New York Times Highlights Necessity to Prevent Fractures

On November 7, 2008 the New York Times ran a story titled, Once Just an Aging Sign, Falls Merit Complex Care. This article highlights the dangers many people face with fractures as they age. I encourage everyone read this article and begin educating themselves about fragility fractures, which are fractures that occur as a result of fragile bones.

With the population aging rapidly, this issue will strain our healthcare system unless doctors and the general public embrace aggressive, preventative measures. There are two major factors that predispose people to fragility fractures. First, is bone health. The second is the risk of falls.

Currently bone health is only measured by a bone density scan, called a DEXA scan. DEXA scans, however, only measure the amount of minerals in bone, thus their "density." However, they do not measure bone quality. Yes, DEXA scans can be predictive of fracture risk, but relying only on bone mineral density is a grave mistake that literally can kill, because it alone does not predict well enough the risk for fractures. In fact, the World Health Organization (WHO) is recommending doctors and patients begin taking a more comprehensive view of osteoporosis, and move away from the narrow view of looking just at bone mineral density, to evaluating fracture risk as a whole.

As discussed in our article, Osteoporosis: Beyond Bone Mineral Density (Part 1), which was the cover article for the journal Integrative Medicine, 12-40% of the elderly who sustain a hip fracture die within six months. The cost for treating the more than 2 million osteoporotic fractures that occurred in 2005 was nearly $17 billion.

The standard of care for osteoporosis is drug therapy with medications such as Fosamax and Actonel. However, many people are unable to take these medications due to their side effects they can create, such as ulcers. And even if they were to take these medications, they decrease fracture risk by less than 50%.

Research now shows that the best way to reduce fracture risk is to take high doses of vitamin K2, along with supporting nutrients such as vitamin D and calcium. There have been many clinical trials using vitamin K2. So many, in fact, that the esteemed Archives of Internal Medicine published a review of all the clinical trials for osteoporosis that used vitamin K2. The researchers concluded that 45 mg of vitamin K2 (as MK-4) decreases the risk of vertebral fractures by 60%, hip fractures by 71% and all nonvertebral fractures by 81%.

The research on 45 mg daily of vitamin K2 (MK4) points to it being better than Fosamax without any of the Fosamax side effects. Additionally, evidence is accumulating that taking Fosamax for five years or more may actually increase your risk of fracture because Fosamax increases bone density without enhancing bone quality. Bone quality refers to the complex mixture of minerals and connective tissue that help bone absorb an impact from a fall without breaking. Vitamin K2 (MK-4), on the other hand, works by promoting formation of the connectivce tissue in bone, thereby allowing bone to better absorb the impact from a fall without breaking.

There are several different forms of vitamin K--K1, K2 and K3. And even within these forms, such as vitamin K2, there are different sub-forms (eg, vitamin K2 as MK-7 or MK-4). And readers must understand the only form and dose shown in clinical trials to reduce fracture risk is 45 mg of vitamin K2 as MK-4. When trying to promote bone health naturally, it's crucial that people only take dietary supplements with the amount and form of nutrients shown in clinical trials to protect them.

The only bone formula currently on the market that contains this amount of vitamin K2, plus calcium and vitamin D is Osteo-K, which I formulated with my partner, Dr. Steve Pieczenik, who has a MD from Cornell Medical College, a PhD from MIT, and who was a board examiner in both Neurology and Psychiatry. We created this product for two reasons. In searching for ways to help my patients in my clinic, Montana Integrative Medicine, I was unable to find a dietary supplement that contained the dose and form of nutrients shown in clinical trials to reduce fracture risk. We created this product also because Dr. Pieczenik's wife was unable to take Fosamax due to its side effects.

Some people ask if vitamin K2 increases clotting risk because they've heard that people taking blood thinners such as warfarin (eg, coumadin) shouldn't take extra vitamin K. Clinical trials that used vitamin K2 evaluated this question and showed no increase in the tendency to clot. However, people taking coumadin should absolutely not take extra vitamin K as a dietary supplement unless they speak with their healthcare provider first.

In addition to prescribing Osteo-K to my patients to help them prevent fractures, I also discuss other ways in which they can decrease their risk. A major factor for fractures is the risk for falling. The North American Menopasue Society (NAMS) has published very practical recommendations for decreasing this risk, which include ensuring optimal lighting, removing clutter and low-lying objects from the environment and providing non-skid rugs, among others. The complete table of recommendations can be viewed in our Osteoporosis patient handout, Preventing Osteoporosis and Modifying Fracture Risk, which accompanied our Osteoporosis: Beyond Bone Mineral Density (Part 1) article in the journal Integrative Medicine.

The bottom line is this: the best evidence-based medical research points to the powerful role vitamin K2 (MK-4) can play in reducing fractures. The only dietary supplement that contains the form and amount of this nutrient is Osteo-K.

Mercury Fillings--The FDA Forced to Change its Position

I received an email tonight with fantastic news. After 30 years of defending the use of toxic mercury fillings, the FDA is being forced to restate its position. A team of lawyers and consumer advocacy groups should be thanked for working tirelessly to help protect the public. Below is the email I received, which was written by Charles G. Brown, National Counsel for Consumers for Dental Choice.

If you have mercury amalgam fillings, you should speak to a dentist who specializes in mercury-free dentistry to see if you should have yours removed. You should also consider being tested for mercury accumulation in your body. Mercury toxicity can cause anxiety, autoimmune diseases, depression, fatigue, hair loss, insomnia, irritability, memory loss, recurrent infections, restlessness, tremors and ulcers.

To learn more, read the article, "Heavy-Metal Toxicity--With Emphasis on Mercury" and accompanying patient handout, "Toxic Metal Contamination: Mercury." These were written by Drs. John Neustadt, ND and Steve Pieczenik, MD, PhD and published in 2007 in the journal, Integrative Medicine.

* * *

And now, here is the email message written by Charles G. Brown:

We have won our ten-year battle to get the Food and Drug Administration to comply with the law and set a date to classify mercury amalgam.

On Monday, we settled our lawsuit, Moms Against Mercury et al. v. Von Eschenbach, Commissioner, et al . FDA will finish classifying within one year of the close of the public comment period on its amalgam policy, that is, by July 28, 2009.

There’s more good news. During a several hour negotiation session, FDA agreed to change its website on amalgam -- dramatically. Gone, gone, gone are all of FDA’s claims that no science exists that amalgam is unsafe, or that other countries have acted for environmental reasons only, or that the 2006 Scientific Panel vote affirmed amalgam’s safety. Instead -- see http://www.fda.gov/cdrh/consumer/amalgams.html -- FDA has moved to a neutral course, while recognizing the serious health concerns posed by amalgam in particular for children and unborn children, for pregnant women, for those with mercury immuno-sensitivity or high mercury body burdens. FDA now states, for example:

“Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetus.”

“Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner.”

Perfect? No. A 180-degree reversal from FDA’s 30-year policy of protecting mercury fillings? Absolutely.

To change FDA policy, we tried petitions, Congressional hearings, state fact sheet laws, Scientific Advisory Committee hearings, and letters galore -- to no avail. So in the great American tradition, we sued. The case came to a head this spring. On April 22, working with Johann Wehrle and Gwen Smith, I filed a motion for an injunction before Judge Ellen Huvelle. Three sets of briefs later, the government and I presented our oral arguments on May 16. In a crucial ruling, Judge Huvelle ruled that our 11 plaintiffs -- the diverse group listed below -- have standing. She said FDA should classify, and invited the two sides to mediate. On May 30, before Magistrate Judge John Facciola, Bob Reeves (who flew in from Lexington KY) and I hammered out an agreement with FDA officials and lawyers.

The impact of the re-writing of its position on amalgam can hardly be understated. FDA’s website will no longer be cited by the American Dental Association in public hearings. FDA shows awareness of the key issues involved. As it prepares to classify amalgam, FDA has moved to a position of neutrality. Indeed, having repeatedly raised the question of amalgam’s risk to children, young women, and the immuno-sensitive persons in its website, I find it inconceivable that FDA will not in some way protect them in its upcoming rule.

PS 1: Our talented (and pro bono publico ) legal team includes Consumers for Dental Choice president Sandy Duffy, Bob Reeves, Johann Wehrle, Sandra Keech, Mike McClory, and Gwen Smith; Larry Pilot served as legal advisor on the FDCA.

PS 2: Great appreciation to our gutsy plaintiffs, a team of four nonprofit groups, two public officials, three dental professionals, and two consumer victims: Moms Against Mercury (Amy Carson and Angela Medlin), Connecticut Coalition for Environmental Justice (Dr. Mark Mitchell), Oregonians for Life (Mary Starrett), mercury expert Michael Bender (in his capacity as Commissioner of a Vermont advisory board on mercury), Arizona Senator Karen Johnson, Dr. Andy Landerman, Dr. Corrie Crowe, dental assistant Karen Palmer, consumer advocates Linda Brocato and Anita Vazquez Tibau, and (of course) Consumers for Dental Choice.

More Bad News for The Pharmaceutical Industry--A Broken Paradigm

Note: This blog is a reprint of a Guest Opinion piece written in August 2007 by Drs. John Neustadt and Steve Pieczenik, and published in the Bozeman Daily Chronicle.

The news for the pharmaceutical industry has been very bad lately. A study published in the August 2007 issue of the Journal of the American Geriatrics Society conclude that people who use the histamine-2 receptor antagonists (“H2 blockers”) medications that block stomach acid, which include Zantac, Prilosec and Tagamet, have a nearly 250% increased risk of dementia.

Just a few months earlier, in May 2007, the US Food and Drug Administration (FDA) issued a warning for the diabetes medication, Avandia, which was shown to increase the risk of heart attacks by 30-40 percent, and last year the Journal of the American Medical Association (JAMA) reported that the risk of hip fracture increases by 22% after one year and nearly 60% after four years in people taking proton-pump inhibitors, another class of stomach acid blocking medications that includes Prilosec, Nexium, Prevacid. These revelations are just the surface of a very serious problem in the American healthcare system that are putting millions of people at risk.

This story of medications causing dangerous, sometimes fatal, adverse effects is not new. Another JAMA study in 1998 concluded that fatal drug reactions for hospital patients “appear to be between the fourth and sixth leading cause of death,” and that the rate of fatal drug reactions had been stable for the past 30 years, killing more than 100,000 people annually. We don’t want to give the impression that we condemn pharmaceuticals; however, the data are clear, medications can be very dangerous as well as very helpful. One has to always balance out the potential risks with the potential benefits, and that discussion should always be between you and your physician.

It’s not even that pharmaceuticals per se are the culprit, but it’s the underlying paradigm in medicine that needs to be changed. The current philosophy underlying medicine today is that diagnoses are based on symptoms and treated with medications to simply suppress the symptoms instead of identifying and treating the underlying causes of disease. For example, depression is treated conventionally by prescribing antidepressant medications, which, while they may be very helpful, do nothing to correct the underlying biochemical causes of the depression. Taking Prozac may lift someone’s mood and help them through a difficult period, but no one has a deficiency in Prozac.

In contrast, a medical system that approaches diseases by first evaluating the underlying biochemical causes of the disease and then correcting them using targeted biochemical therapies, can correct the underlying causes. The biochemical pathways for depression are well documented. Without being too complicated, the mood-lifting hormone serotonin is produced in the body by transforming the amino acid tryptophan into serotonin, and requires vitamin B6 and magnesium to do so. There are other relevant pathways for generating mood and energy, but this simple example illustrates a central point about the underlying biochemical dynamics of depression.

The concept of causality versus symptoms is a major shift in paradigm, which the pharmaceutical companies and the medical profession in general have not accepted. The premises for this new biochemical medicine are simple:

• Premise 1: health and disease are biochemical;
• Premise 2: if someone was healthy and they’re not now, something’s changed in their biochemistry;
• Premise 3: if you identify and treat the underlying biochemical dysfunction(s), disease may be prevented and cured.

Dr. Pieczenik’s case is a perfect example. Several years ago he was diagnosed with mature-onset asthma, for which he was prescribed steroids and an inhaler. He refused to take these medications because he knew that they would cause their own adverse effects. Instead, he made an appointment with Dr. Neustadt, who ordered a comprehensive biochemical screen that tested more than 450 variables of biochemical function. Biochemical testing revealed the underlying cause for Dr. Pieczenik’s asthma. His symptoms resulted from an inability to produce the hormone epinephrine, which is a bronchodilator, because he became deficient in copper, which is required to convert the amino acid tyrosine to epinephrine. Within two weeks of starting the therapy to realign his copper, all of his breathing difficulties stopped and he has had no breathing problem since then.

The problems with the pharmaceutical industry and our current medical system stem from an inherently incorrect philosophy where symptoms are treated and not their causes, and medical testing does not evaluate the underlying biochemical causes of disease.

These revolutionary concepts in medicine and how they can help you are described in great detail in the book, A Revolution in Health through Nutritional Biochemistry, written by Drs. Neustadt and Pieczenik. It is available on Amazon.com.

About Drs. Neustadt and Pieczenik
John Neustadt ND studied naturopathic medicine at Bastyr University, is clinic director of Montana Integrative Medicine (www.montanaim.com) and president of NBI Testing and Consulting Corp (NBITC, www.nbitesting.com) and Nutritional Biochemistry, Inc. (NBI, www.nbihealth.com) in Bozeman, Mont. He is an editor of the next edition of the textbook, Laboratory Evaluations for Integrative and Functional Medicine, and the author of the books, Thriving through Dialysis with Jonathan Wright, MD and A Revolution in Health through Nutritional Biochemistry with Steve Pieczenik, MD, PhD.

Steve Pieczenik MD, PhD, trained at Cornell, Harvard and MIT. He is a board certified psychiatrist, was a board examiner in neurology and psychiatry and is chairman of NBITC and NBI.

Prolotherapy, A Safe and Effective Treatment for Musculoskeletal Pain

"I have been a patient who has benefited from Prolotherapy....My intractable pain was not intractable and I was remarkably improved."

--Former U.S. Surgeon General C. Everett Koop

"Prolotherapy was the right choice for me. My knee joint was painful, hot to the touch, and the knee cap snapped and popped. X-rays showed the joint had deteriorated significantly. After three treatments the ligaments and tendons had regained normal function and flexibility and I was pain free. Prolotherapy is a proven technique that has been around since the 1930s and I had read about it in golf magazines. Unlike cortisone, an injection which masks the pain, Prolotherapy restores joint integrity. Prolotherapy costs significantly less than orthopedic surgery and with no downtime. I had not realized that over time I had given up horseback riding, golfing, hiking, snowshoeing, and cross country skiing because it hurt. I no longer use the excuse 'I can't, I have bad knees.' I'm enjoying an active life again thanks to Dr. Neustadt and Prolotherapy."

--Joan, age 54, Bozeman, MT

* * *

Musculoskeletal pain can be debilitating. Whether it's pain in the knees, low back, neck wrists or ankles, everyone experiences this discomfort at some time in their lives. It's been estimated that over their lifetime, 80% of Americans suffer from low back pain. There are many potential reasons for musculoskeletal pain. It can be from tight muscles, from direct injury from sports or a car accident, and even from food allergies or infections. But the most commonly overlooked cause of musculoskeletal pain is ligament or tendon instability.

Ligaments are bands of connective tissue that connect two or more bones. Tendons are bands of connective tissue that connect muscles to bone. Both of these structures--ligaments and tendons--are frequently damaged just by normal wear and tear. There are a lot of nerves at the spots where the ligaments and tendons attach to bones. When the ligaments and tendons are weakened, additional stress can be placed on these attachments and cause pain. George Hackett, MD, one of the founders of the modern techniques and education in prolotherapy in the U.S. concluded that up to 90% of people have degenerative changes in their weight bearing joints (low back, hips, knees, etc.) by the age of 40.

There are many causes for pain, and an integrative pain specialist will conduct a thorough interview with the patient and a detailed physical exam. Many pain treatments just suppress the symptoms with anti-inflammatories (eg, Aleve, Ibuprofen, Tylenol) and steroids. However, if the underlying cause is ligament or tendon instability, then in most cases it can be corrected with prolotherapy. The pain is relieved and function is restored.

Prolotherapy is a simple, natural technique. It has been used and studied for more than 70 years. Usually all that's injected is a simple solution contain dextrose, glucosamine, some vitamin B12 and a local anesthetic.

The underlying cause of musculoskeletal pain is often a weakened ligament. Prolotherapy can restore joint integrity and relieve pain from:

• arthritis
  
• whiplash
  
• sciatica
  
• disk problems
  
• low back pain
  
• rotator cuff (shoulder) pain
  
• tennis elbow
  
• old sports injuries that are now acting up
  
• knee pain (osteoarthritis, ACL or PCL injuries)
  
• TMJ (temporomandibular joint) dysfunction.
  

Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body's healing system, a process called inflammation. The technique involves the injection of a proliferant (a mild irritant solution) that causes an inflammatory response which "turns on" the healing process. The growth of new ligament and tendon tissue is then stimulated. The ligaments and tendons produced after Prolotherapy appear much the same as normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, testifying to the new and ongoing creation of tissue. The ligament and tendon tissue which forms as a result of Prolotherapy is thicker and stronger than normal tissue, up to 40% stronger in some cases!

The concept of strengthening ligaments goes back to the time of Hippocrates. Reports of shoulder joint instability and its many repair methods date back to Hippocrates' treatise, "On Joints." Hippocrates described the practice of using cautery to cause the capsule to scar and thus tighten around the joint. While his technique is no longer used, the underlying concept is similar to Prolotherapy—strengthen the ligaments.

In the 1930s many case reports emerged in France and the United States of musculoskeletal disorders, such asTMJ, knee pain, and sacroiliac joint (SI joint, which holds yourpelvis to your lower back), being successfully treated with Prolotherapy. In 1956, George Hackett, MD, a surgeon, published thefirst edition of the textbook Ligament and Tendon Relaxation Treated by Prolotherapy. Dr. Hackett reported a 12-year success rate of 82% in the treatment of 1,800 patients with back pain using Prolotherapy.

Then, in 1983, microscopic examination of rabbit tendons after Prolotherapy treatment confirmed the that Prolotherapy stimulates connective tissue repair. This study was published in the journal, Connective Tissue Research (Liu YK, Tipton CM, Matthes RD, Bedford TG, Maynard JA, Walmer HC. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. 1983;11[2-3]:95-102). Another landmark study was published in 1987 in the prestigious journal Lancet by Dr. Thomas Dorman. The study demonstrated the effectiveness of using Prolotherapy to treat back pain (Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LF. A new approach to treatment of chronic low back pain. 1987;2:143-146). Interestingly, Dr. Dorman was Dr. Neustadt's mentor. Dr. Neustadt spent more than 300 hours studying directly with Dr. Dorman at Dr. Dorman's private clinic, the Paracelsus Clinic in Kent, WA (www.paracelsusclinic.com).

More recently, in 2005, the Mayo Clinic featured Prolotherapy in its Health Letter publication, which stated that Prolotherapy stimulates tissue growth and is used for tendon and ligament pain (Alternative Treatments. Dealing with Chronic Pain. Mayo Clinic Health Letter. 2005 Apr;23(4):1-3). Numerous clinical trials have proven Prolotherapy to be helpful in the treatment of musculoskeletal pain.

You may also learn more by reading Dr. Neustadt's FAQ on prolotherapy and a summary of Prolotherapy Research.

Guide to Dietary Supplements

Dr. Steve and I have been traveling and speaking with retailers, physicians and the general public about nutrition, medicine and dietary supplements. One thing has become glaringly clear to us. Nearly everyone out there has no idea how to evaluate the quality of a dietary supplement. We therefore created our NBI Interpretive Guide to Dietary Supplements, which you can download by clicking here. The Guide is written in an easy-to-understand, Frequently Asked Questions, format. Questions that you get answers to include,

1. Should I take dietary supplement?
2. How do I know if a dietary supplement is good?
3. Are there any potentially toxic nutrients?
   

We are actively working to educate retailers on how to best evaluate dietary supplements so that they can provide the best advice to you, the consumer. NBI Health nutraceuticals are now being carried by Rosauer's Huckleberry market, Medicine Shoppe, Montana Harvest, Gesundheit! Nutrition Centers, other retailers and physicians across the country.

Ask that your local health food store starts carrying NBI Health formulas so that you, your family, neighbors and friends will have easier access to these high-quality nutrients.

Oprah's Thyroid

My wife Romi, a big Oprah fan, showed me the October 2007 issue of O Magazine, in which she discussed her recent struggle with hypothyroidism (low thyroid function). Oprah's public discussion of her health issues has brought widespread attention to this condition. Thyroid hormone is sometimes called the "master hormone" since it affects every system in the body. That's why I wanted to spend some time educating my readers about this essential element to good health.

The thyroid gland is a butterfly-shaped gland at the base of the neck. It produces the thyroid hormones levothyroxin (T4) and triiodo-thyronine (T3). About 80% of thyroid hormone is T4 and about 20% is T3. T4 is inactive and is converted into active T3 in different tissues in the body.

This is why low thyroid function can cause such wide-ranging symptoms. According to the Merck Manual, the American Association of Clinical Endocrinologists, and the Thyroid Foundation of America symptoms of hypothyroidism in adults include feeling cold; depression; fatigue; weight gain; inability to lose weight; coarse, dry hair that is brittle and falling out; constipation; dry, coarse skin; puffiness or swelling around the eyes; joint aches; restlessness; forgetfulness; decreased sex drive; and more frequent infections. And this is just a partial list. Low thyroid function can also occur in neonates and children, which requires immediate medical attention as it can cause stunted growth and developmental delays.

Within adults there are two general categories of hypothyroidism--autoimmune and non-autoimmune. An autoimmune condition is one where the immune system attacks the person's own tissues. Autoimmune thyroid dysfunction is called Hashimotos Thyroiditis after the doctor who discovered it in 1912. There appears to be a genetic link, as Hashimoto Thyroiditis tends to run in families. Therefore, if a relative of yours has been diagnosed with an autoimmune thyroid condition and you are experiencing any of the symptoms above, you may want to get your thyroid tested. More on thyroid testing in a moment.

If the reason for low thyroid function is not an autoimmune condition, there are several explanations. First, some medications and diseases may decrease thyroid function. Second, it may be that the conversion of T4 (inactive thyroid hormone) to T3 (active thyroid hormone) is not happening well enough. This conversion requires the minerals selenium and zinc. If a person is deficient in either of these nutrients, they could have difficulty creating T3. This condition is called "functional hypothyroidism" because your thyroid gland is producing enough of the thyroid hormones, but they're not being transformed into the active form. Additionally, high levels of cortisol, a stress hormone secreted when people are under stress, inhibits the creation of T3.

Finally, thyroid hormones come from the phenylalanine, an essential amino acid, meaning that your body cannot produce it, but that it must be ingested from food or dietary supplements. Phenylalanine is transformed in the body to tyrosine, which requires iron, and then down its pathway to form thyroid hormones.

While there can be many different explanations for the myriad symptoms associated with hypothyroidism, a comprehensive thyroid evaluation includes a physical exam and blood tests for TSH (thyroid stimulating hormone), Free T4, Total T3, red blood cell intracellular selenium and zinc, serum ferritin (the most sensitive laboratory indicator of iron deficiency) and plasma amino acids. If an autoimmune hypothyroid condition needs to be ruled out, then your doctor will order an antithyroglobulin antibody and antithyroid microsomal antibody blood tests.

Unfortunately, conventional medical screening for thyroid function does not test for the actual thyroid hormones themselves or for any of the nutritional factors required to produce and activate thyroid hormones. Instead, the standard screening test for low thyroid function is a measurement of TSH, which is actually produced in a region of the brain called the anterior pituitary gland. Its role is to stimulate the production T4 and T3 in the thyroid gland. In "functional hypothyroidism" the TSH and T4 are normal, but the T3 is low. This may simply be due to low selenium or zinc.

People who only receive the conventional medical workup can experience depression, fatigue, difficulty losing weight, and frequent coldness when the underlying cause may be low thyroid function because of nutritional deficiencies and/or chronic stress. I have had many cases of people with normal TSH, normal T4 and low T3, which have been corrected by identifying nutritional deficiencies and prescribing those nutrients to the patients.

This leads me to the interpretation of the TSH test. Many labs are still relying on the old reference range, which has an upper limit of normal of 5.0. An elevated TSH is the laboratory criteria for diagnosing hypothyroidism. However, what is considered "normal" has been changing. In 2002 the American Association of Clinical Endocrinologists (AACE) recommended that upper limit of normal be lowered to 3.0, and also in 2002 the National Academy of Clinical Biochemistry (NACB) suggested the correct upper range of normal will someday be lowered to 2.5.

Many clinicians use a combination of laboratory values and symptoms to determine when to treat, and most, including myself, will consider prescribing thyroid replacement hormone when the TSH is 2.5-5.0 when the patient is symptomatic and other causes are ruled out. If your TSH is greater than 2.5 and you are symptomatic, you may want to discuss with your doctor if it's appropriate to try low-dose thyroid replacement hormone.

The thyroid gland is incredibly important. If you have not been getting regular thyroid tests at your annual physicals, I recommend you do so. At the very least, get your TSH checked regularly.

(Note: Dr. Neustadt was voted as one of the leading thyroid doctors in the Thyroid Top Doctors Directory.)

Osteoporosis--Don't Forget Vitamin K2

Osteoporosis is a major health concern in the United States and leads to an inability to do normal, daily tasks and even early death. More than 10 million people in the U.S. have been diagnosed with osteoporosis, and the National Osteoporosis Foundation indicates that 44 million people are at risk for the disease by virtue of having low bone mineral densities. Each year 1.5 million fractures occur in people with osteoporosis. The cost of treating fractures of the spine alone is more than $745 million. Hip fractures are more expensive still.

People with osteoporosis are at an increased risk for fractures, particularly of weight-bearing bones such as the hip and spine. Debilitating acute and chronic pain in the elderly is often attributed to fractures from osteoporosis and can lead to further disability. Fractures of the hip and spine have a 15% greater chance of dying within five years than people without these fractures. After a hip fracture, only 50% of people regain the same level of independence they had before the injury, and 12 to 40% of patients who suffer hip fractures die within 6 months.

While calcium and vitamin D are important, they aren't the whole story. In fact, clinical trials mostly conclude that these two nutrients decrease the rate of bone loss, but don't necessarily decrease the risk of fracture. Decreasing fracture risk is the most important thing for preventing complications from osteoporosis. In fact, the only risk from osteoporosis is fractures, so what people really should be looking as is the ability for a drug or nutrient to decrease fracture risk.

Well, the best nutrient for your bones turns out not to be vitamin D or calcium, although they are important. The most important is Vitamin K2. There have been many clinical trials using vitamin K2. So many, in fact, that the esteemed Archives of Internal Medicine published a review of all the clinical trials for osteoporosis that used vitamin K2. The researchers concluded that 45 mg of vitamin K2 decreases the risk of vertebral fractures by 60%, hip fractures by 71% and all nonvertebral fractures by 81%. This is better than Fosamax without any of the Fosamax side effects.

The only bone formula currently on the market that contains this amount of vitamin K2, plus calcium and vitamin D is Osteo-K, which was formulated by Dr. Neustadt to help his patients. It's now available to anyone in stores and online at www.nbihealth.com. Don't wait until it's too late. Take Osteo-K.

Some people ask if vitamin K2 increases clotting risk because they've heard that people taking blood thinners such as warfarin (eg, coumadin) shouldn't take extra vitamin K. Clinical trials that used vitamin K2 evaluated this question and showed no increase in the tendency to clot. However, people taking coumadin should absolutely not take extra vitamin K as a dietary supplement unless they speak with their healthcare provider first.

To your health,

Dr. Neustadt