Did you know that “bone-eating” osteoclast cells are derived from immune cell precursors and are stimulated by inflammation, just like other immune cells? Or that bone has its own glycocalyx whose health is essential to realize the benefits of exercise for bone? Folks, Dr. Keith McCormick is back on New Frontiers with ever-more juicy pearls like these, and with important updates on bone care for functional medicine practitioners and patients alike. Dr. McCormick is living proof that osteoporosis and a history of multiple bone fractures – he had 12 between the ages of 45-50 – are not an irrecoverable life (or death) sentence. In fact, even as he nears 70, Dr. McCormick is out there competing in Ironman and pentathlon events, living his life to the fullest.
Dr. McCormick is arguably the top thinker and practitioner on bone health from a systems and functional point of view. His nuanced navigation of diagnostic tools as well as both pharmaceutical and nonpharmaceutical interventions is fully comprehensive and deep. You’ll want to tune in to find out how he navigates his patient cases, casting a wide net for underlying contributing factors, his go-to interventions for specific situations, how he doses supplements, and more. Please do let us know what you think, and leave us a review wherever you listen to New Frontiers – DrKF
Resolving Osteoporosis and Optimizing Bone Health – A Tour de Force Update
Have you ever pondered why certain individuals with osteoporosis escape fractures while others face a different fate? Or sought ways to help patients with aggressive osteoporosis who resist medication? In this episode of New Frontiers, we embark on a comprehensive exploration of osteoporosis from a functional perspective with leading bone health expert, Dr. Keith McCormick, as our guide. We’ll explore the intricate connections between the immune system, vascular system, hormones, gut and osteoporosis, shedding light on the complex interplay between . Dr. each. Dr. McCormick also delves into essential testing methods beyond bone density scanning, and offers insights into the broader considerations when diagnosing and supporting patients with osteoporosis. Get ready for a profound discussion that will revolutionize your clinical approach.
In this episode of New Frontiers, learn about:
- Dr. Keith McCormick’s personal journey recovering from severe osteoporosis
- Importance of assessing bone health in everyone, regardless of risk factors
- Why we should measure bone quality not just density
- The most useful diagnostic tools, beyond bone density, that help you course-correct much more quickly
- Monitoring trabecular bone score (ask your radiologist if it’s available!) and bone turnover markers C-telopeptide (CTX), N-telopeptide (NTX), and P1NP
- Using P1NP to determine the effectiveness of anabolic medications like Forteo
- Optimal reference ranges to use (they’re different to the lab reference ranges)
- Nuancing Prolia use to minimize the chance of rebound bone loss, especially in those that respond most favorably to the medication
- Determining good candidates for medication, in addition to nutrition and exercise, and which medications to use when
- Walking through the thought process for someone with moderate osteoporosis who only wants to do nutrition and lifestyle
- Remembering to rule out other underlying causes of bone loss including parathyroid imbalance, hypophosphatasia, Ehlers-Danlos syndrome, multiple myeloma and more
- Distinguishing between Celiac disease and gluten sensitivity, and why gluten avoidance matters for some
- Why we should be thinking of osteoclasts as similar to macrophages, and stimulated by the same pro-inflammatory triggers (leaky gut, dysbiosis, food sensitivities etc.)
- The role of estrogen in calming the immune system and improving “mechanotransduction” in the bone glycocalyx so that we can actually reap the bone benefits of exercise
- Don’t forget the basics – vitamin D, calcium (if not enough in diet), magnesium, vitamin K (K2 MK-4, K2 MK-7, and K1 in combination and not too much), protein, electrolyte sufficiency, trace minerals
- Maxing out supplemental calcium at 500-700 mg where possible, the rest should be from food – think sardines, kefir, and greens!
- Alpha lipoic acid, N-acetylcysteine, berberine, resveratrol, quercetin and more for lowering elevated bone resorption markers
- The rational for a lower dose approach that can be sustained over the long term
- Evaluating and targeting the glycocalyx and nitric oxide systems (ADMA, advanced lipid panels, Arterosil, tocotrienols, pomegranate and more)
- Gut health as a central contributor to bone health in nearly all patients
- Exercise – frequency and type trumps duration
- Vibration plates help in addition to exercise, as long as that glycocalyx is healthy
- Stress management, environmental toxins and more!
Dr. Kara Fitzgerald: Hi everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. And today I have one of the very, very, very best and one of my first podcasts. This is Dr. Keith McCormick, and we talked back in 2015. Let me give you his background and why I’m absolutely honored and thrilled and excited to have him with me today. Dr. McCormick is a board certified chiropractic physician in the states of Massachusetts, Colorado, and California. He’s been in clinical practice since 1982. He earned his bachelor’s from Stanford and his doctorate from the National College of Chiropractic. He is an instrument rated commercial pilot and a US Army Veteran. Sports have always been a big part of his life. At Stanford, he competed on the varsity cross country and fencing teams. As a junior he was the silver medalist in the 1973 Modern Pentathlon World Championships.
He competed and succeeded in a whole lot of other events, but really one of the crowning moments, actually you’re continuing to compete Dr. McCormick, but he was in the 1976 Olympics in Montreal. He was part of the modern Pentathlon team and he is also a former US record holder, the most points scored in a pentathlon competition. Dr. McCormick continues to compete in triathlons of all distances and has completed six Ironman competitions, five of them after recovering from multiple osteoporosis related fractures. I want to add to this bio before I welcome you. It was this journey- I know this about Keith. Keith is a friend of mine and as I said, we’ve podcasted before. This incredible sports journey that continues to be a huge part of his life, that brought him to his own experience with severe osteoporosis, and maybe we’ll touch on that a little bit, but it has focused his career. He’s the leading, I’m not even going to say one of – he’s the leading physician in the functional integrative space and really beyond, thinking about osteoporosis through a systems lens, through a systems functional lens.
His first book was this slim volume A Whole-Body Approach to Osteoporosis. I pulled it off my shelf, it’s dogeared, I’ve folded tabs, I’ve highlighted it, I’ve got notes in here. I’ve used this in clinical practice. I’ve recommended it to other physicians over the years, many, many times, and I’ve recommended it to patients for years. He recently updated it with this 700 page volume that is a must for us as providers. This has got to be sitting on our shelves. This will become dogeared in my practice as just a brilliant update on this book. And it’s also written in plain language. So, this is something that regular folks who have osteoporosis, or have some kind of a bone loss issue, or are working, have a loved one with it, this is a book that they can access and use as well. So I value your friendship. I just value your brilliance, your commitment to the science. I mean, we go back to when I was in my postdoc in the lab. So many years, we go back. Welcome.
Dr. Keith McCormick: We met in Georgia twenty years ago or something.
Dr. Kara Fitzgerald: Long time ago. Welcome once again, Dr. McCormick to New Frontiers in Functional Medicine.
Dr. Keith McCormick: Thanks for having me, Kara. Appreciate it.
Dr. Kara Fitzgerald: Yeah, absolutely. We’re going to dive into all your thinking on bone loss and how we want to work with it as clinicians. But just tell me a little bit about your story, your incredible story. And you continue to compete, really as intensely. And you just mentioned to me earlier that you’re 69, and clearly so healthy. You resolved your own osteoporosis. Tell me a little bit and then we’ll just jump into the book.
Dr. Keith McCormick: Well, I’ve been running and swimming and doing everything since I was five years old. My life is athletics. And when I turned 45, I started breaking. I had twelve fractures in five years, and I’ve had probably twenty-two fractures in my life, something like that. I went to several endocrinologists, five of them to be exact, and they just wanted to put me on drugs. And I said, “No, I can’t do that. Just got to figure this out.” And I said, “I’m 45 years old, am I supposed to… I’m going to live until 90. Am I going to take drugs for 45 years?” It didn’t make sense to me. So I knew I just had to totally immerse myself in figuring this thing out. And that’s what I did. I just plunged into it headlong and figured out a lot of things and wrote these two books and yeah, I’m still competing and I don’t fracture.
People can do a lot more than they think they can. And that’s why I wrote Great Bones, the new book the way I did. I wanted it to bridge this gap between the public, the layperson, and the doctor. Because doctors need to know a little bit more about this disorder and the layperson needs to know how to interact with their doctor, number one. Number two, how to even understand the complexity of this thing. And yes, the book’s a little complex in certain places and you have to wade through it and pick things out and maybe not read certain things if it’s too complex. But I think what it does is arm the patient with a way to communicate better with their physician.
Dr. Kara Fitzgerald: And it arms the physician with an approach to osteoporosis. There’s just no question about it. I’ll use it in my practice just as I used your original volume, which was a quarter of the size, but still very smartly written, very actionable. You’re not anti-medication, and we’ll talk about that, but before we do, who’s at risk for osteoporosis and what are the risk factors?
Dr. Keith McCormick: Everyone. There are all these risk factors that doctors usually have in their head: Underweight, female, people who take medications. There’s lots of risk.
Dr. Kara Fitzgerald: Non-athletes, sedentary. So you blew all those up.
Dr. Keith McCormick: That’s right. I had osteoporosis and I never took a drug, I was an athlete all my life, I drank milk out the wazoo. I mean, I was hooked on milk. I did everything right and I still got it. So I don’t even pay attention to risk factors. Everybody should be assessed for bone loss. And bone density exams aren’t perfect, but they’re sure worth doing. They’re non-invasive, they’re cheap, they’re simple to do. Everybody should have a bone density, at least by the time they’re 50-55 years old.
Dr. Kara Fitzgerald: Okay. All of us by 55, at the latest, 50. Does family history flag- Yeah, go ahead.
Dr. Keith McCormick: The sooner you find out you have low bone density, the more you can do about it. If you don’t find out until you’re seventy or eighty, it’s a lot harder to gain it back. If you find out when you’re 45 like I did, it was great. I still had time to improve upon. I wish I would’ve known a lot more. It took me five years to get up and running because I had to educate myself, but it would’ve been better for me to find out at forty.
Dr. Kara Fitzgerald: Sure. Or in your case, you probably were showing up with bone loss even earlier if you fractured-
Dr. Keith McCormick: I’m sure I was.
Dr. Kara Fitzgerald: At forty-five.
Dr. Keith McCormick: The reason why is because number one, I was gluten sensitive. I’m not celiac. But also I just trained really, really hard and I was low weight and probably didn’t get enough protein. When I was training really hard, I trained probably 14 to 16 hours a day. I mean it was all day long for years and years and years. That was my training as a professional athlete. When you do that, totally immersing yourself, it does build up a lot of oxidative stress, a lot of increase in pro-inflammatory cytokines, and I’m sure that fueled my osteoclasts to break down bone.
Dr. Kara Fitzgerald: Right. But I do want to point out, as you and I were just talking about offline, that you’re still engaging in Ironman triathlons. You’re still doing it. You’re still out there. You said you just came from a half-marathon or a half Ironman, and then you went and did a marathon six days later. You just told me that. So you are working out way on the other side of the bell curve, but you’re fine now and you’re healthy. You’re just doing it smart. You’re great.
Dr. Keith McCormick: But I’m doing it smart. Totally different than what I used to do. Yeah.
Dr. Kara Fitzgerald: That’s another conversation, as I said to you then. But I would just love to understand how you’re doing it, how you’re doing very intense athletics at almost 70 with such vibrant health. It’s awesome and your bones are intact and strong and it’s really very inspirational for me and I know it will be for other people as well. It’s so, so cool. We have this, I think, inappropriate belief that doing intense athletics, doing ultra-athletics can be damaging. And then in a certain population or doing them inappropriately, as you were early on in your career, is damaging. But you figured out how to do it right and someone’s got to mine that gold. Maybe it will be me. All right, so what are the best diagnostic imaging tools for bone health, bone status?
Dr. Keith McCormick: There are so many laboratory tests. I think there’s so many that we don’t even realize how many we have available to us. So number one, everybody has the bone density and that’s for the… So bone strength is a combination of density and quality. And a bone density exam only does bone density. So there’s bone quality too. Fifty percent of the bone strength is quality and we don’t even know what that is. I have patients that are -3.0 and they break and I have others who are -4.5 and they don’t break.
Dr. Kara Fitzgerald: Yeah, so define that. So how do we figure it out?
Dr. Keith McCormick: Well, there’s a few ways. The trabecular bone score is a good way to go, but that’s only one little aspect of quality and that’s trabecular connectivity. A TBS, or trabecular bone score, there’s not very many of them available, and it’s not a test, it’s a computer add-on to a DEXA. In Massachusetts where I am, there’s only 10 or 12 of them, but you have to call up the hospital and talk to radiology and say, “Hey, does your DEXA have TBS capability?” So what they do is they just analyze the bone density results with the computer and they’re looking at the gray scale, the pixel gray scale of the trabecula to see if they’re connected. So if you have disconnected trabecula, it’s degraded. It’s a degraded quality of bone, which increases your fracture risk. So that’s probably the number one way to look at quality.
Number two is certain labs. I use a lot of bone turnover labs. The main bone resorption lab test I use is C-telopeptide. You can also use N-telopeptide. The N-telopeptide and C-telopeptide, are similar in that they’re just opposite ends of the collagen molecule that you’re testing for, and when that number is high that says the osteoclasts are hyperaggressive and breaking down too much bone and we get a lot of bone collagen then running around in our blood. Or a person can do an NTX, N-telopeptide, and that’s either urine or blood. But in order of accuracy, I would say the spot urine NTX is the worst, the 24-hour urine NTX is a little bit better, the serum NTX is much better, and then the blood CTX is the best and that’s what I use.
Dr. Kara Fitzgerald: And that’s available, I mean that’s available through our standard insurance covered from Quest. Yeah.
12:48 – Dr. Keith McCormick: And then for bone formation I use P1NP (Procollagen Type 1 N Terminal Propeptide). I used to use osteocalcin, but that’s a really squirrelly test and not that accurate. It’s really, really, really affected by food and time of day and stuff. I mean, so is CTX, let me say one thing about CTX: The reason why a lot of physicians don’t use these turnover markers is because they’re frustrating because you have to do them exactly right. With the CTX, the only way you’re going to get accurate results is the patient needs to be fasting. They need to go to the lab first thing in the morning because there’s a huge difference between seven o’clock and even 11 o’clock. It just really decreases in its levels throughout the day. It’s high at three in the morning, it’s the lowest at three in the afternoon.
Dr. Kara Fitzgerald: Interesting.
13:46 – Dr. Keith McCormick: And then no biotin and no collagen for 48 hours before.
Dr. Kara Fitzgerald: Good. I was going to ask you about collagen, but biotin also, it’s one of those labs that just is influenced negatively by biotin.
Dr. Keith McCormick: And then for P1NP, which is called Procollagen Type 1 N Terminal Propeptide, it is much better than osteocalcin for bone formation, so osteoblastic activity. And I use that not on every patient. I use CTX on every patient. But the reason why I use P1NP is, let’s say if a person is going to do an anabolic drug, such as Forteo or Tymlos or Romosozumab, you want to make sure that these drugs are working. Five percent of the time they don’t work, so it would be silly to do teriparatide, which is Forteo for two years, where the person is injecting themselves every day and then two years later you find out, oops, it didn’t work.
Dr. Kara Fitzgerald: Wrong drug. So how do you figure that out?
14:44 – Dr. Keith McCormick: You make sure you get a baseline P1NP. Three months into it you do a repeat P1NP, and it should be up a lot. If they had a baseline of 40 for P1NP, it should be up to at least a 60 or 70.
Dr. Kara Fitzgerald: That’s awesome.
15:00 – Dr. Keith McCormick: If it’s not, then you know it’s not working. You’ve got to switch to something else. Then I continue to do, especially at 18 months, I do that P1NP again because if it’s back down to 40, I know that teriparatide isn’t working anymore. And that happens, it loses its oomph after 18 months. If it’s still up, if the P1NP is still high, then continue for the full two years.
Dr. Kara Fitzgerald: Okay. I want to just ask you a couple of questions on that. That’s so, so helpful. Is there an optimal reference range for either of these or are you relying on the lab ranges? Are those comfortable for you?
Dr. Keith McCormick: We don’t rely on the lab ranges. They’re terrible.
Dr. Kara Fitzgerald: Okay.
15:40 – Dr. Keith McCormick: For example, the C-terminal peptide I think is between 36 and 1,036, something crazy like that. So, no. A good reference range for CTX is between 300 and 400, or 250 and 400. I think people start losing bone at around 350 CTX. If a person is on a medication, like a bisphosphonate or Prolia, that will bring it down to 100, maybe 50, and even below 50, which I don’t like because a lot of these drugs can over-suppress the osteoclasts and that causes other issues. I watch their CTX, I watch the bone-specific alkaline phosphatase for over-suppression, and you have to keep doing these markers to see what’s happening. As the drugs can work, they can work too much. Another example, and sorry to keep getting-
Dr. Kara Fitzgerald: No go, go, go. This is really helpful.
16:46 – Dr. Keith McCormick: I’m talking to much about the medications. Prolia has issues in that it’s good in building bone density and bone quality. But if it works too much, if it works too well, then when you stop it’s very difficult to not have a rebound in bone loss. So, I usually don’t recommend that people take Prolia for more than- Prolia is a what’s called a RANKL inhibitor – a receptor activator for nuclear factor kappa B – inhibitors, an antibody against that. And RANKL is a direct stimulator of the osteoclast. So, if it’s an inhibitor, you directly take away that stimulation of the osteoclast, osteoclastic comes down. But Prolia is an injection you take every six months. So, at six months you need to do another injection, because there’s about a 210% variability in Prolia’s actions on people. In other words, some people it works for five months, some six months, some seven months, some eight months, some even nine months.
But if you’re a five-month person and you miss your next injection and don’t get it until seven months or eight months, you’re going to be losing bone during that time. You’ve really got to do it every six months. But if you do it too long- So Prolia has this nasty part about it where what it does is it doesn’t kill the osteoclast like a bisphosphonate does. It shrinks down these osteoclasts and makes them into these osteomorphs that are just quiescent, shrunk down, osteoclasts. As soon as you stop Prolia, all those osteomorphs burst out, then you have tons and tons and tons of active osteoclasts running around. And that’s why a rebound happens and you break down bone. And the longer a person’s on Prolia, the more it works, the better its response. And that’s why when patients say, oh good, I responded really well to Prolia, and I go, yeah, a little too much. Because a really good response to Prolia means that there will probably be even a worse rebound afterwards.
And so, you have to do Reclast after you’re done. The longer you’re on Prolia the harder it is to stop that rebound, but you have to (follow up with) Reclast. And on the Reclast, let’s say the person did- I usually don’t recommend more than three in injections of Prolia, but after those six months of Prolia, you check the CTX and then- This is all written in my book. It’s a little complicated. – But because you want to make sure that CTX starts rising a little bit because you have to do Reclast which is called zoledronic acid after Prolia. Otherwise, you can’t use Fosamax or Actonel because it’s not strong enough to prevent that rebound. You do the Reclast, but you have to make sure that there’s some activity in the osteoclasts for the Reclast to be absorbed. I spell that all out in the book because it is a little complicated.
19:58 – Dr. Kara Fitzgerald: Yeah, it was so important though. I’m assuring everybody listening, we’re going to get to natural interventions and we’re going to talk about how those affect how we put together a good bone density protocol and all of that and how they influence labs. I want to talk about all of that. But since we’re talking about the medications, who is a good candidate for meds and how do you stratify what drug for a given individual?
20:32 – Dr. Keith McCormick: It’s so important to understand that this is not about drugs. This is not about nutrition and exercise. This is about everything. And that’s what you have to look at. I have so many patients that are -4.5 or -5.5, -6.0. We’re not going to get away with just doing nutrition. It’s not going to happen. But I have other patients who are -2.5, -3.0 that are fine with just doing nutrition. Even if they have osteoporosis it doesn’t mean they have to do a drug. There’s lots of factors that go into this. So yes, every single person is an individual and every single person has to be looked at. So yeah, I think it’s okay to not do a medication here. Or no way! They have to do a medication. But all during that time they’re doing a medication, and usually medication it’s only three years or so that we use it and then they’re off of it, but all during those three years we’re making them better, we’re making them healthier, and then they’re okay usually.
Dr. Kara Fitzgerald: Okay, and we’ll talk about all of that and I want to hear your drugs. But before you go into that, if you’ve got fabulous trabecular strength, what kind of number is going to flag you for no med required? How low can you go where you don’t need to prescribe a med versus when are you going to use it?
Dr. Keith McCormick: There’s just hundreds of variabilities right there.
Dr. Kara Fitzgerald: Okay.
Dr. Keith McCormick: I can’t say a number, but I would say in general, if they’re over a -3.4 and they have trabecular disconnect, they’re going on a medication.
Dr. Kara Fitzgerald: Okay. By the way folks, in his book Keith has a lot of case studies and you actually have really, really beautiful examples. I was looking in the genetics chapter and you just outlined a few different scenarios, but there are plenty of cases so that you can see his thinking in action in the book. When somebody requires medication what are the ones that you’re thinking about if you can influence that decision?
Dr. Keith McCormick: All these drugs. There are probably only ten different drugs or so. There’s not that many to figure out, but they all have different abilities and different risks and different applications. There are four bisphosphonates essentially. There’s Actonel and Fosamax, which are oral. They give you maybe one or two percent of bone density a year. Remember just bone density, not bone quality. There’s Xgeva, which I don’t even want to talk about. Ibandronate, because it’s terrible, and it causes people all kinds of adverse effects. So I never ever, ever, ever recommend that. And then there’s Reclast, which is zoledronic acid gives you three to four percent a year bone density. And that’s an infusion, so one-year infusion. And I think that’s great for somebody who has a high C-telopeptide. I can’t get it down to-
For example, if somebody comes in and they have a -3.2 and their C-telopeptide is a 900, which is pretty high. And going back to your question about reference ranges, 900 is in the reference range that they give, and it looks normal. Well, it’s not. They’re losing bone at 900 for sure. Probably I’m not going to get that 900 down to 350 with just nutrition. I’m probably not. There’s just too much going on. There’s genetics involved in this and I’m not going to get it down. If they have a 500 for sure, I’m going to probably get that 500 down to 300 or 350 with just doing nutrition. Which is a big deal because anything over 350, they’re losing bone. So I’m taking them from losing bone to not losing bone and being much healthier without doing drugs. But if they’re way up at 800, 900, 1000, we’re not going to get it down.
Some of the things that do bring it down pretty easily are alpha-lipoic and N-acetyl cysteine, berberine, getting rid of other things in their diet, making sure they’re not losing calcium in their urine, making sure the pH of their body is better. The more acidic they are, the worse things are.
But those are the bisphosphonates. That’s the pretty simple way to go. But if the person has a lot of degradation of trabecula and they have a really bad bone density, it’s not the way to go. I had a patient the other day and she was a -4.5, degradation of her trabecular and her physician prescribed her, I think Fosamax. Yeah, Fosamax. And I go, whoa, that’s not good enough here.
Then there’s Prolia. Prolia gives people about five or six percent of bone density a year. Like I said, it’s what’s called a RANKL inhibitor, and it does give a little bit of bone quality. It does great on hips. It’s probably my favorite for a person who has a really poor hip score. If they have low abundance in their spine and they are okay in their hip, then a bisphosphate is fine. But if they have low, low bone density in their spine and a -3.3 or -3.4 in their hip, you’ve got to do Prolia. That’s much better. Do that for one and a half to two years, then back it up with Reclast. If they have a lot of degradation though, and not too bad of hips, Forteo which is called teriparatide, and Tymlos, which is called abaloparatide, are a really good way to go. They give you eight to ten percent of bone density in two years or a year and a half, and they do great at rebuilding quality trabecula. The problem is with them, they don’t do great on the hip. I’ve even seen them decrease people’s forearm. Because remember when you look at somebody with a parathyroid issue or primary hyperparathyroidism, you look at their forearm and their forearm bone density is usually really low. The reason why is because parathormone attacks cortical bone.
Even though with teriparatide and abaloparatide you’re doing a daily injection, and even though the parathormone level, (this is a recombinant DNA parathyroid analog) only rises about an hour every day. You inject it, it increases in the bloodstream for an hour and then it’s gone. Usually it stimulates the osteoblasts, the osteoblasts then stimulate the osteoclasts to build up, so both osteoblastic and osteoclastic are increased. But sometimes it lingers and now it degrades the cortical bone too, both in the hip and in the forearm. So sometimes the Forteo and Tymlos don’t do a great job in the forearm or the hips. You’ve got to be really careful.
Dr. Kara Fitzgerald: And I’m assuming you’re going to follow up with a DEXA and a TBS?
Dr. Keith McCormick: In a year. No doubt about it. You’ve got to do that to make sure we’re not screwing up something else. We’re not improving the spine yet hurting the person’s hips. That would be terrible.
Dr. Kara Fitzgerald: Right, right.
Dr. Keith McCormick: And then the final drug I’ll talk about- Well the HRT is hormone- I’m really big estrogen proponent. I think it does so many good things that- Anyhow. What’s called romosozumab, or Evenity, is the final one I’ll talk about. And that is what’s called the sclerostin inhibitor. It’s an antibody against sclerostin. Sclerostin is produced by the osteocytes and it produces sclerostin.
Sclerostin decreases the osteoblasts activity. So romosozumab is an antibody against sclerostin. So it takes the sclerostin away, allows the osteoblast to do their job. I’ve seen really good results with romosozumab. It’s incredibly expensive. I think like a hundred thousand a year so insurances usually won’t okay it unless a person has at least a -4.0 and multiple fractures. But it does give people ten to twelve percent bone density a year in their spine and maybe five or six percent in their hips. So it does a pretty good job. It’s only given for a year, it’s a once-a-month injection, and you follow it up with Prolia or a bisphosphonate. So, there are the drugs.
Dr. Kara Fitzgerald: Okay, good. And you cover them all in the book. Here’s the book, Great Bones. It’s great book. We’ll link to the book and we’ll link to your website. You have supplements and you have a clinic. Are you accepting referrals at the clinic? I know you’re busy. Are you?
Dr. Keith McCormick: Yes
Dr. Kara Fitzgerald: Okay, amazing. I’ve sent people your way many times. All right, so let’s talk about the nutrition and the supplements again, and the lifestyle and the exercise prescription, et cetera. Let’s talk about the rest of the story. Let’s cover your foundational protocol, maybe with an eye towards the individual who doesn’t need meds. Or let’s say they’re right there at the threshold. Let’s say they have a pretty aggressive osteoporosis, but they’re adamant that they don’t want to go the med route. And you think, okay, I might be able to do this. Walk me through what that kind of protocol looks like. I know it’s individualized, but I’m curious what you’re doing for somebody there.
Dr. Keith McCormick: I do labs. I always do a core based set of labs. I do a CTX, a C1NP (aka P1NP) if I’m thinking about drugs for the person, for sure. I do a 24-hour urine calcium, number one, if they’re losing too much calcium, and number two, if they’re getting enough calcium in their diet. This isn’t about calcium. I think you kind of understand that. Osteoporosis isn’t about calcium, but calcium is important.
Dr. Kara Fitzgerald: Yeah.
Dr. Keith McCormick: They come back with a fifty on the 24-hour urine calcium, and I think, well, maybe they’re just not absorbing or getting enough in their diet.
Dr. Kara Fitzgerald: What’s an acceptable number on the 24-hour urine calcium?
Dr. Keith McCormick: I’d like a 100 to 225, something like that.
Dr. Kara Fitzgerald: Okay.
Dr. Keith McCormick: Then homocysteine. Homocysteine is so easy to fix on people. I get homocysteine on everybody. If it’s above 12 or 15 then it will increase osteoclastic activity and increase the cross-linked stiffness in the collagen fibers. So that makes for bone to be stiffer and therefore more prone to fracture. So it’s a quality issue and it’s easy to fix. I also get hs-CRP, high-sensitivity C-reactive protein. You get hs-CRP and you go from one to a three and that person has twice the fracture risk of anybody.
Dr. Kara Fitzgerald: Wow.
Dr. Keith McCormick: It’s a big deal. Same with homocysteine. You get up to 20 on homocysteine, they have a three to four times fracture risk. These are easy markers to bring down, and I think that’s what I really want to push in this interview, because it’s laboratory tests. You don’t need to wait for bone densities every two years. You look at labs, you can do them every four to six months. And you say, okay, yep, I’ve just decreased this person’s hs-CRP, I’ve just decreased their homocysteine, I’ve just improved their NLR ratio, their neutrophil lymphocyte ratio. I’ve done all these things. I know I’m on the right track. And then you know that what you’re doing is helping.
What else do I do? A lot of times I do a DHEAS. In women I’m thinking of maybe doing estrogen. I definitely get a sensitive estradiol on them. Pretty much everybody with a lot of bone density loss, I get a gluten panel. I get anti-tissue transglutaminase, IgA, total IgA, anti-gliadin antibodies IgG and IgA. I get those on most everybody.
What else do I get? I get Vitamin D, of course. I like it to be at minimum, minimum at 35, but probably 40-60 nanograms per ml. I don’t push for 70 or 80. I don’t think that’s helpful. I do a serum protein electrophoresis on people I’m a little bit worried about, a little bit older and you always get that. And that’s about it. But then from those, I look for things like, does this person have a parathyroid issue? And let’s just address that one because that’s kind of a big deal. I probably see a parathyroid person every week.
Dr. Kara Fitzgerald: Okay.
Dr. Keith McCormick: They’re very common. And it’s often the person that is a 10.0 on their total serum calcium and their PTH (parathyroid hormone) is a 52, which both of those are normal numbers. The reference range for PTH is, I think, 15-63 usually, depending on the reference range. So, 52 or 55, the clinician that they’re seeing says, “Hey, everything’s fine.” Or 10.0, or 10.1, that’s fine. But it’s not fine a lot of times. And as you know, PTH and serum calcium can go up and down depending on the day. So I do lots of serum calcium and PTHs.
There are a lot of parathyroid people out there that aren’t being identified and that will decrease their bone density for sure. You really have to figure that out. The 24-hour urine calcium, same thing. There’s a lot of people who, number one, are losing serum calcium in their urine and aren’t identified. And then there’s a whole other group of people that are on hydrochlorothiazide by their physician because they did a 24-hour urine calcium when they were taking supplemental calcium, and now they’re taking supplemental calcium during the collection of urine. And so, they have a 400 and it looks like they have hypercalciuria and they don’t. They were just taking a supplement-
Dr. Kara Fitzgerald: Or they could be drinking a fortified plant milk, right? The fortification is so rampant. We’re probably unwittingly consuming.
Dr. Keith McCormick: That’s right. Now they’re identified as a hypercalciuria person and put on meds. I’ve seen many, many, many of those. But I guess-
Dr. Kara Fitzgerald: And the SPEP, can you just go circle back to that? The serum protein electrophoresis.
Dr. Keith McCormick: I’m just trying to rule out MGUS (Monoclonal gammopathy of undetermined significance) and MGUS doesn’t necessarily lead to bone loss, but it’s certainly something you have to be aware of for multiple myeloma. And I see that sometimes. I’ve probably had four cases of that, so I want to make sure I’m not missing that. Every single case of osteoporosis doesn’t mean it’s osteoporosis. It could be something else causing bone loss. And that’s the issue you really have to be so aware of. A person comes in with osteoporosis and you’ve got to rule out everything. It can be something else. I’ve had three patients now with hypophosphatasia. I remember reading, “Oh, you’ll never see hypophosphatasia.” And I do. Ehlers-Danlos syndrome, you’ll never see that. Yep, I’ve seen that. There’s a lot of different things out there that cause bone loss.
Dr. Kara Fitzgerald: Do you cover that in the book? Things that you want to rule out. You do. Yeah. So physicians, clinicians, and just the consumers listening to this podcast, the book is such a treasure for these. That’s common, less common, but potential issues.
Dr. Keith McCormick: Potential issues that are not that uncommon. But I want people to know that you can use these laboratory tests as therapeutic targets. They can identify things that we’re going to say, “Okay, this is off. I’m going to fix it. I’m going to address something and fix it.” Because then you can use that nutritional input to say, “I’m going to get that homocysteine down, I’m going to improve that… whatever.” And then you see it improve. You go, “Oh right, I’m on the right track here.”
Dr. Kara Fitzgerald: And your patient is really excited about it. Okay, so let’s go back to this person who’s not going on meds but they’ve got a pretty aggressive osteoporosis. You’re going to start them on a nutrition protocol. What does that look like?
Dr. Keith McCormick: First, if they have a gluten issue, obviously they go gluten-free.
Dr. Kara Fitzgerald: How often do you find that? And how do you diagnose gluten sensitivity versus celiac?
Dr. Keith McCormick: I look at anti-tissue transglutaminase and if it says it’s celiac, it’s celiac. If it’s about twenty or so, they’re probably celiac. Twenty, twenty-five, something like that. If that’s a two and their anti-gliadin antibodies are thirty, then it’s sensitivity. They’re still coming off of gluten. I don’t care if their anti-tissue transglutaminase is a two and their gliadin antibodies are fifteen, or twelve, they’re still coming off of gluten. Gluten causes bone loss, not just from a disruption of the enterocytes of the villi in the gut, so decreased absorption, but it also causes bone loss because anything that ramps up the immune system is going to ramp up the osteoclasts, because the osteoclasts are a form of a white blood cell.
They are derived from the hematopoietic stem cells, the same as the white blood cells are. So you get on the macrophage-monocyte cell line from the hematopoietic stem cells, is the osteoclast. Well, same goes for the white blood cells. The white blood cells talk to each other through proinflammatory cytokines, interleukin-1, interleukin-6, tumor necrosis factor, interleukin-17. Every time they talk to each other with those cytokines, the osteoclasts are listening, they’re saying, “Ah, there’s something going on.”
Dr. Kara Fitzgerald: Sure. Information for me.
Dr. Keith McCormick: I’m all excited. The only thing I know how to do is eat things and I eat one thing and that’s bone.
Dr. Kara Fitzgerald: It’s just like a macrophage. You mentioned a bone specific macrophage.
Dr. Keith McCormick: I think if people wanted to know one thing that they came away with on this, that’s what I would say. Look what a macrophage does. Look what an osteoclast does. They’re both eating things and they’re both related and they both talk the same exact language. So anything that influences those macrophages, you know, dysbiosis, leaky gut, you are going to have increased osteoclasts.
Dr. Kara Fitzgerald: Well, this circles back to your original point about everybody being vulnerable for osteoporosis or bone loss to one extent or another. Inflammation is de rigueur, certainly in this country and really around the world. And unfortunately just as we age, unless we’re really mindful of it, if we’re really intentionally living, inflammation will increase. And that correlates with bone loss.
[00:40:43] Dr. Keith McCormick: That’s why I like estrogen too because estrogen itself is an immune system modulator. It calms down the immune system, but it also helps with mechanotransduction. For example, the reason why atherosclerosis and osteoporosis are related is because angiogenesis and osteoporosis are related because you get poor capillary health and you get a poor endothelial glycocalyx, there’s the same system in bones. You have a glycocalyx in the dendritic connections between osteoclasts and between osteocytes. And just the same as in the endothelium in the vascular system, if that glycocalyx is degraded, you’re probably going to have a degraded glycocalyx in the same dendritic system in the osteocytes. And now they’re not going to be able to talk to each other and they’re not going to be able to talk to the osteoblasts. So you can exercise all you want, but that mechanotransduction is not going to get the message to the osteoblasts and the person’s not going to have osteoblastic activity from the exercise they do. So looking at a person’s vascular system health is another way to go.
Dr. Kara Fitzgerald: What do you do? What would you recommend for imaging?
Dr. Keith McCormick: Well, for imaging, I don’t, because I don’t really do that, but I would do laboratory tests. Let’s say a person has a discordance on a hip. Let’s say their left hip is a -2.8 and their right hip is a -3.4 neck. It’s a little weird. Maybe they’re having a vascular issue. Maybe the vascular issue is causing discordance. I might do an ADMA or doing the different things we can do for nitric oxide. Looking at the triglycerides, HDL-
Dr. Kara Fitzgerald: Interesting. Fascinating. Wow. Okay. So ADMA, asymmetric dimethylarginine. And then looking at a complex lipid panel you get an idea of what’s happening in that arena that could be actually influencing the hip differential.
Dr. Keith McCormick: And if they have a liver issue, they might have fatty liver. I mean fatty liver is just rampant now.
Dr. Kara Fitzgerald: Yeah, yeah, yeah. Very common.
Dr. Keith McCormick: That might be an issue that 70% of the liver blood flow is gathered from the gut. So you have dysbiosis that’s going to screw up that, you have fatty liver that’s going to screw up red blood cell production, things like that. So all these things are connected. And I keep getting away from your question.
Dr. Kara Fitzgerald: I know, from my original question, but it’s really interesting. It’s funny, Keith, we used to do this all the time when I talked to you in the lab. This is very familiar, but it’s really interesting. All right. Well I have to ask you a question in this arena. Thinking about the endothelial glycocalyx and the bone glycocalyx, there are some cool seaweed products out on the market now for the endothelial glycocalyx, would you consider that in a bone intervention?
Dr. Keith McCormick: I definitely would. And also with the gamma and delta tocotrienols. But yes, that seaweed, I can’t remember what it’s called.
Dr. Kara Fitzgerald: Yeah, Arterosil is one of them but yeah.
Dr. Keith McCormick: And any of these nitric oxide boosters, like pomegranate, are going to help.
Dr. Kara Fitzgerald: Fascinating. Yeah. All right, so let’s go back to our patient. Let’s go back to our patient. Okay. That’s really interesting. I know other people are into it, but yeah, let’s walk through putting together a protocol.
Dr. Keith McCormick: All I got to is decreasing their gluten.
Dr. Kara Fitzgerald: Their gluten. We’re taking them off gluten.
[00:44:44] Dr. Keith McCormick: That’s all I got to. But I would make sure that they’re getting vitamin D. And going back to the basics, making sure they’re getting vitamin D, magnesium, vitamin K. What does vitamin K do? It carboxylates or activates the osteocalcin. And what’s osteocalcin? It’s produced by your bone cells, it is a protein that essentially is a nucleator for the hydroxyapatite crystal, and you must activate that for the crystal to form. I usually say 500-700 micrograms of K2 MK-4, 50-100 micrograms K2 MK-7, probably 500 to 1000 for K1. If you do that, there’s enough carboxylation of osteocalcin going on. So that’s enough.
Dr. Kara Fitzgerald: Awesome.
Dr. Keith McCormick: Protein is huge. As people get older, they do not eat enough protein. So, was it 1.2 grams per kilogram or something like that?
Dr. Kara Fitzgerald: Or even more? Yeah.
Dr. Keith McCormick: I usually say at least 70 grams a day.
Dr. Kara Fitzgerald: What type?
Dr. Keith McCormick: I like hemp protein, pea protein, whey protein. Hemp is a really good one, but just regular food too. Sardines are great.
Dr. Kara Fitzgerald: Yeah. Salmon.
Dr. Keith McCormick: Fish, salmon.
Dr. Kara Fitzgerald: Do you stay away from animal protein for any reason or just you don’t consume it? Are you vegetarian? I think you might be vegetarian. Are you?
Dr. Keith McCormick: No. I eat roadkill, Kara.
Dr. Kara Fitzgerald: Oh, you eat anything. Oh yeah, you eat road kill. That’s your secret. That’s your secret to succeeding at those triathlons. You’re out there like chowing on the roadkill.
Dr. Keith McCormick: No, I don’t eat, like I said don’t eat-
Dr. Kara Fitzgerald: A possum.
Dr. Keith McCormick: I can’t remember the last time I had beef. So I don’t eat pork, I don’t eat beef. I don’t recommend them, but fish, chicken is fine, shrimp.
Dr. Kara Fitzgerald: Okay. We’re increasing the protein, we’re pulling them off of gluten…
[00:46:49] Dr. Keith McCormick: Salt is a big deal. I have so many patients who come in and they’re very proud that they’re on a low salt diet. That’s not good. If a person’s too low on salt that’s detrimental to bone too. You need some salt. But obviously too much salt increases the release of calcium in the urine. So I look at the sodium level on their CMP and make sure that it’s okay.
Dr. Kara Fitzgerald: And where do you like to see it? Just within what kind of range?
Dr. Keith McCormick: Within normal range, but if it’s below 134, that’s an issue.
Dr. Kara Fitzgerald: What about potassium on a CMP? What’s a good potassium for you?
Dr. Keith McCormick: I just make sure it’s in the reference range but I don’t look to see if it’s high or low. If it is high or low, then that’s an issue. But what I do look at is a person’s first morning urine. And if that’s a 5.5 all the time, then I boost them up and I have them take electrolytes. I have this product called OsteoMineralWay, and it’s the mineral part of goat whey.
Dr. Kara Fitzgerald: Wow.
Dr. Keith McCormick: Goat milk. And they get a gallon of minerals and it’s a great alkalinizer. It’s not very high in magnesium, but it’s high in calcium, potassium, and bio-organic sodium. It’s really alkalinizing and I have them take that every day. And if that doesn’t improve besides their increase in green leafy vegetables and stuff, then I have them take potassium citrate or bicarbonate.
Dr. Kara Fitzgerald: And I will link on your website. I was going to bring this up after we moved through the protocol. But Dr. McCormick has a beautiful line of supplements and I know some of the protocols you’re leaning on your products OsteoNaturals. And again, we’ll pop it in the show notes, but okay.
Dr. Keith McCormick: I just make sure that like I said, if their pH is really low, I want to get them up to 6.5. The potassium really helps to do that.
Dr. Kara Fitzgerald: And you’re measuring pH how?
Dr. Keith McCormick: Just for the urine.
Dr. Kara Fitzgerald: Okay.
Dr. Keith McCormick: There’s a hydration membrane around bone. All day long people are breaking down their tissues. At night they go into repair and a lot of hydrogen is produced, acidic hydrogen ions, and so you need to alkalinize or buffer those hydrogen ions. And there are your four minerals that, besides breathing that does it, get rid of the carbon dioxide. Magnesium, potassium, sodium, and calcium, those are your alkalinizing minerals.
[00:49:31] So there’s a hydration membrane filled with the sodium and potassium that surrounds our bones, that’s actively tapped by your body to buffer those hydrogen ions. But if that hydration membrane is not replete with potassium and sodium, if we go to the parathyroid hormones, parathormone is released and that stimulates the osteoclast to break down bone to mine the calcium and magnesium to buffer the pH.
Dr. Kara Fitzgerald: Wow. Interesting.
Dr. Keith McCormick: You want to make sure that does not happen.
Dr. Kara Fitzgerald: Right. Okay.
Dr. Keith McCormick: And I’m not saying calcium is the best way to do it. It’s the only way I kind of know what to do and it’s not perfect, but at least it’s something and it helps.
Dr. Kara Fitzgerald: Do you recommend people start their day with some electrolytes then?
Dr. Keith McCormick: Not necessarily start their day, but for sure taking electrolytes, trace minerals, and- But yeah, I think electrolytes are very helpful and trace minerals.
Dr. Kara Fitzgerald: So, this person again, has pretty severe osteoporosis. What are going to be some of the workhorse nutraceuticals you’re prescribing and how do you dose them?
Dr. Keith McCormick: If they have-
Dr. Kara Fitzgerald: And what type of calcium? If you’re going to use calcium? Yeah, go ahead.
Dr. Keith McCormick: Yes, I don’t care which type of calcium, but I don’t like calcium carbonate. Calcium malate chelate, calcium bisglycinate, calcium citrate, they’re all fine, calcium tartrate. If they have a high CTX, I for sure put them on resveratrol, quercetin, at least 200 milligrams of each. Alpha-lipoic acid 300 milligrams, berberine 300, N-acetylcysteine is great for helping the estrogen work and for antioxidant. That’s what we’re trying to do. We’re trying to bring down the oxidative stress because that’s what’s going to promote the osteoclasts. But the alpha-lipoic acid and cysteine, berberine, those really, really help. Fish oil, really good way to go. Like I said, the calcium and magnesium, I usually say 300-400 milligrams of magnesium, trace minerals. For calcium, I usually only do 500-700 milligrams, max, because I want them to get their calcium through their food. I sell a calcium supplement but I often tell people, don’t buy it.
I want you eat your sardines. I want you to eat your greens and I want you to try to figure out how much you’re taking. If you’re getting 1200 milligrams, then you don’t have to take it. But if you’re not, and a lot of people don’t do any dairy at all, they’re probably going to have to take it because it is hard to get 1200 with no dairy at all. But I push people for Kefir. Goat Kefir is super because people can eat goat much better than cow. Lots of minerals, lots of protein, there’s lots of probiotics in there.
Sauerkraut, kimchi, all those things are great for the gut. So gut health is so prime in improving that person that we’re talking about that has a -3.3. If they have poor gut health, I’m going to attack that gut health.
Dr. Kara Fitzgerald: Well, wouldn’t you say that’s probably de rigueur? Poor gut health and osteoporosis. I would imagine most of if not all of your patients-
Dr. Keith McCormick: Well, that’s true. Ninety percent of them, yeah.
Dr. Kara Fitzgerald: And I just wanted to point out to the listeners who might be thinking about the dosing. You’re pretty modest with your dosing. For instance, berberine is routinely prescribed these days at 1500 milligrams and you recommended three (milligrams) thinking about the mechanism for bone. Yeah, go ahead.
Dr. Keith McCormick: Yeah, because they talk to each other. The berberine helps the alpha-lipoic acid do its job and the taurine in there really works way better when you do it with these other things. And these people are going to be on it long-term. I don’t want somebody on berberine 1500 milligrams for years. So it’s okay to do berberine that long if you’re working on a gut issue, but we’re going to work on that gut issue in other ways besides the berberine probably. So they’re on that for a while. So yes, it is low-dose stuff.
Dr. Kara Fitzgerald: And that’s always been your approach. What else do I want to ask? And lifestyle interventions for this patient? What kind of exercise are you going to prescribe? Are you going to prescribe vibration plates, like the OsteoStrong protocol that some people are using as well? What are the lifestyle pieces in general? Not just exercise.
Dr. Keith McCormick: The more exercise they do, the better. The more time-
Dr. Kara Fitzgerald: What type?
[00:54:48] Dr. Keith McCormick: The more times that they exercise is better. So you don’t want a person exercising three days a week for an hour and a half each time. I want them to exercise six days a week for 30 minutes. And regular walking doesn’t cut it. Either really brisk walking, but also you have to do weights. Weights and squats and split squats and regular squats. But making sure that that back is protected because you put too much weight on that person and they really can break. But lightweights.
I really always advocate that people hook up with a PT or trainer because it is so easy to break and there’s nothing worse than being all excited and wanting to do exercise to help your bones and then a week later you break something because you didn’t know what you were doing. Flexion is dangerous. Extension is a good way to protect yourself. So anytime you flex and twist or just flex that spine, you’re putting tremendous a amount of pressure on the anterior part of the vertebrae and that’s how you’re going to get a wedge fracture.
But yeah, progressive resistance and high intensity training helps, but only under the guidance of somebody who’s watching the way you’re bending and stuff. Vibration plates I think have their place. They do not take over the place of exercise, a vibration plate is in addition to exercise. And the more you stimulate those osteocytes to stimulate the osteoblasts, the better it is. That vibration helps, but we also have to make sure that the endocalyx and that glycocalyx is healthy or you’re not going to get anything out of this. I always think of exercise as a two-phase thing, making sure that that person has good glycocalyx ability, that they have the ability for the osteocytes to make that mechanotransduction.
And that’s one of the reasons why I push for estrogen a lot of times because estrogen helps improve that mechanotransduction. That stimulus of the exercise to the osteoblasts to build bone – estrogen helps that. And doing a low-dose estrogen is not dangerous. Bioidentical, low-dose estrogen with a patch or cream, and making sure that- An estradiol level only has to be 20-30 picograms/ml to do its job as far as maintaining bone density. You’re not going to really improve bone density with estrogen, but you’re going to help maintain it.
Dr. Kara Fitzgerald: Awesome. That’s great. What about testosterone?
Dr. Keith McCormick: Yeah, I don’t-
Dr. Kara Fitzgerald: You use DHEA, but yeah, go ahead.
Dr. Keith McCormick: I use DHEA, but I don’t use the testosterone. And the reason why is because I think that it’s just changed into estrogen. Estrogen is where it’s at. I think there was a push ten years ago for testosterone, I don’t see that as much. I’ve never seen it promoted in the literature that much, so I don’t think it helps.
Dr. Kara Fitzgerald: And years ago when we talked, you were not interested in high dose K2 as it was used in, I think, a couple Japanese studies. And you actually said that it had the potential to suppress testosterone.
Dr. Keith McCormick: That’s right. Because you need undercarboxylated osteocalcin for testosterone production, for insulin production in the pancreas, for other things in the body. When you do too much vitamin K, it’s too pharmacological and I think you can mess up other things. You need a balance between the carboxylated and the undercarboxylated osteocalcin.
Dr. Kara Fitzgerald: So fascinating. Many things exist in that U curve. You know, the sweet spot you want at the bottom of the U. Not too little, not too much. You talk about cortisol in your book in a variety of ways, the stress response even inherited. What about yoga, meditation? What are some of the lifestyle things that you think are essential for bone health?
Dr. Keith McCormick: Definitely. I mean, cortisol increases, DHEA decreases, cortisol increases and estrogen, testosterone decrease. So sure, that’s a big part of this. And any stress, whether it’s physical or emotional stress is going to hurt your bones. There’s nothing worse than cortisol for boosting osteoclastic activity. It definitely does a great job in that and hurts your osteoblasts and hurts osteocytes and increases osteocyte death. So all those are important lifestyle changes for sure.
Dr. Kara Fitzgerald: What about toxins? What about persistent organic pollutants? What about eating organic, avoiding glyphosate, et cetera, et cetera? Yeah. Metals obviously, lead.
Dr. Keith McCormick: Endocrine disruptors or decrease in- Yep. I really push or organic foods and even where a person lives. That’s a hard thing to change, obviously. You do have to be aware of that kind of thing. But the best we can do most times is organic foods, and when you go for your run, you don’t go run by the freeway.
Dr. Kara Fitzgerald: It’s remarkable how many people do. I mean, it’s really remarkable.
Dr. Keith McCormick: And I ride bikes all the time, so I’m in the traffic all the time. But I try to ride on low traffic roads. Not only so I don’t get run over, but so I don’t breathe the stuff too.
Dr. Kara Fitzgerald: Yeah, of course. We’ve covered a lot and I know everybody will get your book. I guess we’re really wrapping up here. I think that ultimately there’s a lot of hope in your message. Even if you need meds, it’s going to be for a finite period and you’re going to do all of the underlying work that you outlined and people can get better. And you’re a testament. You can get better and get on with your life and you can go do Ironman. Some people, probably not all, but-
Dr. Keith McCormick: I think you’re right. The medications are not bad. They’re just bad when misused. And they’re used long-term by a lot of physicians and they’re not addressing the other parts about the person’s body. They’re not addressing their liver health, their vascular health, their overall health, their protein intake, their nutrition intake. They’re not addressing that. They just do the drugs and they leave them on them for long term. Well, that’s not what should happen. But doing the medications short term, if they’re necessary, they’re okay to do them. But am I a big proponent of drug therapy? No, but I am a proponent of using them when we have to get a person, emergency medicine, getting them out of that hole so they’re not going to fracture. And then we keep them out of the hole with doing the right things that we’re going to do nutritionally and exercise-wise in that way.
Dr. Kara Fitzgerald: That’s awesome.
Dr. Keith McCormick: And when we do this all by looking at therapeutic targets. We do all these lab tests, we look for things we can fix and we attack those things in the way most of the listeners are going to know how to do. And they don’t have to know specifically about osteoporosis. And that’s what the beauty of this whole thing is. Everybody knows how to look at a CBC and fix things on the CBC, fix things on a CMP. Well, when you fix those things, you’re going to help work on their bone health.
Dr. Kara Fitzgerald: Absolutely, yes. And we’re good in functional medicine at dealing with underlying inflammation and gut health, et cetera, et cetera. So yeah, it makes sense that you’re going to be addressing bone health with all of those foundational, functional interventions. There’s a lot more that you cover in the book. The book is, again, 700 pages long, folks. So there’s many supplements we didn’t cover today, and I know some of you are wishing that we had talked about strontium or boron or some of the other things and we could go on and on about them or biotin. But do grab the book. It’s $40, it’s going for $39.95. And this is a reference that you’ll use for years and years to come. How are you today? I mean, how is bone health for you and how carefully do you monitor it?
Dr. Keith McCormick: I started off in -4.5. I’m a -3.3 now and I’ve been a -3.3 for twenty years.
Dr. Kara Fitzgerald: But your trabecular strength must be pretty fabulous?
Dr. Keith McCormick: The truth, I’ve never had a TBS done, so.
Dr. Kara Fitzgerald: You’ve got to get it done.
Dr. Keith McCormick: I could, but there’s no TBS test sites in Western Massachusetts that I know of.
Dr. Kara Fitzgerald: Right. Well, and clearly you’re doing pretty well. You’re not fracturing.
Dr. Keith McCormick: But no, I’ve never done a TBS and I would like to, but I just stay at -3.3 and I think everybody says it’s natural to lose bone density. And I used to always believe that and I used to always say that, but I’m not sure that’s true anymore. Because I’m not losing bone density. I stayed the same. I was a -3.3 fifteen years ago and I’m still a -3.3.
Dr. Kara Fitzgerald: That would scare some people to be a -3.3. That would scare some people and hold them back from living as fully as you are. What would you say to that?
Dr. Keith McCormick: Well, I think if you’ve been at a -4.5 then-
Dr. Kara Fitzgerald: You’re rocking.
Dr. Keith McCormick: I’m rocking. That’s right.
Dr. Kara Fitzgerald: Yes.
Dr. Keith McCormick: My CTX used to be really, really high. So, a person with -3.3 with a normal CTX, that’s no worries usually. But a -3.3 with an 800 CTX, that’s a worry. So CTX can be used not just to say that person’s losing bone density, but it’s going to also be used to say they have a high fracture risk. So that CTX is directly related to fracture risk.
Dr. Kara Fitzgerald: It’s essential and it’s easy to do. Well, listen, Dr. McCormick, it was really great to talk to you today. It was a fun tour de force in looking at all things bone health. I really appreciate you coming on. I wish the best success to you, and well, and you’re already out there in the world doing it, treating people around the world. I know you consult with folks around the world. We’ll link to everything in the show notes folks, so just head over there and definitely buy his book. And I thank you.
Dr. Keith McCormick: Thank you very much.
Dr. Kara Fitzgerald: Yeah, absolutely. Absolutely.
Office phone: 413-253-9777
R. Keith McCormick is a board-certified chiropractic physician in the states of Massachusetts, Colorado, and California, and has been in clinical practice since 1982. Dr. McCormick earned his bachelor’s degree in human biology at Stanford University and his doctorate at the National College of Chiropractic. He is an instrument-rated commercial pilot and a U.S. Army veteran.
Sports have always played a vital part in Dr. McCormick’s life. At Stanford, he competed on the varsity cross-country and fencing teams. As a junior, he was the silver medalist in the 1973 Modern Pentathlon World Championships. Two years later he won the North American Championship and in 1976 was a member of the United States Olympic Modern Pentathlon Team that competed in the XXI Olympiad in Montreal. He is the former U.S. record holder (1976) for most points scored in a pentathlon competition. Dr. McCormick continues to compete in triathlons of all distances and has completed six Ironman competitions — five of them after recovering from multiple osteoporosis-related fractures.
- NFFM Podcast: Osteoporosis – Metabolic Disease of the Bone with Dr. Keith McCormick
- DrKF Blog: The Protein Magic Formula
- DrKF Clinic: Patient consults with DrKF physicians including Younger You Concierge
- Bio Age Lab Test
- Bio Age Self Assessment Quiz
- Younger You book
- Better Broths and Healing Tonics book
- Younger You Virtual Group Program