Recently, I interviewed Dr. Ben Weitz, who fractured his femur and was told it might never heal, he turned to the same principles he’s used with patients for decades: ‘root cause, functional medicine’ thinking. In this conversation, he shares how he designed a bone-healing protocol that combined targeted nutrition, vitamin K2 and vitamin D optimization, growth factors, and the right kind of exercise stimulus. If you would prefer to listen to the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
Welcome back to the podcast!
Dr. Ben Weitz:
Thank you so much, Eric. I wanted to talk about my health crisis. I think it’s interesting that a lot of people in the functional medicine world, including yourself, who got into functional medicine, partially because you had your own health crisis in your case with hyperthyroidism. I have spoken to a lot of other functional medicine practitioners who had stories about their health crisis. I’ve gone to discussions about how to be a good speaker and how to tell your story. I always felt like I didn’t have that health crisis. I was always generally somewhat healthy. Never necessarily ate healthy, did the wrong things, but never had a health crisis.
Now, I’ve had my health crisis. On Halloween 2023, I was in my home with socks on on a wood floor. I was handing out Halloween candy. I had a bowl of Halloween candy in my right hand. My dog who is very energetic, I had his leash around my left arm. My dog pulled, my leg slid, I went down on my hip, and I fractured my femur. It was an emergency situation. I was taken to the ER. The next day, I had surgery to repair my proximal femur. They put two steel rods inside. It was a whole thing.
I started doing rehab. It’s my nature to be very much into exercise. I’m very aggressive with rehab. Initially, they talked me into going into this rehab place that they said was very aggressive. I was going to get 3-4 sessions a day. Of course, it didn’t quite work out that way. I didn’t stay in there too long. I think I was in there for four days. I decided to go home and do my own rehab.
About a week after the hospital, I was in Gold’s Gym with my walker. I had a PT coming to the house. I started doing even more research on bone health. What I knew already, even though I had done several episodes about osteoporosis and had looked into medications, supplements, diet, lifestyle, and exercise factors related to bone density, I now had a renewed interest in making sure my femur could heal.
I started taking high-dose Vitamin K2, the MK4 version. I got my Vitamin D levels up to the 60-80 level. I added boron, calcium magnesium. I even did some strong DM citrate. I was taking collagen, glucosamine. I was making sure I was eating foods that would be beneficial for bone. I addressed my microbiome with probiotics and prebiotics and fermented foods.
Unfortunately, it wasn’t healing the way it was supposed to. I kept going in for an X-ray every month. There was a gap.
What was supposed to happen is after the surgery, the two parts of the bone are supposed to be flush against each other. In my case, after the surgery, there was a gap. It was difficult for the body to bridge that gap with new bone.
At some point, after about three months, I got a CAT scan. It showed that there was some fibrous healing, but there was still no bone. There was this gap where the bone was just not forming.
After four months, it was termed a non-union, meaning that it was not going to heal statistically. I sought advice from several orthopedic surgeons, both of whom recommended that I get revision surgery. That means the two steel rods I have right now in my femur crisscross and are inside the femur. I can’t really feel them. It was a good surgery, but they recommended they pull those rods out, which would not be an easy thing. The bone I’m sure is already formed around them. They probably have to chisel them out. After that, I would have a hole in my femur. Unlike a construction project, they can’t fill it in with cement.
Then they recommended this revision procedure, where I have a rod down the outside of my femur and screws all the way down. I decided there was no way I was going to do that. I had this one prominent orthopedic surgeon say, “You need to do this revision surgery.” I said, “I’m not doing it. I have made some improvements. There is some fibrous tissue that’s been forming.”
The question is, is fibrous tissue a precursor for bone to form? Or is it potentially in the way? I talked to several doctors about that. A friend of mine is the head of physical therapy at USC, and he said it’s a good thing I had fibrous tissue. The collagen is the basis for bone formation. The body is trying to bridge the gap with fibrous tissue, so it can turn it into bone.
Some of the other doctors said when you have a non-union, the fibrous tissue is in the way, so we have to scrape it out and shove the bones together again.
I decided to come up with a plan to get my femur to heal without getting another surgery. Besides the healthy diet, supplements, and rehab, I decided to get a prescription for a drug called Forteo. Forteo is one of the few drugs for osteoporosis that stimulates new bone formation. In other words, it stimulates osteoblasts.
For those who are not familiar with bone physiology, we have two main types of bone cells. We have osteoblastic cells that build new bone, and we have osteoclast cells that break down bone. There is a constant balance between building up and breaking down.
You might ask yourself, “Why would the body break down bone?” It’s kind of like the cleanup crew. Normal activity, as you go through your life, especially if you exercise or do physical things, you break down your muscles. Working out is not an anabolic process; it’s actually a breakdown process. Then the body rebuilds it stronger.
Same thing happens with bone. You go through a normal day of activity, and you’re actually breaking down a certain amount of bone. Then you need the osteoclasts to come in and clean up that junky bone, so the osteoblasts can lay down new bone. This process occurs throughout your life.
We used to have this concept that all the bone formation occurs by age 20 or 30 or something like that. After that, you just lose bone. We had this same concept about brain cells. You can have all the brain cells you are going to have by a certain age. After that, you just lose brain cells.
We have learned that’s not true. The body continues to have this balance between growth and breakdown throughout your life. It’s just that when you’re younger, the balance is tipped toward growth. When you get older, it tends to tip toward breakdown.
But both of those processes continue throughout your life. In order to tip the process toward more osteoblasts, more bone buildup, I started taking daily injections of this medication called Forteo. Forteo is one of the few anabolic bone drugs that actually stimulates the osteoblasts.
The other drug that is on the market that is even more commonly used than Forteo is called Evenity. Most of the people who have osteoporosis take drugs that block bone breakdown. They block the osteoclasts.
The most common category of drugs are drugs called bisphosphonates. Phosphomax. There is a whole series of those. These block the bone breakdown. You end up with more bone.
The problem is without the cleanup crew, you’re not getting rid of the junky bone. That is why these drugs have been somewhat disappointing in terms of helping to prevent fractures, which is the main thing people are concerned about with loss of bone density or osteopenia or osteoporosis, which is the more severe form. You end up having less bone density. Because of less bone density, you have a higher risk of fracture.
Most people are using these bisphosphonates. Unfortunately, that’s why you’re seeing some unusual side effects in some cases, where people get bone that is weaker, so there is actually spiral fractures of the femur, osteonecrosis of the jaw, and some other side effects that can occur. You’re blocking the osteoclast activity.
Dr. Eric:
You just took the Forteo, and you didn’t take any of the bisphosphonates, like Phosphomax?
Dr. Ben:
No. What I did was also used measurements to see what was going on. As you know, in functional medicine, we often do testing to see exactly what’s going on, like with thyroid. We want to know the whole picture. We want to see exactly what’s going on.
The medical profession generally just gets the minimal amount of testing necessary. “Here’s your medication. See ya.” Nobody is monitoring. Is it doing what it’s supposed to do?
Ideally, if you’re working with a patient with bone issues, osteoporosis, a failed fracture that is not healing, you would want to know A) What is the level of bone growth? B) What is the level of bone breakdown? These can be measured through blood tests. Probably the best test for bone breakdown is CTX, and the best blood test for bone building is called P1NP. It’s useful to do both of those to see what’s going on.
When you use a drug like Forteo, one of the things that can happen is it increases the bone building. When you stop, you can get this big increase in bone breakdown. I made sure I monitored mine. If it looked like my osteoclast activity was ramping up, I would have considered following the Forteo with a bisphosphonate or Prolia. I didn’t see that big of a ramp-up, so I didn’t do that. That’s a scientific way of figuring out exactly what’s going on.
In addition to taking Forteo—I took daily injections for five months—I also got Human Growth Hormone. The use of it is controversial. The surgeon who prescribed the Forteo, after I showed him some studies that HGH was effective for non-union, he wasn’t willing to prescribe it. I felt like I needed it to put my body into anabolic, so it could ramp up the healing. I took a modest dosage. I did two IUs, five days a week, for five months as well.
I also used a bone stimulator that works through ultrasound. I put it directly on my hip in the area of the fracture. I did it for 20 minutes, twice a day.
I did those three things plus the supplements plus the rehab plus the healthy eating. After five months, my femur healed, and the gap was closed. After a nine-month ordeal, and now I am another year out after that, my femur, my hip are 100%. I have no pain, no limitations. I have gotten my strength back. I continue to make sure I exercise in a way that will increase bone density or at least maintain as much bone density as possible.
Dr. Eric:
Squats and deadlifts?
Dr. Ben:
Exactly. Squats and deadlifts. I also do some ballistic activity. There is a physical therapist from Australia whose name is Dr. Belinda Beck. She has published the only studies that have shown an increase in bone density with exercise. Her studies are the LIFTMOR trials. Part of her program involves that you need to jump in the air and land and have that ballistic loading on the femur.
Obviously, you have to be careful. You have to start out very slowly. You can possibly risk a fracture, but that ballistic loading has been shown to be very beneficial for stimulating new bone.
I now get up on a 24-inch platform and jump down. In her study, she has people jump onto a pullup bar, pull themselves up, and then drop down.
You can start out by doing hill drops and jump off the ground. Going in the air and landing, that ballistic loading of the bone has been shown to be very beneficial for stimulating bone formation, bone strength. There is actually something called bone strength in addition to bone density.
Dr. Eric:
Bone strength versus bone density.
Dr. Ben:
The best way to measure bone density is with a bone densitometer test. It’s basically some X-rays of your spine and hip and sometimes your wrist. This is a way to measure the bone density.
There is something called the T score, which measures your bone density compared to a healthy 30-year-old. There is your Z score, which measures your bone density as compared to someone your age. If the lab also has additional software that will measure trabecular bone score, TBS, you want to ask the lab and your doctor who prescribes the bone density test to include the TBS.
When you have a bone, you have the cortical bone. Inside, you have the trabeculi, which are these crisscross hatches. These are really important because the TBS is a measurement of bone strength, the bone’s ability to withstand stress. TBS is even more directly correlated with fracture risk. You want to have good bone density, but you also want to have good bone flexibility or TBS. That’s something that’s important to monitor. That allows the bone to withstand loading and different kinds of stresses.
Dr. Eric:
Can you have low bone density but a good TBS? Do they go hand in hand, where typically if one is low, the other will be low?
Dr. Ben:
Yes, you can have a low bone density with a somewhat better TBS. That means you’re less at risk for fracture.
Let me explain why some patients who have very low bone density on their T score. The way the T score goes is if you have up to -1, that is considered osteopenia. If you’re -2.5 or more, that’s called osteoporosis.
If you have someone with a T score of -4, which would be a significant amount of osteoporosis, but maybe they don’t have a fracture because they have better TBS. Unfortunately, it’s usually not measured. You have to make sure the lab has this software. They don’t actually have to do another test. They just do an analysis.
By the way, if you’re getting your bone density score, or you’re a doctor or a practitioner who is taking a look at a patient’s bone density, ask for the complete print-out of the bone densitometer results, not just the results.
What will happen is you will get this sheet that will just give you the T score and the Z score, or maybe just the T score and something about a fracture risk. You really want the full print-out because unfortunately, patients aren’t always positioned the exact right way. They don’t necessarily always collimate it exactly the right way.
If a patient has scoliosis, if they have increased or decreased curvature in their spine, if their hips aren’t positioned the proper way, it can change their bone density. If they have significant osteoarthritis, it can look abnormal because you have these spurs. If they have scoliosis, it might look like they have less bone because you can’t see it head-on, as there is a curvature in their spine. Those things need to be taken into consideration, and they’re often not.
Dr. Eric:
How would you know? I didn’t know this honestly, as far as getting the complete print-out. It sounds like the complete print-out talks about the positioning of the person. How would you know if they’re not properly-? Is it a matter of them not being properly positioned? Or if they are properly positioned, but they have something like scoliosis or osteoporosis, it could lead to false results?
Dr. Ben:
Absolutely. When it comes to the positioning, you have to ask the patient, were their feet put against something that puts their hips slightly internally rotated? Was their back flat? When you get the print-out, it will have a diagram, and it will show which part of the hip and also which part of the spine. Usually, it’s enough where you can see if they have significant osteoarthritis or scoliosis. You can also see if you need to get a separate lumbar spine X-ray and look at that.
If they have osteoarthritis, then they’re more likely to have spur formation that will make it look like they have extra bone. If they have osteoporosis, typically, it may look like they have less bone.
Dr. Eric:
Okay. Osteoarthritis might have spur formation, which looks like there is excess bone, more bone formation.
Dr. Ben:
Yep.
Dr. Eric:
Even if someone has osteoporosis, but they also have osteoarthritis, that might actually increase the- If their T score is -3.5, it might actually look better than it is if they have osteoarthritis.
Dr. Ben:
Exactly. We know there is a significant percentage of people who have osteoarthritis. Unfortunately, they don’t always position the collimator properly. It’s really important that they do the exact same part of the lumbar spine and the exact same part of the hip. Sometimes, they do both hips to compare.
Dr. Eric:
I have a question. Did you get a DEXA scan prior to-
Dr. Ben:
No, I didn’t. Unfortunately, men typically are not asked to get a DEXA scan. It’s just assumed that there is a low likelihood of men having osteoporosis. Unfortunately, there is probably a much higher rate of low bone density in men that we don’t know about, simply because we don’t test.
So many other things are like this. I’m sure you know from being in functional medicine and doing the additional testing that is not often done, you find out all this stuff that you wouldn’t have ever known.
Dr. Eric:
I know from my personal experience, you had one of the bone experts on your podcast, and I was listening to him. I got a DEXA. I showed up with low bone density, which was surprising. Looking at my history of hyperthyroidism and also not getting enough calcium, I was in denial. “Oh, I’m getting enough through plant-based foods.” I wasn’t keeping track of how much calcium.
With the history of hyperthyroidism, they should have given me a bone density scan. They didn’t. I asked. I’m getting ready to turn 55. This was in 2024. I’m the one who had to ask, “I have a history of hyperthyroidism. Never got a bone density scan. Could I get one?” I rarely go to a primary care doctor, but my wife talked me into going to one for a check-up. I’ll go with her. Teachers’ insurance. I asked. Surprisingly, he ordered one.
Sure enough, I didn’t know at that point about the TBS. Honestly, I didn’t ask. I didn’t get a TBS. Who knows?
I was also surprised because I have been active all my life. I go to the gym. I haven’t been doing squats and deadlifts. I haven’t been doing the right exercises for my lower back. I was doing back extensions. It wasn’t like I wasn’t doing any back exercise. Not putting the compressive load on the spine and the hips.
Dr. Ben:
It’s understandable. A lot of us are afraid of compressing the spine. You have experts out there advising against doing those exercises. A lot of us have had some episodes of back pain in the past and are cautious about not doing those things.
Unfortunately, as Belinda Beck has shown, you have to do heavy weights with those basic exercises that load the spine and hips if you want to have good bone density. She has the people who follow her program do five sets of five reps on deadlifts and squats and overhead press.
Dr. Eric:
Five sets of five reps of heavy weight.
Dr. Ben:
Max, yeah. I don’t do five sets, but I’m doing heavy deadlifts and squats when I can tolerate it.
Dr. Eric:
I do four sets. The first one or two are warm-ups, especially that first one. I don’t want to jump into it.
Dr. Ben:
I do the same thing. I am probably on deadlifts only doing two super heavy sets. I had stopped doing deadlifts years ago because I felt like they were aggravating my back, and I didn’t think I could tolerate it.
Dr. Eric:
Now I understand. Same thing. Well, I just never did them honestly; it’s not that I thought they were aggravating my back. I just never did squats or deadlifts. I did other weight-bearing exercises.
I was going to ask if you ever did cold laser or anything. You mentioned you did bone stimulators.
Dr. Ben:
I did some cold laser. But I used this bone stimulator. There are two on the market. There is one that works with electrical that you need to do for a pretty long period of time. There is one that works through a pulsed ultrasound. The surgeon preferred the pulsed ultrasound, so I went with that one.
They recommended doing it once a day, so I did it twice a day. I spoke to the rep about doing it three times a day, and she said twice a day probably will give you slightly better benefits, but three times might be too much. I don’t recommend doing it three times a day. Of course, I would have easily done it three times a day.
Dr. Eric:
My guess is yes because you have done a lot of research in the past and currently: How about vibration plates? Weighted vests?
Dr. Ben:
Yes, I did vibration plates, especially at the beginning because I couldn’t do that much weight loading. I got a vibration plate. I started using it at the home. I thought that was helpful at the beginning. Once I was able to do the heavy loading and everything else, I fell off doing it.
Dr. Eric:
You did it initially.
Dr. Ben:
Yes.
Dr. Eric:
For a few months?
Dr. Ben:
Yes, I did it for probably 4-5 months.
Dr. Eric:
You mentioned the Forteo. Any medication could potentially have side effects, but the Phosphomax, those are notorious as far as known for their side effects.
Dr. Ben:
There are some possible significant side effects with Forteo. Rat studies have shown bone tumors forming, osteosarcoma. It hasn’t been shown in humans.
The current understanding is if you do it for two years or less, you have a very high rate of safety. After that, if you’re causing your body to produce more bone, you put it in that anabolic stage for too long, I could see excessive bone forming. Some of that could be cancerous. It would make sense.
The new thinking about how to treat osteoporosis is that you do a drug like Forteo or Evenity, and you do it for a year or two. Then you follow it with a bisphosphonate.
Dr. Eric:
What happens if you don’t follow it with the bisphosphonate?
Dr. Ben:
That’s the whole thing. Once again, it’s great that they’re rethinking the way we use drugs. Why not test? For some reason, the medical profession just doesn’t want to spend the money on testing.
The idea is that when you ramp up the osteoblasts, and you stop, the body ramps up the osteoclasts, and then you will lose bone.
Dr. Eric:
Yeah.
Dr. Ben:
Why not test to find out if that’s really the case? That’s what I did. I didn’t see a big ramp-up of osteoclastic activity. Otherwise, I would have asked to be put on a bisphosphonate.
Dr. Eric:
You determined that by testing the CTX and P1NP?
Dr. Ben:
Yes, exactly.
Dr. Eric:
Interesting.
Dr. Ben:
The CTX is measuring the rate of bone breakdown, and the P1NP is measuring the rate of bone formation.
Dr. Eric:
Also, I was wondering why, maybe it wouldn’t make a difference, but if you are taking Forteo every single day, and if it’s ramping up the osteoblast production, if you abruptly stop, which would affect the bone breakdown, rather than do the injection every day, after a year or a year and a half, do it every other day? Gradually?
Dr. Ben:
I kind of did that, not as careful as I could be. Basically, I stopped after five months, but I was getting tired of doing it. I was feeling better. I don’t have time to do it today, so I’ll do it tomorrow. The last three weeks or so was kind of like that, where I did it less consistently and then just stopped.
Dr. Eric:
Another question I have. Yours was a unique situation. Yours was a trauma. Then it was labeled as a non-union. You had a choice: get another surgery, which you didn’t want to do, or let’s try this other approach with the Forteo, HGH, stimulation.
For someone who just has osteoporosis, because osteopenia, typically especially if it’s mild, they won’t recommend the Forteo, maybe not even a bisphosphonate. Maybe they will with osteopenia. With osteoporosis, no doubt. If someone has osteoporosis, a T score of -3.0 or -3.5 or -4.0, how do they know should they- Is it a good idea to take Forteo? Is it a good idea to try to do everything naturally? Maybe do another DEXA scan in a year or two after doing things naturally?
In your case, I understand why you did it because it was a unique situation. For someone where time seems to be on their side- Now you never know. You could fall like you, and then you’re in trouble. That’s the argument to getting the medication. The potential side effects… For some, it could be a difficult decision. Same thing with anything. With Graves’, you could say to take antithyroid medication or not. You could always take antithyroid medication if the natural approach doesn’t work. Same with surgery, which would be a last resort.
What’s your opinion as far as when they should consider Forteo?
Dr. Ben:
First of all, the bisphosphonates have been used as the only drug in a lot of cases. I think that doctors are starting to rethink that after some of the side effects and the fact that we haven’t seen a dramatic decrease in fracture risk that we want with the bisphosphonates.
Currently, they only recommend a drug like Evenity or Forteo if they think you’re at very high fracture risk. It’s hard to know that. A very low T score. Maybe you’ve had several other fractures in the past.
I think it makes sense to consider doing a drug like Evenity or Forteo first for a year or two, possibly followed by a bisphosphonate rather than just take a bisphosphonate. It makes a lot of sense than just blocking that bone breakdown. You have to make sure you’re doing all the other things first. Be on a healthy diet. You don’t want to be leaching calcium out of your bones.
I see too much emphasis on the dangers of calcium. Most of that is just complete nonsense. The reason why everybody is afraid of taking calcium, and I even got caught up with that.
Dr. Eric:
Same here.
Dr. Ben:
There were a number of studies over the years showing that taking calcium supplements, having higher levels of calcium was beneficial in reducing hypertension, cardiovascular risk, death from heart disease. Then a couple of studies came out that seemed to show that calcium increased your risk of heart disease.
The thought was that when we talk about heart disease and the risk of heart attack, the big process we’re thinking about is atherosclerosis, which is the formation of plaque buildup in the arteries that over time starts reducing the flow of blood and oxygen through your bloodstream, and in particular, through the arteries in the heart.
If you have a heart attack, usually, that means one of those plaques ruptures and then completely blocks that artery. The part of the heart muscle supplied by that artery suffers damage. If it suffers enough damage, you can die. If not, you just damage part of your heart.
The fact that these plaques get calcified, the thought was, hey, if we have calcium, you will have an increase in calcified plaque. There were a few studies that seemed to show this. It turns out that those were not really good studies. The participants were not using Vitamin D and Vitamin K.
The reason why it’s so important to take Vitamin D when you take calcium is Vitamin D grabs hold of the calcium and says, “Come over here into the bones. Don’t get into the soft tissues.” Vitamin K in particular says, “No, don’t get into the soft tissues. Just get into the bone.” It’s really important in my opinion, and I think the data shows this, to have a good, healthy level of Vitamin D. That requires testing, supplementing, and retesting.
Too many patients have low Vitamin D. The doctor says, “Take 1,000 or 2,000 Vitamin D,” and maybe doesn’t even test them again. Or tests them in a couple of years and says, “It’s still low. Oh well.”
The reality is, most of the time, if you have really low levels of Vitamin D, you probably need more than 2,000 IUs; you might need 5,000 or 10,000. Some people respond really well, and their Vitamin D might ramp up to 120. A lot of people don’t. You need to test. You need to supplement appropriately, and you need to retest.
Whenever you’re taking Vitamin D, you want to make sure you’re taking Vitamin K. There are three different forms of Vitamin K on the market. We have Vitamin K1, which is found in green leafy vegetables.
We have two forms of Vitamin K2. We have MK4 and MK7. Today, there is a lot of hype around the MK7. It is the newest one. It’s been promoted a lot. It seems to have some benefits. Most of the studies on bone density were all done with MK4. A lot of these were done in Japan. Really significant increase in bone density and decrease in cardiovascular risk taking the right amount of MK4.
Most of the supplements on the market for K2 involve 150mcg. The studies that have shown the most benefit use 45mg of MK4. That’s what I’ve been advocating for patients who are concerned about bone density. There are a few companies that offer that now. I think it’s really important.
Getting back to the calcium thing. There are a few poorly done studies that seemed to show that taking calcium supplements was associated with increased heart risk. The reality is for a modest amount of well-absorbed calcium, and as you know, when it comes to supplements, we want to make sure they are well absorbed. You don’t want to use calcium carbonate, which is limestone, because it’s not that well absorbed. You want to take it a few times a day with meals, so you have stomach acid to break it down. You also want to have good hydrochloric acid production, or you won’t break it down.
When it comes to calcification of the plaques, it turns out we shouldn’t be so worried about calcification of the plaques. We should be worried about having any plaque formation. If you are going to have plaque in your arteries, you’re better off if that plaque is calcified. Calcified plaque is stable. Uncalcified plaque or soft plaque is unstable. When you have a heart attack, 70% of the time, that is because you have soft plaque that ruptures and forms a clot.
Dr. Eric:
When you do a calcium score, that is looking at the hardened. You will have to do an angiogram or something else?
Dr. Ben:
Yes, the best test is the CT angiogram with artificial intelligence through a company called Clearly Health. You can look around. There should be a lab in your area that offers that test. A CT angiogram with artificial intelligence. That test will show the soft plaque as well as the hard plaque. That can be very important.
You can have a younger guy who has some plaque and say the coronary calcium scan is not that high, but they can have a lot of soft plaque. Usually over time, the plaque will tend to calcify.
If you take a statin, statins tend to calcify the plaque. Some people think that that’s a bad thing because you might see an increase in the calcium score. Once again, you don’t want any plaque in your arteries. If you are going to have plaque, you’d rather have it be calcified than soft and unstable.
Dr. Eric:
Makes sense.
Dr. Ben:
To take a modest amount of calcium with magnesium, as long as you take the Vitamin D and Vitamin K, is safe and beneficial. I think it’s really important for bone density.
Dr. Eric:
All right. Wonderful advice. I have a calcium score, which was thankfully zero. Like you said-
Dr. Ben:
Mine, too.
Dr. Eric:
I have not gotten the angiogram.
Dr. Ben:
It’s a little more invasive. You have to take some radioactive iodine. It is a CT scan.
Dr. Eric:
Radioactive iodine or just iodine contrast?
Dr. Ben:
It has to be radioactive, right? It’s iodine contrast, but it has to be picked up by X-rays. You don’t want to get it done a lot. I think it’s worth getting it once or twice. You want to make sure you go to a lab that has the most modern CT scan. The modern CT scans use less radiation than the older equipment.
Dr. Eric:
That’s good to know. I’m just thinking, again, dealing with people I work with as well as the people listening to this have thyroid conditions. There is good and bad with iodine.
Dr. Ben:
Right, I totally understand that.
Dr. Eric:
If anybody is thinking about that CT angiogram, I can’t say it’s risk-free for someone with hyperthyroidism.
Dr. Ben:
Absolutely not. I understand that. I know about the iodine thing. I have Hashimoto’s.
Dr. Eric:
It’s still good to know. If you get a calcium score, that’s great, but it’s incomplete.
Dr. Ben:
If you have a calcium score of 0, that’s pretty good. That means you will unlikely have a higher score on the CT angiogram.
Dr. Eric:
All right. This was a lot of great information. I learned some things. I will definitely inquire about the TBS. It sounds like not every facility offers that. I might have to look it up.
Dr. Ben:
They have to have the software. If you have your DEXA scan done at a lab that has the software, they could go back and reanalyze your previous test.
Dr. Eric:
I wouldn’t necessarily need to get another DEXA if the facility I went to offers that. They could go back and still use it?
Dr. Ben:
Yes.
Dr. Eric:
Even if it was a year ago?
Dr. Ben:
I think so. I’m sure they have a digital copy of your data.
Dr. Eric:
Yeah, I’m sure they do. I might have to inquire and see if the radiology place that I went to offers that.
Dr. Ben:
Most doctors don’t know about it, so they don’t often order it. It makes sense.
Dr. Eric:
It makes perfect sense. If you have a good TBS, even if you have osteopenia or osteoporosis, especially osteoporosis, you still want to do some of the things you mentioned, but still, there is at least some reassurance. You might not be at great risk of getting a fracture.
Dr. Ben:
In a similar vein, if you measure LDL particle size and number, somebody can have a higher LDL, but if they don’t have a lot of small, dense LDL and larger LDL particles, you are really not at that much risk.
Dr. Eric:
Dr. Ben, thank you so much for sharing this. I’m glad that protocol worked for you, non-union is no longer an issue, and you got that bone formation. Thank you so much for sharing that. Can you remind people where they can find you?
Dr. Ben:
You can go to my website, DrWeitz.com. You can call my office in Santa Monica at 310-395-3111. Please check out the Rational Wellness Podcast, which is available on all the audio platforms: Apple Podcasts, Spotify. There is also a video version on YouTube.
Dr. Eric:
Awesome. Thanks again. This was a really good conversation. I’m sure a lot of people benefited. The bone density is widespread, not just in the thyroid space, but really everywhere. Like you said, not enough doctors are recommending it, mainly for women, and they are waiting until they already have it.
Dr. Ben:
It’s crazy to wait until they have osteoporosis. Why not check it at 40? Let’s be proactive. That’s one thing about functional medicine. If we find out about these chronic diseases, which are these long processes, let’s find out down here, not way up here. We tend to wait until someone has a severe case.
Dr. Eric:
I agree. Thank you. This definitely will bring more awareness. Always enjoy chatting with you. We’ll definitely have to have you back when you get that longevity book. You have to make it a goal in 2026 to finish that book.
Dr. Ben:
Thanks.
Dr. Eric:
Take care, doc.
Dr. Ben:
Thanks, bye.
***
Dr. Eric:
Awesome conversation. It was a little awkward reading his bio. It was his fault because he didn’t give an updated bio. When I have a repeat guest, if they don’t include an updated bio, I will just read the old bio. I didn’t realize he mentioned that he was writing the book a few years ago. As I read it, I realized that was a few years ago. Did he finish writing the book? He didn’t. Lesson learned on my part: even if it’s a repeat guest, maybe don’t read the bio if they haven’t updated it.
Dr. Ben unfortunately fractured his hip. He was handing out Halloween candy and holding his dog on his other hand. Traumatic. We’re recording this a little bit before Halloween. I wanted to ask him if he, when handing out candy, is it more natural candy, or is it just the regular candy, like M&Ms and Snickers? If someone is a naturopath or chiropractor, you’d think they would go to Trader Joe’s or Whole Foods and buy more natural candy.
I find it’s better not to give candy. If you want to give out natural candy because I can understand not wanting to give junk. At the same time, the kids usually don’t want natural candy. They want Snickers and M&Ms. It’s different with your own kids if you’re raising them to eat natural stuff, like snacks without artificial flavorings and colorings. Just wanted to bring it up since it might come out after Halloween. I’m not sure. It’s being recorded right around this time.
Should you get a bone density/DEXA scan? I asked Dr. Ben if he got one prior to his fracture, and he didn’t. Most people don’t get one. I got one only because I asked for one, or else I still wouldn’t have one.
I should have asked for one a long time ago because I dealt with Graves’ in 2008. I probably should have had a bone density scan sometime in my 40s or right after that. It was 2008 when I turned 38. 39/40, I should have had a bone density scan. I waited years after that.
A lot of people have osteopenia, osteoporosis and don’t know it. I’m not a big fan of scans, but everything is risk versus benefit, especially if you have hyperthyroidism. It doesn’t make a difference. There are people with osteoporosis who don’t have thyroid conditions but have gut issues. They are not properly digesting or absorbing the nutrients they need. There are numerous reasons for low bone density. If you haven’t had a DEXA scan, something to consider.
TBS looks at bone strength compared to bone density. I mentioned how that’s not something I got. I have had other bone experts. I should have relistened to some of these. I should have done research before doing the DEXA scan. Quite frankly, I was surprised. I did it. I didn’t think I would have low bone density. I figured I’d do it, and it would be fine. Maybe I’ll go back and still potentially get the TBS if they offer it at the radiology place. I need to remember to look into that.
If you haven’t had a DEXA scan, or if you plan on doing another one in the future, get the TBS. Eventually, I will do another one and make sure to get that done if I can’t go back and get it done for the DEXA scan I did previously.
When to consider bone density medication? This might seem a little odd of an episode because he was talking about taking the Forteo, taking HGH. The big thing is the Forteo. I don’t love medication for bone density. The bisphosphonates are worse. You are supposed to follow up Forteo with bisphosphonates.
He had a bit of a desperate situation. It was either get the surgery or try something different. If I were him, I don’t know I would have thought about doing that, but it was brilliant taking the Forteo and HGH. He went all out. Five months, which most people take Forteo for osteoporosis for two years.
It’s not an easy decision. I know for some people listening, they might think it is an easy decision. “I just won’t take the medication.” That was my perspective when I dealt with Graves’. Easy decision. I will just start with bugleweed and motherwort. If I need to, I can take antithyroid medication.
There are always risks. There are risks when you don’t take antithyroid medication. If you have severe osteoporosis, and you slip and fall, you could potentially be in a lot of pain for a long time. Then you have to weigh the potential side effects.
It’s up to the person. If someone has really severe osteoporosis, I understand if you decide to take the medication. Regardless, whether you take the medication or not, you want to do everything else. As Dr. Ben mentioned, you want to eat healthy, do proper exercise, make sure you have healthy Vitamin D levels, take Vitamin K2, which we’ll talk about K2 in a minute.
Vibration plates. I have been using a vibration plate three days a week for 10 minutes a day typically. I don’t think you’re supposed to use it every day from what I’ve read.
I also have a weighted vest. I don’t use that every day either.
I will usually do everything on the same day. Not sure if I should be doing that. I figure I’ll do my squats, deadlifts, vibration plate, and weighted vest three days a week. The other days, I will give my body a rest. Maybe it’s better not to put that stress on it every single day. That’s the approach I take.
With the vibration plates, I read you’re not supposed to use it every day. The weighted vest, it might be fine to do it daily. I wouldn’t use it for squats and deadlifts every single day.
Vitamin K2. He spoke about the difference between MK4 and MK7. Most studies out there are using MK4. He said that the amount included in most supplements is low, and you should be taking 45mg, which is a lot.
I have done research with Vitamin K2, and I know higher doses seem pretty safe. I am not concerned about taking 45mg. You figure most supplement companies do their own research, and they would know. He said there are only a couple companies that offer supplements of Vitamin K2 in MK4 that offer it in 45mg dosing. I did do a little bit of research. Meant to ask him, but I forgot. Life Extension is one of them. I don’t know what the other one is.
I wanted to finish up by mentioning what type of calcium should you take? He mentioned not to take calcium carbonate but didn’t say what you should take. You want to try to get as much as you can through food. You want to get 1,000-1,200 of calcium per day. I have to check the units. I should know this, but I’m blanking.
Thorne Research’s Advanced Bone Support is really good. They use calcium malate. The only thing is that calcium can be constipating. If that’s the case, calcium citrate is pretty good also for bone health. If you’re on the sluggish side with the bowels, calcium citrate may be better. Calcium malate is also an option.
Of course, try to get as much as you can through food. I don’t eat fish with bones. If you do, that’s an excellent source of calcium. Sardines, for example. I do get some plant-based sources.
More recently, I have been drinking goat milk kefir. I don’t recommend this while someone is healing, especially if someone has an autoimmune thyroid condition. I recommend a break from dairy while healing. Since I have been in remission for a long time, I haven’t been dairy-free all these years. I haven’t been drinking milk. Goat milk kefir. That’s what I’ve been doing from a calcium standpoint. I supplement with some calcium, too.
That’s pretty much all I wanted to chat about. As usual, I hope you found this episode to be valuable. I look forward to catching you in the next episode.