now we know from research in humans that antibiotics interfere with the hormones ghrelin and leptin two hormones that help regulate our appetites. The more ghrelin you have the more likely you are to overeat. Leptin has the opposite effect and suppresses appetite. Interestingly, they have also found that those people with H. Pylori in their stomachs had far less ghrelin detected after a meal. In the past decade H. Pylori has been implicated in the development of stomach ulcers but now research is showing that H. Pylori may have a protective effect on preventing obesity. In the early part of the 20th century before the advent of antibiotics H. Pylori occupied the stomach of almost every person. Today that is not the case, and research is also showing that a lack of H. Pylori is also linked to an increase in Asthma in children as well. Certainly, there is a case for antibiotics for situations that demand it to save lives. However, is the rise in obesity and asthma in both children and adults linked to the contamination of milk, chicken, eggs and meat from the overuse of antibiotics in the vast majority of our food supply? I think the answer is at least partially yes. I am not alone. Additionally every child by the time he/she is 18 has already received from 10-20 courses of antibiotics. The probable collateral damage from our exposure to antibiotics is now suspected by researchers to be linked to type 1 diabetes, allergy syndromes, celiac disease, irritable bowel syndrome by the disruption of our micrbiota. In addition they are showing that children born by Cesarean section have a greater amount of allergies and asthma. Nearly a third of the births in the U.S. are Cesarean and in China the figure is closer to 50%. Researchers are also showing that compared to indiginous populations, modern societies have a less diverse microbiome.

Susan Lynch, an associate professor at University of of California found that Lactobacillus sakei may be singularly capable of warding off sinusitis problems. Other researchers have found that Streptococcus mutans as the principal cause of tooth decay. When you eat sugar, S. mutans releases acid that corrodes the teeth.

Intestinal permeability or Leaky Gut Syndrome is a term that has been used in functional medicine for over a decade. Essentially it describes the end result of a gastrointestinal area that over time has developed a compromised mucosal barrier. Most likely it is the combination of antibiotics, living in a stressful world with fast food, high amounts of refined sugar, and exposure to immune compromising chemicals that led to this condition. At the same time, the modern obsession about sanitizing our home environment and our lack of time outdoors may also be implicated in this recent development. Our mucosal barrier has a surface area equivalent to a tennis court where our microbiota live. Changes is the ideal microbial environment is being shown to compromise the mucosal barrier and allow pathogenic bacteria to slip through cracks that then migrate throughout our bodies causing inflammation to whatever area they finally come to reside. If it is in the joints that imflammatory process might present itself as Rheumatoid Arthritis, if it comes to inhabit the thyroid, it may result in Hashimoto’s Disease, if it is in the colon it may show up as Ulcerative Colitis or Crohns Disease.

So now that we see the connections between the gut, our microbiota, and the manifestation of symptoms of chronic illness, we can no longer look at illness the same way. When we get sick or develop illness we can see the destructive effects of employing heavy duty drugs to the long term prospects of our health. Although it may take longer, increasing the microbiota of our internal world, removing the toxins from our diet along with other comprehensive holistic approaches can in many cases have better results and less side effects than traditional allopathic approaches.

In 2007, The National Institutes of Health launched a project to map the human microbiome. Called the Human Microbiome Project, it is to follow 242 healthy people, periodically sampling their mouths, nasal passages, skin, and other sites on and in their bodies. In 2008 the European Commission and China joined the effort too with the Metagenomics of the Human Intestinal Tract Project, known as MetaHIT. All animals have unique biomes and plants do too. Recently researchers employed experiments with the use of fecal implants from calm adventurous mice to timid anxious mice and saw those timid anxious mice become more adventurous. Fecal implants in humans have been over 90% successful in treating severe Clostridium Difficile infections. Based on the experiments with mice, might we soon see this treatment for anxiety or depression in humans?

In the future using specific micro-organisms to treat illness will be cutting edge science, but until more information is gathered we have multiple probiotic supplements that help restore the microbiota of our systems. Additionally, eating adequate amounts of fiber from different foods containing different polysaccharides can act as prebiotics for microflora to grow. Eating naturally fermented vegetables is another very impactful way to increase the microbiota of our systems. In Functional Medicine we often use a comprehensive digestive stool analysis to identify pathogenic bacteria, yeasts and parasites when trying to understand chronic illness. I have personally seen this test reveal important data and used it to help patients with many different conditions.

Think this information was too much to digest? or was it just an appetizer and you would like to know more. Well, if you are hungry for more, here are a couple of articles that I used to write this paper that you can read in its entirety. Bon Appetite!

http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_specter

http://www.nytimes.com/2013/05/19/magazine/say-hello-to-the-100-trillion-bacteria-that-make-up-your-microbiome.html?_r=0

http://www.scientificamerican.com/article.cfm?id=fda-comes-to-grips-with-fecal-transplants

Superfoods for Supersmoothies

Dr. Paul Goldstein
495 Union Ave. Ste. 1
Middlesex NJ 08846
732-271-0400

The following list is a compilation of some ideas for added ingredients to make a smoothie as a meal replacement for people adding power packed nutrition to their diet while decreasing the overconsumption of refined carbohydrates and foods that have diminished nutritional value. Depending on the patient, non dairy milks such as coconut milk, almond milk or hemp milk could be used as a base, or plain clean water or even a herbal tea that has cooled. Powdered greens or leafy spinach along with frozen berries, a banana would also be common additions to most smoothies. There are many videos on youtube with great ideas for anyone to research and learn from. There are many companies that sell the items mentioned in this paper, but I have avoided giving a specific brand name to any of the ones that I use. This is for general knowledge and I hope you find this information useful.

Acai Is a small purple berry, the fruit of tall palm trees found in the Amazonian floodplains. It is celebrated for its high levels of antioxidants, omega fatty acids, and phytonutrients. The whole berries are processed immediately after harvest by a freeze-dried method to ensure maximum nutrient content.

Arabinogalactan Arabinogalactan (AG) is a polysaccharide found in the cell walls of a wide variety of edible and non-edible, woody plants. The wood of the western larch tree (Larix occidentalis) provides a rich harvest of free arabinogalactan from its inner bark.

Larch AG acts as a food supply to friendly intestinal bacteria. Like the well-known fructooligosaccharides (FOS), AG is considered a “prebiotic.” The non-absorbed fiber is eagerly fermented by the distal gut microflora, resulting in an elevated production of short-chain fatty acids (SCFAs)—primarily butyrate, but also propionate. SCFAs are critically important to the health of the colon and are the principal energy source (butyrate) for the colonic epithelial cells. Many clinicians use prebiotics to prevent and treat intestinal conditions like diverticulosis, leaky-gut, irritable bowel syndrome (IBS) as well as inflammatory bowel diseases (IBD) like Crohn’s and ulcerative colitis.

Because of its mild taste and excellent solubility in water or juice, it is easy to use with children. Clinical feedback suggests an occasional reaction of bloating and flatulence in less than three percent of individuals (mostly women). This side effect is probably due to the effect AG has on beneficially altering intestinal microflora and will often disappear after several days to one week.

Blackstrap Molasses Is made from harvested sugar canes and from machines used to press the juice out of the cane. The sugar cane roots go very deeply into the soil, commonly 15 feet down and ranging from 6.5 to 19 feet – deep enough to bypass nutrient depleted topsoils that have become the norm and take in more nutrients. There are three grades of molasses: sulphured, unsulphured, and blackstrap.

Sulphur is used to process unripe green sugar cane. This chemical sulphur is not so good for most human consumption. Sun ripened sugar cane is processed without using sulphur. So unsulphered molasses is a better choice. The mechanical pressing and centrifical extraction of the sugar crystals combined with the triple boiling necessary to extract table sugar from sugar cane or beet sugar produces a thick dark substance known as blackstrap molasses, which is the most nutrient dense of all.

Blackstrap molasses has a low glycemic index. This means the glucose and carbohydrates are metabolized slowly, demanding less insulin production and stabilizing blood sugar. The result is less lipids or fats occurring in the blood. And it means that you’re chances of becoming diabetic while satisfying your sweet tooth is virtually nil.

Because of its high iron content, many use blackstrap molasses to holistically overcome anemia. Iron is essential to creating red blood cells. In addition to iron, blackstrap molasses contains folate, a natural source for folic acid, along with some other B vitamins, which all combine to form the synergistic mix that promotes red blood cell production.

Then there is magnesium in abundance, along with calcium. Both are densely packaged within this natural food source. Magnesium is important for balancing with calcium for bone production and energy. It is necessary for the smooth function of our nervous system. It is also helpful in maintaining heart health. Insufficient magnesium levels can result in muscle spasms, including the heart muscle, which of course relates to arrhythmia or even heart attacks.

Potassium is another mineral abundant in blackstrap molasses. A deficiency in potassium results in weak muscles and is considered a factor in causing arthritis. Potassium also helps maintain a calmly functioning nervous system. It too is important for the nervous system and heart health. Even the American Heart Association has included unsulphured blackstrap molasses as a food supportive of good heart health.

Manganese, a trace mineral, is very high in content with unsulphured blackstrap molasses. Manganese ions function with a number of enzymes, and are essential to combating unusual free radicals. Like magnesium, manganese also supports cellular absorption of nutrients, and is also beneficial to the nervous system.

There certainly are a lot of nervous system supporting nutrients in this sweetener! Seems that it would be a useful alternative and deterrent to the hyperactivity and ADD in youngsters who consume too much sugar. And unsulphured blackstrap molasses has been used successfully for just that!

Other minerals that appear in abundance are copper and zinc. Zinc has been tagged as the male mineral because it helps support a healthy prostate. Working with zinc, copper helps eliminate the oxidation damage of superoxides.

All the minerals and nutrients of unsulphured blackstrap molasses are in their natural, balanced form to create a bio-accessible, nutritional synergy unavailable from supplements that are not food. Regardless of the amounts of nutrients listed in synthesized supplements, there is more bang for the buck with whole or super food sources.

Camu Is a berry from a low lying shrub in the rainforest. It contains more vitamin C and bioflavanoids than any other food in the natural world. It has 30-60 times more vitamin C than an orange. Yet to further catapult this berry into superfood status, camu also contains many other important nutritional elements — such as a broad range of antioxidants, phytochemicals, amino acids, as well as many vitamins and minerals like beta-carotene and potassium. The powerful elements found in camu have a wide range of therapeutic effects, making the berry particularly effective in assisting the immune system, fighting inflammation, and serving as a strong anti-viral food. It has been freeze dried to preserve its maximum nutritional components.

Cacao Cacao contains a naturally rich supply of antioxidants, and is also an excellent source of dietary fiber. In addition, cacao is known to be one of the highest dietary sources of magnesium, contains an impressively high iron content, and also possesses many other essential minerals in significant quantities. It also contains high amounts of flavonols and polyphenols. The dried seeds from the South American evergreen tree Theobroma Cacao tree has long been used not only for currency among the indigenous people of Central and South America, but has been used in sacred rituals dating back hundreds of years by the Mayans and other civilizations in those areas.

Cacao Nibs Cacao beans are protected by a paper-thin shell, which you remove before eating. When the shell is removed, the bean often breaks into small pieces, called nibs. Nibs have all the nutritional benefits of the whole bean with the added convenience of having the shell removed for you.

Why Unprocessed Chocolate is Good for You
Antioxidants: Cacao has more antioxidant flavonoids than any food tested so far, including blueberries, red wine, and black and green teas. In fact, it has up to four times the quantity of antioxidants found in green tea. Health benefits of these antioxidants include:

Promote cardiovascular health – Help dilate bloods vessels, reduce blood clotting, improve circulation, help regulate heartbeat and blood pressure, lower LDL cholesterol, and reduce the risk of stroke and heart attacks.
Protect from environmental and metabolic toxins – Help repair and resist damage caused by free radicals, and may reduce risk of certain cancers.

Neurotransmitters: By increasing the levels of specific neurotransmitters in our brains, cacao promotes positive outlook, facilitates rejuvenation and simply helps us feel good.

Serotonin – Cacao raises the level of serotonin in the brain; thus acts as an anti-depressant, helps reduce PMS symptoms, and promotes a sense of well-being.

Endorphins – Cacao stimulates the secretion of endorphins, producing a pleasurable sensation similar to the “runner’s high” a jogger feels after running several miles.

Phenylethylamine – Found in chocolate, phenylethylamine is also created within the brain and released when we are in love. Acts as mild mood elevator and anti-depressant, and helps increase focus and alertness.

Anandamide – Anandamide is known as the “bliss chemical” because it is released by the brain when we are feeling great. Cacao contains both N-acylethanolamines, believed to temporarily increase the levels of anandamide in the brain, and enzyme inhibitors that slow its breakdown. Promotes relaxation, and helps us feel good longer.

Essential Minerals: Cacao beans are rich in a number of essential minerals, including magnesium, sulfur, calcium, iron, zinc, copper, potassium and manganese.

Magnesium – Cacao seems to be the #1 source of magnesium of any food. Magnesium balances brain chemistry, builds strong bones, and helps regulate heartbeat and blood pressure. Magnesium deficiency, present in 80% of Americans, is linked with PMS, hypertension, heart disease, diabetes and joint problems.

Sulfur – Cacao is high in the beauty mineral sulfur. Sulfur builds strong nails and hair, promotes beautiful skin, detoxifies the liver, and supports healthy pancreas functioning.

Essential fats: There is a misperception that chocolate is fattening. In truth, the fats in cocoa butter are healthy fats. Cacao contains oleic acid, a heart-healthy monounsaturated fat, also found in olive oil, that may raise good cholesterol. Also, substances found in cacao are known to help reduce appetite.

Cacao beans are harvested today in much the same way as they were by the Aztecs. After the pods ripen, which takes 5 to 6 months, they are removed from the tree and carefully cut open with a machete, and the cacao beans are extracted.
After harvesting, the beans are placed on banana leaves in large wooden boxes and left to ferment for several days. During fermentation, complex chemical changes take place. The bitterness of the bean is reduced and the rich chocolate flavor begins to develop. The beans are dried after fermentation, and during this drying process, the brown color develops and further flavor development occurs.

Cacao Butter Cocoa butter is one of the most stable fats known, containing natural antioxidants that prevent rancidity and give it a storage life of two to five years, making it a good choice for non-food products. The smooth texture, sweet fragrance and emollient property of cocoa butter make it a popular ingredient in cosmetics and skin care products, such as soaps and lotions. Its faintly pleasant aroma also lends benefits to its cosmetic uses.

The fat that occurs naturally in cocoa beans, gives chocolate its distinctive smoothness and “melt-in-the-mouth” texture. Cacao butter is higher in stearic acid, one of the principal fatty acids in cocoa butter, which has been found to reduce levels of cholesterol in the blood.

Chaga Mushroom Extract Unique among mushrooms Chaga has one of the highest ORAC values (anti-oxidant properties), even more than blueberries. This wild crafted Chaga is made from a combination of both hot water and ethanol extraction. High in beta glucans it has potent immune system supporting properties.

Chia Seeds A long, long time ago – long before the era of terracotta “chia pets” — the chia seed was cultivated and eaten by the ancient Aztecs, Incans, and Mayans and was considered a staple food alongside corn and beans. “Chia” is the Mayan word for “strength”, and though these cultures may not have had the medical research to back up their health claims, chia is enjoying an escalating renaissance by today’s medical community as well as everyday consumers. Also full of dietary fiber, vitamins, and minerals (especially calcium and iron), chia has much in common with flaxseed, with the distinct advantage that its natural antioxidants make its delicate healthy fats more nutritionally stable.
Chia seeds are an excellent source of dense nutrition with their healthy omega oils, easily digestible protein, and antioxidants. In fact, chia is so high in essential fatty acids that it contains eight times more omega-3s than salmon, gram for gram. Also full of dietary fiber, vitamins, and minerals (especially calcium and iron), chia has much in common with flaxseed, with the distinct advantage that its natural antioxidants make its delicate healthy fats more nutritionally stable. Research has linked this valuable food as a being beneficial for many health issues, including diabetes, hypoglycemia, celiac disease, and lowering cholesterol.

Chia seeds have a mild nutty flavor, and develops slightly sweet notes when sprouted. It may be used much like flax powder in creating a power breakfast: just sprinkle a spoonful into oatmeal, granola, cereal, or yogurt. It also works very well as a flour substitute and can be used to make hearty breads, crackers, and more. Additionally, chia is considered highly hydrophilic – meaning the seeds have a unique ability to absorb liquid and form a gel. This makes chia especially good to use as a thickening agent in recipes like soup, smoothies, or enjoyed as a pudding with a touch of sweetener.
When soaking Chia for use in regular smoothies, I soak one part chia to five parts water and keep it refrigerated. One ounce of Chia soaked to five ounces of water will keep in the refrigerator for one week. Depending on how much you use, it would be best to avoid making too much at one time.

Coconut Oil The coconut provides a nutritious source of meat, juice, milk, and oil that has fed and nourished populations around the world for generations. Nearly one third of the world’s population depends on coconut to some degree for their food and their economy. The coconut palm is so highly valued by them as both a source of food and medicine that it is called “The Tree of Life.” Only recently has modern medical science unlocked the secrets to coconut’s amazing healing powers.

Coconut oil has been described as “the healthiest oil on earth.” That’s quite a remarkable statement. What makes coconut oil so good? What makes it different from all other oils, especially other saturated fats?

The difference is in the fat molecule. All fats and oils are composed of molecules called fatty acids. There are saturated fats, monounsaturated fats, and polyunsaturated fats. Coconut oil is composed predominately of medium-chain fatty acids (MCFA), also known as medium-chain triglycerides (MCT).

The vast majority of fats and oils in our diets, whether they are saturated or unsaturated or come from animals or plants, are composed of long-chain fatty acids (LCFA). Some 98 to 100% of all the fatty acids you consume are LCFA.

So the physiological effects of MCFA in coconut oil are distinctly different from those of LCFA more commonly found in our foods. The saturated fatty acids in coconut oil are predominately medium-chain fatty acids. Both the saturated and unsaturated fat found in meat, milk, eggs, and plants (including most all vegetable oils) are composed of LCFA.

MCFA are very different from LCFA. They do not have a negative effect on cholesterol and help to protect against heart disease. MCFA help to lower the risk of both atherosclerosis and heart disease. It is primarily due to the MCFA in coconut oil that makes it so special and so beneficial.

Tropical oils and mother’s milk are by far the richest food sources of medium chain fatty acids available. The closest other source of these vital building blocks for our immune system would be milk fat and butter, comprising around 3% of its content. Any other vegetable oil is completely deficient in these medium chain fatty acids.

It should also be remembered that the negative research done on coconut oil in the past was the result of one study conducted four decades ago, using hydrogenated oil also known as Palm oil (which has been processed and altered from its original form), not with virgin coconut oil. Research shows that some saturated fat is in fact necessary for human health and modern research shows that the medium chain fatty acids help to increase our metabolism and are more easily digested than fats found in other oils. This is because they are processed directly in the liver and immediately converted into energy. There is therefore less strain on the liver, pancreas and digestive system and these MCFA provide the body with a wonderful, quick source of energy.

Coconut Butter -Coconut Butter and Coconut oil, like human breast milk, is rich in lauric acid, which boosts immunity and destroys harmful bacteria and viruses. Coconut oil and Butter has been shown to kill the Candida Albicans yeast, which is caused by antibiotics, birth control pills, and modern living. Yeast overgrowth has caused a whole generation to be tired, foggy headed, unable to optimally digest food, and suffer from a range of other illnesses. Coconut butter is more of a whole food than coconut oil meaning that it contains the fibrous portion of the coconut meat along with the amino acids, vitamins and minerals found within as well. To hear more about coconut oil and coconut butters benefits check out this link from Dr. Bruce Fife author of The Coconut Oil Miracle. http://www.coconutresearchcenter.org/Interviews-with-Dr-Fife.htm

Colostrum Also called first milk, colostrum is produced by all mammals anywhere within the first 24 hours after giving birth. This first milk is different in that it is loaded with immune factors to be passed to the newborn that will give it the immune enhancing factors to help it survive in the world. Cow’s generally produce more colostrum than their calves need and the extra colostrum from pasture raised cows can be collected and can be utilized by humans without much difficulty. Since there is only minimal lactose and casein in the colostrum it is usually tolerated even by those with a sensitivity to milk products but in the event that someone is very sensitive then a very small amount can be taken until their immune system allow a larger dose.

Gogi Berries Often coined as “red diamonds” on the Asian market, the Goji berry has long been regarded as one of the most nutrient-rich superfoods on the planet, with ancient Chinese monks crediting this berry to greater health, vitality, longevity, energy, and stamina. Western science agrees that indeed this special berry has a remarkable nutritional profile, and it is now among the most highly sought after superfoods around.

Arguably among the most potent superfoods known, the goji berry offers an exceptional balance of daily macronutrients: containing carbohydrates, high-quality protein, healthy fat, and soluble fiber. The Goji’s solid plant-based protein is packed with 18 amino acids — including all 8 essential amino acids – which is 10% of the fruits composition. Also full of free-radical-devouring antioxidants, Goji berries have been historically used to support the immune system and longevity. Rich in vitamin A and a good source of vitamin C, these berries additionally possess over 20 trace minerals and vitamins including zinc, iron, phosphorus, riboflavin (B2), vitamin E, and carotenoids which include beta-carotene. And to put things in perspective on just how powerful the little Goji berry is, ounce per ounce it contains more vitamin C than oranges, more beta carotene than carrots, and more iron than soybeans or spinach. Goji berries are a truly remarkable food.

There may be some possible herb-drug interactions with Goji berries. If you take warfarin (a blood thinner), you may want to avoid goji berries. Goji berries may also interact with diabetes and blood pressure medicines. Also, if you have pollen allergies, you may want to stay away from this fruit. However, when eaten in moderation, Goji berries appear to be safe.

Himalayan Salt -Many people are unaware that common table salt is actually full of many forms of chemicals and even sugar! Salt, while necessary for life as we know it, can be dangerous if taken in this chemical form.
Commonly sold table salt is composed of 97.5% sodium chloride and 2.5% chemicals like iodine and absorbents, and sugar. Common salt is also dried at more than 1,200° Fahrenheit, a process which zaps many of the natural chemical structures of naturally-occuring salt.

Himalayan crystal salt is far superior to traditional iodized salt which is extremely toxic. Himalayan salt is millions of years old. It is a pure form of salt, untouched by many of the toxins and pollutants that pervade other forms of ocean salt.
Known in the Himalayas as “white gold,” even though some of the crystals have a pinkish hue, Himalayan Crystal Salt contains the same 84 natural minerals and elements found in the human body. This crystal form of salt has also been maturing over the past 250 million years under intense tectonic pressure, creating an environment of zero exposure to toxins and impurities.

Lucuma: Lucuma is considered a healthy alternative sweetener as it lends a sweet taste to recipes, but is very low in sugars. With naturally occurring beta-carotene, niacin, and iron, lucuma powder is a welcome antidote to notorious “empty calorie” sweeteners. The orange and yellow pulp of this exotic, sweet fruit was once hailed the “Gold of the Incas,” where it has been cultivated since ancient times. A native to the highlands of Peru, Chile, and Ecuador, the fruit of the beautiful evergreen lucuma tree has been honored spiritually as well as in cuisine due to its exquisite composition. Today, lucuma continues to enjoy enormous popularity in its native lands, and in some countries is actually favored over classics like chocolate and vanilla as an ice cream flavor.

Maca Maca is the powdered root of the Lepidium Meyenii plant. Known for its ability to support healthy energy levels, maca has been used by the Incas as a kind of “Incan superfood” for thousands of years.This superfood, grown in the high Andes mountains in Peru, is packed with vitamins, minerals, proteins, tannins, complex alkaloids and other phytochemicals. It’s one of the favorite powders to add to any smoothie, and it’s used by virtually all the raw foodies and superfood advocates. Maca is also a rich source of plant sterols, including sitosterol, campestrol, ergosterol, brassicasterol, and ergostadienol. From a mineral standpoint, maca exceeds both potatoes and carrots in value, and is a source of iron, magnesium, calcium, potassium, and iodine.

Macuna Pruriens -This indian adaptogenic herb has many beneficial qualities. It is one of the few herbs that is balancing to any of the three doshas (kapha, pitta, vata) that ayurvedic medicine talks about. It also contains L-Dopa which is low in Parkinsons patients. Additionally it helps build libido, helps with sleep, and helps with depression.
Mesquite Mesquite is of particularly great value to those looking to balance blood sugar levels. Mesquite flour offers a naturally sweet flavor to recipes, but its sugars are derived from fructose (which does not require insulin to digest and is readily metabolized). Additionally, the flour is an excellent form of fiber – meeting almost a quarter of daily needs in just two tablespoons – which not only improves digestion but further benefits sugar metabolism. Mesquite also contains lysine (an amino acid), as well as notable quantities of digestible protein, calcium, magnesium, potassium, iron and zinc. As such a balanced food, it is easy to see why our Native American ancestors relied so heavily on mesquite as a staple form of delicious nourishment. Mesquite is in the carob family and has a mildly sweet taste.

Olive Leaf -While it is known that olive oil contains a healthy monosaturated fat called oleic acid with a number benefits, it is now known that the leaf is also full of medicinal benefits too. Olive leaf is rich in several phenolic compounds such as oleuropein, hydroxytyrosol, tyrosol, rutin, luteolin, catechin, and apigenin along with a wide range of amino acids, vitamin C, and minerals. Together these compounds make Olive leaf a potent antioxidant superfood. In terms of measuring a food’s antioxidant potential there is a measurement called the ORAC scale. This stands for Oxygen Radical Absorbance Capacity. This is a measurement of a foods ability to soak up free radicals like a paper towel can pick up a spill. According to Jonny Bowden PhD olive leaf scores higher on the ORAC scale at 7608 compared to Gogi Juice at 1215, Acai Juice 900, Mangosteen Juice 855, and Noni Juice at 270. It has also been shown to lower blood pressure and to lower blood sugar levels.

Noni Raw unpasteurized Morinda (Noni) is far superior to the pasteurized diluted with fruit juice Noni juice sold in bottles. It is a tropical fruit that has incredible antimicrobial properties. It can be used to kill virus,’ bacteria, spirochetes, parasites, and fungal overgrowth.

Pine Pollen (Pinus Pini) has been used in Chinese and Korean medicine for over 2000 years. It has been shown to restore energy, slow down aging, battle fatigue, and build a strong immune system. It has also been shown to increase testosterone levels in the blood.

Pomegranate Powder Potent antioxidant with significant amounts of vitamin A,C,E, and folic acid.

Reishi Reishi Mushroom (Ganoderma Lucidum) has been used in the far east for almost 4000 years. In China it is called Ling Zhi (mushroom of immortality). Aside for being used as a longevity herb, in also is useful for kidney and lung disorders, ulcers, fatigue, insomnia, and heart disease. The bioactivity is due to over 100 different polysaccharides including beta-glucan, tri terpines, proteins, sterols, minerals (including germanium) and fatty acids. There have been studies showing it to be effective against H.Pylori, and certain species of Klebsiella along with fungal and parasitic issues too. It also has chemoprotective, anti-inflammatory, hepatoprotective, and anti-oxidative properties. Studies have shown it to activate T-cells and certain cytokines, especially IL-2, as well as macrophages. It can act as a mast cell inhibitor leading to an inhibition of histamine release. It can also lower cholesterol, and blood pressure and minimize the methylxanthine reactions from too much theobromine in coffee, tea, chocolate, etc.

Osteoporosis
A Holistic Approach
Dr. Paul Goldstein
732-271-0400

Introduction
Osteoporosis is not a normal consequence of aging. It is the end result of a chronic imbalance of nutrients, lack of physical activity, and disruption of hormones and neurotransmitters from the chronic overexposure of chemicals in our food, water, air, and modern way of life. It is estimated that there are 10 million Americans diagnosed with osteoporosis and an estimated 30-50% of women and 15-30% of men will sustain an osteoporosis related fracture in their lifetime. The Pharmaceutical industry does offer drugs for this problem, but they do have serious side effects and in my opinion a more comprehensive and holistic approach should be given greater consideration.

Bone is Dynamic
Within bone there are cells that build more bone called Osteoblasts. There are also cells that break down bone cells that are called Osteoclasts. This is an ongoing negative feedback process and occurs like it does in any other part of the body. Osteoporosis is the net loss of bone cells in relation to the net addition to new bone cells. This is called a catabolic state. If there were a net gain of new bone cells it would be called an anabolic state. Over time, this catabolic state that exists within bone results in osteoporosis and a lowered Bone Mineral Density (BMD).

Diagnosistic Testing
Most diagnosis’ of osteoporosis or BMD deficits are made from an extremely safe test called a DXA scan. The results are given in T and Z score. T compares your BMD to normal and Z compares your score to others in your age and gender group. The WHO (World Health Organization), says normal T scores are greater than or equal to -1.0. Low bone mass is between -2.5 and -1.0. Osteoporosis is a having a T score of -2.5 or less and severe osteoporosis is having a T score or BMD of -2.5 or less with a history of fragility fractures.

Some doctors will test to see if you have an elevated Bone Resorption Test which would contribute to the catabolic state mentioned above. If it is elevated then that measures an overactive osteoclastic situation and bone loss, and you now have a baseline to gauge improvement of therapy. One bone resorption test is N-Telopeptide (NTX) which measures small molecules of bone collagen being excreted through the urine. A reduction in NTX means a reduction in bone loss and less risk for fractures. Another bone resorption test is C-Telopeptide (CTX). This measures a different part of the collagen molecule and can be done through urine or blood. The last bone resorption test is Deoxypyridinoline (DPD). This is also tested through urine.

There are also Bone Formation Markers to test the osteoblasts ability to form bone. If the bone resorption tests are normal, then the problem in an abnormal T score could be from abnormal osteoblastic activity to build bone. The first test for bone formation is Osteocalcin. This is a protein produced by osteoblasts and is important for activating the mineralization of bone. It is dependant on vitamin K for its function. Another bone formation test is Bone Specific Alkaline Phosphatase (bsALP). This detects early signs of osteoblastic activity, and over suppression of bone resorption during bisphosphonate therapy. Taking bisphosphonates can over suppress osteoclastic activity and consequently by a disturbed negative feedback loop inhibit the osteoblastic process that you desire. Therefore if the bsALP falls too low, it may signal taking a break from the medication. The last test for bone formation is P1NP which is only used to test the amount of collagen in your blood and if a patient is considered to have severe osteoporosis and is considering the injectible medication Teriparatide (Forteo).

Aside from these specialized tests there are more common tests that are essential to see a bigger picture of what is happening in an osteoporosis patient. A mineral assessment such as Calcium, Magnesium, Phosphorus, and Potassium can easily be checked on a blood test. Vitamin D (25-hydroxy), and Vitamin K can also be checked along with Parathyroid hormone which helps maintain blood calcium and phosphorus levels. It is the active form of vitamin D (1,2-dihydroxy) that is converted into calcitriol in the kidneys in order to increase calcium absorption in the intestines which then activates a negative feedback loop to the thyroid to release Calcitonin (a thyroid hormone) to lower blood calcium. Measuring estrogen, progesterone, DHEA, and testosterone in both males and females is useful too because of the anabolic effects of these hormones. Conversely measuring cortisol which is a stress hormone produced by the adrenal glands would measure the catabolic effects.

Another important test is Insulin Growth Factor 1or (IGF-1). Very similar to Insulin, it acts to increase muscle mass and bone density. Protein intake stimulates IGF-1 production. 1.0-1.5 grams of protein for each kg (or 2.2 lbs) of body weight is a good measurement to remember. However, too much animal protein, and refined carbohydrates will make your body too acidic and your body will buffer the acidity with the release of alkalizing minerals like Calcium and Magnesium resulting in a net loss of minerals. Checking your oral and urine ph with a specialized ph paper can give you the feedback as to whether your diet is more acid forming or alkaline forming and this can reveal the consequences of your daily food intake.

There are other tests to consider that are not as well known. These tests fall into a category of testing for functional problems. One of the theories about the loss of bone is that since it is dynamic tissue it is prone to the same problems of other tissue in the body that might be under stress. For instance if someone has a food sensitivity the tissue in the gastrointestinal tract becomes inflamed and causes damage to the absorptive potential of the villi of the small intestine and also the lymph nodes (Peyers Patches) of the small intestine. Therefore it is easy to see how those same stresses to the immune system of intestinal system might also affect the immune system of the bone marrow too. Inflammation is likely to be a key factor in uncovering a holistic approach to improving BMD since there is evidence that inflammation causes the bone marrow to become more fatty, crowding out osteoblasts and decreasing the production of red blood cells. This is why osteoporosis patients are also frequently anemic. The tests for inflammation might include a stool analysis to see if there are markers such as Lysozyme or Alpha Anti-Chymotrypsin causing inflammation in the small or large intestine. On blood tests sedimentation rate, C reactive protein, and Homocysteine would be tests that could be run to analyze inflammation as a problem. Tests like Interleukin 2, Interleukin 6 and Tumor Necrosis Factor (TNF) are considered inflammatory cytokines that also signal immune system stress and inflammation. Once any of these are identified as a problem, then the next step is to stop the inflammation through diet modification and through dietary supplements.

Drug Therapy and its consequences
The most common prescription for osteoporosis is Biphosphonates. Short term use of Biphosphonates does reduce bone fracture risk but it does not reduce inflammation and it has its associated side effects such as stomach pain, and joint pain. In essence it is like putting a fire retardant blanket over the embers of a campfire. The heat and inflammation are still there smoking under cover and the insidious inflammatory process is still at work.

Are you Catabolic or Anabolic?
This is the key question in understanding the risk you have for Osteoporosis. If your body has an acidic ph level, if you have markers for inflammation that are elevated, if you have cortisol imbalances due to high stress from work or other issues, if you have chronic stress to your immune system from various sources, if you have toxicity from a poor diet or environmental exposure, this will all contribute to inflammation and a Catabolic state and the breakdown of bone tissue. This breakdown is not normal and can be reversed. However the consequences of any of these factors took years to develop and it could take years to normalize.

How to become Anabolic
If you have an acidic ph you will want to incorporate more vegetables and fruits into your diet. An approach that is becoming more popular is juicing or blending your fruits and vegetables. It is easier to juice a few carrots, some celery and an apple for breakfast than it is to sit down and eat those foods. Without the fiber the nutrients from those foods will be rapidly absorbed and the benefits will accumulate over time. Blending some foods is beneficial but some foods like carrots can be difficult to blend completely. There are high speed blenders like the Vitamixer that can do a decent job of it but it might be most beneficial to do both. Eating a diet that is high in animal protein and carbohydrates is acid forming and will not alkalize you so those foods should be kept to a minimum.

Running lab tests to observe the changes in blood and urine chemistry for inflammation and repeating bone density testing is how you can observe improvement and hopefully get off medication for osteoporosis if you are on it.