The Ugly Truth About "Bone-Building" Drugs for Osteoporosis

01/10/08

This Week In HealthBeat News:

• A Letter from Dr. Myatt - Happy 2008! New Year, New Plans!
• The Ugly Truth About "Bone-Building" Drugs for Osteoporosis
• Flush-Free Niacin Causing a Rash - What To Do?
• L5-HTP, SSRI's, and Neurotransmitters - Again...
• Laughter is the best medicine: Thoughts on Marriage - From Kids...

A Letter from Dr. Myatt

Happy 2008! New Year, New Plans!

We've made a few (quite a few!) changes and improvements around here for the New Year. One of these involves HealthBeat, so I'd like to tell you about it.

First, we're converting HealthBeat News over to "blog" format. This will allow us to publish breaking news as it happens --- that means daily or almost-daily. BUT, the HealthBeat Newsletter (what you're reading now) will be published every other week instead of weekly.

For those who want daily health news, you can sign up to receive the blog posts delivered to your mailbox. For those who want the "short course" (the newsletter), you'll continue to receive it, only less often. You'll see some format changes that should make it easier to read, too. (This issue is still in the "old format." We expect next issue to be in the "new format.")

Please look for your next HealthBeat in TWO weeks. Your feedback will be appreciated.

Here's wishing you a healthy, happy and prosperous 2008!

Dr. Myatt

The Ugly Truth About "Bone-Building" Drugs for Osteoporosis
(And The Safe, Natural, Effective Alternative)

By Dr. Dana Myatt

Osteoporosis means "porous bone," a bone-thinning disease that affects some 25 million American women. It is called a "silent" disease because it comes on with few or no symptoms. Often, a fall resulting in a fracture is the first evidence of weakened bones. Other symptoms and signs of osteoporosis include a decrease in height, spontaneous hip or vertebrae fractures, and back pain. (Note: most back pain is NOT caused by osteoporosis, so don't get hypochodriacal on me!)

In elderly women, death resulting from complications of hip fracture is far more common than death from breast cancer, yet few people realize the potential seriousness of this condition. Although osteoporosis is more common in post-menopausal women, it also occurs in younger women, in men, and in all age groups. Caucasian and Asian women are at greatest risk because their bones tend to be less dense to begin with.

OK, you get the picture. Osteoporosis is clearly a real health problem for many Americans. So it seems reasonable to take a medication that can make bones thicker if you've been told that you have osteopenia or osteoporosis, right? Please don't go there until you consider these facts.

The Drug Is A Success - The Bone Died. ("To Save The Village We Had To Burn It Down")

The popular drugs prescribed for osteoporosis --- alendronate (Fosamax, Fosamax Plus D), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel, Actonel W/Calcium), tiludronate (Skelid), and zoledronic acid (Reclast, Zometa) --- are all in a class of drugs called "bisphosphinates." (Abbreviated as "BP's"). Although they are marketed as "bone-building" drugs, the real truth is quite a bit more ominous. These drugs work by killing a type of bone cell called osteoclasts. You read that right --- the drug works by killing normal bone cells.

But Wait! There's More! ("Other Than That, Mrs. Lincoln, How Was The Play?")

In addition to this insane "mechanism of action" (killing normal bone cells), the potential side-effects range from a mere nuisance to deadly serious.

Stomach upset, inflammation and erosions of the esophagus are a common side-effect of the oral forms of these drugs. But not to worry that this might be a sign that the drug isn't healthy for your body. Your doctor will simply tell you to "remain seated upright for 30 to 60 minutes after taking the medication." Wasn't that easy? Problem solved.

Bisphosphonates given by injection bypass the stomach troubles but have their own problems, including "flu-like symptoms after the first infusion." Manufacturers claim that this only happens the first time, but a quick search of online bulletin boards of people who have had this reaction tells a different story. Many people report severe flu-like symptoms and bone pain that was aggravated by each subsequent dose.

One study found in increase in "serious atrial fibrillation" among zoledronic acid (Reclast, Zometa) users, but the FDA dismissed this as "not significant." Since all these drugs are in the same class, however, the finding raises concern about this atrial fib connection and ALL bisphosphonate drugs.

[Nurse Mark Note: Atrial Fibrillation can quickly develop into a heart attack]

Last and not least, bispohsphonate drugs (ALL of them) are associated with a osteonecrosis of the jaw. In plain English, this means death of the jaw bone. The problem occurs more often with IV BP's but is also seen in oral BP use. As one medical article stated, "This complication can have a significant impact on the quality of life for those patients with advanced stages of necrosis." Uh, you mean because the dead part of the jawbone will have to be removed and possibly bone-grafted? With resultant facial deformity (not to mention pain and suffering)? Yeah, that might ruin your week... or month... or life...

Is Bone Death Better Than Osteoporosis? (Is That Really A Serious Question?)

Obviously, I'm not a fan of bisphosphonate drugs. The class of bone cells that they destroy --- the osteoclasts --- help to "remodel" bone. This means that bone is supposed to be a living, growing, constantly changing tissue. Bisphosphonates change all that.

On the other hand, a life-threatening fracture from osteoporosis is no picnic, either. So what do I recommend for osteoporosis prevention and reversal? Nature's way, of course!

Rebuilding Bone The Natural Way

It has long been known that declining sex hormones are associated with decreased bone mineralization. It is also known that un-natural hormone replacement, as practiced in conventional medicine, is a cause of breast and other hormone-related cancers (and increased risk of stroke, heart disease, blood clots and dementia).

The "middle ground" on hormone replacement therapy is to use natural (bio-identical) hormone replacement therapy as practiced by holistic medical practitioners. Following hormone testing (urine testing is better than saliva or blood tests), a custom formula using doses and forms as found in nature will be prescribed.

Normal bone formation requires the right "mix" of nutrients. Vitamin D is necessary for proper bone mineralization, and the latest medical research shows that we are getting far less than we really need. [NOTE: Maxi Multi's have just been re-formulated to include 800IU instead of the previous 400IU per daily dose]. Folate, vitamin B6, B12 and vitamin K should also be in your daily "mix" and are found in optimal amounts in Maxi Multi's.

Exercise, especially the kind that puts some stress on bones such as walking, help "tell" the bones to take up more minerals.

And of course, the minerals that build bone must be present. This usually requires mineral supplementation with calcium, magnesium, boron, manganese, zinc, copper and the "forgotten mineral," strontium.

Strontium, the "Secret Sauce" for Strong Bones

Strontium, a naturally-occurring mineral in the same class as calcium and magnesium, has been shown to prevent bone loss AND increase bone density even in already-established cases of osteoporosis. This, plus strontium (NOT the radioactive kind!) has little if any negative side effects. Read more about Strontium: The Missing Mineral for Osteoporosis Prevention and Reversal in this previous edition of HealthBeat.

The Short Course On Strong Bones And Bone Remineralization

Osteoporosis is not caused by a bisphosphonate deficiency! Given the potentially devastating side-effects of this class of drugs, doing it "nature's way" should be a first choice for most people with osteoporosis (or those interested in prevention).

Exercise, sex hormone balance and obtaining all necessary bone nutrients including strontium will prevent and reverse most cases of osteoporosis without causing harm in the process.

References: Found at the end of this newsletter

Flush-Free Niacin Causing a Rash - What To Do?

Marsha writes:

Dr. Myatt,
I am writing concerning the Flush Free Niacin. I have been taking it faithfully since I placed my order. I worked up to the recommended dosage of 2 capsules, 3 x's a day. I have had not problem until recently and I recently had a niacin flush with a red rash covered my body. It lasted for some time. I took a couple of baby aspirin's to try and lessen the reaction, and eventually it went away. I am concerned now about taking it, as I do not want this to happen.
I was wondering if there is anything I can do while taking this to prevent this rash or possibly I am taking too much for my system. Are there foods I should not eat when I take it, or should I be taking something else when I take the capsules. I do not like taking the aspirin because along with the Fish Oil and Garlic I take it makes my blood too thin and I bruise too easily.
Any suggestions would be appreciated.
Marsha

Dr. Myatt replies:

Hi Marsha:

Here's our website page on high cholesterol: http://www.drmyattswellnessclub.com/cholesterol.htm

Please note that I recommend using Red Yeast Rice either instead of or in addition to (a smaller dose) or niacin.

In Health,
Dr. Myatt

Nurse Mark comments:

Dr. Myatt was the "Good Cop" on this one - and I'm going to be the "Bad Cop" this time...

Folks, this is a perfect example of how people can have problems when they treat their health as a "do-it-yourself project." We mention in every article where we discuss Niacin use or any cholesterol-modification program that people should be working with the cooperation of a physician when using niacin, red rice yeast, or any other cholesterol modifying substance. Why? Because cholesterol is serious business! While very high cholesterol levels are claimed to be bad for us (and that claim is seriously questioned, even doubted by some very prominent authorities) a cholesterol level that is too low places us at all sorts of risks - not the least of which is the risk of hemorrhagic stroke! (That is the "brain-bleed" kind of stroke - a Very Serious Thing indeed!) Without cholesterol, a basic building block of life for our bodies, our blood vessels don't hold together very well. Cholesterol is so important that if we don't get enough from our diet our liver will actually make it for us.

There is ample evidence in conventional medical literature that a cholesterol level of less than 160 puts one at increased risk - yet the drug companies persist in their efforts to have every man, woman and child taking their high-priced statin drugs!

Now Marsha is certainly on the right track - she has obviously done her homework and educated herself. Flush-Free Niacin is one of the very best choices for cholesterol control and cardiac benefit with a huge amount of conventional scientific research to back up it's benefits. She could not have chosen a better substance with which to lower her cholesterol levels, if indeed they were truly too high.

[Dr. Myatt comments: Cholesterol by itself is WAY over-rated as a risk factor. Without knowing what you are trying to treat (high cholesterol? Low HDL? High triglycerides? Bum ratios?), it is hard to know if you need to take niacin or anything at all.]

Marsha says in her letter that she worked her way up to the optimal dosage of No-Flush Niacin, and it sounds like she was using that dosage without ill effect for some time before experiencing her reaction.

I'm sure that I've never heard of anyone being truly "allergic" to niacin, though the "niacin flush" can certainly be distressing to someone who has never experienced it before. It usually involves the face and neck, is warm, and sometimes itch - it is caused by the increase in small-vessel circulation that niacin provides. It goes away on it's own in anywhere from 10 to 30 minutes without any treatment. Marsha describes her rash as "covering my body" - certainly very non-typical for a niacin flush though in some more sensitive people it can affect more of the body and last up to 3 hours.

I am left to wonder if there might have been something else in Marsha's environment that could have precipitated a rash like she describes: a new soap, a new food, new clothing, or anything new or out of the ordinary that could have irritated and induced a histamine release and rash.

There is also the possibility that Marsha indulged in enough naturally niacin-rich foods to have tipped her over the edge of her tolerance to niacin - there are a number of foods that supply niacin.

Dietary niacin sources include:
Animal products such as liver, heart and kidney, chicken, beef, tuna, salmon, milk, eggs.
Fruits and vegetables: leaf vegetables, broccoli, tomatoes, carrots, dates, sweet potatoes, asparagus, and avocados.
Seeds include nuts, whole grain products, legumes, and saltbush seeds.
Fungi sources of niacin include mushrooms and brewer's yeast.

The most likely cause for this is far more benign though - the flush can indicate "saturation" meaning that she has found her upper limit or need for niacin, and she should maybe decrease dose a little.

Marsha, this would be a time when you would want to have cholesterol and liver enzymes re-tested. You DID have them tested to begin with, and note that we recommend that they be monitored periodically, right?

Although the risk is much less, niacin can cause elevation of liver enzymes, can elevate homocystein levels and aggravate blood sugar disturbances. We can't emphasize this enough: if you have a blood-lipid abnormality that requires treatment, you should be monitoring this with blood tests. This almost always requires a doctor's care.

The fact that Marsha reports "easy bruising" also means a doctor should be involved. Blood tests can tell when the blood has been sufficiently thinned without going overboard.

Now we come to one of my pet peeves as a Nurse: the success of Big Pharma in convincing people that there really is "a pill for every ill" and that our first reaction to any symptom should be to rush to the medicine cabinet.

Marsha developed a rash - so what did she do? Just what the drug companies wanted her to do - she popped a pill!

Marsha is right to be reluctant to take aspirin, even very small amounts can have a "blood thinning" effect.

Big Pharma has marketed "baby aspirin" as being somehow more benign and certainly a smaller dose than normal adult aspirin. Well, it is a smaller dose - but you can accomplish the same thing by breaking a regular aspirin tablet in half. You see, there is no other difference between regular and "baby" aspirin - they are both acetylsalicylic acid, a synthesized drug with a long history. The only difference between regular and "baby" aspirin is that some brands of "baby" aspirin have dyes or coloring added - some even use sweeteners and artificial flavors to mask aspirin's bitterness.

Lets face it - aspirin is aspirin.

This is a perfect example of the placebo effect - someone experiences a symptom, takes a pill that has no effect on that symptom, the symptom goes away on it's own as it would have without the pill, and the person's belief in the efficacy and usefulness of that pill is solidified. Aspirin is an analgesic (to relieve minor aches and pains), an antipyretic (to reduce fever), and an anti-inflammatory. It also has an antiplatelet ("blood-thinning") effect. It's not an antihistamine.

The niacin flush is believed to be cause by the release of histamine, a naturally-occurring substance released by cells. Grape seed extract (a natural anti-histamine) taken before niacin makes makes more sense than aspirin.

My Advice to Marsha? You have the right idea, you are on the right track. Why not consider a real investment in your good health, and arrange a consultation with Dr. Myatt - who can sort out all the pieces of your medical puzzle and give you a coordinated, effective strategy that will quickly have you on the road to your best health ever - and probably save you money too!

Dr. Myatt has the last word: Niacin is still acknowledged as one of the safest, most effective lipid-lowering, hdl-raising substances known. It has a high margin of safety and is worth taking even with the flush. Back off on the dose slightly, take grape seed extract, and get your lipid levels and liver function checked to verify treatment success and lack of side effects.

References: Found at the end of this newsletter

L5-HTP, SSRI's, and Neurotransmitters - Again...

HealthBeat Readers will remember Roberta, who wrote with questions about L5-HTP and SSRI drugs such as paxil. I answered, saying that rather than "shot-gunning" at the problem with either Paxil or L5-HTP perhaps Neurotransmitter testing and a consultation would be a better strategy. This left Roberta wondering just how that might work - here is her question and my answer:

Roberta wrote:

Hello Mark,
    Thank you for publishing my email in your recent newsletter. Again, the information is truly appreciated. I have a question about the fee regarding the neurotransmitter profile. Will I need to set up an initial consult first, order the profile and then a follow up consult for the report? I need to plan ahead and knowing the regimen of care would be helpful.
    My reason for seeking care previously with my conventional practitioner is that the insurance cost (through group employer plan) is so outrageously expensive that it leaves little wiggle room in the budget. Although, in the future, my goal is to save for alternative care. I hate to use the word alternative, as holistic medicine seems more natural and inviting to one's body than anything conventional can throw at you. So what truly should be considered traditional & normal?? Just my ramblings...
 Any info you can give me would be greatly appreciated.
 Thanks again!
Roberta

And, here's the answer:

Hi Roberta,

You can approach the Neurotransmitter profile from different angles, depending on how much of a "do-it-yourself project" you want to make of it.

The approach that I would suggest, and the one that will probably be the most economical in the long run would be to arrange a consultation appointment with Dr. Myatt first, before spending the money for the Neurotransmitter profile. It could be that after our team completes our New Patient Intake research and analysis and Dr. Myatt reviews that and does her own research that she may find some obvious and inexpensive corrections that can be made even without performing any lab work or further testing. Alternately, she may suggest some things that you can do to begin the corrective process - then have you do the testing under conditions which can provide much more useful results. If labs or tests are indicated, she will be able to give you very focused and targeted directions - again, likely saving you money and time over the more conventional "shotgun" approach of "A.T.K.T.M." - which stands for "All Tests Known To Medicine".

The second approach, which assumes that you are very certain that Neurotransmitter testing is indeed indicated (med-speak for necessary) it to order and complete the Neurotransmitter test and then, if there are results that warrant it, arrange a consultation with Dr. Myatt to discuss options and strategies - this is a bit like putting the cart before the horse though...

The third option, if you are really certain that you have the knowledge and skill to pursue that as a "do-it-yourself project" is to order and complete the Neurotransmitter test and then use the results to direct your own health strategy accordingly. Alternately, you can present the results to your current conventional doctor - but don't be surprised if he / she doesn't really know what to do with them and may even dismiss them as valueless. (Mostly because conventional medicine really doesn't have any pharmaceutical answers to neurotransmitters beyond the SSRI drugs that are being pushed so hard these days...)

When you order any of our tests the labs will send the results to Dr. Myatt who will then forward those results to you - it is your test, and your results. Even without  your being an established patient she may well take the time to include a very brief review of any abnormal results and some basic corrective strategies for normalizing those results. Keep in mind that this brief review does not, and cannot take the place of a consultation!

You may want to inquire of your employer insurance plan whether there is a discretionary fund available (sometimes called a "Health Savings Fund" or some such) that can be used to pay for non drug or surgery based treatments. This is available through some insurance plans to cover the cost of such things as physiotherapy, massage therapy, acupuncture, and other so-called "non-conventional" treatments, and many of our patients have been able to tap these funds successfully - though you may need to jump through some paperwork flaming hoops on your own to do so.

It seems odd that Health Insurers will happily pay thousands of dollars monthly in claim costs for conventional physician visits and drug prescriptions, but will balk at paying a few hundred dollars for testing and consultation that could eliminate the need for those expensive drugs and quite possibly save them thousands, even tens of thousands of dollars in claim costs over the long haul...

Isn't it strange how we have become so conditioned to look to our health care system for quick symptom relief rather than corrective care? We don't do preventative maintenance - we wait until something breaks, and then put a Band-Aid on it...

I remember the wise words of an old farmer who said "If you're stuck in a hole and want to get out, the first thing you gotta' do is stop diggin' !"

Hope this helps,
Nurse Mark

Laughter is the Best Medicine

Out Of The Mouths Of Babes... this falls under the category of "Kids Say The Darndest Things!"

The following has not been verified by us for accuracy, but truthfully, who could come up with answers like these but kids?

HOW DO YOU DECIDE WHO TO MARRY?

• You got to find somebody who likes the same stuff. Like, if you like sports, she should like it that you like sports, and she should keep the chips and dip coming.
  Alan, age 10
• No person really decides before they grow up who they're going to marry. God decides it all way before, and you get to find out later who you're stuck with.
  Kristen, age 10

WHAT IS THE RIGHT AGE TO GET MARRIED?

• Twenty -three is the best age because you know the person FOREVER by then.
  Camille, age 10

HOW CAN A STRANGER TELL IF TWO PEOPLE ARE MARRIED?

• You might have to guess, based on whether they seem to be yelling at the same kids.
  Derrick, age 8

WHAT DO YOU THINK YOUR MOM AND DAD HAVE IN COMMON?

• Both don't want any more kids.
  Lori, age 8

WHAT DO MOST PEOPLE DO ON A DATE?

• Dates are for having fun, and people should use them to get to know each other. Even boys have something to say if you listen long enough.
  Lynnette, age 8
• On the first date, they just tell each other lies and that usually gets them interested enough to go for a second date.
  Martin, age 10

WHAT WOULD YOU DO ON A FIRST DATE THAT WAS TURNING SOUR?

• I'd run home and play dead. The next day I would call all the newspapers and make sure they wrote about me in all the dead columns.
  Craig, age 9

WHEN IS IT OKAY TO KISS SOMEONE?

• When they're rich.
  Pam, age 7
• The law says you have to be eighteen, so I wouldn't want to mess with that.
  Curt, age 7
• The rule goes like this: If you kiss someone, then you should marry them and have kids with them. It's the right thing to do.
  Howard, age 8

IS IT BETTER TO BE SINGLE OR MARRIED?

• It's better for girls to be single but not for boys. Boys need someone to clean up after them.
  Anita, age 9

HOW WOULD THE WORLD BE DIFFERENT IF PEOPLE DIDN'T GET MARRIED?

• There sure would be a lot of kids to explain, wouldn't there?
  Kelvin, age 8

And the #1 Favorite is:

HOW WOULD YOU MAKE A MARRIAGE WORK?

• Tell your wife that she looks pretty, even if she looks like a dump truck.
  Ricky, age 10

References from The Ugly Truth About "Bone-Building" Drugs for Osteoporosis:
1.) Osteoporosis: Part I. Evaluation and Assessment. American Family Physician, March 1, 2001.
2.) Side effects courtesy of Merk's Fosamax website: http://www.fosamax.com/alendronate_sodium/fosamax/consumer/side_effects/index.jsp
3.) Alendronate and atrial fibrillation. N Engl J Med. 2007 May 3;356(18):1895-6
4.) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis.  N Engl J Med. 2007 May 3;356(18):1809-22
5.) Osteonecrosis and bisphosphonates in oral and maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 2007 May;19(2):199-206.
6.) Biophosphonate-related osteonecrosis of the jaws. Dent Clin North Am. 2008 Jan;52(1):111-28.
7.) Bisphosphonate Use and the Risk of Adverse Jaw Outcomes: A medical claims study of 714,217 people. J Am Dent Assoc. 2008 Jan;139(1):23-30.
8.) Osteonecrosis of the jaws secondary to bisphosphonate therapy: a case series. J Contemp Dent Pract. 2008 Jan 1;9(1):63-9.
9.) Bisphosphonate osteonecrosis of the jaws; an increasing problem for the dental practitioner. Br Dent J. 2007 Dec 8;203(11):641-4.
10.) Bisphosphonates and bisphosphonate induced osteonecrosis. Oral Maxillofac Surg Clin North Am. 2007 Nov;19(4):487-98, v-vi.
11.) The current state of postmenopausal hormone therapy: update for neurologists and epileptologists. Epilepsy Curr. 2007 Sep-Oct;7(5):119-22.
12.) Strontium Ranelate Reduces the Risk of Nonvertebral Fractures in Postmenopausal Women with Osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) Study. J Clin Endocrinol Metab. 2005 May; 90(5):2816-22. Epub 2005 Feb 22.
13.) Picking a bone with contemporary osteoporosis management: Nutrient strategies to enhance skeletal integrity. Clinical Nutrition (Epub ahead of print, 2006 October 12).
14.) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis.” New England Journal of Medicine 350 (2004):459 - 68.
15.) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. Journal of Clinical Endocrinology and Metabolism 90 (2005):2816 - 22.
16.) Strontium in Finnish foods. International Journal for Vitamin and Nutrition Research 52 (1982): 342 - 50.
17.) Gaby AR. Preventing and Reversing Osteoporosis. Rocklin, CA: Prima Publishing, 1994, 85–92 [review].
18.) Strontium ranelate: a dual mode of action rebalancing bone turnover in favour of bone formation. Curr Opin Rheumatol. 2006 Jun;18 Suppl 1:S11-5.

References from Flush-Free Niacin Causing a Rash - What To Do?:
1. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study.Neurology. 2007 Dec 12 [Epub ahead of print].
2. Statin Treatment and the Occurrence of Hemorrhagic Stroke in Patients With a History of Cerebrovascular Disease.Stroke. 2008 Jan 3 [Epub ahead of print]
3. Serum total cholesterol levels and risk of mortality from stroke and coronary heart disease in Japanese: the JACC study.Atherosclerosis. 2007 Oct;194(2):415-20. Epub 2006 Sep 12. Summary: The risk of mortality from intraparenchymal hemorrhage was significantly higher for persons with low total cholesterol levels [less than 160 mg/dl)] than with those with higher levels.
4. An excellent article on niacin can be found here: http://www.doctoryourself.com/niacin.html
5. no flush, no good. [Harv Health Lett. 2007]
6. On call. [Harv Mens Health Watch. 2007]
7. Niacin plus statin: powerful anti-cholesterol partnership. [Heart Advis. 2007]
8. Niacin into the void. Failure of HDL cholesterol drug may B this vitamin's big chance. [Harv Health Lett. 2007]
9. Expert commentary: niacin safety. [Am J Cardiol. 2007]