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.

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 physicians from Cornell, Harvard, MIT and Bastyr. 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.

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 Center, 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.

Buyer Beware!

Currently the US FDA does not require manufacturers test their products for purity and potency, so it really is a "buyer beware" situation. If you're not an educated consumer, you are at an extremely high risk for toxic metals exposure and for wasting your money by buying nutrients that your body cannot absorb. This section aims to educate you on how to choose the highest quality dietary supplements so you can enjoy all the health benefits and protect you and your family.

Repeatedly peole ask us what makes a good dietary supplement. Unfortunately, there’s a lot of confusion out there. Too often, people simply pick the cheapest one-a-day product off the shelf. However, people would be better off, and possibly healthier, not buying any supplement based on price or the one-tablet-per-day formulas. There are two issues here. First, numerous studies have detected dangerous levels of toxic metals in dietary supplements. And second, these dietary supplements contain vital nutrients such as magnesium, copper and zinc, in forms that the body cannot absorb.

Toxic metals contamination is a big problem in the dietary supplement industry. Numerous studies have shown that dietary supplements containing raw materials from China and India contain dangerously high levels of lead, arsenic and other contaminants. A 2006 survey of dietary supplements produced in South Asia and sold in 20 stores in the Boston area revealed that 20% of the dietary supplements contained heavy metals. Of those with heavy metals, 13 contained lead as high as 37 mg/g. No safe level of lead consumption has been established by the U.S. Environmental Protection Agency (EPA).

Another 2002 case report described arsenic toxicity in a 39-year-old woman taking the dietary supplement Chitosan, derived from chitin, a polysaccharide found in shellfish. Chitosan is believed to help people lose weight by blocking the absorption and storage of fat. The woman ended up in an emergency room complaining of fatigue, headache and weakness for the past six months. She had been taking six capsules daily of the “fat blocker” pills for a year. A 24-hour urine collection revealed 186 mcg/L arsenic, which is more than three times higher than the upper limit of normal. Analysis of the pills revealed an incredibly high arsenic content. Shellfish is a known reservoir of arsenic, and no other sources could be identified. (NBI’s weight-loss dietary supplement, Slimatol, contains no chitosan, hormones or stimulants such as caffeine.) An analysis of 22 case reports, case series and epidemiological research concluded that heavy metal (particularly lead) poisoning through traditional Chinese medicine use has been reported with regularity.

Form matters. Nutrients are packaged in different forms in dietary supplements. The form in which a nutrient is packaged determines how much of it you can absorb. To understand if a dietary supplement contains the highest absorbable nutrients, simply grab a dietary supplement bottle, such your multivitamin and mineral supplement, and look for magnesium, zinc and copper.

If any of these say "oxide" next to them (e.g., magnesium oxide), you are wasting your money because the oxide form of a nutrient is the least absorbable form. For example, people can only absorb about 2% of the magnesium when it comes from magnesium oxide. That means if a manufacturer lists, let's say, 100 mg magnesium (as magnesium oxide) on their label, you're only actually getting into your body about 2 mg magnesium. You are literally pooping out the rest since it's not absorbed and passes right through you. Magnesium is so poorly absorbed that it's used clinically as a laxative at higher dosages.

The most absorbable form of minerals is when it comes as amino acid chelates. When a mineral is complexed with an amino acid as an amino acid chelate, the absorption can be increased up to about 75%. Therefore, you'll want to purchase a dietary supplement that has its minerals (e.g., magnesium, zinc, copper) in this form to ensure you're actually getting your money's worth. Other highly absorbable forms of minerals are picolinate (e.g., chromium picolinate), citrate (e.g., potassium citrate) and malate (e.g., calcium malate). If you're not purchasing quality, you might as well just save your money, because the nutrients are not effectively being absorbed anyway and you're just creating expensive poop.

Additionally, the highest quality multivitamin and mineral supplements have a serving size of 4 to 6 capsules daily. If it's less than that, you're pretty much guaranteed that the oxide forms of minerals will be present. The reason why the better nutraceuticals require more capsules per day is that the amino acid chelate forms take up more space than the oxide form, which manufacturers can crush down into a one-a-day tablet.

Unfortunately, not knowing what makes up a high-quality dietary supplement can literally put your life at risk. This is exactly what happened to Dr. Pieczenik. Several years ago before getting involved with functional biochemistry, he simply bought supplements based on the cheapest price. He was taking what he thought were high-potency vitamins and minerals he bought at different dietary supplement stores. Yet while he thought he was taking adequate amounts of B-vitamins and minerals, he wasn't. Dr. Pieczenik ended up developing mature-onset asthma because of specific nutritional deficiencies that were identified on his MetaCT 400 test. He was low in B-vitamins, copper and chromium and had other dangerous health conditions he didn't even know about. He learned, as I hope all of you do, that knowing what to look for in a quality dietary supplement can literally save your life. He was so concerned about the poor quality of the supplements on the market that he founded NBI with Dr. Neustadt to ensure that consumers have access to the highest quality, safest nutrients available anywhere. So get your money's worth and insist on quality. Your health is worth it.

What you can do. Prior to purchasing a dietary supplement, read the label. If it's a multivitamin and mineral formula, don't purchase it if it contains any minerals in their oxide forms. Only purchase formulas that contain magnesium, copper and zinc completely as amino acid chelates. Second, insist that all ingredients in the formula have been tested for purity and shown to be free from contaminants (e.g., lead and fungal spores). The best way to do this is to verify that the formula you are buying is tested for purity and potency by calling the manufacturer or asking the retailer for documentation. The manufacturer of all formulas that are tested should have certificates of analysis on file and be willing to provide those to you. Otherwise, you are putting yourself and your family at risk of dangerous heavy metal accumulation, which can decrease IQ and cause depression, irritability, gastrointestinal upset, rashes, blindness, extreme fatigue, insomnia, memory loss, tremors, hair loss, ulcers and recurrent infections.

When you purchase NBI nutraceuticals, we guarantee all raw materials are tested and quarantined throughout the manufacturing process to avoid contamination. All finished batches are then third-party tested and shown to be free of contaminants such as lead and fungal spores. We have on file certificates of analysis for each of our products. Our goal is to keep you safe and healthy. We guarantee our quality.

References
Ibrahim D, Froberg B, Wolf A, Rusyniak DE. Heavy metal poisoning: clinical presentations and pathophysiology. Clin Lab Med. Mar 2006;26(1):67-97, viii.
Bachanek T, Staroslawska E, Wolanska E, Jarmolinska K. Heavy metal poisoning in glass worker characterised by severe dental changes. Ann Agric Environ Med. 2000;7(1):51-53.
Caussy D. Case studies of the impact of understanding bioavailability: arsenic. Ecotoxicol Environ Saf. Sep 2003;56(1):164-173.
Ernst E, Thompson Coon J. Heavy metals in traditional Chinese medicines: a systematic review. Clin Pharmacol Ther. 2001;70(6):552-560.
Crinnion WJ. Environmental medicine, part three: long-term effects of chronic low-dose mercury exposure. Altern Med Rev. Jun 2000;5(3):209-223.
Saper RB, Kales SN, Paquin J, et al. Heavy Metal Content of Ayurvedic Herbal Medicine Products. JAMA. 2004;292(23):2868-2873.
Shrestha M, Greenberg MI. Lead poisoning derived from Ayurvedic medication.(Abstract). (Abstract). 2002;40(5):678(671).
Caraccio TR, McGuigan M, Mofenson HC. Chronic arsenic (As) toxicity from Chitosan[R] supplement.(Abstract). (Abstract). 2002;40(5):644(641).

Welcome to The NBI Supplement

Drs. John Neustadt and Steve Pieczenik are very excited to start our new blog. As we sit in an internet cafe now in Bozeman, MT in April, a spring snow shower is adding even more snowpack to the high country. This means great spring skiing and plenty of water for the summer.

Normally, we work together to develop our companies when Dr. John is not seeing patients at his clinic, Montana Integrative Medicine, and Dr. Steve is not flying around the world helping our government as an expert in counter terrorism and psychological operations. We may seem like a strange pair, and we are. But we are united in two things. First, we are passionate about ensuring people have access to the best quality integrative medical care. Dr. John was trained in naturopathic medicine at Bastyr University, while Dr. Steve studied at Cornell Medical College, Harvard Medical College and MIT.

Second, we are dedicated to helping the public by formulating and manufacturing only the highest quality dietary supplements and cutting edge medical tests. Our tests have been called "metabolic CT scans." The MetaCT 400 test is the most comprehensive test panel, which analyzes more than 450 variables of biochemical function. You can learn more on our testing website, www.nbitesting.com.

Our line of dietary supplements were created out of necessity. Dr. John was trying to use nutritional medicine in his clinic and could not find the clinically relevant dosages of nutrients as dietary supplements. Dr. Steve had a medical problem that was induced by taking poor quality dietary supplements that depleted his copper and caused mature onset asthma. We combined conventional medical knowledge with naturopathic medicine to create our line of unique dietary supplements. All of our formulas are based on clinical trials and basic science. They are manufactured at an FDA-approved manufacturing facility that is GMP certified, the highest credentials in the industry. No raw materials come from China and everything is manufactured in the USA. We also pay extra to insure that every batch is free of dangerous contaminants and that what's on the label is exactly what's in each capsule. Oh yeah, and we only use the most absorbable form of nutrients available. As physicians, we refused to skimp on quality.

This blog will be an ongoing forum to help improve your health through diet, lifestyle and dietary supplement. If there's a topic you'd like discussed, let us know. Drop us an email to drneustadt@nbihealth.com.