Dr. Victoria Maizes

Hi, Andy.

Dr. Andrew Weil

Hi, Victoria.

Dr. Victoria Maizes

Today we have one of our own, one of our graduates, an integrative rheumatologist named Olga Kromo, who, practices in Florida and is an expert on osteoporosis.

Dr. Andrew Weil

Well, I'd love to see more integrative rheumatologists out there. And I think she is helping develop the field.

Dr. Victoria Maizes

Fabulous, let's get her on.

Dr. Victoria Maizes

Doctor Olga Kromo is an integrative rheumatologist and a graduate of the Andrew Weil Center for Integrative Medicine at the University of Arizona. She's a staunch believer in the phrase attributed to Hippocrates, “Let food be thy medicine”, and she coaches her patients on the importance of nutrition and wellness. Dr. Kromo serves as the president of the Florida Society of Rheumatology, and she founded the National Integrative Rheumatology Society.

Welcome, Olga.

Dr. Olga Kromo

Thank you so much, Victoria. I appreciate that introduction.

Dr. Victoria Maizes

I see so many women who are worried about their bone health. Some have osteopenia. Some have osteoporosis. Can you explain to our listener what the differences?

Dr. Olga Kromo

Osteoporosis. First and foremost, let me just say that most people, most patients think that it's a disease. It's really not. It's natural aging of the bone. And there's so many things that go into it, but just the separation between osteoporosis, which is significant bone weakness, and osteopenia, which is essentially the stuff before it's your bone is already thinning, but it's not gotten to a point where it's considered very weak bone, which is osteoporosis.

Dr. Victoria Maizes

That's really helpful. So what puts us at risk? Besides, as you said, it's part of natural aging for us to have some bone loss.

Dr. Olga Kromo

You know, I really do see it as a problem of, calcium and vitamin D metabolism. Malnutrition, which is a huge one for me. And I would love to discuss that further. And environmental toxin exposure that damages either the bone directly or how we form bone to begin with.

Dr. Victoria Maizes

Maybe you could unpack a little bit about, those different factors that you just mentioned.

Dr. Olga Kromo

I guess let me start with calcium and vitamin D, because that does start in our youth. You know, we really form the majority of our bones when we're younger. Teens, young adults. And this is really when nutrition needs to be paid attention to. And that usually involves having a good intake of calcium and vitamin D, and there's just so many things that go into it. It's very much affected by our diet. It's very much affected by our cultural preferences for foods and behaviors. And it's just so important to educate yourself on that when we're younger, because the best treatment of osteoporosis is actually prevention of bone loss and formation of good bone. And that does require good calcium, good vitamin D, good vitamin K2 and other nutrients.

Dr. Victoria Maizes

So we'll get to the other factors. But Andy, obviously a huge part of your career has been ‘let's get people to eat a healthier diet’. And especially, let's focus on kids, adolescents.’ You know, a lot of times their diet is not particularly healthy. What would you advise?

Dr. Andrew Weil

Well, I think, very important, piece of information to get across to young people is that both bone and muscle are mostly formed early in life, in the teenage years, up through your 20s. And after that, all you can do is slow down loss. You can't make new tissue. So I think people need to understand that in those early years, good nutrition and attending to all the factors that build maximum bone and muscle mass are very, very important.

Dr. Victoria Maizes

So one of the, people I know you pay attention to is Walter Willett. And, you know, Walter Willett is sort of famously, quoted as saying, you know, “we have so much focus on calcium. Maybe it'd be better to take the cow for a walk rather than drink the milk”

Dr. Andrew Weil

I was fascinated to learn that the country's with the highest, calcium intake, often have the highest rates of, of hip fractures paying for the highest rates of dairy intake. You know, very contrary to what the dairy industry puts out about milk building strong bones.

Dr. Victoria Maizes

So Olga, how do you explain that?

Dr. Olga Kromo

You know, I really think that it needs to be appropriate calcium intake, but from food sources and it needs to be combined with vitamin D and other minerals, as well as good protein. So it has to be done in moderation. It has to be done with good quality. I think a lot of the concerns about calcium and protein really stem from what is packaged with what kind of chemicals, what kind of, pesticides it had done in an appropriate ratio.

But we do see that calcium is essential for bone building and, but also protein and exercise and everything else that goes together with it. The American diet unfortunately, does not predispose, our current young adults and teens. So the intake of these nutrients, additionally, I find that the SAD American diet, also causes a lot of inflammation that interferes with absorption and bone building.

Dr. Andrew Weil

Yeah, it's the problem mainly with intake or was it with absorption and utilization?

Dr. Olga Kromo

It's actually both, I think some of the toxins that come from with the food that we're consuming interfere with absorption and formation of bone. And on top of that, we just don't get enough of the right nutrients from the current intake that our teens and young adults are seeing.

Dr. Victoria Maizes

So I, I also want to say I'm really a food first kind of person. And I really believe you can get adequate calcium from food. There's actually some risk of calcium supplementation. We can get to that later. But in terms of food, dairy, high quality dairy can be a good source of protein and calcium in young people. Some people don't tolerate dairy well, as they get older. And there are many, many plant sources of calcium. So figs and almonds and legumes, I mean, there's lots of other places to get your calcium besides dairy so that you have an adequate intake from food and don't necessarily need to supplement. Is that something you would agree with?

Because I know the you know, right now in the U.S., we recommend 1200 milligrams. It varies a little depending on your age and, whether you're pregnant. But we recommend 1200, and that's a lot that that's harder to get to food. Other countries recommend 500 or 700.

Dr. Olga Kromo

You know, I think it has something to do with other factors in our diet. But yes, the current recommendation is about 1200 a day, 12 to 1400 a day, but only about 6 to 700 of it from a supplement. The rest does need to come from food, and the food sources are much better quality calcium, and they're usually bound to other nutrients like protein and vitamin D that are necessary for its use in the bone. And even the 6 to 700mg in a supplement still needs to be divided. We really don't absorb that much in one sitting. So taking one large supplement at nighttime without a meal really doesn't. It's not going to do a lot of benefit. And there is some potential risk loss.

Dr. Andrew Weil

What’s the role of vitamin K in bone health. And where do we obtain that from?

Dr. Olga Kromo

Absolutely. So vitamin K is essential. It activates it creates a lot of proteins that help calcium actually make it to the bone. It chaperons the calcium and other minerals to the bone so that it can be used for formation. And we actually find that majority of the trouble with taking calcium without without vitamin K is what is concerning with heart disease and deposition of calcium in the arteries and such.

Dr. Olga Kromo

Vitamin K two is really egg yolks, liver, animal products. There's two types. There's vitamin K2, which is the active form, and there's vitamin K which is inactivated. And that needs to be activated by the liver. And I think eggs is probably our most common source in the American diet. But cheese, butter, we don't really consume that much butter.

Natto is actually a fantastic source. Yeah.

Dr. Victoria Maizes

Have you ever eaten natto?

Dr. Olga Kromo

Yeah.

Dr. Andrew Weil

Fermented stuff, I like it.

Dr. Victoria Maizes

And do you, you are unique and like, it's so slimy. It's like oohh.

Dr. Olga Kromo

But it's a power food in so many ways. It just has so much benefit.

Dr. Victoria Maizes

You know, Japan is one of the few countries that has an actually higher rate of osteoporosis than the US, and Japan is where natto is really commonly consumed.

Dr. Olga Kromo

I think it has a lot to do with other things that they're consuming that actually contribute to bone thinning. Plus their true dairy intake is pretty low as well. They're not really, they don't consume a lot of cheese or milk or yogurt, but as far as I'm concerned, a good grass fed, organic, dairy product like a cottage cheese.

And particularly if it's fermented, it's just magic. It's just such a great thing. You can tell if you if you can tolerate it. You know, some patients truly cannot.

Dr. Victoria Maizes

So you mentioned, calcium, vitamin K. What about some of the other you mentioned vitamin D some of the other vitamins and minerals like boron, manganese how important are these. And should people be taking one of these kind of bone specific. Because the the typical multivitamin, does it have vitamin K2 in it.

Dr. Olga Kromo

It doesn't. And it usually doesn't even have enough vitamin D to tell you honestly, or calcium for that matter. So I actually very much do recommend taking a bone specific calcium blend. It has to be a blend. It has to be a good quality calcium. Usually I recommend citrate or carbonate. It does have to come with a vitamin D.

It does have to come with a dose of K2 and some of the other minerals, which is magnesium in particular. So there's a perfect blend ratio without which we're really not utilizing the supplement in a good way. So, you know, the zinc, copper, manganese people can get carried away by low dose zinc, maybe 12.5 to 25 mg a day, I think is enough.

Dr. Victoria Maizes

Andy, this makes me think about the early years of integrative medicine where everybody was so focused on a single vitamin, and then they'd say, “look, we did that study. It didn't work”. And all this really pointing to the way in which these different vitamins and minerals work synergistically. Can you talk about that a bit?

Dr. Andrew Weil

Yeah, I think that's a general pattern in nature that, nature produces complexes of related compounds. And probably it is desirable to take the whole complex. And the best way to get that is from foods, you know, when supplements at best, you know, partially represent what we find in naturally occurring.

Dr. Victoria Maizes

Yeah, yeah. So you also spoke earlier to the importance of, building not just bone but muscle and, our skeleton and the way we do that is being physically active. In fact, one of the easiest ways to lose bone density is to go to bed. We used to put people to bed rest. We don't really do that very much. Not just because of the skeleton, but also because of our skeleton. So, Olga, do you have favorites? Like, these are the very best exercises for bone health.

Dr. Olga Kromo

I truly do, and this is one of my favorite topics. And it doesn't have to be anything scary and excessive. this is the issue that I think a lot of our patients are having. You know, somebody older will come in and they're already kind of weak. They're already kind of fragile. They have this new suspected diagnosis, a potential diagnosis of bone thinning.

They're afraid to move. They're afraid to do anything that will make them fall and potentially break. So I usually kind of start with whatever is the easiest for them or the easiest to understand and handle. Go for a walk, but a take a backpack, put two books in it. That's the weight on your bones bone cells have these little vibration receptors inside that mechanoreceptors.

And in response to a little bit of bouncing, a little bit of pressure from walking and a little bit of weight will, above, as in a bag with some books in it that will give you some stimulation to those bone cells to start depositing more mineral into the bone, and will stick on the bone. Another one that's amazing. If the patient is able to do it is yoga. And in particular, there's this, you have to actually hold poses of yoga for 12 seconds, and that seems to be the magic number. And that will stimulate the same kind of receptors or those little vibration sensors in the bones to stimulate deposition of minerals in those bones, for those bones to feel a little healthier for the cells and about to feel healthier.

Pilates is another amazing one, so it doesn't have to be high impact. We're not talking about running or jumping or, you know, very aggressive activities, just daily activity, walking, yoga, Pilates. There's another one that I really love which is bar, which is very controlled movements. Those things will help. And an exciting addition happens or an exciting interest that's happening now in osteoporosis and this is not new, but it's kind of seeing a resurgence is the vibration plate. And my question about that. Yeah absolutely. I'm not sure if it was developed by NASA but it was definitely used by NASA to prevent osteoporosis or treat osteoporosis in astronauts that had no pressure on their bones from the atmosphere because they were outside of it.

And there's a resurgence and it definitely does make a difference. And this is something that's really easy to recommend to patients because they literally just need to step on it and be on it for 15 minutes. Which is not easy. You know, if you turn that thing up, it will it will be pretty intense. But it it also improves balance muscles, you know, so it improves stability a little bit so prevents falls.

So there's a ton of benefit. And there's some new gyms specifically tailored for osteoporosis that now have them. So it's easier to find.

Dr. Victoria Maizes

You know it's funny because you just describe someone who is frail and at a higher risk, perhaps, of falling and breaking a bone. But I have to say, I see a lot of women in my practice who are very fit and have osteopenia or early osteoporosis. Some of them have significant osteoporosis, and they're, you know, runners, there are hikers and they're devastated and they do not want to take medicine.

So what you what do you think about that particular profile? Can that woman avoid medication through lifestyle and supplements, or does she really need to think about medication that.

Dr. Olga Kromo

Absolutely. I think every patient Can do things, in a way to improve their bone health, but it needs to. But it's there's multiple factors that are taken into account. We definitely need to understand what their home or hormones are doing, whether that's testosterone, testosterone in men or estrogen and women.

We definitely need to understand what their diet looks like. I think that healthy patient who is very active and very physically fit, but nevertheless has bone thinning, there's other issues there, including environmental pollution, including eating the wrong foods because sometimes they just don't have the right nutrients. And, obviously the hormones need to be taken into account. Thyroid hormone, too much or too little of thyroid hormone in that healthy patient will affect their bone quality.

So some of the things that need to be assessed is obviously how much contaminants, how much polluted pollutants they're taking in, you know, non-conventional foods will have a ton of cadmium in them, from the pesticides used to grow those foods that interferes with bone metabolism. I want to say about 20% of current osteoporosis is actually from cadmium and, in glyphosate.

Additionally, you know, lead, which has been illegal since 1970 in gas, but because now we have unleaded gas, but before then. So anybody who's over 50 at this point that was inhaled and stored in the bone and during menopause, which is when the bone starts to become more fragile. So that's when it starts coming out and it's toxic to the kidneys, it is toxic to the liver.

And that affects bone metabolism. What can we do about it? Zinc actually helps. Resveratrol is something that's fantastic to take. And it's easy to access. Glutathione iron is wonderful alpha lipoic acid. So there's a couple of natural things that can help that very healthy middle aged men or women who wants to improve their bone health and obviously exercise and obviously vitamin D.

And I think this is really something that we do need to discuss because it's just so essential. Vitamin D, and I want to say so many of us are completely malnourished in that specific nutrient.

Dr. Victoria Maizes

Vitamin D has become more controversial recently, you know, with, society saying you don't actually have to check vitamin D levels. I personally still check vitamin D levels on my patients because many are low, and I'm not sure that the current recommendations are for optimal health. What do you what do you think? Where do you like people's vitamin D levels to be? And you know, how often do you check them?

Dr. Olga Kromo

Absolutely. Vitamin D is my one of my most important recommendations, both in inflammation and osteoporosis. I see so much benefit from vitamin D replacement. All of us are low. You know, we only gain vitamin D from, sun exposure, and we can even discuss that and nutrition, but it's really sun exposed mushrooms and sun exposure.

You know, there's very little sources that we're getting. And even with sun exposure, you need 20 to 30 minutes of exposure to arms and legs above a certain, below a certain latitude. So in northern latitudes, we don't even make it regardless of how much time we spend in the sun in the winter, in the winter months. I would love for all of my patients to be at a vitamin D level between 60 and 90, which takes effort.

Majority of us…

Dr. Victoria Maizes

60 and 90 milliliter?

Dr. Olga Kromo

Correct Yeah. We usually, you know, usually we shake out between 20 and 40. I very rarely see, anything either below that or above that. It can it definitely contributes to muscle building. It definitely contributes to control of inflammation. And it 100% is essential for good bone quality. So we have to supplement whether we're supplementing once a week, which is not the best form, or if we're supplementing once a day with D3, which is a better form.

I typically tell patients you need about 5000 a day, and it has to be combined with the calcium, and it has to be combined with magnesium to really show its benefit. But this is one of those things that is so valuable for inflammation. And just so needed for bone quality. And most of us are deficient. And when you combine that with, microbiome disruption and leaky gut and, and gluten intolerance, that is just so widely rampant right now, you're not absorbing vitamin D, you know, and then the way toxins affect us, the way lead and mercury and some of the and cadmium and some of the other toxins that we're picking up from the environment affect us is they prevent us from being able to activate vitamin D. And that's the main cause on, osteoporosis.

Dr. Andrew Weil

Although I see many women who have been diagnosed with osteopenia and made very fearful about that. And in general, I'm a little leery about preconditions, I think that we have gone overboard and creating these preconditions and opportunities for medicating them. Correct. And I often tell women that and what osteopenia does not necessarily progress to osteoporosis. And it is a warning sign that you should be taking better care of your bone health.

Dr. Olga Kromo

Absolutely. In fact, some women, I don't think, ever get to a bone density. That's not quote unquote osteopenia because some ladies just have smaller bones. You know, some of us never get that super, super thick bone, but that's normal for us. So that is not a place to treat. I think that's a place to introduce dietary recommendations, maybe improve some exercise, improve vitamin supplementation.

Absolutely. I agree with you 100%. And even when somebody truly gets to a level that's considered osteoporosis, which is again, you know, that's kind of like a cut off that we said it's not necessarily immediately a high risk of fracture. And there's another way of testing it. And we can discuss that even there I think the first and foremost assessment that needs to be done is what is your nutrition?

What are your risk factors? What are you not doing that you could be doing to optimize bone density? And if it's somebody who is very close to menopause, meaning they just started menopause, there's some things that can be done there that are more natural for them than for somebody who's older and really activate that estrogen system.

Dr. Andrew Weil

And what do you think about the bone building drugs and when are they indicated and what are their risks.

Dr. Olga Kromo

So we have several ways of testing for osteoporosis. We have the traditional bone density which is the DEXA. So as people know it, which is really tells you nothing about the structure of the bone, but only the mineral content of the bone. And then we have a better test, in the DEXA. So the bone density has its limitations.

It doesn't necessarily predict fracture. And then we have another way to predict fractures which is FRAX. And that actually tells us what is the chance of somebody breaking a bone or a hip in the next ten years. So I actually prefer to use the FRAX score to predict who needs treatment. And based on that, we decide which way we go.

And osteoporosis treatment has to be, a well-planned, sequential approach. So for somebody who is truly at risk for fracture, based on those two studies, I first and foremost recommend doing something that affects the estrogen system for somebody who is younger. There's a couple of medications, but there's also things like soy. You know, soy is a wonderful phytoestrogen.

We can start with soy supplements if they're early on. Additionally, the next step would be a medication called Avesta. It's, serum or selective estrogen receptor modulator. It's an older medication. It does affect the estrogen system. But it's also anti-cancer in the breast. And it's probably pro estrogen in the bone, which is beneficial to those patients earlier on in their menopause course.

There's always a hormone replacement therapy if anybody's interested. But that is a decision that needs to be made with them and their gynecologists. And an assessment of risk versus benefit. That has to be a serious conversation. But we're doing it in a much gentler, much more appropriate way now that than it has been done for the last 20, 30, 40 years.

Where it has caused some trouble. But that's, I think, a beautiful choice. We do have some older medications, like, fosamax and axonal and some of the other ones that prevent your bone from being broken down. But those are older medications, and I'm not a big fan because they kind of just put your bone into pause.

You know, I'm not I prefer to do something that actually activates your bone and helps it grow and thicken. And we have actually some new choices as well that truly build bone. So for somebody who's really high risk, we have some new, biologic medications which activate the natural processes within the body to regain some bone thickness. But those are reserved for patients with more significant disease or somebody who has already had a fracture.

And again, the number one reason to treat osteoporosis, this is what I tell all patients, is to prevent a fracture. That's the reason.

Dr. Victoria Maizes

One of the things people ask me is is it working? And, you know, said we can do a repeat DEXA, but that doesn't necessarily tell you that much about the quality of the bone. And then there are these bone marker blood tests. How much do you like those as a follow up tool?

Dr. Olga Kromo

There. We're still not great at being able to tell what's going on with the bone, but we do have more options than before. Bone markers are usually markers of either bone building or bone breakdown. If we are using a medication that's building bone, that's activating the bone cells into a build mode, because, you know, there's two types of bone cells, there's those that break down and then there's those that build, if we're activating the builders, seeing blood levels of, tests showing that, yes, there's active building happening at is give us hope that we're doing the right thing with the patient, that we're actually activating the right processes.

And those tests are also useful in patients who have been on the older medications that I've mentioned, like fosamax and actinal. And we want to know if the bone is reactivating, because, again, the trouble of those medicines is they do put your bone in to pause. And sometimes if we're doing bone surgery or trying to do a different direction with their treatment, we want to see those numbers come up.

Dr. Victoria Maizes

Yeah. One of the things I know people are most fearful about, and it's a reason people choose not to take medication, is osteonecrosis of the jaw, which is rare, but it's this terrible side effect where you have necrotic or dead bone tissue and it makes, for example, the dentists very reluctant to take care of someone who's on one of the bisphosphonate medicines, although, you know, it also happens with some of the other medications.

So, what do you do? I mean, for example, I usually ask people to go see a dentist to make sure that they've got really good, dental care prior to starting one of these medications.

Dr. Olga Kromo

So this is one of the things that needs to be assessed before we start any treatment, “what is your risk?” Because typically we will see asked in your courses of the jaw and somebody who does have before treatment and bad dental health, or a history of root canals or chronic infections in the bone, because the way the bone heals is by breaking down first and then building.

That's a natural process in the bone. And if we're interfering with the breakdown of the bone, we're going to be interfering with the healing of that infection. And that's the trouble with some of these medications, in particular, the ones that are putting your bone into pause because you will not be able to clear that infection. It's interfering with that process.

Some of the medicines that we have now that actually build bone, they avoid that issue. Because they actually activate the bone. And sometimes we will use the bone activating medicines to clear out. Oh, and if it does happen or the osteo necrosis of the jaw if it does happen. But dental health is essential. And that's one of the things that needs to be addressed in somebody who's doing bone treatment more frequently than, than usual.

Dr. Andrew Weil

How does inflammation affect bone health? You mentioned it briefly earlier. You know, I think most people in our society are in a pro-inflammatory state. Diet certainly is a major effect on that. But how does that affect bone health.

Dr. Olga Kromo

So we have the two types of bone cells. We have the builders. And then we have the ones that break the bone down. The ones that break the bone down are activated by inflammation. So in fact when you have inflammation you're activating bone breakdown. So that includes your diet. That includes rheumatoid arthritis, lupus, the medications that we use to control inflammation or at least the old ones like prednisone and corticosteroids also activate bone breakdown.

So yes, that's really the process. Vitamin D interferes with that process. So that's one of the reasons to give vitamin D in patients with inflammation. That's one of the benefits. And another product that's fantastic for this is turmeric extract or curcumin. That's one of the benefits of curcumin. And I often give it together with medications for inflammation for that specific reason and the fact that it improves their innate inflammation.

Dr. Andrew Weil

You mentioned, rheumatoid arthritis and lupus. Let me just ask you a general question. I think we're seeing an increase in autoimmunity in our society. You know, especially in women. And I'm not sure of all the factors responsible for that. We're also seeing it a lot in children. What's what is your impression that that's contributing to that?

Dr. Olga Kromo

I think it's environmental and diet. I, I truly, I truly do. I think the genetic predisposition has not changed.

Dr. Andrew Weil

Right.

Dr. Olga Kromo

I really do think that it's all the plastics, the PBE, the, the bpas and the phthalates that actually trigger inflammation in women quite a bit and contribute to shoguns and lupus. I think the leaky gut and the glyphosate covered wheat that were the genetically modified glyphosate covered wheat that we're feeding to our children, all of the, synthetic colorants and all the synthetic additives that we're adding to their our diet are contributing to inflammation.

And I think a majority of this starts in the gut.

Dr. Andrew Weil

Do you agree with that?

00:29:37:07 - 00:30:03:10

Dr. Victoria Maizes

I'm really concerned about those two triggers for autoimmune disease. And, just to give people a sense, you know, one way to protect yourself is with organic, because you can't spray glyphosate on organic crops. And so that rids that particular issue. Even foods that aren't genetically modified like wheat are often sprayed with glyphosate because it's a desiccant. It makes it easier to harvest the crop. So, organic is really your friend. And then avoiding plastics, it's not as hard as it once was. We have glass, Tupperware. You know, we have glass water containers, stainless steel water containers. You can put a water filter in your own home and remove some things. Reverse osmosis, which used to waste a lot of water and now is more, efficient at working and wasting much less, is affordable and can be added to home sinks.

Dr. Victoria Maizes

And all of these things add up to reducing the amount of exposure and therefore reducing the likelihood that you're going to kind of tip into one of these autoimmune problems.

Dr. Andrew Weil

Yeah, I think protecting ourselves from microplastics is a more difficult challenge.

Dr. Victoria Maizes

I totally agree, but my understanding is that some of that is removed by the reverse osmosis. I don't think the nano plastics. We have an answer for, so we have to put less of that in the environment, which, again, we used to buy in glass if we stop, you know, using all these plastic water bottles, we're going to have less.

Dr. Olga Kromo

There's an interesting, a very exciting publication that came out about two weeks ago about fermented dairy and the micro bacteria and fermented very specifically probiotic called lactobacillus reuteri. That has shown absorption of microplastics from the human body.

So so this is my plug for my favorite health food of all time, which is fermented dairy, fermented kefir, fermented grass fed kefir is, health food in every possible way. Protein, microbiome support, plastic absorption, calcium. So many things.

Dr. Victoria Maizes

We're going to have to look for that article. I hadn't seen it, but another plug for kefir is it actually has, more organisms than yogurt. And so if I like them both, go for the kefir before.

Dr. Olga Kromo

And there's strawberry flavored ones. I understand that the plain one is a little hard to, you know, get adjusted to their strawberry flavored ones. There's blueberry. So I'm for kefir. But, you know, there's other things that are really important to also discuss with, we didn't really get a chance to touch on with osteoporosis.

One of the issues that we have in the American diet is we are so high in sodium, we very much see that the higher is your intake of sodium, the more calcium your body needs, because we actually kick it out into the urine to balance the sodium that we're consuming. So that's another issue to truly address with our diet.

And then again, the sad American diet, the sad, high sodium, high in inflammatory seed oils, high in sugar and high fructose corn syrup, all of those things certainly contribute to osteoporosis. And that's why I feel it's an environmental disease at this point.

Dr. Victoria Maizes

So the other thing that we do, with our bone is we buffer acids. You just talked about the need to, excrete sodium, but we also buffer to keep our blood PH as stable as possible by mobilizing calcium, and we worry. So how much do you talk to your patients about acidic foods?

Dr. Olga Kromo

You know, I think acidic foods also mostly comes from processed foods. So, for example, sodas, you know, there's so much acidity that comes with consumption of, soda in particular. So Coke, diet sodas, all of them. There's additional chemicals that come with those as well. And as we're trying to balance the chemical load that comes with any, any, sugar loaded soda, you know, carbonated beverage, a lot of that comes out as acidic.

And or our kidneys try to balance that. So fluorine, which actually breaks down bone, actually breaks down bone that's found in sodas. It's found in tea. So is, Mercury, unfortunately, in terms of truly consuming, too high of a protein load, you know, there's some excitement right now about these carnivore diets and keto diets.

Yes. Increasing acidity will cause excretion of additional calcium, but typically we find that it's not so much of a concern as some of the pesticides and some of the chemicals that are added to the food. If if I can get them to eat healthy, it will balance some of the acidity from their diet.

Dr. Andrew Weil

Olga, I trace mineral that you did not mention is strontium. There was a period when that was being recommended as a supplement for bone health.

Dr. Olga Kromo

You know, I haven't actually used it personally. I know of it. But in terms of true recommendations as to what are what intake is beneficial and how so? I don't know too much.

Dr. Victoria Maizes

There was a series of studies. It was it was actually, sold in Europe, in the EU, as a dietary supplement that was recommended for osteoporosis. And then they found it increased heart disease. And so it was pulled from the European Union marketplace. We still see strontium as a dietary supplement in the U.S, but I stopped recommending it when those EU reports of increased heart disease came out.

Dr. Olga Kromo

Yeah, during my education, it was not something that was offered as a useful additive. And so I've never actually had to use it. One thing though, if, if you're willing, I would like to also mention is the stomach medications. So the acid medications and why are they associated with osteoporosis.

Dr. Victoria Maizes

Are Talking about PPIs? You're talking about that put it on pump inhibitors as because there's lots of stomach med. So.

Dr. Olga Kromo

Right. Yes. So pantoprazole, Nexium. You know, they're commonly used or commonly prescribed, and unfortunately they're commonly prescribed in an incorrect way. They're never intended to be chronic long term use medications. But this is how they're often used. And regular PPI regular tonics or Nexium use increases your risk of osteoporosis by 50%. Your lifetime risk even short courses of fortonics can increase your osteoporosis risk because they decrease stomach acid.

They decrease absorption of calcium, they decrease absorption of vitamin D, they can cause problems with your microbiome, and they interfere with absorption of just about every vitamin.

Dr. Victoria Maizes

Well, you have given us so much important advice. And, I know that osteoporosis is a topic that Body of Wonder listeners have really wanted to hear more about. So thank you so much for sharing your deep expertise on this important topic.

Dr. Andrew Weil

Yes.

Dr. Olga Kromo

I'm so grateful for this time. Thank you. Thank you both.