A Holistic Approach to Osteoporosis: Beyond Conventional Testing with Dr. John Neustadt

Hi everybody, I'm Dr. Sanda Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most in a natural way. Everyone, welcome to another episode on the Holistic Dentistry Show. I'm your host, Dr. Sanda Moldovan, and today we will be talking about strong bones, osteoporosis, and I have a very special guest, Dr. John Neustadt, who is in San Diego practicing as an ND. He is Celebrating the second edition of the number one Amazon bestselling book, Fracture Proof Your Bones. And you are also recognized internationally as an expert in integrative and functional medicine with a deep focus on osteoporosis and fracture prevention. And as one of the top 10 cited authors in the world for your work, you published over 100+ medical articles. Was editor of the textbook Laboratory Evaluations for Integrative and Functional Medicine, and you are on the corporate advisory roundtable for Bone Health and Osteoporosis Foundation. So Dr. John Neustadt, welcome to the show.

Thank you. It's great to be here.

Quite a few accomplishments there, but I really wanna go back to what triggered this, this passion for bone, especially after you graduated from Bastyr University.

Uh, like 20 years ago, if we had had this conversation and you were to say one day you were going to be deeply involved in the bone health space and lecturing at conferences and writing books about this, I would've looked at you like you were crazy. It was not even on my radar, but I had a few patients coming in and they had osteoporosis and I was trained to work in an integrative medical fashion and use nutri— nutrition and exercise and diet and lifestyle. And yes, medications when appropriate, but through integrative approaches, their bone density was going up. My mother-in-law at the time had osteoporosis as well, and she was taking Fosamax and her bone density was going up. So she was happy. Her physician was happy and I was happy. I thought she was protected. We all did. And then she tripped on a throw rug in her house and broke her hip. And I thought something's wrong with this picture. So I started looking at the research and was absolutely shocked what I found that, you know, we've known since the 1990s that a bone bone density test predicts less than half of people with osteoporosis who will fracture. And then in 2008, another study came out that, you know, looked at the data and concluded that for women with osteoporosis, it only predicts— a bone density test only predicts 44% of those who will fracture. And for men, only 21%. And yet despite that, even now, 20 years later, the conversation clinically almost exclusively revolves around that test number and improving the number on the test instead of working and treating the patient sitting in front of us, the patient in the office who is really scared. Because the biggest risk with this is not a number on a test, it's whether somebody breaks a bone.

Yeah. And you know, there's this, you know, as an oral surgeon, I actually do see a lot of patients on Fosamax for like 20 years and they're still on it. But, but there have been some studies where bisphosphonates, where they actually do take them and After 7 years, it increases the risk of fractures. So it's not even protective.

Well, it's interesting. When I was looking at the, you know, doing a deep dive into the medications in for my second edition of my book and reviewing the research and expanding on that chapter, I learned that, you know, technically failure of a medication only occurs when you've broken 2 bones, 2 or more bones. And in fact, the improvement that in the bone density test results that an osteoporosis medication creates— and they all do, they all improve bone density— is not an indication that fracture risk is, is being reduced. And you're right, you know, taking them for 5, 7, or more years is definitely not indicated. That is not the standard of care anymore, nor recommendations from, from medical organizations.

What is the indication now? Is it to just take it for a short period of time, if anything? Yeah.

So the length of time that's recommended is no more than 3 to 5 years, typically about 3 years. Before switching to another medication, because the longer somebody takes it, the greater the risk for, well, two things, two very dangerous and scary complications. One is atypical femoral fractures. That is, you break your, your leg, it actually can increase the risk of fracturing by laying down, you know, how the body lays down bone and creates new bone. It puts it into an abnormal pattern that creates weaker bone. And so it's a small percentage of patients that this all, that it happens to, but it is significant. And so somebody could actually break a bone because it's increased their fracture risk. But then they also are at increased risk for a very dangerous complication that I know, sure, you know of very well, which is osteonecrosis of the jaw, where the jawbone literally just starts to disintegrate from something as simple as a tooth extraction.

Absolutely. And it can be very painful. I've actually had to deal with osteonecrosis of the jaw, and the bone basically dies. That's what it is. It dies and it harbors bacteria. It's hard for us to actually get vascular bone in patients that have been longstanding or on high doses of bisphosphonates for different reasons. And it is difficult and debilitating for patients.

Yeah, absolutely. It's a, it's a scary situation. And it's interesting because in dentistry now, before procedures will be done, even something as, as simple as a tooth extraction in people who are on bisphosphonates, the recommendation is to discontinue this bisphosphonate. I'm sure that you've, you've seen that. But what I've learned is that there, there were really no studies indicating, well, how long does somebody need to be off the bisphosphonate in order for that risk to decrease? Maybe you have some perspective on that that I haven't learned, but I was fascinated by that.

Yeah. So I mean, we have conflicting information with this, but typically we go to with a CTX test for this. I mean, I've seen some reports that say these bisphosphonates stay in the body and they mess up the bone metabolism forever, that it don't really change anything even if we stop it. Do you recommend any testing at all to see what the bone metabolism is doing?

With respect to the bisphosphonate medications? Mm-hmm. And when they come off of it? Well, not really because there's not any good, I mean, I've, I've yet to see any good studies when people come off of it that are linked or associated with reductions in the risks of atypical fractures or osteonecrosis of the jaw when it comes to these markers, these bone turnover markers like CTX or P1NP, those sorts of things. I think that it is just a lot of, a lot of unknowns. I mean, just clinically, there's a, there's a limit to the knowledge that we have in terms of these medications and, and how they behave. But we do know that they, they stay in the body for about 10 years, those bisphosphonate medications.

Yeah, that's a long time.

Yeah.

Now you have a different approach to treating osteoporosis, and in your book you actually talked about digestion being linked to bone strength. So tell us more about that. How's digestion linked?

It's very clear now there is a gut-bone connection. I mean, it's unambiguous that what's going on in your intestines directly and indirectly affects bone health. Chronic inflammation in the gut, dysbiosis in the gut, that's unhealthy balance of bacteria and other organisms that will move into the bloodstream, those chemicals from that, those inflammatory molecules, or what are called inflammatory cytokines, and they can directly travel to the bone where they stimulate osteoclast activity. Osteoclasts, for your listeners, if they're not aware, are the cells, the bone cells that break bone down, and the osteoblasts are the cells that build bone back up. And you need a, we need a healthy balance of both. They're, they're constantly working. And when there is healthy bone remodeling, that is new bone being created, old bone being broken down. That's when we have healthy bone. But when you get too much osteoclast activity, you get an imbalance and you have more bone breaking down, and that can be created by chronic inflammation. And we see that a lot in, in ulcerative colitis and irritable bowel disease, Crohn's disease, those types of chronic inflammatory diseases. But now it's been linked to even subtler diseases, not even that extreme, just that chronic inflammation of the gut, the dysbiosis in the gut, the chronic immune activation destroys bone. And then what happens indirectly is over time, the lining of the intestines becomes damaged. And so people get malabsorption. They're not absorbing their nutrients as effectively— vitamins, minerals, amino acids, fatty acids— and those nutritional deficiencies that can occur then secondarily impact bone health and increase bone loss and increase the risk for osteoporosis and fractures.

So what happens when the body goes through inflammation? Is it because, uh, like it's a more acidic pH and the body's using the calcium to balance that, or?

Well, it's not really. It's interesting you say that because there's this, there's a fad out there, or there's a lot of information about this acid alkaline diet. And, and yes, the pH can be balanced from the reservoir of calcium, can be pulled from the bones into the bloodstream, but the reality is that our stomach is an acid environment. It's a, it's a low pH when it's producing healthy stomach acid and food gets digested and then the pH starts going up into the, into the in lower intestines, the small intestines. It gets up to about a pH of 6 and 7, which is a little more alkaline. But the studies showing people on a chronic sort of acid diet and is it really the pH that's increasing their risk for osteoporosis? You know, no one's really tested that theory that I've seen, but what they have tested and what has shown is this overall dietary pattern, not necessarily linked to pH, but the standard American diet, which tends to be a rather acidic diet, high in processed foods, high in, in red meat. Those are considered more acidic than plant-based or plant-forward diets like the Mediterranean dietary pattern that is linked to increased bone loss, osteoporosis, and fracture risk. And the Mediterranean dietary pattern, which is the opposite of of the standard American diet is a more basic diet. Is it because of the pH? Is it because of the vitamins, the minerals, the healthy fatty acids that are in there? I don't know. But the reality is that the closer that somebody follows the Mediterranean dietary pattern, the greater the benefits, not just for bone health. It's associated with a 20% reduction in osteoporosis risk and hip fracture risk, which is the most dangerous type of fracture. But it's also linked to lower risks of every chronic disease that's been studied that I'm aware of, you know, cardiovascular disease, dementia, Parkinson's disease, cancer, death from cancer. I mean, just on and on. So yeah, whether somebody wants to ascribe it to the pH or just the overall dietary pattern, which is where I typically look to see what somebody's overall dietary pattern is, not whether they're consuming one specific food that's more acidic than another specific food. I wanna look at the total balance of what they're eating throughout the day.

Makes sense. And the Mediterranean diet I think is the most researched diet in terms of health and chronic disease prevention out of all the diets that come on the market, the carnivore diet, you know, the Beachbody diet. I can't keep track with all of them. Now, you also mentioned male osteoporosis. For the longest time, we thought osteoporosis was a women's problem. As we hit menopause, you know, our bone density starts to go down. But why do you feel there's a male this osteoporosis epidemic?

Well, what's happening with men, and the research is showing that testosterone in men is declining, and when testosterone in men declines, it's a risk factor for osteoporosis and fractures. And so that is, I think, a, a large reason. I also think that, that it's not just men. Osteoporosis and bone loss is increasing overall in the population. And that also goes back to diet and consuming ultra-processed foods. There's, there's evidence now that the more ultra-processed foods somebody consumes, the, the worse the health outcomes, and it is now linked to bone loss and osteoporosis as well. And, you know, men like women are consuming a lot of ultra-processed foods. Right now, there's about 60% of the American diet is ultra-processed food. Those, you know, packaged foods on the shelves in stores that have a long, a long shelf life and, and are easy convenience foods that you pop in the microwave. 70% of packaged foods now, approximately in the US markets are, are ultra-processed foods and people are consuming them multiple times a day. So that also affects male health. I also think that men are more sedentary overall than in past generations, and that also leads to bone loss. But about 20%, the officially, the official, you know, numbers are about 80% of osteoporosis cases are in women and about 20% in men. But I also think that most people aren't getting a bone density test and those numbers probably aren't that accurate.

So where do you start in your practice? You get a patient, obviously they have probably several issues, but one of their issues is bone density problems. Where do you start? Do you start with hormones? Do you start with gut health?

You know what I do? I start with framing the condition and the test results in their proper fashion, in their proper context. What happens invariably is, you know, people will come to me and they have the diagnosis. They've had the conversation with their physician, and most people are absolutely terrified. They've been told they have to, oftentimes they have to start a medication immediately, and if they don't, they're gonna fracture. And that's told to them in no uncertain terms. You're gonna break a bone. You're gonna end up in the hospital. I've even had patients that have been told by their physician, if you don't take this medication, you are gonna fracture and you're going to die. And so they're terrified. And so the first thing I do is I have them take a few deep breaths, and then I put the bone density tests in the proper context. And I said it before, and this is what I say to them, that a bone density test predicts less than half of women who will fracture and half of men. It only predicts 44% of women, in fact, with osteoporosis who will fracture, and only 21% of men. Every medical organization that has looked at this issue has correctly concluded that fracture risk depends on factors, largely other than bone density. And yes, it's important. You have to start doing something about it. You have to start being proactive, but it's not an emergency. There's time to educate yourself, to learn what you can do to put together a holistic bone health program that makes sense for you. And that may or may not include medications. But in order to make that decision, you have to have the information and a plan to understand how you're going to move forward and how you're going to test and track and be comfortable and confident in the decision you make. And that's what my book attempts to do. It walks people through creating holistic bone health programs that make sense for them based on the published evidence and clinical trials and epidemiological research. So I don't necessarily start with hormones. I don't necessarily start with diet. I don't necessarily start with exercise. I start with what the patient needs first, because this is not a simple thing. It is not here, take this pill and be done. It oftentimes has taken years for them to get into this situation. And it's about meeting the patients where they're at and understanding their challenges, their, their, where they're, they want to begin and then start working with them in that direction. Because what, what I've learned is that radical or large changes done quickly tend not to be sustainable. And this is about doing incremental changes over time to create new healthy habits that are going to build bone, and in the, in the process also reduce your risk for many other diseases because that foundational health practices of diet, lifestyle, and exercise is not just about helping bones. It helps every system in the body. And then help them transition into doing that. And I'll give you an example. When it comes to diet, most people, as we've already mentioned, are not eating that healthy Mediterranean dietary pattern. And I tell people, I don't want them to make any changes immediately. In fact, I don't want them to make any changes for the first 2 days. I want them to take and just write down what they're eating. And then I want them to calculate how many grams of total fiber are they getting and how many grams of protein are they getting, because that is what I want them to focus on. I've broken down that Mediterranean dietary pattern into two discrete things that I want people to focus on, and that is gonna help them transition into eating this way. And most people then are not eating the 30 grams of total dietary fiber that I'm recommending, and most people are not getting enough protein in their diet. The amount of protein somebody consumes can account for 2 to 3% of bone mineral density. Just that alone. One of the problems with the bone mineral density test is it only measures the mineral component of bone, and that's why it's not very predictive of fractures. Bone is a complex tissue, like all tissues, has different things in it. There are 180 to 200 proteins in bone in addition to collagen. Collagen is the main structural protein in bone that gives bone its ultimate strength and flexibility to withstand, uh, fall and not break and not be brittle. Making sure we're getting enough protein to produce the collagen and other proteins that our body needs to give the body the raw materials it needs to do its job is crucial to long-term success. So I have people take their body weight and multiply it by 0.6. So 0.6, if their body weight is in pounds, that's 0.6 grams per pound of body weight per day. These diets that are saying, or these recommendations, take up, you know, gram of protein per, per pound of body weight per day. There's just no evidence of that being effective. And the problem is I experimented with myself is that I tried eating that much and what happened, I was so full, I didn't eat the other vitamins and minerals and other plant nutrients I needed. In fact, it created dysbiosis in me.

Yeah.

Getting all that fiber that the body needs to feed the healthy bacteria, to modulate blood sugar. And so I had to correct that in myself. And so Based on the research and clinical trials that I found, I recommend a more, I think, practical and moderate approach based on that research. And because you can be doing everything right, you can be exercising, you can be doing, you know, taking nutrients that have been shown in clinical trials, in supplements to, to support healthy bone density and improve bone density. But over and over I've seen if you're not consuming the raw materials, you're not giving the body those raw materials to function. It can't build the, the collagen and improve the bone mineral density to improve the health of your bones. So that foundation is really important. And if that's where they want to start by slowly making baby steps, meaning don't radically change what you're eating in your kitchen overnight, maybe walk through this process over 4 or 6 weeks, whatever's comfortable for you, because it often requires shopping differently, having different snacks, cooking differently, having different spices. And if your family's involved, having them involved as well. And so I just try to take a very practical approach because what the research shows is very clear. It doesn't really matter where somebody starts in terms of overall health activities. If they start to improve their diet, if they start to exercise, if they're sleeping better, once people are doing better and doing health-promoting activities in one of those domains, What the research shows is they're more likely to start doing other activities in other domains, and this success starts to build on itself. And that's what I want to create.

I love it. That's such great tips you gave there. Now, I have women that are older in their 70s, and they said, oh, there's no hope for me. I don't think my bone mineral density is going to get any better. What would you say?

Well, that, that's really a conclusion that's not based on the research. And my experience. I mean, you definitely can improve bone mineral density. And I think what happens sometimes is, is people have stories that they make up in their head based on their own models or insecurities or what they've heard. And so I just try and do this for myself as well. I'm not always successful, but when somebody tells me something or I'm thinking some self, a self-limiting belief, I ask my, why am I thinking this way? Did, is there Show me the data. And is there something, am I really just limiting myself or is this really true? And that self-limiting belief is unfortunate because our actions will follow from our beliefs and what we think. It is a self-fulfilling prophecy. And I'll give you an example. When people have, women have a fear of falling, that alone increases the risk of falling by hundreds of percent. Compared to somebody without the fear of falling. And I talk about this in my book. I mean, just dealing with those fears and that self-limiting belief. And I've had so many women come to me and say, I've stopped doing what I love because I'm so afraid of breaking a bone. So let's not— I don't tell people don't be afraid. I don't think that's very effective. What I like to do is educate and empower people of what the research shows and the steps they can take to be stronger, to be steadier on their feet. Because what we know actually that another study 20 years ago, looked at the bone density test and looked at how stable these people were when they stood, what was their risk of falling? And what they found for men and women, when their risk of falling was low, bone density test predicted about 5% of men and women under 70 who would fracture. And if they're over 70, only about 10% overall of men or women who would fracture. And it was that stay being stable and steady on their feet. So when people are really afraid, of falling or they're— they have this self-limiting belief that I can't improve bone density. I educate them. And first of all, I tell them based on experience and research that, that, that's simply not true, that we can. But then it's about helping them start moving in that direction.

Yeah. Now, what are some of the hidden fracture risks that people don't know to get screened for?

That's a great question. And there are a couple that I really want to make sure people hear today. The first that comes to mind is the medications they're taking, because there is a long list of medications that doctors are prescribing that destroy bone, increase fall risk, and increase fracture risk. And the physicians who are prescribing them don't even know that those— they're doing that. In fact, about 95% of the elderly who are at the highest risk for falls and fracture are on a medication that increase their risk for falling. And in one study where these women were hospitalized because they fell and broke their hip and they ended up in the hospital, 76% of them were on a medication that increased their osteoporosis, fall, and fracture risk. And then when they were discharged from the hospital and they left, there was no overall benefit, meaning that if they were switched or given a different medication, they were just given a medication that did that increased their risk. And what we find is that the most commonly prescribed medications, antidepressants like SSRIs, Wellbutrin, Prozac, acid-blocking medications like proton pump inhibitors, glucocorticoids like prednisone and more, they destroy bone and they increase fracture risk and fall risk. In fact, with SSRIs, those class of medications, we now know that for every 19 women taking it, we would, for 1 to 5 years, will expect one of them to fracture because there are serotonin receptors on bone. And serotonin, when serotonin receptors are activated, they stimulate osteoclast activity to break more bone down and break it down faster. The other hidden risk for, for fractures that I would say is their home. Most fractures occur in their home. And so making sure that their home is a safe environment, that walkways are clear of things they can trip over, that walkways are well-lit, that there's no tables sticking sticking out into the walkway that they can knock their leg on and fall, that stairs are fixed.

Hmm, very interesting. I'm glad you mentioned medications because 2 out of 3 Americans are on some type of medication. I'm sure the percentage of people that are on antidepressant nowadays in the last 4 years is higher from what I hear from my medical colleagues than it used to be. And these are things they have to be aware of, especially if they're young and they're taking these medications for years. My guess is the longer you take them, the more an they have. Am I correct?

It's true. Yeah. So the, the general story is that the higher the dose and the longer the duration, the longer somebody's taking it, the, the greater the risk. So we, we see this with aromatase inhibitors that are used for breast cancer and other estrogen receptor positive health issues. They block estrogen production and, uh, 20% of women on them for 5 years are expected to, to fracture one in one in. And so So the lower the dose, the shortest the duration of medication that you can be on, the greater, the, the better it is, the safer it is. Or if you can switch to a safer medication that doesn't have these effects on the bone, even better. Or if somebody can work with an integrative doctor, a naturopathic doctor, a functional medicine doctor, somebody to, to sort of approach these situations differently. So maybe you don't need the medication or, or perhaps need less of the medication. That's going to work in your favor. And I'll give you an example. 50% of proton pump inhibitors, acid blocking medications, are prescribed for acid reflux. And acid reflux can often be fixed by simple dietary changes or looking to see if there is a dysbiosis that can be treated in the gut and corrected. And then somebody won't need the medication.

Yeah, absolutely. Now, I want to talk a little bit about supplementation. I have patients coming in and on my health history, I always have an intake on what supplements are you on? And I oftentimes see, uh, like calcium, magnesium, vitamin D. What are your thoughts about calcium, magnesium, and vitamin D for bone health?

I look at the research through a very narrow lens, and that is, have clinical trials been conducted that have shown that the nutrient maintains bone strength? The most sensitive indicator for bone strength is if somebody breaks bone. And so I want that to be the endpoint that is evaluated in the study. Most studies don't do that. Most studies look at bone density. It's an easier, less expensive study to run, but as I already mentioned, the bone density test predicts less than half of people who will break the bone.

So magnesium, for example, there's only one clinical trial with magnesium was done in the 1990s. It did show bone density improved, but it did not look at fractures. When you look at magnesium diet research, the research is inconclusive whether actually dietary magnesium reduces fractures. And don't get me wrong, don't get me wrong, I'm a big believer in magnesium. I love magnesium, and most people don't get enough in their diet. But I prefer people get the magnesium in the diet from food, in leafy vegetables, fruits, because they have the other nutrients antioxidants that our body needs to thrive, and it should be in a good multivitamin anyway. Calcium and vitamin D, in contrast, have been shown to maintain bone strength as well as improve bone density.

Neither are approved by the FDA to treat osteoporosis. And in fact, no dietary supplement is approved by the FDA to diagnose, treat, prevent, or cure osteoporosis. But in clinical trials, looking at nutrients, there are some that have been shown to promote healthy bone density and improve bone density and maintain strong bones. But you have to have calcium and vitamin D together in the right amounts. If you have one without the other, you don't get those benefits, but you don't necessarily have to take them as a dietary supplement. My preference is that people get it from diet. Diet should be the foundation, and dietary supplements should be used as the FDA intended, as a supplement to a healthy diet.

Diet.

Now, the average American woman consumes only about 800 milligrams of calcium in her diet, and the average American man about 1,000 milligrams of calcium. The, the USRDA for calcium for women is 1,200 milligrams. So for many women, getting 400 milligrams as a dietary supplement of calcium is appropriate, but by no means should it, should it be, in my opinion, a universal recommendation that everybody take calcium as a dietary supplement. It should be customized. Analyzed and by looking at their, their— what we know is that calcium and vitamin D can reduce fracture risk by 18 to 23% in these studies.

Wow.

Now the caveat for vitamin D is that if you have enough vitamin D, taking more vitamin D doesn't necessarily improve your bone health even more. So the maximum fracture reduction, hip fracture reduction with vitamin D is associated with a blood level of 30 to 44 nanograms per milliliter. So I am a fan and I advocate people get their vitamin D tested and then supplement as appropriate.

And many doctors like myself and perhaps you like to have the vitamin D even higher because that is, that could promote youth health. But when I'm just looking at this, you know, again, through this narrow lens of bone, 30 to 44 nanograms per mil, per milliliter, that blood result is associated with maximum maximum fall reduction and maximum hip fracture reduction. And to get there, most people can get there by taking about 2,000 per day of vitamin D. So that's, those are my thoughts on calcium, magnesium.

Yes. I'm glad you mentioned also testing because I, you know, I encourage always all dentists that are doing dental implant surgery or bone grafting or periodontists that are doing these, these procedures to test vitamin D level. And now it's easier than ever, especially with a blood spot test that we can do for them. You know, in the dental office, we're not exactly equipped to draw blood, Necessarily, but, uh, I think the testing has gotten so much easier that it's something we can incorporate and it's recommended prior to any kind of bone regeneration, uh, procedure.

Well, and it's so easy now. There's even direct-to-consumer testing. People can order their own lab tests online to get the, the information they need to make better decisions for their health.

Yeah. Amazing. Anything else you'd like to mention that we haven't talked about, um, regarding your book, Fracture Proof Your Bones, that you put in there that's, um, surprising There's a lot of surprising research that, well, it surprised me, frankly.

You know, one of them was the study I mentioned about, you know, fall risk and, and bone density, how, how poorly bone density tests actually predict, you know, fall risk when somebody is strong and steady on their, their feet. And I think that, you know, there are other nutrients that have been shown that have good clinical trials on them that I discuss in the dietary supplement chapter. There's more information on diet and lifestyle. And one of the things that I think is really important that I would like to mention is the chapter on, on social connection, because that's also something that's not discussed typically in doctor's appointments. That's being engaged and involved in your community and with other people. And there is research on this showing that when people have a strong social network and it doesn't take a lot of friends, I mean, I mean, it seems to plateau at about 3 friends that people have that they do things with, that they, they have a relationship with, they call, they, and they go out with or have conversations about, and they're engaged in their community with, that, that is associated with better outcomes. And if somebody actually unfortunately does fracture a hip, that is linked to faster recovery and discharge from the hospital. And I found fascinating the research on oxytocin. I think one of the mechanisms underlying that is oxytocin. Oxytocin is a hormone for bonding and love and safety and osteoblasts, those cells in our bones produce their own oxytocin. And I was shocked when I read this and their study linking not only better oxytocin to longevity, but women with osteoporosis have lower oxytocin in studies than women without osteoporosis. And in animal studies, there are better outcomes in terms of bone health and fracture risk when oxytocin was given to these animals. And so I think that that was a surprising finding to me, and it takes the evidence that I've learned in this book and it really rounds out the suggestions because it's really not just about medication, again, which might be appropriate. It's not just about diet. It's not just about exercise. It's about about a holistic way of thinking and living your life that's more in alignment with health, with what your body needs, and circadian rhythms, and helping to promote your healthy biochemistry and healthy metabolism so you can just flourish. You feel better, you have more energy, you live better, and your bone density and fracture risk improve.

Amazing amount of surprising information. I did not know about the oxytocin myself. And you also have a newsletter, actually, at nbihealth.com and we're gonna put that link below in the show notes if people would like to check it out, cuz you are a wealth of information.

Thank you so much. Thank you.

Where, where can people find you?

The best place would be on my website, which you mentioned, and I appreciate that. It's nbihealth.com. NBI stands for Nutritional Biochemistry Incorporated, nbihealth.com, and all my resources and information are, are there.

Awesome. Well, Well, Dr. John Newstadt, thank you so much for joining us and enlightening us into looking at a holistic approach to strengthen our bones. And everyone, thank you for joining us. If you enjoyed this episode, please share it with one of your friends or family members, and don't forget to comment on our YouTube channel if you'd like to hear anything else or any other topics. Until next time, stay healthy. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram @drsandamoldovanova. This is Dr. Sanda Moldovanova, and remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.