The FOOT Plan: Osteoporosis Therapy Update and Outcomes
A Doctor and Patient Perspective
Mark Swanson, ND
Most every ND treats patients with osteoporosis. Much fewer treat and monitor progress enough to reach successful treatment outcomes. There is often a greater tendency to simply supplement the patient and let nature run its course. The key to successful outcomes is to demonstrate efficacy in the patients who receive it. There has not been a consistently effective, readily available natural therapy reported for osteoporosis that offers the same or superior bone mineral density (BMD) increases and fracture risk reductions as the leading pharmaceuticals. This has certainly been the case with calcium/vit D and most of the popular bone support products compared to bisphosphonates.
This article is an update and outcome report on The FOOT Plan (Fully Optimized Osteoporosis Therapy) from the patients’ words and perspective. The treatment rationale was previously outlined in the February 2008 issue of NDNR. This update is the first to report successful outcomes demonstrating robust increases in bone mineral density (BMD) with sustained fracture risk reductions in cases of severe osteoporosis fragility within 1 year of initiating treatment.
The pharmaceutical treatment spectrum for osteoporosis is limited. Concerns of the effectiveness, safety and marketing with an illusion of strong healthy bones have come into question. The numbers to treat (NTT) estimates with bisphosphonates is unacceptably high and is significantly greater than strontium. In other words, it requires much higher numbers of patients to be treated with bisphosphonates before a fracture is prevented. There are many patients who are also medication failures for one reason or another. Many who do end up seeking naturopathic care do so because they have already declined the drugs and decided, “These aren’t for me.” They are frustrated and often feel their doctors failed them, not that they failed any treatment. Would it be fair to ask ourselves if this could apply to NDs also? If we don’t have the effective and viable natural drug alternatives, yet continue to treat, are we guilty of the same illusion of care?
Writing this article also points to a professional disdain for the physicians who regard themselves as “osteoporosis experts,” who turn a blind eye to compelling and often overwhelming research on natural therapies knowing full well their own treatment shortcomings and limitations. This has clearly been the voice and position of a national osteoporosis foundation. For example, a quick tour of the website makes almost no mention of strontium, potassium alkalization, melatonin, K2 and the “new” D3 dosages, testing and optimal levels. Yet among patients in the discussion groups, strontium and D are the “hot topics.” When the “experts” do weigh-in and provide strontium information, they are quick to conclude that supplementation is not FDA approved and patients should not take it. End of conversation. This is no different than the “expert” conclusion we see with red yeast rice vs. statins.
Beverly and Eleanor are 2 patients with similar osteoporosis histories and outcomes. Both have severe fragility osteoporosis. They are at the top of the osteoporosis “How bad is it?” scale. You might say Eleanor won the highest T-score contest and Beverly failed the bone quality test. They likely share some of both. They’ve had so much bone loss and/or quality deterioration that even a cough or a sneeze might trigger another fracture. These have been 2 of the most challenging and difficult to treat osteoporosis patients. They are not rare or unusual though. For Eleanor and Beverly, prescription drugs are no longer an option. Diet, calcium and D have had no effect, and the most popular bone support products have not prevented bone loss. This is a bony situation that is deep in their genes.
Beverly is a 73-year-old Caucasian female who is healthy, happy, and normal weight for her height.
Height loss, back pain, multi-disc degeneration, end plate compressions and annular tears, multiple kyphoplasties, hip fracture, family history of osteoporosis.
“I was diagnosed with osteopenia in 1996. By 1998, I had severe osteoporosis. My first fracture occurred shortly after and since then I’ve had compression and stress fractures in the ankle, hip, thoracic spine, and kyphoplasty at L2 and L4. I’ve always considered myself health oriented. I grew up on a farm, drank whole milk, rode horses and ice skated, was always active and rarely ever sick. I had numerous falls but never broke a bone. I am Norwegian and my relatives living here and in Norway have osteoporosis. Bisphosphonates were never an option for me because I had previous jawbone infections and problems with my esophagus. When L1 collapsed I was referred to the head of osteoporosis research at the University of Washington. I underwent kyphoplasty and was prescribed a parathyroid hormone drug. It improved the density in my spine significantly but had no effect in the hips. I took this for 2 years, which was the maximum time allowed me because of cancer risk. Calcitonin was then prescribed, but had no effect. My only option now was to have more kyphoplasty when the next compression fracture occurred. It finally did twice and it was performed on L2 and L4. In August of 2007, I fell and broke my left hip requiring surgery. All my bone loss returned and I was worse than ever. In 2008, I began the FOOT Plan. My physician at the University agreed to monitor my BMD. He said I had nothing to lose at this point. No pun intended.”
After one year, the BMD increases in her spine and hip were impressive. The DXA scan of L1, L3 in October 2009 showed a 9.2% increase from the previous year (T-score -2.0, previous -2.6). This was 11.8% above her 2003 baseline reading and is now improved to osteopenic. The right hip increased 12.9% from the previous year (8.2% above baseline). Her left hip was not reported due to previous fracture interference.
Beverly sums up her progress: “I have had no new fractures. My arthritis symptoms and pain are gone, my muscles feel much stronger now, scoliosis gone too, and I walk and look much younger. I can do a lot of things more easily now. Before I could barely clean my house. I can do almost everything I used to do. We walk the beaches and trails here on the island every week. I am ever so grateful for the FOOT Plan. It has saved my life.”
Eleanor is a 67-year-old Caucasian female who is healthy, vegan, lactose intolerant, normal weight for her height.
Height loss, back pain, extreme skeletal fragility, spinal kyphoplasty, mother had osteoporosis.
“I was active since childhood and did everything from body building to home remodeling and painting. I taught yoga and belly dance from 1970-2007. I had a compression fracture in my lower back and just thought it was stubborn back pain. My chiropractor x-rayed my back and discovered a new fracture and another one that had previously healed over. I felt confident that I could take care of it myself. That was short lived. One day I couldn’t get out of bed. I finally had kyphoplasty. It helped stabilize my spine and reduced the pain. I was urged to take a bisphosphonate drug, but refused it. My PCP remained insistent. I asked how much bone density increase I could expect in a year’s time if I took it. She said, “About 2%.” No thanks, I’ll stick to my green juice and Vita Mix thank you. She just shook her head.
I decided to visit a wonderful naturopath in our area who recommended the FOOT Plan in 2008. She then referred me to Dr. Swanson who developed the program. He offered to consult with my PCP and other physicians. The third day after embarking on the program I began to feel more energy and the mental fuzziness I had completely disappeared. In 3 weeks I knew the plan was already at work. Despite this, my PCP continued her doubt about the FOOT Plan and said with repeated insistence and authority it will not increase my bone density or reduce fractures. I still refused. She finally softened some, “Ok, you can stay on it, but take the bisphosphonate too.” But, how would I know which is working? We were at a stalemate. My doctor was steadfast and adamant that I start bisphosphonate therapy and I was equally adamant against it.
“A year had passed since starting the FOOT Plan and my PCP finally agreed to do an “early” DXA scan to settle the disagreement at the suggestion of Dr. Swanson. The purpose was mostly for the PCP to observe her predicted negative results of this “unproven” natural therapy. This would be her data point to say, “See, I told you so.” However, we knew it was going to be ours to say the same to her.”
The BMD increases at 12 months (October ‘09) after starting the FOOT Plan were robust and stood out from the report. There was a 17.7% increase in the lumbar spine (T-score: -5.3%, previous -6.0) and a 5.9% increase in the left hip (T-score: not reported) from the previous DXA performed 18 months earlier. No change was observed in the right hip (T-score -3.8). For reasons not fully understood, bilateral hip densities often will vary widely from each other and with response to treatment.
Eleanor summed up her progress: “Today I am improving by leaps and bounds. I realize that my osteoporosis has a long way to go until my bones are back to normal. I could still fracture, so I’m more careful. Come hell or high water though, I won’t change my mind about staying on the plan. I have implicit faith in it. I can feel the improvements and the numbers don’t lie. My daily dosages are exactly as prescribed with no adjustments. Onward and upward!”
There is no question whether the FOOT Plan improved the early outcomes in these patients. The progress of Eleanor and Beverly continues to their delight without any new pain, fractures or mobility limits. Their quality of life has improved significantly. This has been much to the surprise of their physicians who doubted this therapy. Now, they mostly continue to hold firm to the belief that for every disease there must be a drug (or surgery) to treat it. This is what I describe as the allopathic “wall of resistance.” It’s made of granite. They may not want to admit it, but they aren’t arguing with the success.
This story is from the trenches within the exam room and along a medical journey. It is not intended to be an academic discussion of countless literature citations to support a theoretical treatment and outcome. This is coming to you from the live footage, with real expressions of actual patients with documented results. For reference hungry readers please email me and I will do my best to provide these to you. The forum door is open to all discussions and questions.
The synergy of the FOOT Plan’s components is a clear demonstration of the application and efficacy of scientifically-based natural medicine. It is equally an adherence to the philosophy of Vis Medicatrix Naturae. The wall of resistance still stands, but has not been an insurmountable hurdle. The treatment and excellent progress continues. Both Eleanor and Beverly have a lasting smile that reflects great satisfaction. There are many other patients with osteoporosis who are on this program that feel the same.
It is the expressed opinion of myself and others that there are few differences between the bioavailable and net therapeutic benefits of strontium (citrate) vs. strontium (ranelate). Studies on citrate-bound minerals are numerous and positively demonstrate superior bioavailability and safety. Strontium interpretation on DXA is relatively recent and is currently a point of discussion and debate within the scientific research community. Some over-estimation of the DXA score due to greater x-ray attenuation of strontium occurs compared to calcium in bone. The precise percent of attenuation difference has not been firmly established. What is agreed upon, however, is that even relatively low amounts of strontium incorporated in bone acts as a strong anabolic agent and has rapid and sustainable bone trophic effects. It directly targets the osteoblast (vs. antiresorptive treatments on osteoclasts) and simultaneously increases both bone density and quality while reducing fracture risk early in the course of treatment. This action likely continues until normal density is reached, regardless of age. The long-term safety has been established. Compliance and acceptance has been high. The bone restorative effects appear to be further improved when combined with the nutritionally-researched bone synergists outlined in the FOOT Plan.
The FOOT Plan – Fully Optimized Osteoporosis Therapy:
- Strontium (citrate) – 681 mg at bedtime. Take at least 2 hours away from calcium supplements, milk products, or food fortified with calcium.
- Melatonin – 3 mg at bedtime.
- Alkalizing mineral citrates – potassium (citrate) – 400 mg; calcium (citrate) – 250 mg; magnesium (citrate) – 150 mg; vitamin D3 – 400 IU powder 1.5 scoops BID with water or juice. Do not take with potassium-sparing diuretics.
- Vitamin K1/K2 synergy – K1- 500 mcg, K2 (MK-7) 45-90 mcg, K2 (MK4) – 1 mg per day. Do not take with warfarin or blood thinners.
- Vitamin D3 – 1000 IU. Dosage based on 25(OH)D screening results to maintain optimal target of 50-60 ng/dL.
- Fish oil – 300 mg EPA / 200 mg DHA – 1 softgel BID.
- Flax oil – 1000 mg – 1 softgel BID.
- Multivitamin – 2/day.
The current status quo of antiresorptive treatment options for osteoporosis therapy is predictably short. The emerging research on the recent discovery of a gut-serotonin link to osteoporosis and anabolic bone restoration is nothing short of fascinating and remarkable science. For the first time, the osteoporosis “on switch” has been effectively turned off. The paradigm shift is near.
Mark Swanson, ND is a 1984 “pioneer” graduate of Bastyr University, and is in private practice in Sequim, Wash. He has been the senior medical advisor at a leading professional-label supplement company for 18 years; is a former editor of the Journal of Naturopathic Medicine; and has years of experience as a national product director, consultant, and representative to supplement manufacturers and functional medicine laboratories. Dr. Swanson’s clinical and research interests range from osteoporosis to metabolic syndrome/diabetes, cardiovascular disease, asthma and complex illness. Enjoying life on the Olympic Peninsula is a mandatory prescription for good health. E-mail him at firstname.lastname@example.org.