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Osteoporosis
Excerpts from a talk by John. R. Lee, M.D.Home | More Information | Contact Us
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Bone is living tissue and hormones have an effect on bone. Estrogen causes bone resorption while progesterone and testosterone cause new bone to be made. Bone is always being torn apart and put back together again, just like your skin, hair, the lining of your intestines, and all the other cells in your body — except brain and muscle cells. They are all being replaced, and bone replaces itself. The long bones in the legs and the arms take 12 to 14 years for a total 100% replacement. The bones in your back-bone, heel and the more open bones called trabecular bones, are completely replaced every two to three years. So every two to three years every single molecule, every single mineral, everything in your trabecular bones have all been changed to new bone. Bone replacement is a continual process. The ultimate strength and density of the bone is determined by the balance be-tween these two effects: 1) the undoing and 2) the redoing. If the undoing is happen-ing more rapidly than the redoing, the end result is you will be losing bone. If the new bone formation catches up, you will stay even, and if the new bone formation can be pushed higher than the undoing, then you will have new bone again. So what I stumbled on to is that progesterone causes new bone formation. Many books have a graph that shows bone mass as a function of time. A safe range for bone mass for your backbone is 0.9. If your measurement is above 0.9 you will probably not have a fracture if you fall accidentally on something soft. But if it is below 0.9 and you trip over a step or fall pretty hard, you will probably break a bone. Therefore 0.9 is a kind of safe threshold I use to compare bone densities.
The process starts when a girl is about age ten. Her skeleton begins growing and showing more and more bone. Around age 35 she reaches her peak of bone mass. From age 35 on she starts losing one to one and a half percent of her bone mass per year, so she could lose 15% to 25% before menopause. At menopause it falls more rapidly, and then returns to approximately the same rate of loss as before. This sounds wrong because the popular consensus is that menopause precipitates osteoporosis. Menopause is not the cause. Actually, it is something that happens 10 to 15 years before menopause while women are still making a lot of estrogen, having periods and losing bone. Bone loss is called osteoporosis. What happens at age 35 while there are still good estrogen levels which cause the bones to start losing bone mass? Along comes a beautiful report in the New England Journal of Medicine from a woman doctor in Vancouver who was head of the Department of Endocrinology. She followed hormone levels, first in women athletes, then in other women, and she found a high incidence of anovulatory cycles. Anovulatory cycle means that the ovaries didn’t make the eggs that month, and if women don’t make the eggs, they don’t make the progesterone. She found that at age 35 about 50% of the women in North America start missing ovulation, even though their periods continue to be regular. The woman doesn’t produce eggs each month, and therefore she is not making progesterone. She also found that while this was taking place, the testosterone, cortisone, and estrogen levels stayed the same. Everything stayed the same on the hormone levels except progesterone. When progesterone went down or disappeared, that’s when osteoporosis started happening. The doctor proved that the decline of progesterone is at least a cause of osteoporosis, even in the face of plenty of estrogen. This study proved that estrogen deficiency is not the cause of osteoporosis. Doctors have been wrong for many years, because they have been measuring the loss when estrogen fell at menopause, and concluded that the bones were declining because estrogen levels fell. Bone loss is not due to estrogen going down. Bone loss happens because you are not ovulating and not making progesterone every month. You are becoming deficient in progesterone. You are not keeping up with new bone forma-tion. This appears to be new information, and yet charts showing bone decline starting at age 35 have been around for a long time. Apoptosis means normal, programmed cell death. The only reason you can stay healthy and young is because cells die on time, so new cells coming along will have a place to work. The word means “a falling away.” It’s like the leaves of the trees in the fall in Vermont and Maine. The trees look bare during the winter, but in the spring new leaves come back. The one set of leaves did their work during the growing season, and the next set of leaves will do their work during the next growing season.
Bone apoptosis happens when osteoclast cells come along and eat up old bone that’s been there for years and need to be taken away. There are millions of these little osteoclast cells. When they get down to good bone, they stop and leave. As soon as the osteoclasts leave, then another type of cells called osteoblasts come in. Their purpose is to put in new bone. The new bone they put in is stronger than the bone that was there before. This is why your bone mineral density goes up. They can make better bone. Once the osteoclasts take away the old bone the osteoblasts go in and build new bone. (Sometimes these osteoblasts are called osteocytes.) Real, living osteoblasts get embedded in the bone they are making. They stay alive, but not forever. They die off all the time. When they die, the bone they’ve made begins to get more porous, weaker and more likely to break, and that’s when the next cycle begins. Osteoclasts and osteoblasts are partners in the bone building process. First, the osteoclasts take out the old bone that is weak, then the osteoblasts move in to fill and make new bone. Bone mineral density measurements represent an average of these two processes. It reminds me of our bank account. When it gets too low my wife says, “Put more money in.” And I say, “It wouldn’t get so low if we didn’t take so much money out.” There are two processes going on. So when the doctor looks at a bone mineral density report, what he sees is the average of the two processes, but he doesn’t know which one is predominant. If your bone mineral density is falling, your doctor does not know whether you’re losing more bone than you ought to, or whether you’re not able to make enough new bone to catch up. What I learned is that progesterone turns on the processes which lead to new bone formation. Estrogen slightly slows up the loss of old bone. That’s why at menopause, when estrogen decreases, you have an increase of bone loss, called bone resorption. However, within three or four years the body adjusts to the new estrogen level, and the bone loss goes back to the bone resorption rate to what it was before menopause, and then progesterone works again. During those three to five years prior to the onset of menopause, progesterone might not be able to accumulate enough new bone to catch up with the loss that is occurring, but after a few years it will.
Now you know how bones are made. You’re always making new bone, and you’re always getting rid of old bone. The timing between a period of quiescence and an increase, then another quiescence followed by new bone being made again is a re-markable biological process. The time required to renew all of the molecules, atoms, calcium, magnesium, phosphorus and everything else in your long bones, such as the compact bones of your arm and your femur, is about 12 to 15 years. Your backbone, called trabecular bone where there are more open spaces and which do not have as much torsion pressure; tturns over more rapidly. About every five years you will have 100% new bone in your backbone, heel bones, and kneecaps. Isn’t that amazing? You are making yourself new every few years! So what you need is something to help the osteoblasts. In men the helper is testosterone, and in women it is progesterone. Some doctors said my patients got well because there was some kind of placebo effect or the force of my personality was such that people got better, and it had noth-ing to do with progesterone. I told them, “If it’s a placebo effect, it’s an exceptional placebo effect, because the tests prove that the bones actually got stronger.” There is a little acceleration of bone loss on these charts at age 50 to 55, which is around the time of menopause, but then it straightens out on its own and continues the same decline as was happening before menopause. So the big loss at menopause is only a temporary time. Some women may need a little estrogen during this period, but after they get past menopause all they need is progesterone, and the bones come back. What I found after three years, is that untreated, a woman will lose 1.5% to 2% of her bone mass a year. You might get a little surge of estrogen, but then it remains level. When progesterone was added, the average woman gained 15% new bone in three years. Such a thing was never before been reported by anyone, so I wrote a paper about it, and it got published in an international journal. I received letters from all over the world, but not one letter from a doctor in the United States.
When I retired from practice nine years ago I asked my nurse to pick out 100 records of women on progesterone. Out of the 100 I took only those who had at least three years of bone mineral density tests every six months. I was left with 62 patients. The average increase in bone density in these postmenopausal women over three years was 15.4% versus a normal expected loss during that period of time of 4.5%. That is almost a 20% average difference between what normally happens and what happens when women are using progesterone. Estrogen only slows down bone loss for the period of menopause, and after menopause it doesn’t even do that. Progesterone, however, causes new bone growth even in postmenopausal women. I then divided my patients up into two groups – those with a lot of bone loss and those with pretty good density. I found that the worse the bone was at the beginning, the more it responded to progesterone. The women with good bone at the beginning essentially stayed the same. Doctors generally say that you can’t help women over 70, because they are 20 years post menopause, and the bones are inactive. The bones are only inactive because they don’t have the hormone progesterone to telling them to get to work! In dividing the results with those over 70 and those under 70 among my pa-tients, the gain was essentially identical in both groups. So the bones do get to work again, and age has nothing to do with it. Examples from my practice of how progesterone increased bone densityThis first chart was in 1982. The lady was 72 years old and had very poor bones. She had broken her forearm lifting her sick husband. She went to her doctor who told her that she had such poor bones that she had to take fluoride treatment. She told him that was a bad idea because she had taken Dr. Lee’s class at College of Marin on Opti-mal Health, and he said fluoride was a bad thing for bones. So he told her to go see Dr. Lee. I put her on progesterone and she had a 24% improvement in bone density over the next 30 months. Her bone density went from .669 to .865. Given her height and weight this is a perfectly fine bone mineral density.
On the next lady I measured all four bones in her back with Dr. Malcolm Powell’s dual photon bone mineral density test. All four of these bones increased in density. The bone density actually increases in all the bones throughout the body. It wasn’t just that the bones that were specifically low did any better than the others. Progesterone had a positive effect on all the bones. The next woman was from Pennsylvania. Her husband was a Ph.D. in the medical sciences and her son was a doctor. She woke up one morning with terrible back pain when she was 74 years old. They found she had advanced osteoporosis. Remember that I said 0.9 was a good number for bone density? Well, her’s was .446. She had lost well over 50% of all the minerals in her bones. She had been a health nut. She exer-cised. She ate right. She took all the right supplements. She was doing everything right and looked great, and her mind was as sharp as a tack. She didn’t seem to be aging at all, and yet her bones had lost all this bone mass. She had gone through menopause at age 44, and here she was at age 74, 30 years later doing everything right, and she still lost so much bone that she had a spontaneous compression facture of her lumbar spine. So she got another doctor who was an orthopedist and a radiologist. She had five people in the medical profession on her case when she called me. I had met her at an EPA meeting years before, and she had heard that I was writing a paper about os-teoporosis. This was before I wrote my first book about progesterone. I told her I would send her the papers, but the treatment was in her case just to add some proges-terone, a normal physiological dose, because I knew she was doing everything else right. She was getting the calcium and the phosphorus, and she was eating right. When she told her husband she was going to use progesterone cream, he said that he had talked to a doctor who was an expert on the subject and there is nothing in any of the books that say progesterone would build bone. So she called me and asked if this information was written in any books. She asked if I had any references and things like that. I told her, “No, if it was already written in books I wouldn’t have both-ered to write it up myself.” I was writing the book because I was reporting things I saw in real patients, but couldn’t find in any books. The woman stuck with my thinking and told her husband she was going to try progesterone cream despite his objection. Finally her husband gave in saying, “Then in six months we’re going to make you get another bone mineral density test.” In six months she went from .446 up to .516. That’s over 14% in six months! Another test was done ten months later and her bone density was still increasing.
Every year they send me these reports. One year she actually went down a little bit, and on this report her husband had written in, “Her lower value at the 23rd month is possibly due to a nerve block given to her.” So I called her doctor and asked what he was giving her. He said, “Well, I felt a little out of the loop, and I wanted to do some-thing.” So he gave her two or three injections of methylprednisolone, which is cortisone. Cortisone blocks progesterone from its receptors in bone cells. That’s why all people on cortisone are at high risk for osteoporosis. It blocks progesterone from doing its work. Cortisone’s message to the cells is, “Stop whatever you’re doing.” If you have poison oak, your doctor can give you cortisone, and it will stop the poison oak. If you have inflammation in your joints like rheumatoid arthritis, he can inject cortisone, and it will stop the inflammation. Cortisone stops the cell from doing what it’s doing because of inflammation. In the case of bone cells, it stops them from making new bone. This was the reason the woman’s bone density measurement went down in the 23rd month. When I explained this to her husband, they stopped the injections and the bone density increased again. After four years she had gained 37.9% new bone. There is no other treatment anywhere that comes close to this. In her case it was the only thing she needed. Her doctor told her that she would have to take estrogen. She replied, “Oh no, my sister took estrogen, and she died of breast cancer.” You have to be stubborn, and this lady was stubborn. Her husband told her it couldn’t work. Her son told her it couldn’t work. Her doctor told her it couldn’t work. Her orthopedist told her it couldn’t work. Her radiologist told her it couldn’t work. Now, one by one I’ve gotten letters from all these doctors – her radiologist, her orthopedist, her doctor, and her husband – all basically saying, “If we hadn’t seen it with our own eyes, we would never have believed what you wrote in your book.” I still haven’t heard from the son, but he is using proges-terone in his practice, so we got them all changed in their thinking. And this is how it is going to happen – one by one, people are going to see that progesterone works.
In a couple of my patients progesterone was not working. One lady was taking too much thyroid hormone which accelerates bone loss, and when we got that straight-ened out her bone density improved. Another lady was 75. She didn’t make hydrochlo-ric acid. If you don’t make hydrochloric acid you can’t absorb calcium. It took great brains to discover that. You have to be very, very clever. She came in and said, “I don’t think I’m absorbing the calcium.” So I asked her why she thought that and she said, “Well, I can see the little calcium pills in my bowel movements.” So, clever as I was, I said, “I think you’re not absorbing the calcium! The reason is that you don’t have enough hydrochloric acid.” She disagreed and told me that the Ross Valley Clinic was giving her a medicine to suppress her acid because she’d had indigestion for years so she probably had too much acid. They gave her Tums, but that didn’t help. Then they gave her Tagamet. Tagamet stops the stomach from making acid, but that didn’t help her indigestion. I told her that she had indigestion because she didn’t have the acid necessary to digest her food so the undigested food goes into the intestine where the bacteria that live there digest it, ferment it, and make all these things that cause gas and indigestion. I suggested that she try some hydrochloric acid. She was afraid of getting an ulcer, but I persuaded her to try some betaine hydrochloride from the health food store. Not only did her indigestion go away, but her bones immediately began to get stronger as well. The doctor was treating a symptom. It didn’t work, and he wasn’t even curious enough to figure out why it didn’t work. Approximately 50% of people over 70 don’t make enough acid to absorb calcium. A large number of older people take antacids on a regular basis. Maalox, Mylanta, and all of the H 2 blockers stop the stomach from making its normal acid. And now these H 2 blockers such as Pepsid AC and Tagamet, are being sold over the counter. They knock out 85% to 90% of the stomach’s acid production. These people will not be able to absorb nutrients like calcium. Antacids increase the osteoporosis problem and may be related to eventual deep bone deficiency and pernicious anemia. Gastric cancer could also be related. Mother Nature makes these stomach acids for a reason. Antacids stop the absorption of calcium, no matter how it is given.
Winston Churchill once said, “Every once in a while it happens that people stumble over the truth. But most of the time they pick themselves up and go on as if nothing happened.” That’s what I don’t want to do. I don’t want to go on as if nothing hap-pened. Something happened to me. I fell into this, and I saw all these good things that were happening.
There are things in life that do not need a double blind, placebo-controlled study. We have a pasture on our farm, and we pasture horses for people. There is one horse that likes to kick at you when you walk behind her. You don’t need a double blind study to avoid getting kicked. You avoid the horse, and that’s all you need to do. If someone says all sheep are white, all you have to do is bring in a couple black sheep. You don’t have to do a double blind study. It’s the same thing with natural progester-one cream. If they say that after age 65 osteoporosis cannot be reversed, and you reverse it in 62 women using just progesterone, you don’t need a double blind study! I’m not against someone doing a double blind study, but they know that no one will pay for it. Progesterone is a real hormone and since it’s not a patentable synthetic, there is no money to be made so no one is going to ante up the $500,000 to $1,000,000 to do a study.
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