Dr. Goto talking bone health, osteoporosis, osteopenia and more on Dr. Peter D’Adamo’s podcast

You can learn more about the Dr. Goto and the D’Adamo practice here @ https://www.genmedcenter.com/who-we-are

“So if you're really a person who likes to take a yoga class once a week, you're probably not going to get much of a payoff in terms of bone density. But if you are a regular practitioner, and you do it long enough, it compares favorably to in many of the other ways exercise can induce and prevent bone loss and maintain structural integrity.”

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“Hello, and welcome to house call with Dr. DAdamo. I am your host, Peter D'Adamo. And I'm being ably assisted by my colleague, Dr. Jennifer Goto.

Thanks for having me.

This is episode four of our podcast series, and is devoted to maintaining and optimizing your bone and structural health. Jen, I'm going to turn over the microphone to you to let the audience benefit from a little bit of background information in terms of bone, what it is, and an understanding of how it's dynamically shaped. And then after that, we'll kind of go through some of the therapeutic options and ways that people can maximize their bone health going forward as they go through the various stages of life. All

right, so we'll start with just a little bit about the anatomy of the bones themselves. So it's important to realize that the bones themselves are dynamic tissue, so they're constantly being broken down and rebuilt. And these processes are governed by two types of cells. So we have the osteoblast cells, which are responsible for building the bone. And then we have cells called the osteo class, which are responsible for breaking that bone down. And

I think it's important for people to realize that they both have important functions, one isn't bad. Just because it removes bone and one isn't good, just because it lays it down, bone can be constantly, architecturally re sculpted over the course of a person's life, depending upon the dynamics of their weight and gravity. So this is really a question of essentially, the capacity of the body to sculpt bone. And although later on, we'll discover that disorders like osteoporosis are often accompanied by more activity on the part of the osteo class. In other words, to take away bone cells, we really need both in order to be able to have the perfectly architecturally sound and structurally strong type of bone that keeps us healthy and protects us. Absolutely.

So it's really just about maintaining the proper balance and making sure that the cells are all functioning in the appropriate manner. So when we look at the components that build the bone itself, we can divide these into inorganic and organic compounds. So the inorganic compounds are comprised of the salts of calcium and phosphate. And this is really what gives bone its compressive strength. And

I think the most important salt that people might be aware of, is hydroxy apatite, because it's sometimes marketed in, in calcium supplements, I believe,

right, and a lot of bone supplements, then we have the organic compounds. So this is the collagen portion of the bone. And it's made of proteoglycans, and things you're probably familiar with, such as hyaluronic acid confined sulfate. And this is what gives bone its shear strength, right

tensile strength is the kind of strength that is the kind of stress that kind of goes sideways or has a shearing effect. And compressive strength is the strength that keeps the second floor of a building above the first floor of a building. And you need both you need you need to have the comp, a combination of those two types of resistance. And so in its ultimate wisdom, the body has structure to a combination of the characteristics of different types of bone that does this type of protective effects in offsetting gravity and allowing us to use bones to work as levers and allow us to do mechanical things like carry heavy things and, and even just move from point to point.

Absolutely. There's two types of bones. So there's the cortical bone, which is the hard part of the bone, which is responsible for this smooth, solid white appearance of bones. It's where all the minerals are. And then there's also the trabecular, or what we call spongy bone, which is the paws network inside of the bones. Additionally, then we also have the bone marrow, which is responsible for blood cell production. So that's the basic anatomy of bone. So now we can start getting into some of the more common conditions that we see in some of the pathologies that we see. Dr. DE Adama mentioned osteoporosis, which is defined as a bone density of 2.5 standard deviations or less of the peak bone mass relative to others in your age and sex group. And

then osteopenia is kind of a gray area where you don't have osteoporosis, but there's something funky about your bones. And depending upon how aggressively that is interpreted in my dictate the use of certain types of bone mineralization drugs like Fosun max or not, why did this Mathematics, I mean, when you start to compare the bone of somebody who's postmenopausal and healthy, to somebody who's 36 years old and healthy, it's since a comparison where the more elderly person is never going to win. And a lot of times this can be made into a pathology that is not necessarily accurate. And we still haven't gotten to the point, I think a lot of the times of looking at comparison comparing the age appropriate groups to each other. This was a big deal. When it came time to using estrogens as drugs, they just were trying to retain bone to the level of somebody who was 40 or 50 years younger, and giving them hormones at a level that would have been sufficient for somebody in that age bracket. But you can't give those levels of hormones to somebody who's got 70 year old tissues that you can give them to somebody who's got 40 year old tissue. So there's a lot of controversies when it comes to basically the best way to handle bone health. And one of the most interesting ones that I've always been amused by is the so called Bone hypothesis, which is commonly promulgated by dieticians, amongst other people who really shouldn't look better. But back when the normal state of affairs was to just kind of advocate, I guess what you would call fat phobic diets or protein phobic diets, dietetic community used to use the excuse to high protein diets could cause bone demineralization, because the protein would act to cause an acidity to build up in the body. And then the body would then counteract the acidity by reaching calcium from the bones in order to buffer the acidity with minerals. And this is still commonly advanced by dietitians except that the mechanism is probably correct. But the rationale is certainly wrong. It's been proven wrong in numerous studies. And it turns out that the body doesn't really take calcium off the bone in order to change the acidity as a result of protein intake. But rather, it triggers other mechanisms that simply increase the absorption of calcium from the digestive tract. So I think the body's probably a little bit smarter at how to regulate acidity from a high protein diet than most dietitians would give it credit for. But there's also an important blood type specific component here, that really plays a really strong role with regard to how effective the whole bone hypothesis is, and literally throws it into a cocktail, if you ask me. It has to do with an enzyme called intestinal alkaline phosphatase. And it's got a long name. So we sometimes just abbreviated AIP. It's one of the background of certain enzymes known as phosphatase is, for instance, when somebody says, Well, my liver enzymes were elevated, which was a sign that concern my doctor that I might have something wrong with my liver, that's the liver fraction of the phosphatase. And then there's another one that comes out in heart muscle. And then here's one that comes out in your digestive tract. So it's known as intestinal alkaline phosphatase. It's an interesting enzyme, because around the time when you were 14 weeks old inside of your mother, it was the greatest enzyme by volume in the fetus. And it has a tremendous effect at that time because the fetus is going through a developmental process that involves having to produce a intact digestive tract in terms of the absorption and all the other things that are involved. And so it turns out that long past the point when we're in a field situation, intestinal alkaline phosphatase still functions as a big healing component with regard to the intestinal lining. But from a blood type perspective, it actually has a whole lot more interesting associations, because since the 1950s, it was known that the level of this enzyme varied significantly by the blood type and secreted status of the person who was being analyzed. And originally, they were looking at this exclusively with regard to one of the major functions of this intestinal alkaline phosphatase, which was to split cholesterol. And so the idea that the high levels of intestinal health and phosphatase which by the way are found in blood group O, compared to the other blood types might explain why perhaps they were better suited to a high protein diet with regard to the cardiovascular consequences, which are sometimes thought to be the result of increasing too much fat and protein in the diet. The theory being that since the alkaline phosphatase, was higher in typo and was responsible for splitting cholesterol, that maybe this conveyed a little bit of protective benefit when it came to type. Oh, eating a higher protein diet. That's probably true to this day because he does partially explain why typo has lower rates of most of the common forms of heart disease. But one of the major effects in terms of intestinal alkaline phosphatase as well, is that it increases the absorption of calcium in the gut. And so consequently, here's another particular piece of evidence that kind of throws the whole bone hypothesis sort of into disarray, but falls directly in line with the observation that in many instances, the increase in acidity is offset by improvements and absorption. So here's blood type O with a better level of an enzyme that's keyed into the absorption of calcium, and the breakdown of fat that's triggered by the intake of fat and protein. So in essence, these people have the ability, perhaps better than the other blood types are sure of being able to benefit not only in terms of the benefits of protein in a general sense, but in type O increasing protein actually results in the activation of an enzyme that helps split cholesterol and improves the absorption of calcium. And this also shows some significance with regard to the secreted status. Because it turns out that if you add secreted status to the calculation, NASA creators have higher levels of intestinal alkaline phosphatase than six meters. So if you're going to make a whole spectrum, we would say that the host recruiter is the highest in terms of alkaline phosphatase and the a non secrete or is the lowest. And this is actually been shown by by some research, and there's actually evidence that the unfortunate type, a person may be producing a blood type antigen, which actually may actually inactivate intestinal alkaline phosphatase directly. So in a way, it does go a long way to explain why perhaps if the type aids the standard American high fat diet, they're going to have more consequences with regard to cardiovascular disease, because they don't have the enzymatic machinery to break these things down and profit by the consumption of those foods by the activation of enzymes, like alkaline phosphatase. You know, there's another area also wanted to talk about a little bit which is repairing after your your bone breaks. And it's really only something that's the kind of I suppose a observation that I've made over the years, and I thought I would share with the audience. And it had to do with the fact that a while back, I had broken an ankle doing martial arts and doing a spin kick, which resulted in me collapsing into the floor and landing on top of my ankle, then we're going to have to do all the typical things one does if that situation, they were looking at actually pinning the bone in there and everything. And I said, well give me some time. And let me see what I'm going to do. I come back in a couple of weeks, and we'll see if that's the state of affairs. And if that's so we'll go ahead and do it. So they slept on one of these air kind of splint thingy things and I wore that for a while. Then I did some research and it came to the conclusion that there was a real need for vitamin C in what are known as branched chain amino acids. leucine of Aileen and isoleucine. These are the three branched chain amino acids, because research was published that showed that these were the things that the demand was the greatest for and bone that was repairing itself from the break. So I thought to myself, what is the what is the problem and just giving a large amounts of things, which the evidence seems to suggest is in high demand and rapidly healing bone. So I took this and went back and saw the the orthopedic doctor at that point. And he was shocked. He said, You know, you had your ankle, I feel like a 20 year old, he said, and so I gave this to some other people and it does seem to be effective so that after traumatic injuries, i i do recommend that this is something that people consider as a sort of a post recovery type of routine. Now there's lots of supplements as well that can be indicated for proper bone health. And I think Dr. Jenn has a few that she wants to talk to you about here. Absolutely.

So probably the most common that we hear about would be vitamin D. So we know that vitamin D aids in the absorption of calcium from the gut and then we have it's an AK which helps the movement of the calcium into bone formation. Aside from the vitamins we have other minerals that are also required, so we have things like manganese and magnesium and boron. Manganese is important for supporting the ligamentous structure around the bones themselves. And so it's particularly in spinal bone where we see the discs take Picking up a lot of the compressive force that occurs in the spine, manganese can be particularly helpful because it helps to strengthen the ligamentous structure, which were helped to hold the bones in place so that the discs don't come under so much stress. Vitamin

D is an interesting one, I mean, it barely qualifies as a vitamin, it's closer to a hormone, especially when it turns into its active role. And if you look at it from a genomics standpoint, it's a powerhouse, it turns on over 300 plus genes. So it's got a lot of roles in immune, immunological and gene expression that are completely independent of its role as a vitamin. And I think one of the things we don't really realize is that there is an interplay between vitamin D and the parathyroid as well, which is, again, a major calcium regulator, Vitamin K is a major benefit is I think it mostly prevents calcium from going in the wrong places. We want it to go on the bone, but not necessarily into your arteries. And Wally, the general tendency has been for people to have a kind of a mix of d3 and k two. And it's associated with lower levels of vitamin K are associated with well, and associated with osteopenia or osteoporosis. One of the other ones that generally tends to get under recognized is magnesium. I think a lot of people don't realize it, but the vast majority of us are clinically or sub clinically magnesium deficient. For the simple reason that the dietary levels of magnesium in our foods has been dropping pretty much since the beginning of the 20th century, you know, from when we went into large scale, agricultural, industrial agricultural behavior with modern fertilizers and things. And also to the fact that, you know, if we've moved more towards a grain based diet and away from life food diet, which intends to provide the vast majority of our magnesium. And again, magnesium would be hard to just talk about it. And as it's rolling in a bone regulatory sense, because magnesium is, is what's known as a catalyst or a cofactor in most of the enzymatic reactions that produce energy in your body, so anything having to do with the metabolism of carbohydrates and, and the production of energy from their, their, their metabolism is magnesium dependent. But also to magnesium deficiency tends to mess up the balance between the bone laying osteoblasts and the bone munching osteo class. So when you've got a subclinical level of magnesium, that delicate balance tends to become a little bit more of a oscillating type of thing, rather than a very delicate turning of the of the rudder. And again, this is like homeostasis. Everybody thinks of magnesium and all they think about is, you know, probably going to the bathroom because most people take magnesium as a sort of a gentle laxative, but there are so many forms of magnesium that can be used without having big effects on on the function of your digestive tract. And as Dr. Jen said, manganese has a significant role in my understanding, because it strengthens the ligaments that are aligned along the sides of the spinal column, where they're actually doing the majority of the girdling of the spine. And when they become lacks, it typically is associated with a lack of magnesium and manganese rather. And ultimately, it forces the, the intervertebral discs to function like a structural component, when really they were designed to function as a shock absorber. So it's like your car, if your chassis is not supporting itself, then you have to rely on the shock absorbers to hold the car up, that's not going to be a formula for a whole lot of long term success. You know, one of the things that comes up a lot on the internet generally is bone broths. Unless you could take a moment and just kind of give us a little bit of a background on that and what you think about the benefit of making these bone broth, if indeed there they are, they are beneficial. Sure,

yes, you can make bone broth by boiling the bones of pretty much any animal. Mainly we see them produce from chicken or turkey or be sometimes lamb. And the benefits are that you get a lot of the minerals being pulled out of the bones. And so you get this high concentration of minerals that's easily absorbed. It's also really beneficial for people who don't have great digestion. So maybe aren't getting enough from the diet. But you do have to be careful with the sources of the bones. You just want to make sure that you're getting bones from organic grass fed animals. You want to be careful that they've been to For heavy metals and things like that, and

lead is a particular issue when it comes to anything having to do with bone, because letting calcium tend to be very similar electrostatically when it comes to their molecular characteristics, and so anywhere, you know, you have led, it's going to get itself involved in calcium metabolism. So, yes, you have to be very careful about the sources. And then there's a few little things I've noticed it's very high in glutamate. And some people say that if you have like neurological issues, you should avoid large amounts of glutamate in your diet. But one of the benefits is that it's a very labor intensive, but inexpensive way of getting glucosamine and chondroitin, which are the two bone building nutraceuticals that many people consume as, as supplements. You know, I mean, I've had I've had bone broth from a variety of different sources. Some tastes better than others, I'll say that, and some of them very strong. But some people swear by them. And I think the only things we need to be aware of are the source materials. And there's some theories that should pull acid in there, like from lemon juice or something, or some people use vinegar to sort of help extract out the things while the broth is being made. But it turns out that actually, that might increase the glutamate content, which perhaps maybe is something that we might not necessarily want to recommend, you can just boil these things to death, and you'll get everything out of them. That's going to come out of them. That's for sure. Now, basically, I'm going to talk a little bit and Dr. Jen is gonna work through this with us as well on some of the typical botanical things I've used over the years and we've used in the center of excellence over the house call. One of them is just the unfortunately named Horny Goat Weed, which apparently has marketed mostly as a I don't know a male enhancement aphrodisiac, I suppose it's supposed to be a benefit in I think erectile dysfunction. I've never been sure it's the horny and Horny Goat Weed had to do with the fact that it had horns, or the fact that it was a Horny Goat, in which case, perhaps maybe that was an over extrapolation with regard to what this herb can do. But epimedium, which I routinely mispronounce, I think I might have just mispronounced that, again, contains an important ingredient called Karen, I see a R I N. And a Karen has a huge number of studies in the literature that are involved in maintaining bone health, largely because of the interaction between a Karen and epimedium as the source of the Karen, with what are known as bone morphogenic proteins, which are genes that are involved in the activation of the whole bone growth mechanisms on a genomic level. And then basically, the studies show that it in combination with calcium and decreases bone loss in the spine and hip and women compared to women who were just taking calcium alone, and this is a menopausal women. So what they did is they studied whether or not taking calcium, decrease the rate of bone loss. And then they compare that to women who were taking calcium and taking epimedium. And they found that the combination of the two was better than the calcium alone. Calcium is tends to be kind of a mineral that I suppose we could have given some not at a hat to because it is a common recommendation for people past a certain age to take calcium supplements. There's a mixed bag in terms of results, and perhaps maybe even the notion of whether or not in the long run is the single most beneficial thing. It's not necessarily the calcium. That's the issue. It's sort of what you do with it. There are certain diets that don't get enough calcium, we need to address that perhaps with supplementation. But the best thing I can say is a comprehensive approach to structural wellness is really a combination of things and not just taking a calcium supplement and a couple of Tums every morning and thinking that that's going to do it for you. And there's more we have to talk about as well, such as another herb which we've used a lot called drain area, which Jen might actually be familiar with from all the traditional Chinese medicine it comes out of the Shaolin Temple where they used to beat on each other and take the stuff after to heal themselves.

Yeah, interestingly, the translation actually means men broken bones. So dry Neriah actually helps to inhibit the osteoclast function and increase the osteoblast function. So that means that it stops the breakdown of bones and stimulator induces the building of new bone. Particularly interesting about this is that it helps to decrease insulin motion in the bones. So a lot of times we'll see people with rheumatoid arthritis who are suffering bone loss due to the inflammation and dry Nereo can be particularly helpful and decreasing that inflammation as well as stimulating the regrowth of the bone that's been lost.

And it's actually been shown in recent studies to be quite beneficial for actually the bone loss that's associated with periodontal disease. And typically what's called alveolar bone remodeling, which is the idea that periodontal tissue is constantly trying to stay attached to the underlying bone that's responsible for giving it the anchoring that allows it to align as the teeth and provide that kind of cushioning. And that actually is one of the first steps in periodontal diseases, destruction of the alveolar bone, which is when they start talking about how it got bone loss and gum disease and things and I joined area has some interesting possibilities there with regard to people who are chronically prone to periodontal issues, especially if they've been told by their dentist that they're going to need periodontal work or perhaps maybe that the bones are to the point where they're headed towards implants and things like that dry area we've used for many, many years. I believe this is really one of the great unsung structural bone health botanicals that are out there in addition to epimedium as well, which I'm surprised when I talk to colleagues about it how often they just tell you though, that I heard it was an aphrodisiac. And it's like, well, I don't even know if it's an aphrodisiac, but look at the studies that just imply its benefit in bone health. And it's like it's it's amazing. If you went to PubMed there, there are hundreds of articles on this. So let's talk a little bit about collagen. And I think that the really the important thing here is to understand College, and you have to understand what it's like to be a molecule that likes to be in a basket weave. And by that I mean, if you think about how baskets are woven, you know, they kind of like have the strands that go one way and then strands that are perpendicular to those. So it produces a kind of a cross linking type thing. And collagen achieves that basket weave structure becomes very, very strong and very, very elastic. But when collagen the nature's either through excessive amounts of antioxidant or reactive oxygen type things or tissue destruction, what happens is, instead of having that kind of basket weave, look, the strands align kind of longitudinally, they just sort of look like they did, they're just all lined up as as sort of an in a line. And of course, this is very, very weak. So we're really, really want to do over the course in time to prevent collagen from essentially resulting in the loss of soft tissue elasticity and strength and compressibility is we want to maintain that basket we structure. And there's a variety of actual natural products that have been shown to do this by virtue of what we call your poly phenol content. Joanie want to take us through those? Sure.

So one that we use a lot is called Host chestnut, which is particularly helpful for decreasing the swelling that occurs after bone is fractured, or there's some sort of sprain or arthritis, or a lot of pain that occurs due to inflammation. But his broom is also helpful for improving the blood flow that's necessary for the rebuilding of the bone. And there's an app called Gotu Kola, which kind of combines these things and helps to support the blood flow and also reduces the inflammation.

And then there's the famous Pycnogenol, which is the maritime pine needle extract, which a lot of people take for a variety of reasons, but it's actually been fairly well shown to have an effect in terms of helping college and re orient itself to the more strong basket weave cross linking structure. And it's interesting because you look at these things and you think to yourself, that some of the references to these botanicals go back to herbal monograms or monographs, the 14th and 15th century, people are talking about the use of these things in sprains and how in Shaolin temples in China, they're using join area after they do their martial arts training. And as the observational basis of these things has just become, I'm always so surprised that people can be such empirically sensitive about these things and, and how we risk nowadays with our rush to basically go to the more synthetic, I'm losing this connection to these plants that come from a natural environment that comes through a process of, of evolution that gives them these capabilities. So I'm just always amazed that these early herbalists in their observational skills at the time were just amazing. So before we close, we just give a nod of the hat to the kind of thing stead are obviously part of an everyday program of wellness that don't have benefits in terms of structural integrity. And of course, the big one, there is exercise, genuine to talk a little bit about the ways basically exercise can influence this. And at that point, then we'll sort of summarize things and we'll wrap up this podcast. So

anything that increases your, your weight bearing, or your resistance training is going to help to strengthen your bones. So you don't have to do things that are, you know, super high impact things like piezometric exercises, which are, you know, like squats and jumps and things like that, although those are very useful, we oftentimes see people who just aren't quite in a state to be able to do those. So even things like walking or jogging or hiking, will be really beneficial for supporting your bones. And you can always add an extra weight bearing. So adding ankle weights or adding hand weights, when you're doing these things are just gonna give yourself a little bit extra outcome from those.

It's interesting because especially with regard to resistance, you can start anywhere, at any level, as long as you progress, right? Anything is better than nothing. And it's actually the progression that dictates the improvement. So for instance, you can start with a one pound weight, go to a two pound weight, and go to a five pound weight. And then entire process, people will tell you, Oh, that's not doing anything. And yet it actually is because having started from nothing, to go to one pound significant and haven't started at one pound to go to five pounds. So the idea is with resistance training is the nature of how to do it effectively is to make sure that there's always a degree of progression going on. Yes, then some of the best ways of being able to do bone building exercises involve things that are going to be compressive exercises, like jumps and things but many people don't have the joint strength for that. Although you can essentially work up to it. Yoga has indeed been shown to increase bone density, but only really in people who are regular practitioners.

So if you're really a person who likes to take a yoga class once a week, you're probably not going to get much of a payoff in terms of bone density. But if you are a regular practitioner, and you do it long enough, it compares favorably to in many of the other ways exercise can induce and prevent bone loss and maintain structural integrity.

So this concludes this episode of the house call podcast on structural integrity and bone health. I'd like to thank my esteemed colleague, Dr. Jennifer Goto, for coming in and spending some time with us. Thank you for having me. I'd like to thank you for taking the time to listen to us. We'll have another episode.

Usually these are coming out at the rate of about one every two weeks, you can join the house core group on Facebook, which is just a demo house call. You can search for that. And there you can interact with people who are discussing elements of this podcast and suggest possible guests and topics that we might have. You can go to the dymo.com www dadamo.com For all things blood type, diet and related things that I've researched in the course of my own career. And until I see you all again, this is Dr. Peter D’Adamo. I'm Dr. Jennifer Goto. Take care and until next time, be well