Drugs That Cause Osteoporosis

Research / February 14, 2012

You May Be Taking One of the Commonly Prescribed Drugs that Cause Osteoporosis: Here’s What You Can Do to Protect Yourself

Did you know that drugs commonly prescribed to treat epilepsy, anxiety, insomnia, depression, schizophrenia and even restless leg syndrome cause osteoporosis?

I’ve just learned a great deal more about this, inspired by Julie, who wrote me that, although only age 50, she has severe osteoporosis.  Her doctors say her bones are “like twigs.” In the last 2 ½ years, she has suffered fractures of both her hip and leg. When I wrote back in hopes of helping her figure out why her bones have become so brittle at such a young age, she replied she already knew why:

“I have had epilepsy since I was 6 months old. All epilepsy drugs cause a deficiency in calcium and vitamin D. This is a known fact, and I should have had regular blood tests throughout my life to monitor this, and, hopefully prevent the osteoporosis. This, of course, was never done, and even now they don’t do it, so I have given up asking for it to be done. They only did a test to check bone density a few years ago. By that time, I already had the condition, and it was just a matter of time before I had the first fracture, a couple of years later.”

Needless to say, I was very distressed that her doctors did not monitor the effects on her bones of the drugs they prescribed to manage her epilepsy. Her excessive bone loss could have been prevented!

I’m writing here now in hopes that, together, we can help protect others with epilepsy from developing osteoporosis. If you must take anticonvulsants, I want you to know that osteoporosis does not need to be in your future! If you have epilepsy, there is much you can do to safely, effectively and naturally protect your bones – and, should you have already developed osteoporosis, to restore your bones’ health.

In Your Bones, I wrote (p. 106 and following) about the fact that anticonvulsant drugs used to manage epilepsy (e.g, phenytoin [trade name, Dilantin]; primidone, phenobarbital [trade name, Luminal], valproic acid [trade name, Depacon]) greatly increase risk for osteoporosis. These drugs interfere with vitamin D absorption & metabolism, may cause deficiency of folate and/or vitamin B6, and reduce blood levels of vitamin K – all of which play important roles in bone health.

Julie lives in Europe, where the latest position statement issued by the European Menopause & Andropause Society (EMAS), January 11, 2012, notes that 50-70% of all Europeans are deficient in vitamin D. Since her needs for this nutrient critical for bone health are increased by the anticonvulsants required to manage her epilepsy, it’s highly likely that Julie needs even more than the 4,000 IU/day of vitamin D now recommended by the lead author of the EMAS position paper, Dr. Pérez-López, for postmenopausal women with any of the following risk factors for vitamin D insufficiency: obesity, dark skin, intestinal malabsorption, or residing close to the North or South poles.[1]

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Drugs Used to Manage Anxiety, Depression, Schizophrenia & Restless Leg Syndrome Also Cause Bone Loss

While checking for the most recently published medical journal articles on the bone-depleting effects of the drugs used to manage epilepsy, I discovered that the benzodiazepines, (e.g., Valium, Xanax, Librium, Halcion—and many others[2]), another class of drugs frequently prescribed to treat not just epilepsy, but also anxiety, insomnia, depression, schizophrenia and restless leg syndrome, also cause significant bone loss. Many recent studies confirm this.

One study conducted in Spain, for which results were published in 208, assessed risk factors for osteoporosis and fractures in a large sample of women – 4,960 postmenopausal women aged 50 to 65 years, who were being seen at 96 different primary care facilities across the country. The two top risk factors identified for osteoporosis were low intake of calcium and benzodiazepine use.[3]

Benzodiazepine Drugs Cause Bone Loss

The latest medical journal review articles (reviews are papers that summarize the results of many studies) are now warning physicians that the entire class of benzodiazepines (and as noted above see [2], there are numerous drugs in this group) cause chronic elevation of the hormone, prolactin. These drugs bind to and block off dopamine receptors in the hypothalamus (an area in the brain). By this action, the benzodiazepines prevent dopamine, another important neurotransmitter, from being secreted. Unfortunately, shutting down the secretion of dopamine causes prolactin levels to rise because dopamine is what turns off the pituitary gland’s secretion of prolactin.

How does having chronically high levels of prolactin cause bone loss?

High prolactin levels (a condition referred to in the medical literature as “hyperprolactinaemia”), suppress the activity of the hypothalamic-pituitary-gonadal axis. This triad of endocrine glands interacts and secretes a number of hormones involved with reproduction. The hypothalamus produces gonadotropin-releasing hormone (GnRH). The anterior portion of the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and the gonads (ovaries in women, testes in men) produce estrogen and testosterone, respectively.

More accurately, the pituitary’s secretion of FSH and LH are what signal the gonads to produce estrogen, progesterone, and testosterone. Since estrogen and progesterone play very important roles in maintaining healthy bones in women, inhibiting their production by inhibiting that of FSH and LH causes bone loss. Estrogen prevents excessive activation of osteoclasts (the specialized cells that break down old bone), while progesterone activates osteoblasts (specialized cells involved in building new bone). This is why the drop off in the production of these hormones that occurs with menopause contributes to bone loss. Even in men, estrogen is essential for bone health. Men convert a small, but very necessary amount, of testosterone into an estrogen that plays a critical role in maintaining men’s bones, which is why drugs that disrupt testosterone production cause bone loss in men.

Drugs Commonly Used to Manage Anxiety and Depression Cause Bone Loss

A study, published February 2011, which involved more than 27,000 postmenopausal women in Canada, found that selective serotonin reuptake inhibitors (SSRIs, e.g.,Prozac, Paxil, Zoloft and many others[4]) increased risk for osteoporosis by 46%, atypical antipsychotics (tranquilizers, also called 2nd generation antipsychotics, e.g., trade names Zyprexa, Risperdal, Seroquel, Geoden, Zeldox, Ablify [5]) increased risk by 55%, and benzodiazepines (e.g., Diazepam, Xanax, Paxil, Librium, Valium, and many others; SSRIs are among the benzodiazepines) increased risk by 17%. [6]

Another very large study conducted in Spain—this one included more than 63,000 subjects—found SSRIs to be associated with the highest adjusted odds of osteoporotic fractures –a 45% increased risk. Monoamine oxidase inhibitor antidepressants (MAOIs are less frequently prescribed these days; the most commonly used MAOI is Ensam, a transdermal patch of the MAOI, selegiline) increased risk for osteoporosis 15%, and benzodiazepines increased risk by 10%. A dose-effect relationship was seen with SSRIs and benzodiazepines – the longer any of these drugs was used, the greater the increase in risk for osteoporosis. In contrast, lithium, which is prescribed to manage bipolar disorder, was associated with a 37% lower risk for fracture risk. [7]

SSRIs are very commonly prescribed antidepressants – e.g., Prozac, Valium. These drugs are supposed to just increase brain levels of the neurotransmitter, serotonin, by preventing its reuptake by the neurons that secrete it. However, it has recently been revealed that SSRIs also inhibit dopamine production and neurotransmission[8] – which, as explained above, causes high prolactin levels, endocrine dysfunction and bone loss.

Researchers have now reported very high rates of osteoporosis and osteopenia in people taking long-term psychoactive drugs (e.g., anticonvulsants, benzodiazepines), and the higher the dose and longer the drugs were taken, the greater the bone loss.

Young Caucasian women have been found to be especially vulnerable to developing high prolactin levels (hyperprolactinaemia), with the resulting inhibition of estrogen and progesterone production, and bone loss. Younger women taking any of these drugs and experiencing menstrual problems (an indication that the drug is disrupting normal function of the hypothalamic-pituitary-gonadal axis) should immediately alert their doctors and request tests to evaluate their prolactin levels and BMD.

Ideally, work with a physician knowledgeable about integrative, holistic and/or naturopathic medicine, who can help you identify the underlying causes of your health issues and help you restore your health using effective and safe, natural means.

You do not want a prescription for yet another drug, like a bisphosphonate (e.g., Fosamax, Boniva, Reclast), or one of the other drugs I am now seeing being advocated since women are aware of bisphosphonates’ adverse effects and are refusing to take them. The two latest drugs the pharmaceutical companies are telling doctors to prescribe are denosumab (trade name, Prolia) and teriparatide (trade name, Forteo), neither of which will help you restore normal bone rebuilding and both of which can have significant adverse side effects.

In the Resources section of Your Bones, I’ve provided a full list of medical organizations you can contact to help you find physicians in your area who can help you restore your health naturally. I cannot list them all here, but three such national groups are the American Holistic Medical Association (www.holisticmedicine.org), the American Association of Naturopathic Physicians (www.naturopathic.org) and the Institute for Functional Medicine (www.functionalmedicine.org)

If you must take a psychoactive medication, please discuss which drug might be least harmful with your doctor. Some of these drugs have a lesser antagonizing effect on dopamine receptors in the brain. Others are potent dopamine receptor antagonists, and it is by antagonizing dopamine receptors that antipsychotic drugs cause hyperprolactinaemia—and thus osteoporosis. Conventional psychoactive drugs all cause hyperprolactinemia, but a few of the so-called “atypical” psychoactive drugs, supposedly, do not. I’ve provided references [9],[10] for the latest studies discussing this in the peer-reviewed medical literature. Share these with your doctor and ask for help finding the psychoactive drug with the lowest prolactin-raising profile.

If you are taking one of these drugs because you suffer from depression, you could also ask your physician about switching to a tricyclic antidepressant (Again, working with a physician who can help you understand and naturally correct the underlying causes of your health issues is your best option. Also, once again, there are way too many of these drugs to list here; a link to a full listing is provided below in reference [11]). Tricyclic antidepressants do not appear to promote bone loss and, in one study, were associated with 43% lower risk for osteoporosis.[5]

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The Good News: You Can Halt and Even Reverse Antipsychotic-Drug Associated Bone Loss – Naturally

The good news for anyone with epilepsy – or the numerous other conditions for which psychoactive drugs are prescribed, e.g., depression, insomnia, schizophrenia, restless leg syndrome – is that even if you must continue to take these drugs, you absolutely can combat their side-effects and restore your bones’ health, naturally. Findings in the research studies show that “active management” of bone loss in those with psychoactive drug-associated osteopenia / osteoporosis “can halt or even reverse this process.”[8]

Obviously, intelligent “active management” does not mean taking yet another drug, like a bisphosphonate, with even more bone- and health-destroying side effects!  Intelligent “active management” means supplying your bones with all the nutrients they require to remodel, rebuild and maintain healthful structure and function. It also means correcting or avoiding, when at all possible, the many other factors in our modern lifestyle that promote bone loss, which I discuss in detail in Your Bones. While I cannot recount the entire assortment of these for you here, I can give you what I consider to be some key recommendations regarding nutrients essential for bone health.

Take a highly bio-available form of calcium

As I discuss in Your Bones, several different forms of calcium are used in supplements, but they are not equally well absorbed or utilized by our bodies. YOU need the most effectively absorbed and able-to-be-utilized-by-your-bones form of calcium. So do I, which is why I now take AlgaeCal. I learned about AlgaeCal after Your Bones was published, too late to include it in the first edition of the book, but it will definitely be in the second edition! Other calcium supplements are derived from inedible rock. AlgaeCal is derived from sea-algae, i.e., from living plants that draw calcium and 70 other minerals from sea water and convert them into nourishing form. Thus, AlgaeCal’s plant-digested calcium is optimally bio-available. And many of those other minerals naturally present in AlgaeCal (also in highly bio-available form) play important roles in building bone. Plus, research studies using AlgaeCal prove its effectiveness – a very unusual situation in the natural products industry where, unlike drugs, products cannot be patented, so very few companies spend the money on research to see if their products are truly helpful.

Ensure you are getting vitamin D in an amount sufficient to meet YOUR specific needs

You will need more vitamin D than the average person to get your levels up where they should be. Fortunately, this is easy to do. You just need to have your vitamin D levels checked (a simple blood test to determine your levels of 25(OH)D—a form of vitamin D found in the blood that is the best indicator of overall body status—and then supplement with the amount of vitamin D that YOU need to bring your blood levels of 25(OH)D into optimal range, which is 60-80 ng/mL. For most people (even those whose bones are not compromised by psychoactive drugs), this will mean supplementing with 5,000 IU of D3 per day for 2-3 months, then running a follow up blood test to see where you are and adjusting your dosage accordingly.

I don’t have epilepsy, so I don’t have to take a psychoactive drug to manage this condition, but I do have to deal with my own version of a lifelong issue that compromises my ability to absorb and utilize vitamin D:  Osteoporosis runs in my family, and I know why. I have inherited a genetic SNP (single nucleotide polymorphism) that results in my vitamin D receptors not working very well, so I am less able to absorb vitamin D and need much more than the “average” person. (I need 10,000 IU of vitamin D3 daily, winter and summer, to get my vitamin D levels up into the optimal 60-80 ng/mL range.)

I’m sharing this with you because once I figured this out and supplied my bones with what they needed, my bones began to rebuild.  Almost 15 years ago now, my husband, Dr. Joe Pizzorno, ended up running one of the first genetic panels available that could evaluate SNPs involved in bone health. We decided to run this, at the time, very new test, because I was doing “everything right” and still losing lots of bone well before menopause.  The point here is that like my SNP, anticonvulsant drugs greatly lessen your ability to absorb and utilize vitamin D. But if you give your bones the amount of vitamin D that YOU need to maintain optimal (60-80 ng/mL) blood levels of this key bone-building nutrient, your bones can be on the road back to health as well.

Be sure you are getting sufficient vitamin K2 to benefit from your vitamin D-enhanced ability to absorb calcium

Vitamin D greatly increases your body’s ability to absorb calcium, but it does not tell your body what to do with the calcium you can now absorb. That is the job of Vitamin K, specifically, vitamin K in its K2 form. There are 3 forms of vitamin K available in supplements – vitamin K1, and two types of vitamin K2, MK-4 and MK-7. Vitamin K1 does help lower inflammation (which is good for your bones since too much inflammation activates osteoclasts, the specialized cells that break down bone), but K1 does nothing to activate the proteins that put calcium into bone (i.e., osteocalcin) and keep it out of your arteries (i.e., Matrix Gla-protein). Only vitamin K2 activates these proteins.

In the research, if vitamin K2 is taken in its MK-4 form, you need to take 45 milligrams a day for it to effectively help build bone, and you must take MK-4 in divided doses of 15 mg every 6-8 hours. This is because MK-4 is very rapidly metabolized and cleared from the body in, you guessed it, about 6-8 hours. The MK-7 form stays active in your body much longer –up to 3 days—so, taking only 120 micrograms once daily has been shown to not only activate osteocalcin and Matrix Gla protein (the calcium-regulating proteins), but to build up a reserve, so newly formed osteocalcin and MGP can be continuously activated.

YOU are going to need at least 120 micrograms each day of vitamin K2 in its MK-7 form. Since you are most likely going to be taking at least 5,000 IU of vitamin D3 daily, which will increase your absorption of calcium, you will also want to consider how much vitamin K2 you need to balance the calcium-absorbing effect of your vitamin D. Again, because of my genetic issues that cause me to need more vitamin D than the “average” person, I also need more vitamin K2. I take 240 micrograms (mcg) daily of the MK-7 form of K2. Since the psychoactive drugs needed to manage epilepsy (and also prescribed for depression, anxiety, insomnia, etc.) also increase your requirements for vitamin D, it may be better for you to take 240 mcg of MK-7 daily as well, and this should be quite safe.

Except for people on anticoagulant (blood thinning) medication, e.g., warfarin (Coumadin is the most popular brand name for this drug), vitamin K is extremely safe. No adverse events have been shown at doses of MK-7 even greater than 800 mcg/day. Those taking warfarin, however, need to work with their doctors to safely take vitamin K without disturbing their international normalized ratio [INR]. An INR that is too high indicates high risk of bleeding/inability to produce blood clots needed to prevent you from bleeding to death from even a tiny cut, while an INR that is too low suggests the warfarin dose needs to be increased to protect against excessive blood clot formation. The key factor here is maintaining a stable intake of vitamin K against which your doctor can calibrate the amount of warfarin YOU require.

Just presented research indicates that if you have been prescribed warfarin because you have heart failure, you may be able to discontinue it and use aspirin instead. This past Sunday, February 5, late-breaking research presented at the American Stroke Association’s International Stroke Conference 2012 in New Orleans showed that aspirin is just as effective as warfarin for heart failure patients. This study, which involved 2,305 heart failure patients, found no overall difference in risk of death or for either form of stroke (intracranial hemorrhage or ischemic stroke) between those who received aspirin and those who received warfarin. Researchers also noted warfarin had a higher risk of bleeding. The lead author of this study, Dr. Shunichi Homma, is quoted as stating, “Given that there is no overall difference between the two treatments and that possible benefit of warfarin does not start until after four years of treatment, there is no compelling reason to use warfarin, especially considering the bleeding risk.”[12]

Please share this information. An ounce of prevention – in the form of an intelligent, natural bone-building program – can help prevent much needless misery from these bone-busting drugs.

If, like Julie, you are having difficulty getting your doctor to monitor the effects on your bones of the medications you are being prescribed to manage your epilepsy, depression, anxiety or insomnia, please share this information with your doctor. The footnotes below cite the most recent papers in the peer-reviewed medical journals. (And they include the PubMed IDs [PMID #], making it extremely quick and simple to locate these papers on PubMed). Educate your doctor, so you can get the health care you deserve. If your doctor refuses to become educated, find another, more competent physician.


  1. ^Pérez-López FR, Brincat M, Erel CT, et al. EMAS position statement: Vitamin D and postmenopausal health. Maturitas. 2012 Jan;71(1):83-8. PMID: 22100145
  2. ^http://en.wikipedia.org/wiki/List_of_benzodiazepines
  3. ^Luz Rentero M, Carbonell C, Casillas M, et al. Risk factors for osteoporosis and fractures in postmenopausal women between 50 and 65 years of age in a primary care setting in Spain: a questionnaire. Open Rheumatol J. 2008;2:58-63. PMID: 19088873
  4. ^A more complete listing can be found at http://en.wikipedia.org/wiki/SSRI#List_of_agents
  5. ^http://en.wikipedia.org/wiki/Atypical_antipsychotics#List_of_atypical_antipsychotics
  6. ^Bolton JM, Targownik LE, Leung S, et al. Risk of low bone mineral density associated with psychotropic medications and mental disorders in postmenopausal women. J Clin Psychopharmacol. 2011 Feb;31(1):56-60. PMID: 21192144
  7. ^Bolton JM, Metge C, Lix L, et al. Fracture risk from psychotropic medications: a population-based analysis. J Clin Psychopharmacol. 2008 Aug;28(4):384-91.
  8. ^Damsa C, Bumb A, Bianchi-Demicheli F, et al. “Dopamine-dependent” side effects of selective serotonin reuptake inhibitors: a clinical review. J Clin Psychiatry. 2004 Aug;65(8):1064-8. PMID: 15323590
  9. ^O’Keane V. Antipsychotic-induced hyperprolactinaemia, hypogonadism and osteoporosis in the treatment of schizophrenia. J Psychopharmacol. 2008 Mar;22(2 Suppl):70-5. PMID: 18477623
  10. ^O’Keane V, Meaney AM. Antipsychotic drugs: a new risk factor for osteoporosis in young women with schizophrenia? J Clin Psychopharmacol. 2005 Feb;25(1):26-31. PMID: 15643097
  11. ^http://en.wikipedia.org/wiki/Tricyclic_antidepressants
  12. ^Aspirin similar to warfarin in stroke prevention, article available at http://news.nurse.com/article/20120205/NATIONAL02/102130013


85 thoughts on “Drugs That Cause Osteoporosis

Mary Donaldson-Evans

All very interesting, but what about Arimidex, the estrogen-blocking drug prescribed for post-menopausal women who have had breast cancer? Same advice? Thanks.

Lara Pizzorno

Yes, by by inhibiting estrogen synthesis, Arimidex contributes to bone loss. More than 50 papers on this issue on PubMed, all published within the last 8 years. The good news here is that for all of us, estrogen levels plummet after menopause. Although estrogen play an important role in bone health, so do many other factors. You can still do a great deal to care for your bones naturally and keep your bones strong throughout your life. I listed a few of what I feel are absolutely essential things to do in the blog, but there is way too much for me to sum it all up here. Which is why I wrote Your Bones. If you have not read the book, please take a look. If you don’t want to buy it, they are sure to have it at your library. I just looked on Amazon, and it is available for as little as $7.11.


well Lara i wanted to asking u about that medication name
on the first pic


It’s just a generic photo of a bottle of medication — no specific medication.

– Monica from AlgaeCal

Linda Morrison

Yes, a recommendation for women who have had breast cancer would be welcome, especially since many of the natural formulations for building bone contain boron, which increases circulating blood levels of estrogen and promotes estrogen retention.

Lara Pizzorno

Hi Linda,
Great question! And one I cannot simply answer off the top of my head. I need to look at the research. Will do so and get back to you.

John W

In 1991, I finally agreed to trying two other medications for my temporal lobe epilepsy condition. “Mother, I think the doctors are wrong and one may harm me. So, please watch over me.”
In April 1992, I was placed on Tegretol, 1200 mg/day.
In February 1996, a nurse took me from the Emergency Room up to where I would be staying three days and opened our conversation with “John, Tegretol made you a zombie!” Later: “I guess I fell down (April 6, 1993) at a bad angle and ..” “No, John. It’s the Tegretol! That’s what shattered your (right) hip! Tegretol softens bones and ..” “They never told me that! (They only told me of ten side effects.) … ”
Note1: By October 1996, I was completely off Tegretol and my mind was restored.
Note2: Some people, like my mother, believe whatever doctors say (“And he always said ‘Don’t worry, you son will get used to it … Doctor Lai has a medical degree! Doctors know everything!”)

Lara Pizzorno

Hi John,
Even well-trained, well-intentioned doctors are not omniscent. Truly, your physician may not have been aware of the impact on your bones of the drug prescribed for your epilepsy. In defense of hard working doctors, it is difficult to keep up with all the breaking research while also running a medical practice. Thank goodness we now have the internet and access to the medical research ourselves. No one cares more about your health than you and those who love you. No one knows more about your body and how it is reacting to what you are taking — whether it be medications, supplements, food — anything — than you. Listen to your body! Believe in its desire to maintain its health. You can totally trust this! Learn how to use PubMed and check on anything that doesn’t seem right for you — or write me 🙂 and I will do my best to review the research and let you know what I find in the most current peer-reviewed medical literature.

Paulina Bartnik

Hi Lara,
I’ve been reading this blog and have osteopenia in my femoral necks minus 1’s …well I’m learning a lot thanks to you, and yes I picked up your book on bones. Yes, it is very informative, but right now I had to go back on medications for depression, however, after reading this I think I’m going to go on Lithium since it’s 37% rate reads better than zyprexa. I am on a low dose 4mg. Thanks so much for all your in depth research it is so helpful to many of us. Paulina

Lara Pizzorno

Hi Paulina,
YOU are the reason I have devoted my life to this work. I cannot tell you how much it means to me to know that the information provided in Your Bones has been helpful to you! Thank you for taking the time to send me a note, Lara

cheri clark

Hi- This is re: Lara Pizzorno’s article You May Be Taking One of the Commonly Prescribed Drugs that Cause Osteoporosis: Here’s What You Can Do to Protect Yourself. I am on anti- epileptic Lyrica and take low dose lorazapam.
I looked at all of Ms. Pizzorno’s references and I did not see any one ( except SSRI’s) that had a study that proved that these things contributed to bone loss. The Spain study inferred that the women were at risk because they were taking a benzo. drug that would perhaps make them fall- not that the drug class contributed to bone loss. The SSRI drugs do contribute.
If there are drug studies that prove Lyrica and Lorazapam contribute to bone loss- I would love to know- is it possible that someone could email me with some of them? I have searched the internet as well and cannot find any. Thanks!

Lara Pizzorno

Hi Cheri, I checked PubMed and it appears that Lyrica is not associated with bone loss, which is good news! Your other medication, Lorazepam, is a high-potency benzodiazepine. This is of concern since one of the warnings given with Lyrica is to be very careful with any of the benzodiazepines since Lyrica greatly potentiates their effects. Lyrica does so because it increases neuronal GABA levels by boosting the activity of glutamic acid decarboxylase, an enzyme that converts glutamate (the excitatory neurotransmitter) into GABA (inhibitory) in just one step. Please do ask your physician about this potential issue. Perhaps you could be switched to another medication instead of Lorazepam? The benzodiazepines do contribute to bone loss–as explained in the blog, these drugs cause hyperprolactinemia, which suppresses normal hormone production and results in bone loss. The Spanish study simply confirms among a population of real people the physiological effects of these drugs. And since you are taking Lyrica, also using a benzodiazepine may not be your best option.

cheri clark

Hi- Thanks for your reply. I am taking less than 1 mg of lorazapam and am in the process of getting off of it.
I did look around and saw a study with pub med that stated that low dose lorazapam does not raise dopamine levels: http://www.ncbi.nlm.nih.gov/pubmed/11226811
Also a medical site listed drugs that raise prolactin levels and the benzos were not on the list:
Dopamine-receptor antagonists (eg, phenothiazines, butyrophenones, thioxanthenes, risperidone, metoclopramide, sulpiride, pimozide)
Dopamine-depleting agents (eg, methyldopa, reserpine)
Others (eg, isoniazid, danazol, tricyclic antidepressants, monoamine antihypertensives, verapamil, estrogens, antiandrogens, cyproheptadine, opiates, H2-blockers [cimetidine], cocaine).

Thanks for all you do! Cheri

Lara Pizzorno

Hi Cheri,
You are so welcome — YOU are my reason for doing this work. I am so glad you are on such a low dose and are getting off the lorazapam. What replacement medications are being suggested? I can take a look and let you know what I find, although it looks like you are PubMed savvy yourself! I looked at the study you found suggesting lorazapam does not raise dopamine levels– 2 comments: (1) it was an animal study, not human, so less trustworthy in relation to us (2) was conducted in 2001 — if you look at the research I cited in the blog, you will see it is much more recent. In other words, further studies have revealed that the benzos do raise prolactin levels.
I think the bottom line here is that if you need to be regularly taking any type of drug — not only for epilepsy but any condition — it’s always a good idea to look to see what its side effects are and then doing all you can to mitigate these. In terms of keeping your bones healthy, there is so much you can do, naturally, to promote strong bones! My hope is that taking all the positive actions you can will more than make up for the negative impact of the medication.

cheri clark

Hi- Before I started taking lyrica and lorazapam I researched to see a osteoporosis connection and I could not find it. I still can’t see the lorazapam connection in your resources. Can you give me the link?
I eat OG, can’t do gluten or any dairy, live on a organic veggie farm, take high dose K2, Kaprex for bone inflammation, Vitamin D and a algae bone formula , compounded hormones and other supplements. I am hoping that my next dexa is better as I can’t do any of the drugs. I am disabled so can’t do weight bearing exercises but try to walk daily. I have chronic Lyme Disease with intense pain and stiffness and neurological issues. Thanks

Lara Pizzorno

Hi Cheri,
Re Lorazepam – it’s a benzodiazepine drug. The papers I discussed in the blog confirm that this entire class of drugs has the adverse effect of promoting bone loss. I’m thinking, however, that you would like to see a recent paper specifically involving lorazepam, so I have pulled a 2011 study for you. In this study, researchers were trying to determine if zolpidem (a non-benzodiazepine, trade name, Ambien) might be less harmful to bone than benzodiazepines. Unfortunately, Ambien was not any better and, in some cases, worse — no big surprise since zolpidem binds to GABAA receptors at the same location as the benzodiazepines. In this study, 90 days posttreatment, lorazepam increased risk for fracture by 23%. Here’s the abstract:

J Am Geriatr Soc. 2011 Oct;59(10):1883-90. doi: 10.1111/j.1532-5415.2011.03591.x. Epub 2011 Sep 21.
Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults.
Finkle WD, Der JS, Greenland S, Adams JL, Ridgeway G, Blaschke T, Wang Z, Dell RM, VanRiper KB.
Consolidated Research, Inc., Los Angeles, California, USA.

OBJECTIVES: To determine whether zolpidem is a safer alternative to benzodiazepines.

DESIGN: Retrospective cohort study.

SETTING: Community based.

PARTICIPANTS: Health maintenance organization members with an initial prescription for zolpidem (n = 43,343), alprazolam (n = 103,790), lorazepam (n = 150,858), or diazepam (n = 93,618).

MEASUREMENTS: Zolpidem and benzodiazepine prescriptions were identified from pharmacy databases. Rates of nonvertebral fractures and hip fractures requiring hospitalization were compared before and after an initial prescription for each treatment, adjusting for confounders using doubly robust estimation.

RESULTS: In patients aged 65 and older, the rates of nonvertebral fractures and dislocations were similar in the pre- treatment intervals. The rate ratios (RRs) for the 90-day posttreatment interval relative to the pretreatment interval were 2.55 (95% confidence interval (CI) = 1.78-3.65; P < .001) for zolpidem, 1.14 (95% CI = 0.80-1.64; P = .42) for alprazolam, 1.53 (95% CI = 1.23-1.91; P < .001) for lorazepam, and 1.97 (95% CI = 1.22-3.18; P = .01) for diazepam. The ratio of RRs (RRR)-the RR in the posttreatment period adjusted for the corresponding RR in the pretreatment period-were 2.23 (95% CI = 1.36-3.66; P = .006) for zolpidem relative to alprazolam, 1.68 (95% CI = 1.12-2.53; P = .02) for zolpidem relative to lorazepam, and 1.29 (95% CI = 0.72-2.30; P = .32) for zolpidem relative to diazepam. The RRs decreased with time from the initial prescription (trend P < .001), as would be expected if the association is causal.

CONCLUSION: In older adults, the risk of injury with zolpidem exceeded that with alprazolam and lorazepam and was similar to that with diazepam. If the associations are causal, then the high incidence of these fractures implies that these treatment induce a substantial number of fractures and consequential costs. Further study of the association is imperative.

© 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.
PMID: 22091502

Re Lyrica (its drug name is pregabalin), it does not induce osteoporosis, so is likely a better choice to control epilepsy. Two other anti-epileptics that are said to not promote bone loss are oxcarbazepine (trade name, Trileptal) and lamotrigine (Lamictal). (Here’s a reference on this: Poza JJ. Management of epilepsy in the elderly. Neuropsychiatr Dis Treat. 2007 Dec;3(6):723-8. PMID: 19300606)

If you decide to look into Lamictal – I know that birth control pills, which contain ethinyl estradiol (the non-human lab-created “estrogen” used in birth control pills) decreases serum levels of Lamictal, and if birth control pills are discontinued, there’s a rebound effect in which levels of Lamictal go up – may even double. You said you are taking compounded hormones – which I am understanding to mean you are on bio-identical hormone replacement. I sure hope so — one (among many other) reasons being that non-human, lab created forms of "estrogen" used in conventional HRT are not safe — they increase risk for breast and uterine cancer, heart disease, blood clots — and lots more! Regardless, even real human estrogen may affect Lamictal levels – something to be on guard about.
Re HRT (if BHRT) Great –but even BHRT is good only if administered and monitored correctly. Have your hormone levels been tested? Here’s a link to a review I wrote for Longevity Medicine Review on the various testing options – it’s written for doctors, but you will understand it. If you have not had the 24 Hour Urine profile run, please ask your doctor about this. http://www.lmreview.com/articles/view/select-the-right-hormone-test-for-your-patient-using-bio-identical-hormone-/

I wish I could be more helpful. So much I do not know about you, which makes it hard to be more specific in suggestions. It sounds like you are doing many good things for yourself—eating organic and lots of vegetables is wonderful, so is taking vitamin D, K2, Kaprex. You don’t need – actually do not want to be on any of the bone drugs – not only do these drugs actually increase fracture risk within 5 years max or have numerous significant adverse side effects, but research is just out, the COMB study, that has now confirimed that a combination of nutrients (including vit D3, K2 [MK-7], calcium, exercise) is as or more effective at preventing fracture and restoring bone than the drugs! (Here’s a reference on this landmark research: Genuis SJ, Bouchard TP. Combination of Micronutrients for Bone (COMB) Study: Bone Density after Micronutrient Intervention. J Environ Public Health. 2012;2012:354151. Epub 2012 Jan 15. PMID: 22291722)

A few things I am wondering: How much vitamin D are you taking? Have you had your blood levels of 25(OH)D tested? Where do you live? Are you seeing someone you think is doing a good job treating your Lyme Disease? How long have you had this? I know some outstanding physicians who have focused on Lyme – could give you a referral if this might be helpful. Re exercise – have you ever considered Pilates? Is this available where you live? Very effective for bone and can be done on a mat or lying down on Pilates equipment called “the Reformer” and “Cadillac”, so I am thinking this might work well for you.
Let me know if I can be of help, Lara

cheri clark

Lara- Thanks for all the info. I decided to get a prolactin test- so I had the blood drawn yesterday along with other tests. I am on Bio Identical Bi-est and Progesterone. I have a Lyme Literate N.D. who overseas my hormones, supplements, etc. I am on 2 anti-biotics now for long term use as the bacteria is hard to kill- I have had it for 30-40 years( don’t worry I take CP-1 probiotic-really potent).
The vitamin D3 I take is 6,000iu sublingual and have blood work periodically and maintain it about 80___? . I live in Oregon on the wet side.
Because of the pain and stiffness-which is why I take lyrica) all I really can do is walk. I am bony at 100lbs and 5’6″with a lot of muscle wasting from the past. I get a dexa scan next week and if it is worse than the past I will start the strontium. I don’t want to do drugs. I took forteo for 6 months after a Dr. scared the life out of me cause my results were bad -T score -4.6. So the last test was -3.4 and I focused on the supplements I told you about in a previous post. Learned about how inflammation(which comes with Lyme) can hurt your bones.
Anyway- I could go on and on.
I’ll let you know test results if you wish.
Thanks- Cheri

Lara Pizzorno

Hi Cheri — thanks so much for letting me know more about what you are doing. Yes, please let me know the results of your prolactin test. Really glad you did this!
Your health program sounds excellent. Assuming your doc is either a Bastyr or NCNM graduate, so should be well educated. Your vit D3 may be low — if it’s 80 nmol/L, this translates to just 32 ng/mL — optimal range is now thought to be at least 60 ng/mL — 80 ng/mL, and I am now seeing medical journal articles suggesting 90 ng/mL or even 100 ng/mL.
I very much hope you will start on strontium. I wrote a blog about strontium for AlgaeCal as since Your Bones came out, many women have written me with questions about strontium’s safety and efficacy. I spent about a month reading virtually all the research on strontium (both natural and strontium ranelate) since 1909 and can assure you that it is effective, and the natural forms, e.g., strontium citrate, are quite safe (but NOT strontium ranelate, which has a long side of potential adverse side effects including 2 serious one, VTE and DRESS syndrome). You can read all the details here: https://www.algaecal.com/Blog/the-truth-about-strontium-supplements-side-effects-dexa-results-efficacy-and-more/11333
Also, I am wondering if you can tolerate dairy foods? If so, you might consider increasing your intake of whey, both to help you rebuild some muscle and also because it contains two bone building compounds the research is now spotlighting that appear to be very helpful — one is milk basic protein and the other, ferritin. I’ve written a little about both on the National Osteoporosis Forum and am following the research on this closely. Looks very good. Both MPB and ferritin are available as supplements, but for you, the protein in whey could be a real boost as well. Do let me know how you are doing — be well!

Lisa Kinyon

Hi! Thank you for that depressing, but enlightening article!! I have spent many years on clonazepam (benzo), tegratol, antidepressants, including prozac and zoloft (now I take effexor xr – is that any better?), as well as a drug you did not mention – NEXIUM, which now contains a fairly explicit warning about risks of osteoporotic fractures.

I am 52, had a hysterectomy (complete) at 39, and within two years I developed severe cfs/ids/fms (chronic fatigue syndrome, immune dysfunction syndrome, and fibromyalgia. I have had severe depression since the age of 29 (at least, that’s when I finally got treatment for it) and I have very severe osteoporosis, as well as adrenal insufficiency. I have had at least 10 rib fractures, a double pelvic fracture, and six vertebral fractures (possibly 17 or 18 – still waiting on my latest MRI).

I am hurt and angry about the newest (or oldest, but hidden from the public) revelations about which drugs are worst for bone.

Since three of those rib fractures nearly cost me my life (a severed rib punctured my lung, causing a pneumo/hemathorax , trauma one surgery and untold suffering caused by an egotistical group of surgeons who knew NOTHING about the control of post-surgical PAIN), I am just sick knowing that at least some of this could have been avoided. I have been fully disabled since the age of 40, which is especially sad because I was a school psychologist who loved working with mostly difficult-to-love middle school kids. I feel robbed of the life I once had, of the life I worked so hard to achieve. My illnesses and fragility have put a terrible emotional and financial strain on my marriage and my relationships with my kids, and I am so heartsick, sometimes I can’t even get out of bed (although I should mention that part of this is due to the unrelenting lung illnesses, chronic fatigue, and deep chronic pain from which I now suffer). I am fifty-two years old. Is there ANY hope for one such as me?

Sincerely, Lisa K. Kinyon

Lara Pizzorno

Hi Lisa,

Frankly, I cried when I read your letter. I am SO glad you wrote me! YES, YES, YES, you can heal and regain your health! I am absolutely certain of this. Your health issues are complex, and you are going to need to work with an integrative, cutting edge physician who is willing to and capable of identifying the real causes of these issues, not just prescribing drugs that suppress some symptoms while causing other, often worse, side effects. NEVER DOUBT that your body has the will and intelligence to heal. To give it the opportunity to do so, you (with the help of your doctor) need figure out 2 seemingly simple things: (1) What is your body currently being exposed to that is harming it, so you can eliminate as many of these harmful factors as possible. And (2) What does your body need that it is not getting? If you can let me know where you live, I will check to find a physician in your area who can truly help you. Because of my husband, Dr. Joe Pizzorno (you can check him out on Google), I am in the very fortunate position of having excellent connections to the best doctors all over the U.S. Nothing would make me happier than providing you with a referral to someone who can help you heal! Plus, not only does your family really need you, but so do those middle-school kids whose goodness and potential you can see. Hang in there – you ARE going to get your life back.

Regarding your medications first Effexor, then Nexium:

Effexor (venalfaxine) was the first developed SNRI (serotonin-norepinephrine inhibitor) and is now the most commonly prescribed one. The SNRIs are among the most widely used antidepressants today. Millions of people are on these drugs! Which is pretty scary when you look at their side effects and also how difficult it is to get off them. Do not attempt to discontinue using this without your doctor’s help! Our immediate question in relation to your bone health is, “Do SNRIs, like the SSRIs, prevent dopamine secretion and therefore increase prolactin levels?” It seems likely, but researchers haven’t really looked into this – can you believe it!

Effects of venlafaxine are dose-dependent. At low doses (150 mg/day), it is said to act on serotonergic and noradrenergic systems. At high doses (>300 mg/day), it also affects dopaminergic neurotransmission, but whether its effects on dopamine result in increases in prolactin levels is not noted.

I could not find any studies investigating SNRIs’ effects on prolactin levels. What I did see were 3 case reports of patients experiencing venlafaxine-induced gynecomastia (breast enlargement) or galoctorrhea (spontaneous flow of milk from the breasts not associated with nursing or childbirth) at supposedly low doses (150 mg/day). Both of these effects suggest that SNRIs cause prolactin levels to rise. Here are the references for these case reports:
Karakurt F, Kargili A, Uz B, et al. Venlafaxine-induced gynecomastia in a young patient: a case report. Clin Neuropharmacol. 2009 Jan-Feb;32(1):51-2. PMID: 18978497
Wichman CL, Cunningham JL. A case of venlafaxine-induced galactorrhea? J Clin Psychopharmacol. 2008 Oct;28(5):580-1. PMID: 18794664
Sternbach H. Venlafaxine-induced galactorrhea.J Clin Psychopharmacol. 2003 Feb;23(1):109-10. PMID: 12544389

When I looked further into the mechanism of action of SNRIs, and venlafaxine, specifically, I found it described as “a presynaptic drug which blocks the synaptosomal uptake of noradrenaline and serotonin and, to a lesser degree, of dopamine.” (Reference: Schreiber S, Bleich A, Pick CG. Venlafaxine and mirtazapine: different mechanisms of antidepressant action, common opioid-mediated antinociceptive effects–a possible opioid involvement in severe depression? J Mol Neurosci. 2002 Feb-Apr;18(1-2):143-9. PMID: 11931344) You will remember from the blog that blocking dopamine receptors causes an increase in secretion of prolactin.

Now as to Nexium – it’s a proton pump inhibitor that virtually shuts down your body’s ability to produce stomach acid. The problem with this is that without sufficient stomach acid, you cannot absorb calcium (among other nutrients since acid is required to digest food and foods must be digested/broken down for their nutrients to become available for absorption). In the case of calcium specifically, it must be made soluble and be ionized by stomach acid before it can be absorbed from your intestines. In my book, Your Bones, pp.55-7, I explain why antacids, including OTC antacids (like Tums, Rolaids, etc.), H2 blockers (like Pepcid), and the proton pump inhibitors (PPIs, like Nexium) are harmful to our bones. PPIs are the worst since the others only lessen stomach acid production while PPIs shut it down completely. Must you take this? The doctor to whom I am hoping to refer you will try to figure out WHY you are having indigestion, etc, so you won’t need Nexium! If we can identify the cause of the problem, it almost always can be corrected naturally and safely.

I recommend two things: first, please get in touch with me so I can suggest a referral for you to a doctor who can help you heal. Secondly, please consider getting a copy of Your Bones (or checking it out from your library), so you can get a good overview of what contributes to bone loss and what your bones need to become healthy.

Lisa, you have been through so much, but I can see from your letter that you are a courageous and strong woman as well as a kind and loving one. Don’t give up! I know you can heal. Lara


Yes, I have experience, first hand, now I know, but is it too late? Besides Caltrade D, suplement, is there any healthy food I can eat to help rebuild my bone density?

Lara Pizzorno

Hi Elizabeth, First of all — it is NEVER too late! Our bodies have an amazing capacity to heal and be well if we simply stop doing the things that harm us and provide ourselves with the nutrients we need to be healthy.
I am not familiar with Caltrade D, nor could I find it on-line, so I don’t know what it is supplying for you — nor do I have any idea what YOU need. Depending on where you live — the latitude where you are and thus how effective the UV rays are in producing vitamin D in your skin, and your amount of sun exposure, you may need much more vitamin D than a typical supplement provides. Also, your genetic inheritance may make you need more vitamin D than the average person — mine certainly does! You must run a blood test on 25(OH)D — this is the circulating form of vitamin D — to find out what YOUR vitmain D levels are and then supplement accordingly. Also, each of us is unique, so our requirements for many nutrients vary. I explain how to determine what nutrients YOU need more of and how to figure out how much YOU, specifically, need in my book, Your Bones. I apologize, but there is simply way too much to try to sum up here. Please take a look at the book — I’m sure it is available at your library if you prefer not to buy it, but it is very inexpensive — you can get it for less than $9. Re food — in broadest terms, you want to avoid highly processed, refined, chemicalized “foods” and a diet excessively high in protein (the latter will make your body chemistry more acidic, which will result in calcium being withdrawn from your bones to serve as a buffer and restore a more alkaline pH. ) You should be eating a Mediterranean-type diet with lots of vegetables (leafy greens like kale and spinach contain many nutrients important for our bones), whole grains (brown rice, quinoa, millet, whole wheat, wheat berries or spelt or emmer–the latter two are older forms of wheat no longer available in baked goods these days but very nutritious) , beans, omega-3 rich eggs from hens raised outdoors and allowed to eat healthy grains; and other lean sources of protein (like wild caught fish — salmon and sardines are especially helpful because of their omega-3 fat content). Low fat dairy foods, like yogurt and cottage cheese are also good for bones (if YOU are not allergic to the proteins in cow’s milk; if so, goat or sheep cheeses and yogurt may be helfpul). A great resource for lots of wonderful, quick, easy recipes using whole foods is The World’s Healthiest Foods, a free website sponsored by the George Mateljan Foundation — you can find this at http://www.whfoods.org I helped create this website and continue to assist with it — George is a personal and very dear friend of mine. You will love his recipes, absolutely delicious, and they are all good for our health. You can specify which nutrients you want to focus on, and recipes will be provided using foods rich in those nutrients. Plus, as I mentioned, it is all free, George’s gift to all of us. I’m sorry I cannot be more specific and say exactly what is best for YOU — only you can truly figure it out. But my book will enable you to do so. Hope this gives you at least a general idea.

cheri clark

Hi Lara- I got my blood work back re: prolactin, etc. My prolactin was normal, my D was low-57 ng/ml( it had gone down- I changed my D supp.), I am anemic again( low rbc, hemo., hemat.), and my pth is elevated(but my calcium was normal). I was a little stressed to hear this.I was told by N.D. anemia is part of Lyme disease. I have to wait to see my PCP r: PTH.
I had a dexa today and I hope to God it’s better than before.
I am stressed will let you know dexa results. I did start goat protein powder today . Will start the strontium tomorrow a.m. If I take in a.m. brfore breakfast- that is the meal I take my 1st calcium- is that too close?
Another question- the algae cal is only 720 mgs total. I won’t be doing goat dairy every day. Can I take 6 a day? or is 720mgs enough?
Thanks for all your help.
In appreciation- Cheri

Lara Pizzorno

Hi Cheri,
I’m so delighted to hear your prolactin is normal! That’s a huge relief. Re vit D, 57 ng/mL is not bad (optimal is 60-80 ng/mL), but increasing this to closer to 80 ng/mL would be good. What type of vitamin D supplement are you taking and how much?
Re taking strontium — you only need to wait 2-3 hours after taking your strontium to take calcium (or eat calcium-rich foods). Re AlgaeCal — the calcium provided is exceptionally bio-available, so that 720 mg is going to be very well absorbed and able to be utilized. The published research (an osteoblast cell study and 2 human trials) in which AlgaeCal was compared head-to-head with calcium carbonate and calcium citrate all show that the algae-derived calcium is more effective at building bone than the other supplemental forms of calcium. The osteoblast study revealed that AlgaeCal produced 200 – 400% greater proliferation and mineralization of these bone building cells than did calcium carbonate or citrate. (Here’s the reference for this research: Adluri RS, Zhan L, Bagchi M, et al. Comparative effects of a novel plant-based calcium supplement with two common calcium salts on proliferation and mineralization in human osteoblast cells. Mol Cell Biochem. 2010 Jul;340(1-2):73-80. Epub 2010 Mar 7. PMID: 20213262) In the first human trial, subjects taking the AlgaeCal Plus and Strontium Boost supplements that you are now taking averaged a yearly gain in BMD of 2.79% — this is outstanding since what we are expected to do is lose at least 1% BMD each year (and 2% per year for up to 14 years around the transition through menopause). (Here’s the reference for this one: Michalek JE, Preuss HG, Croft HA, et al. Changes in total body bone mineral density following a common bone health plan with two versions of a unique bone health supplement: a comparative effectiveness research study.Nutr J. 2011 Apr 14;10:32. PMID: 21492428) So, although I do not think it would be harmful for you to take 6 capsules daily, I do not think you need to do so — especially since you are eating calcium-rich foods as well, and taking strontium. I also encourage you to enjoy lots of leafy greens — such as spinach, kale, collards, Swiss chard — are all great sources of calcium plus many other minerals (and vitamins, such as K1) that help promote not just the health of our bones, but our health overall.
Let me know how your DXA turns out. Be well! Lara

Tabatha Dunn

Hi, Lara, I used to have Osteoporosis and have made it to Osteopenia thru 15 years of Fosomax or Actonel which I stopped in Nov. 2010. I have never had a fracture. My last bone density test showed I was a bit above -2.3 in the hip and the spine they can’t read as I have severe scoliosis and degeneration. (I wish they could read those tests somewhere besides the lower spine.) I live in Florida and have a sunny patio that I do venture onto a few times a week and get a bit of weight lifting carrying plants around. I don’t walk for exercise but try to lift weights in the house a few times a week. My D3 level was 44 ng/mL as of last month. (By the way my primary dr. did not know how to test my D3 levels and did the wrong test) I had to ask my Rheumatologist to test it for me and she told me to keep doing what I was doing that I was OK with those figures, but I feel I should increase. I’ve been taking 2,000/day and have increased to 3,000 and one of them has 100 mcg of K2 as Menatetranone.
One question I have is whether or not that is the correct K2 (as in MK7) ??
I have always taken a good Multivit/min. and it had Calc.1000 and Mag. 500 and I was on that for years after finding I had osteoporosis. I took extra as well for a total of 1800/900. But over the years I’ve read here and there that Calc. should be taken separately from Mag. because they both use the same receptor sites. The multi. that I’m on now from GNC doesn’t have much of those two minerals so I take extra and I am keeping the ratio the same but I want to know if I’m doing OK taking them apart from each other?? I always take Calc. Citrate with D (Citracal or similar) because I want good absorption and I can take it between meals and at bedtime and I take the Mag. just sort of in between with or without meals and maybe a couple of hours before bedtime. I was on the Algae Cal/Strontium for a few months and stopped due to nervousness about the Strontium and wondering if the Calc. was enough.
I don’t know if we’re allowed to mention another good book to read but Eat to Live by Dr. Joel Fuhrman is an amazing book all about nutrition and how it affects the body and our health. My husband and I have been following the recommendations for 4 weeks now and he’s expecting to get off his BP meds and I’m hoping that the all natural food (no processed, sugar, etc) will give me all my vitamins and minerals naturally so that I don’t need so many supplements which I currently take, and the elimination of drugs maybe. Lisa’s story also made me cry when I read it and I literally could relate to much of it (disability, job, kids and more) and I wanted to pick up the phone and call her!! and I think reading something like that, besides the wonderful help that you can give her, might give her something constructive to be working on while she works with her doctors, and will give her definite hope (it did for me). I hope you don’t mind my mentioning that but reading that book gave me so much hope that I can improve my health (& hopefully in the process, my bones) and not progress to where the dr. tells me next year she wants me on Reclast just because my scores are going lower. I refuse to go on it. I appreciate your response.

Lara Pizzorno

Hi Tabatha,
Sorry for not responding sooner– I am becoming certified as a Stott Pilates instructor, and this is a training weekend for me (Pilates has helped me so much that I want to be able to give this gift to others). The training is not trivial — I’ve been at it since fall and will not be done until late summer–so about 9 months of study before I will be ready to take the exams (written, practical and oral). I will be writing much more about this — the exercises can be done at home with just a mat on the floor and can target specific bones (spine, hip, femur, etc.) But that’s not what you are asking me about right now — so, in response to your questions:

A vitamin D3 level of 44 ng/mL is not adequate — optimal is between 60 – 80 ng/mL. The test you need to be sure was run is 25(OH)D — this is the circulating form of vitamin D and the best indicator of body levels. You may want to consider increasing your vitamin D3 intake to 5,000 IU /day and restesting your levels after 3 months. Also, spring is arriving — be sure to spend at least a half hour outside (no sunscreen, no hat, no long sleeves, long pant legs, etc.), so you can make your own vitamin D! If you are concerned about skin wrinkling, put sunscreen only on your face and not anywhere else until AFTER you have allowed your body to get some sun exposure. Even an SPF 8 will almost entirely prevent vitamin D formation in your skin.

The K2 supplement you are taking is providing MK-4 — that’s what menatetrenone is, MK-4. In the research studies, the dose at which MK-4 wa shown to be helpful was 15 milligrams (which is 15,000 mcg). Thus, the amount your current supplement is providing for you (100 mcg) is not likely to be helpful. The MK-7 form of K2 –the form used in AlgaeCal Plus at a dosage level of 100 mcg –is the form of K2 that has been shown to be effective at a dose of 100 mcg.

Please check your multiple to see what form of calcium and magnesium it is providing. Calcium carbonate is much less bioavailable than calcium citrate — and neither of these forms of calcium are as bioavailable or as effective in stimulating new bone formation as algae-derived calcium (which is the form of calcium in AlgaeCal Plus). Several research studies have now confirmed this. Please take a look at my response to Cheri on March 1st, which is posted above in the comment section of this blog– I summarized the research on this for her.

You do not need to take calcium and magnesium separately — but you do need to take strontium separately (2-3 hours before or after) from calcium. I very much hope you will go back on strontium, which has been shown in a great deal of research to be of significant help as part of a bone building program. I wrote a blog about strontium for AlgaeCal because since Your Bones came out, many women have written me with questions about strontium’s safety and efficacy. I spent about a month reading virtually all the research on strontium since 1909 (both natural forms of strontium, e.g., strontium citrate, and the patented drug form, strontium ranelate) and can assure you that strontium is effective, and the natural forms, e.g., strontium citrate, are quite safe (but NOT strontium ranelate, which has a long side of potential adverse side effects including 2 serious ones, VTE and DRESS syndrome). You can read all the details here: https://www.algaecal.com/Blog/the-truth-about-strontium-supplements-side-effects-dexa-results-efficacy-and-more/11333

Of course, it’s great to mention other helpful books! I completely concur with Dr. Furhman’s recommendation to avoid processed, sugar-laden “foods” and eat whole unprocessed “natural” foods. It’s wonderful that you and your husband are following his advice and seeing such good improvements in your health! In Your Bones, I have included a great deal about the ways in which the Standard American Diet (too high in protein, loaded with sugars, depleted of many nutrients, too high in inflammatory omega-6 fatty acids, etc.) is harmful to our bones. I also provide lists of foods rich in each of the nutrients we need to build strong bones, discuss how to track what you typically eat for several days to determine whether your diet is supplying the nutrients your bones require, how to choose a supplement if your diet is not giving you the nutrient levels you need, and the key principles of a bone-building diet. Unfortunately, I believe it is now virtually impossible to receive all the nutrients in the amounts required for bone (and overall) health from our diet — the nitrogen fertilizers used to grow (non-organic) fruits and vegetables (which also will contain pesticide residues) result in crops that grow faster but contain less nutrients. I also discuss this research in Your Bones. And unless you are growing your own fruits and vegetables organically and eating them shortly after they are harvested, your food will not get to your grocery store for, typically, at least 10 days after it was picked. This will not affect minerals in the food, but many other nutrients, such as vitamin C for example, will be greatly depleted by the time you purchase the food in your grocery. To get the most nutrient-bang for your grocery buck, buy organic and local. Or plant your own vegetable garden this spring — you will be amazed at how easy this is to do, how inexpensive it is, how much better the food tastes and how much will grow in a very small plot.

Lastly, I do hope you will not go on Reclast — this is one of the trade names for the bisphosphonate zoledronic acid, an IV drug so potent it is given annually. As I expect you know, even FDA has officially recognized that these drugs actually increase fracture risk and recommended to physicians to limit the time a patient takes them to no more than 5 years. In Your Bones, I include more than 30 pages worth of reasons why you should not be on these drugs. I am now seeing see dozens of papers being published in the medical journals each month discussing the adverse effects of the bisphosphonates (ONJ, “atypical” femur fractures, atrial fibrillation, etc.), and they are now starting to recommend doctors prescribe other drugs — primarily Prolia and Forteo, both which also have very nasty side effects, which I will be writing more about. Truly, the most effective–and safest–way of promoting healthy bones is naturally through a bone-building diet, exercise and supplements.
Be well! Lara


Lara, if I,m taking 680 mg strontium citrate would 770mg calcium(from Algae ) be enough calcium ? I have a product called New Chapter Bone Strength and you take 6 small tablets per day..

Lara Pizzorno

Hi Diane,

I took a look at New Chapter Bone Strength — like AlgaeCal it is derived from a form of sea algae, which is good. However, you need to take more tablets to get a similar amount of calcium; it does not contain boron, does not provide vitamin C, and provides less than a third as much magnesium as AlgaeCal does in fewer pills. If you continue to use this, please check the amount of magnesium you are getting in your diet — you need way more than is being supplied by New Chapter. Also vitamin C. Also boron plays an important role in building bone — you need 3 mg per day, and it is very difficult to get this much in your diet without consuming way too many calories.

To determine whether you are getting sufficient calcium in relation to 680 mg strontium citrate, you need to take a look at your diet and estimate the amount of calcium it typically provides. In Your Bones, I’ve outlined how to do this and provide a table listing the commonly eaten foods rich in calcium and the amount of calcium in a serving. You just need to keep a food diary for 5-7 days and then you can figure out what bone nutrients your diet is giving you — not just the calcium, but magnesium, the B vitamins, boron, vitamin C, etc.

I don’t mean to ignore your question — I do realize your primary concern here is calcium, but calcium alone (even with strontium taken separately) is not going to optimally help you build bone. This is one of the reasons the AlgaeCal Plus calcium supplement is much more helpful than other forms of calcium — it delivers highly bioavailable calcium from sea algae that is already in a matrix with adequate amounts of all the other bone building minerals–except boron which is added, and vitamins D3, K2, and C have been added to the supplement as well. So, you are getting the full synergistic effect. Building bone is definitely a nutrient-team effort. If you are lacking in any nutrient your bones require, the building process will be greatly hampered.

Re calcium, take a look at your diet and see how much you typically are consuming in a normal day’s food intake — you may be surprised. Calcium-rich foods include not just cow’s and goat’s milk, cheese, yogurt, cottage cheese, etc, but also salmon, sardines, leafy greens like kale, spinach, collards, romaine lettuce, and other vegetables including cabbage, green beans, broccoli. Tofu, seseame seeds, almonds, even oranges supply some calcium. And calcium in foods is typically well absorbed and utilized because when we eat, (unless we are taking a drug to prevent our stomach from secreting acid) we secrete stomach acid, which solubilizes the calcium and makes it much more able to be absorbed.

I know analyzing your diet sounds like a hassle, but it will likely take you no more than a few minutes each day to write down what you ate, and maybe an hour to add up how much of the nutrients your bones require that your diet is giving you. This is information that will pay you back for the time spent MANY times over. And not just in relation to your bones — these nutrients all play many key roles in our bodies and are essential for a healthy cardiovascular system, healthy brain, healthy blood sugar regulation, healthy metabolism/ good energy production, etc — in sum, healthy aging overall.

Diane Harvey

I was researching information on Lorazepam’s effect on bone loss and happily stumbled on to your site. I have been taking Lorazepam for over 10 years for anxiety and insomnia. Osteoporosis was discovered ten years ago and was significantly worse on my last bone scan in April 2012. In 2004 I got really sick with gut issues which lasted a few years. I was given two strong antibiotics for an intestinal infection which led to vaginal problems for which I was given strong topical medications. That triggered vulvodynia for the last six years, the bane of my existence. Doctors have been little or no help to me. Hence, the continuance with the Lorazepam for the extreme anxiety from all this. For the most part I took .5 to 1 mg except for about a year it was 2mg. Now I have reduced to .025.
I tried Algae Cal with the strontium. Even if I wanted to I can not take the bone drugs as they irritate my bladder (mild interstitial cystitis) but the strontium did the same thing. Strontium Boost has an enormous amount in it. Would a lesser amount do any good? I am going to find your book right away. I am post menopausal. I started a physical therapy program for strength and bones and have looked into all the nutrients for bone building. I did not see mention of manganese here but read much that it is vital. Anyway I am overwhelmed by all the problems, not the least of which is that relentless vulvodynia. I would like to talk to you to see if you could recommend any doctors in my area. I have learned a lot by reading this site. Thank you for it.


This is an excellent site. I am going to subscribe. After taking prescribed 60mg of prevacid twice daily for a year, plus getting very little exercise due to degenerative back probelms, my osteopenia moved to osteoporosis in my spine. I am now taking Zantac 75 mg. twice daily and 4 capsules of an algaeCal product with strontium,boron, magnesium, and other minerals. Will my body now absorb more calcium? I am afraid to get off the Zantac due to acid reflux issues. Thanks,Minna Dew

Lara Pizzorno

Hi Minna,
I am really glad you are no longer on Prevacid. This is one of the proton pump inhibitors — the strongest class of the drugs that shut down stomach acid production. Just one pill can prevent secretion of 90-95% of your stomach acid for an entire day. Zantac is an H-2 blocker, a class of drugs whose effects are not quite as severe as those Prevacid, but you are preventing your body’s production of stomach acid for many hours after this medication is taken, and you must have stomach acid to digest your food properly, so many nutrients, not just calcium, are able to be absorbed. To try to counteract this problem, in regards to calcium, you want to be sure you are providing your body with optimal amounts of the most highly absorbable and effective form of calcium, and this is the calcium derived from sea-alage used in AlgaeCal Plus. This form of calcium has now been shown in both in vitro (lab studies) and in clinial trials of postmenopausal women to be way more effective in promoting bone building than other forms of supplemental calcium, incluing calcium citrate, which is the better absorbed form of calcium derived from rock. Please also take a high potency vitamin and mineral supplement! You really need to provide your body with all the support you can. Do you have any idea WHY you are experiencing acid reflux? Is your doctor trying to help you figure this out or just giving you a prescription for Zantac? If the latter, I urge you to look into working with a physician who can help you discover the causes of acid reflux, so you can heal and will no longer need to take an acid suppressant drug. A book that might be very helpful for you written by Dr. Jonathan V. Wright, MD, is “Why Stomach Acid is Good for You — Natural Relief from Heartburn, Indigestion, Reflux & GERD.”

Kitty Kroger

Hi Lara,
Thank you so much for your informative article. I am taking Lamictal for simple partial seizures. I also have had osteoporosis long before I started taking meds for the seizures. (Before I took Keppra but it had very little effect.) But I’m wondering if Lamictal also can cause bone loss.


Hi, Lara:
I’m a 68 year old male and have been taking 20mg omeprazole (prilosec) time capsules for chronic GERD for well over 10 years. A few years ago I was given a bone density test which revealed I have osteopenia. My gastroenterologist, dismissed the connection, stating the studies linking bone loss with long term use of proton pump inhibitors was “anecdotal”.
I have recently learned that SSRIs can also be linked to bone loss and I have also been on 10 mg of Zoloft for many years. I have been supplementing my diet with 1200 mg of calcium citrate and vitamin D3 daily.

Taking matters in my own hand, I have recently begun to cut the contents of the omeprazole capsules in half without any noticeable increase in GERD. Is there anything else you might recommend to help offset further bone loss?

Lara Pizzorno

Hi Alan — your gastroenterologist needs to get on PubMed and read up! He (or she) is definintely wrong about this. And yes, SSRIs also cause bone loss.

Here is an abstract of one recent paper re fact that omeprazole causes bone loss

Calcif Tissue Int. 2009 Jan;84(1):13-9. Epub 2008 Nov 21.

Increase in vertebral fracture risk in postmenopausal women using omeprazole.

Roux C, Briot K, Gossec L, Kolta S, Blenk T, Felsenberg D, Reid DM, Eastell R, Glüer CC.


Rheumatology Department, AP-HP Cochin Hospital, Paris Descartes University, 27 rue Faubourg Saint Jacques, Paris 75014, France. christian.roux@cch.aphp.fr


Proton pump inhibitors are taken by millions of patients for prevention and treatment of gastroesophageal diseases. Case-control studies have suggested that use of omeprazole is associated with an increased risk of hip fractures. The aim of this prospective study was to assess the risk of vertebral fractures in postmenopausal women using omeprazole. We studied 1,211 postmenopausal women enrolled in the Osteoporosis and Ultrasound Study from the general population. Information on omeprazole and other risk factors for fractures including prevalent fractures and bone mineral density was obtained at baseline. Vertebral fractures were assessed on X-rays obtained at baseline and at the end of the 6-year follow-up and analyzed centrally. At baseline, 5% of this population was using omeprazole. Age-adjusted rates for vertebral fractures were 1.89 and 0.60 for 100 person-years for omeprazole users and nonusers, respectively (P = 0.009). In the multivariate analysis, omeprazole use was a significant and independent predictor of vertebral fractures (RR = 3.50, 95% CI 1.14-8.44). The other predictors were age higher than 65 years (RR = 2.34, 95% CI 1.02-5.34), prevalent vertebral fractures (RR = 3.62, 95% CI 1.63-8.08), and lumbar spine T score </= -2.5 (RR = 2.38, 95% CI 1.03-5.49). Omeprazole use is associated with an increased risk of vertebral fractures in postmenopausal women. Further studies are required to determine the mechanism of the association between the underlying gastric disease, omeprazole use, and risk of osteoporotic fractures.

PMID: 19023510

I am very glad you are proactive and taking charge of your bones' health! In addition to calcium (the form is very important for you — you will not effectively absorb calcium carbonate; calcium citrate is a better option; AlgaeCal is your best option by far b/c it will also be giving you a wide variety of trace minerals your bones need in a highly absorbable form) and vitamin D3 (please have your blood levels of 25(OH)D checked; optimal range is 60-80 ng/mL, so once you know where you are, you will know if you need a higher daily intake of D3 than you are currently getting. For most of us, vit D needs increase during the late fall and winter months as we are unable to produce it from sun exposure if living in northern latitudes), you must also be getting adequate vitamin K2. I have written about this at length in numerous places — if you want the full in-depth discussion, go to Longevity Medicine Review (www.lmreivew.com), article there is free access but is written for docs, so a bit technical.
Bottom line, vit D increases your body's ability to absorb calcium. Vit D does nothing to regulate where that calcium gets put. You want it to go into your bones, NOT your arteries, heart or kidneys. Taking care of this is the job of vit K2, which activates the proteins responsible for putting calcium into bone (osteocalcin) and keeping it out of arteries, etc (matrix Gla protein). K2 is available in 2 forms, MK-4 and MK-7 — MK7 is preferable for a number of reasons which I discuss at length in the review paper on LMR. You should be getting at least 100 mcg of MK-7/day.
Lastly, GERD is very often caused by having not too much stomach acid production but too little! I highly recommend you read this book by Dr. Jonathan Wright, MD — Why Stomach Acid is Good for You. It is extremely common for our gastric acid production to drop as we age; most folks over age 50 are not producing sufficient stomach acid. Not doing so results in indigestion and reflux of the food we become unable to digest. And what are we told to do? Take a pill that further suppresses stomach acid production. Without stomach acid, we are also unable to solublize (put into absorbable form) minerals, e.g., calcium and magnesium, both of which are required for bone. You might also ask your doctor about vit B12 injections — compromised stomach acid production results in our inability to produce intrinic factor, which our bodies must make for us to absorb vit B12.
Hope this helps, Lara

Lara Pizzorno

Hi Kitty — Lamictal (the full name is lamotrigene) does affect estrogen, so it is likely to, but I am not sure –not enough research has been done to say yes or no definitively, although what I did find on PubMed (see abstract below) indicates that this patent medication – like the other antiepileptic drugs — does negatively impact your risk for osteoporosis. My advice to you is to get your NTx level checked frequently (this is a urine test that looks at how much N-telopeptide is being lost in your urine; high levels of NTx indicate more rapid breakdown of bone. You can have this test run much more frequently than a DXA, for which changes take about a year to manifest, so the NTx can give you an idea of what’s happening with your bones in response to this drug much more quickly.) If you need the drug, then your best move is to do everything you possibly can to support your bones’ ability for healthy remodeling. I cannot list everything here, but have done so at length in Your Bones, which is available on Amazon for less than $10 — it’s published by a non-profit group. Here’s the most recent study I could find on PubMed regarding the drug you are taking:
Seizure. 2012 Jul;21(6):471-2. doi: 10.1016/j.seizure.2012.04.002. Epub 2012 Apr 26.

Bone mineral density in adult patients treated with various antiepileptic drugs.

Beniczky SA, Viken J, Jensen LT, Andersen NB.

Source: Epilepsy Clinic, Department of Neurology, Glostrup University Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.

Abstract: There is considerable evidence suggesting, that older antiepileptic drugs (AEDs) and some of the newer ones decrease bone mineral density (BMD). However, there is only limited and conflicting data concerning the effect of levetiracetam on BMD. In this cross-sectional study we analysed data from 168 adult consecutive outpatients treated with AEDs for more than 2 years, and who underwent measurement of the BMD. We compared the incidence of decreased BMD among the patients treated with 6 different AEDs: carbamazepine (CBZ), oxcarbazepine (OXC), valproic acid (VPA), lamotrigine (LTG), topiramate (TPM) and levetiracetam (LEV). Among the patients on monotherapy, reduced BMD was present significantly most often in patients treated with LEV and those treated with OXC. In the group of patients on polytherapy there was no significant difference in the incidence of low BMD among patients treated with various AEDs. Our data suggest that patients on long-term treatment with LEV have a higher risk for affection of bone density.

Copyright © 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
PMID: 22541979


I am taking nexium for GERD symptoms. How easily can plant based calcium be absorbed if acid production is suppressed in the stomach?

Lara Pizzorno

Hi Judy,
The plant-based calcium in AlgaeCal will be more effectively absorbed than calcium derived from rock — without adequate stomach acid, you will absorb only about 4% of calcium carbonate. You also require stomach acid to digest your food (and to release for absorption ALL vitamins, minerals, as well as breaking down protein into absorbable amino acids), so as strange as this sounds, your GERD symptoms may be due to too little, not excess stomach acid. In most everyone, stomach acid production drops off with age, so many of us over age 50 are not producing sufficient stomach acid to digest our food — and this results in GERD symptoms. Then we make the problem worse by taking a drug like Nexium! I urge you to get a copy of a book — probably available at your library but inexpensive paperback as well — by Jonathan Wright, MD and Lane Lenard, PhD entitled “Why Stomach Acid is Good for You” and read it! Nexium is a proton pump inhibitor and has been shown repeatedly in many studies now to promote bone loss.


Hi Lara,

I’m having trouble using your reference section to find the studies used for your article, especially linking SSRIs and benzodiazepines to osteoporosis. Many of the reference numbers for the studies used in your article are for wikipedia and not for studies backing up your statements. I was on SSRIs for many years and now have osteoporosis, so being able to find legitimate and accessible research that may link the two is important to me. I’d appreciate if you could more clearly provide the links to the research you used, especially for the SSRIs and the benzodiazepines in your response to me.


Lara Pizzorno

Hi Todd,
Not sure why you are having this problem nor what happened to the references I supplied with my blog; but the main point is how to help you, and it’s easiest for me to just give you a few of the recent papers here:
Luz Rentero M, Carbonell C, Casillas M, et al. Risk factors for osteoporosis and fractures in postmenopausal women between 50 and 65 years of age in a primary care setting in Spain: a questionnaire. Open Rheumatol J. 2008;2:58-63. PMID: 19088873
Bolton JM, Targownik LE, Leung S, et al. Risk of low bone mineral density associated with psychotropic medications and mental disorders in postmenopausal women. J Clin Psychopharmacol. 2011 Feb;31(1):56-60. PMID: 21192144
Bolton JM, Metge C, Lix L, et al. Fracture risk from psychotropic medications: a population-based analysis. J Clin Psychopharmacol. 2008 Aug;28(4):384-91.PMID: 18626264
Pinheiro Mde M, Ciconelli RM, Martini LA, et al.Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS).Cad Saude Publica. 2010 Jan;26(1):89-96. PMID: 20209213
Pinheiro MM, Ciconelli RM, Martini LA, et al. Clinical risk factors for osteoporotic fractures in Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS). Osteoporos Int. 2009 Mar;20(3):399-408. Epub 2008 Jul 3.PMID: 18597037

That benzodiazepines promote bone loss is well known; many papers dicuss it. If you run a PubMed search using the terms “benzodiazepines” and “osteoporosis,” LOTS of papers will come up. Ditto for the wider class of SSRIs).

If you have not read Your Bones, please check out a copy from your library and read it — or buy the book on Amazon, cost is less than $10 as publisher is a non-profit group. All the factors (except menopause) that negatively impact women’s bones also cause bone loss in men, and men have a few contributing factors (also discussed in Your Bones) that women typically do not have. Men also require all the nutrients that women do to rebuild bone. You can restore the health of your bones! You need to eliminate as much as possible all the factors that are promoting your bone loss (which you will be able to figure out when reading the book) and ensure your intake of all nutrients requried for building bone are supplied (all discussed in the book), along with some regular weight bearing exercise, and your bones will rebuild. You are pre-programmed to do so. I cannot summarize the entire book here, but like I said, you can get it at your library. Hope this helps, Lara


Hi Lara,
l wrote to you a little while back when you were travelling for advice on whether vitamin D -1600 from AlgaeCal was too much and you advised that I should have my levels checked which I have done. My doctor says they are good 101nmol/L and also my calcium levels are good. Thank you for your comprehensive reply. I am currently taking 800mg. vitamin D/1200 calcium carbonate which I know is not the best.. Do you think l can still safely take the l600 iu in the AlgaeCal product.? My worry is that it may cause hypercalcaemia. My osteo specialist nurse said she would not have wanted it any higher – that was some months ago. When I pointed this out to my doctor she said it was beyond her expertise but expressed her concern over too much calcium causing heart attacks etc. Perhaps guidelines are different here in the UK. From what I read and from your feedback it should be ok to take this amount of vitamin D and AlgaeCal is a better calcium supplement.

My osteporosis T scores are pretty poor -4 .1 in my lumbar spine and -3.1 in my hip. Quite depressing Lara. Having read all the inormation you have written about Benzodiazapines and that group of drugs I think this has probably played a large part in my present condition as l have been taking these drugs for years. l have managed to reduce my dosage from 15mg to 9mg but getting off this group of drugs is sometimes as hard as getting off heroine. Also, the other culprit is my digestive system which is quite poor. l have had severe acid reflux for some years now – probably caused for the most part from the Bisphosphonate drugs although l have not taken them for a couple of years. That is when l was introduced to Nexium, etc. and they are very difficult to get off of also. My doctor knows they have a negative affect on bone health but warn the GERD can cause cancer of the oesophagus. l feel l am between a rock and a hard place. I am currently taking Zantac which is slightly better as you pointed out in your previous reply. The GI I see is really not sure what is causing my digestive problems. He says perhaps a motility problem upper and lower but because l had lost a lot of weight said we had to get the acid under control. l do wonder if the diazepam could somehow be involved. l have had various scans and tests as you can imagine. Another GI doctor advised giving up dairy which l have. I presently use Soya Milk and try to take some natural dairy yoghurt which is a bit of a struggle. I do not eat cheese either as l am a migraine sufferer but I do eat lots of green vegetables, some fish , eggs and very little meat. I also take a magnesium supplement, zinc and B multivitamin. Fruit is a bit of a no go area. Sometimes l can have a banana without too much difficulty. I am not a coeliac but l am toying with the idea of a gluten free diet to see if it would help I have tried a vitamin C supplement but it upset my stomach. I might add that I have had three endoscopies which have all showed a normal result apart from a few polyps which have probably been caused by the ppi’s.

You asked why l couldn’t take Strontium Ranelate – the reason being it caused quite severe indigestion and nausea. That is why l am wary of the Strontium Citrate although l would very much like to try it. You said it could have been due to the “ranelic acid” component so l suppose the only way to find out is to try the citrate formula.

l do my best with an alkaline diet. Given all that l have said above do you think l can turn this around Lara ? I have an appointment in January to see a back specialist to check out my back and leg pain. He will probably do an MRI scan. l have a feelling that l may have a compression fracture in my lower discs but l so do not want to take Teraparatide or Denosumab unless there is absolutely no other option. I will get hold of your book but meanwhile would be most grateful for your advice especially on the vitamin D as l would like to take the AlgaeCal product.

Have a very Happy Christmas and so pleased that you are doing so well with your own bone issues.


Lara Pizzorno

Hi Carol,
Please accept my apologies for not getting back to you sooner! AlgaeCal has been reviewing and updating the blog–and I have received a number of questions just now that were sent to me months ago.
Re your vitamin D levels — 110 nmol/L is the equivalent of only40 ng/mL — and this is barely above frank deficiency, which is anything under 30 ng/mL. Optimal is 60-80 ng/mL (or 150 – 200 nmol/L). YOU definitely need at least 2,000 IU of vitamin D3 daily. The issue with vitamin D and calcium potentially causing heart attack is due to not having sufficient vitamin K along with the vitamin D and calcium. Vitamin D increases our body’s ability to absorb calcium but does nothing to regulate where that calcium ends up — you want it to go into your bones and NOT into your arteries. Putting calcium into bone and keeping it out of arteries is the job of 2 proteins (osteocalcin and matrix Gla protein) both of which require vitamin K (specifically vitamin K2) to become activated. AlgaeCal Plus provides K2 along with vitamin D3 and calcium, so you can safely build bone.
Re your digestive issues — there are many possible causes for the problems you are experiencing and none are due to too much acid — PLEASE read a book by Dr. Jonathan Wright, MD and Lane Lenard, PhD entitled, Why Stomach Acid is Good for You. Going gluten free is a very good idea for you — also avoiding cow’s milk and dairy products — at least until your gut heals. The proteins in both wheat and dairy foods are highly allergenic and inflammatory in individuals whose gut function is disturbed. Inflammation causes bone loss. Since I wrote you last, the 2nd edition of Your Bones is out — at the end of the book is a 30 page Labs Appendix going over all the tests you can have run to identify the true causes of your bone loss — if possible, PLEASE get the book and read through this section. I very much hope you can get the help you need to turn things around — YES, you can! Our bodies are preprogrammed to be healthy! Only when overwhelmed by insults do our systems break down; you must identify what is insulting your body and remove the offenders, then provide yourself with the nutrients required for healthy bones, and you will rebuild.
I will be in London at a medical conference sponsored at Nutri, Ltd. My husband, Dr. Joe Pizzorno is speaking. The conference will be held Sept 28, 29. I would love to meet you if you are in London or live nearby; if you cannot get a copy of Your Bones, I can bring one with me to give you. Please let me know how you are doing — again, I am so sorry I just got your questions. Lara.


Could someone please tell me how long it takes fpr Calcium supplments, 1000 miligrams a day plus calcium foods to start putting calcium back into your body. Im so worried Im going to fall and break a hip or something. Im a walker what not going to chance it while the its slippy and snowing out.

Lara Pizzorno

Hi Paula,
Wish it were that simple — while the calcium you consume will immediately be put to use in your body, it is required for many critical functions, not just building your bones. Also, how much calcium you will absorb depends on your digestion. If your digestion is good, you will absorb calcium much more effectively than if your digestion is not good or if you take antacids, eg Tums, or drugs like Nexium, Prevacid, etc. You must be producing some stomach acid to solubilize calcium (both digest your food and put calcium into a form in which it is better absorbed). The recommended daily amount of calcium for women aged 31-50 yrs is 1,000 mg/day; for women over age 50, it is 1,200 mg/day. When you look at this number, you need to realize they are not just talking about calcium supplements, but total calcium intake from food in your diet + supplements. If you have a copy of Your Bones (which you can get via Amazon), look at the section on “Calcium” and you will see a list of all the commonly eaten foods that contain calcium, the typical serving size for each food and how much calcium it provides. You can use this list to estimate how much calcium your diet is typically supplying you each day, then subtract this amount from either 1,000mg or 1,200mg depending upon your age and take the remainder in the form of a calcium supplement. For example, if your diet is giving you 400 mg of calcium each day, then you need to take another 600 mg if you need 1,000 mg/day or 800 mg if you need 1,200 mg/day of calcium in the form of a supplement.
Also, it is VERY important to realize that you must have a lot more than just calcium to build bone. Some of the other key nutrients are vitamin D, vitamin K2, magnesium, and boron. Plus numerous trace minerals play important roles in healthy bone remodeling. PLEASE check out a copy of Your Bones from your library or buy a copy on Amazon, so you can get the information you truly need to have healthy bones.


I would like to know how long it takes fpr the right diet and 1000miligrams of caulcim supplements a day to start putting calcium back in your bones.


Hi Lara,
I am a 52 yr old female who recently had my 1st bone density test which showed osteoporosis in my spine and osteopenia in other areas. My doctor and I were quite surprised since I exercise a great deal- for years I have worked out with weights 2-3 x week, teach spinning (indoor cycling) 3 x week, Iyengar yoga 2 x week, pilates on the reformer 1 x week. I do have family history, my mother has osteoporosis but she had a hysterectomy in her 20’s, and swimming is her exercise (non weight bearing). My question is this in order to stop my ADD medicine (adderal) I started an amino acid regimen (neurotransmitters) monitored by my doctor. He follows a protocol by a Dr. Marty Hinz. My urine levels were checked to adjust my doses. I am wonder if these could be causing my osteporosis. I know they work to adjust my serotonin and dopamine levels. They consist of L-Tyrosine (high doses of this one), L-lysine, mucuna pruriens seed (standardized to 40% L-DOPA), L-cysteine HCL, folate. I do take calcium 1200 mg, and vit D3- 2500 mg. But after reading your blog I understand I need to change the calcium type and get my 25 (OH)D level checked, and also get your book. Any insight would be greatly appreciated! Thanks

Lara Pizzorno

Hi Lori,
I, too, was doing “everything right” (excellent diet and lots of weight bearing exercise) and still losing way too much bone when I was in my late 40s – early 50s. For me, the key issue was having a genetic inheritance that includes poorly formed vitamin D receptors, so I require much more vitamin D than the “average” person to “push” the system, so I can get enough vit D attaching to cell receptors to supply my health needs. Plus I live in Seattle, where the appearance of the sun is a major event for 9 months of the year. This combination set me up for osteoporosis. Your doctor sounds very well informed — you are fortunate to have him! Nothing in the amino acid regimen he has prescribed for you would negatively impact your bones; in fact, they are likely to be beneficial, esp. L-cysteine, which is the limiting factor for our bodies’ production of glutathione, the most potent antioxidant we produce endogenously and very helpful against excess inflammation. As you may know, chronic low grade inflammation excessively activates osteoclasts, the cells responsible for resorbing (breaking down) old bone. Too much osteoclast activity leads to too much bone being resorbed, and thus, over time, to osteopenia/osteoporosis.

In addition to calcium and vitamin D2, bones require quite a few other nutrients for healthy remodeling. Key among them are vitamin K2 (MK-7 form is preferable for numerous reasons which I discuss in Your Bones), magnesium and boron (also discussed at length in the book as are a number of other nutrients — too much to write it all out here). AlgaeCal Plus is an excellent source of absorbable calcium, magnesium, boron, K2 and numerous other trace minerals necessary for healthy bones. I’ve explained in Your Bones how to determine how much of each of the nutrients your bones require is being supplied by your diet and thus how much you need to supplement to reach optimal levels. You will also want to look at all the factors I talk about that promote bone loss; I am coming to believe that the most important of all of them is insufficient stomach acid production, since we must have stomach acid to digest our food properly and release the nutrients it contains for absorption. Having too little stomach acid is VERY common in women over age 50 and causes the same symptoms as producing too much stomach acid, so people take acid suppressing drugs–and this makes the problem even worse! I’ve written about this in Your Bones, and expect to be writing much more about it in the future.

Bottom line — what your doctor is prescribing for your ADD is not going to harm your bones and is MUCH healthier for you than the drugs. Definitely get your vitamin D levels checked and as you read through Your Bones, you are likely to identify a number of factors that could be contributing to your bone loss. Please feel free to write me if you have further questions. You’re on the right track.


Thank you very much. I will get my levels checked and start the appropriate supplements.

Lara Pizzorno

Hi Lori,
You are so welcome! Keep me posted on what you learn and how you are doing. Once you have identified key contributing factors to YOUR bone loss and have been on your bone building program for 3 months, ask your doctor to run a CTx blood test to confirm you are no longer losing excessive amounts of bone.The CTX or C-terminal telopeptide (the full name is “carboxy-terminal collagen crosslinks”) test measures a specific crosslink peptide sequence of type I collagen that is found in bone: the portion cleaved by osteoclasts during bone resorption. Serum (blood) levels of this peptide sequence are proportional to osteoclastic activity at the time the blood sample is drawn. The test used to detect the CTX marker is called the Serum CrossLaps, and current research indicates that it is more specific to bone resorption than the other currently available tests.


Hi- Isn’t it a good idea to get the parathyroid and thyroid blood levels checked periodically when one has osteoporosis or when one wants to explore the reasons why one has it? I have osteoporosis( I wrote a while back) and take armour hormone for hypothyroid. Recently I asked my Dr. to check my parathyroid hormone levels cause I knew if elevated levels were found that it can contribute to bone loss. A few blood tests ago my levels were elevated and so I increased vitamin D. Saw the endocrinologist. Now at 10,000 iu D the PTH is still elevated. My CA is normal. Kidneys ok.
I see the Endo. next week but now she is talking about removing the parathyroid or go on osteoporosis drugs which I won’t do. I will found out why she says that.
I can’t find info on High PTH levels and normal CA ,with normal D. Can being hyperthyroid increase your PTH? I appreciate your help even though it’s slightly off topic. Thanks! Cheri

Lara Pizzorno

Hi Cheri,

Being hyperthyroid speeds up everything, so can certainly contribute to bone loss — but you write that you are taking armour thyroid because you have been diagnosed s hypothyoid — where are you? hyper or hypo? Have you been checked recently? Your armour thyroid prescription may need to be adjusted.

Re your parathyroid glands, you need to run the tests to check ionized calcium and iPTH levels in your blood, plus a 24-hour urine calcium excretion test to see how much calcium your kidneys are clearing out. Is this what your endocrinologist ran for you? If so, and your test results are abnormal, then the question becomes, is it primary or secondary hyperparathyroidism?

Primary hyperparathyroidism is relatively rare (prevalence of primary hyperparathyroidism has been estimated to be 3 in 1000 in the general population, but as high as 21 in 1000 in postmenopausal women. It is almost exactly three times as common in women as men.) Most often, it is due to a benign tumor. Once the offending parathyroid tumor is removed, your bone density should quickly begin to improve since an overactive parathyroid will not be constantly draining calcium from your bones. For lots more information about hyperparathyroidism, an excellent resource is http://www.parathyroid.com.

Secondary hyperparathyroidism may result from insufficient consumption (or absorption) of calcium, vitamin D deficiency, chronic kidney or liver disease, or hypochlorhydria (low levels of stomach acid, which is quite common after age 50, and may be caused at any age by other factors, such as chronic use of acid-blocking drugs. If you are not secreting adequate stomach acid, you are not going to digest your food properly or solubilize calcium, so it can be effectively absorbed.

Hope this gives you a few leads to discuss with your doctor, Lara


Hi- Thanks for your reply. I am hypo and am now hyper as my Primary Dr was trying to increase my levels.
So does being hyperthyroid raise the PTH levels? I need to know how being hyperthyroid makes you lose bone.
My story is too long to share but I had a hot nodule for 15 years that made me hyperthyroid. Had it removed in ’96.Then became hypo.
I will mention the things you wrote about the parathyroid.Thanks

Lara Pizzorno

Hi Cheri,
As I explain in Your Bones (1st edition, pages 90-93 — cannot provide all the info here, but the key point for you is that high levels of parathyroid hormone cause increased osteoclast activity and bone resorption to liberate calcium from bone because calcium is required for many essential functions in our bodies, so its availability is tightly regulated. Bones are our calcium “bank” from which withdrawals will be made if calcium levels in the blood drop. Being hyperthyroid is going to speed up everything in your metabolism — including bone remodeling. I discuss this in Your Bones pp. 93 and following — each bone remodeling cycle involves 3-5 weeks of bone resorption followed by 3 months during which new bone is laid down to replace what has been removed. When the resorption phase is sped up, the rebuilding phase cannot keep pace, and the result is a loss of approximately 10% of bone mass per remodeling cycle. Hopefully, when your primary doctor adjusts your dose of thyroid hormone, your metabolism will normalize. Please ask your doctor about this ASAP.


Thanks Lara- My Endo thinks it’s Primary Hyperparathyroidism even though my CA is normal. Doing an ionized CA (my suggestion from Parathyroid.com) and 24 hr urine CA .

Once she sees the results , then we proceed. I have an experienced Dr and hospital lined up. If it’s familial HP-then what do I do?

I am on a natural regime for Osteo, K2-Thorne, D, Kaprex, Boron and Calcium formula and walking. I guess I will add strontium. Am on lower armour -heart rate is a tad better. Read that a lot of my unexplained symptoms could be from HP.

Will let you know. Thanks


Hopefully, someone has already told you this by now. Calcium supplementation, especially as high as your 1,200 mg/day (and especially since you are taking vitamin D, which increases calcium absorption), significantly raises a woman’s (or man’s) likelihood of calcification in inappropriate areas of the body, especially if they are not ingesting large amounts of “Vitamin K2 mk-7.”

Vitamin K2 mk-7 directs calcium out of the inappropriate areas of the body and into the areas of the body that are appropriate for calcification (ie. bone, nails, teeth).

Inappropriate areas of the body for calcification include (but are not limited to): the inside and outside of blood vessels / arteries, the brain (dementia), the eye lens, the kidneys (stones), the gall bladder (stones), the heart, the lungs, joints, other organs.

Calcium supplementation increases the likelihood of stroke, heart attack, atherosclerosis, heart disease, et cetera. It’s safer to obtain calcium from greens, nuts, seeds, and the rest of one’s diet than from supplementation.

But absorption of the calcium from one’s diet will increase if one is in a position to safely raise their Vitamin D3 blood levels, which they can be if they have been taking enough Vitamin K2 MK-7 for awhile. (I regret that I am still unclear as to how long is sufficient before adding Vitamin D3 ingestion.)

(Some regions of Japan for centuries have ingested around 1,000 mcg of Vitamin K2 mk-7 in their breakfast dish of “natto”: fermented soy beans or black beans. I know of no reason to have any concern about going at least that high.)

(Two of the websites one can check out for more information about Vitamin D3 supplementation are Grassroots Health or Vitamin D Council.)

Lara Pizzorno

Hi Joy,
Yes, I am well aware of the information you thoughtfully shared, and very glad to post your comment for those who might not already be aware of vitamin K2’s critical importance for calcium’s healthful use within our bodies.
Vitamin K2 (as MK-7) is discussed — extensively –in several of my blog posts on AlgaeCal’s website — the post I think you will find most interesting is entitled, Strong Bones and a Healthy Heart Need More than Just Calcium — here’s a link to this blog, in which I discuss, at length, the studies you refer to regarding calcium and vitamin D as a possible contributing factor to heart disease, etc.: https://www.algaecal.com/featured/calciumheartattackstudies/
I also discuss the current research regarding all 3 forms of vitamin K relevant to bone health (K1, MK-4 and MK-7) at length in Your Bones, in both editions. In 2nd edition, see pages 172-177, 180-196, 198, 213-214, 219-220, 222, 311-315, 345, 352, 362.
And have written medical journal review articles about the interrelationship of vitamins D and K for physicians — see Longevity Medicine Review — http://www.lmreview.com — on the homepage you will find a free-access article entitled “Vitamin K2: Essential for Prevention of Age-Associated Chronic Disease.” This article is written for medical professionals, but you will get the gist of it. Vitamin K2 is involved in much more than bone and heart health!
Because MK-7 is more effective at a lower dose in activating the proteins responsible for putting calcium into bone (osteocalcin) and keeping it out of soft tissues (e.g., but not limited to — arteries, kidneys, breasts, brain — this K2-dependent enzyme is called “Matrix Gla Protein), MK-7 is the form of K2 used in AlgaeCal Plus.
In Japan, it is true that natto is regularly consumed. A cup of natto typically supplies 435 mcg of MK-7; few people consume more than 1 cup daily; most consume less than this amount, thus very few Japanese are consuming 1,000 mcg of MK-7 per day. However, consuming this much would, most likely, be safe. I prefer to err on the side of caution and would NOT recommend taking 1,000 mcg of MK-7 daily. In the latest studies, daily doses of 360 mcg are being safely and beneficially used for individuals on hemodialysis for severe kidney disease and also for those with coronary artery disease (a condition in which significant calcification is present in the coronary arteries, i.e., the arteries that deliver blood to the heart). In the most recently published papers on the use of K2 (MK-7) for bone health, women with osteoporosis were given 180 mcg/day of MK-7 with highly beneficial results and no adverse effects.
Vitamin D Council is an excellent resource for information about vitamin D — I have been a member of the Vitamin D Council website for many years now and support their work (they are a non-profit/ .org) with a monthly donation — I urge everyone reading this to consider doing so as well. The information they currently provide on vitamin K is, however, much less robust than their coverage of vitamin D. In addition to my book, Your Bones, an excellent resource for (well documented by peer-reviewed research) information about vitamin K2 is my friend, Dr. Kate Rheaume-Bleue’s book, Vitamin K2 and the Calcium Paradox. Given your comments above, I believe you would greatly enjoy Kate’s book — and mine as well.
Thanks for taking the time to write in, Lara


this product is very good for osteoporosis, its a weighted vest by NYKNYC.COM the vest has given me back 13% of the bone I had lost in less than a yr.
I highly recommend it to anyone who needs to strengthen bones and its safe cant hurt you like these drugs do.

Patte Lau

I read in Consumer Health reports that AlgaeCal contained mercury or lead? Is that correct or not. I would like to start taking AlgaeCalPlus and read you book Your Bones. Also can one take Algae Cal Plus with out strontium and still build bone?
Thank you.

Lara Pizzorno

Hi Patte,
I am copying in for you what I have posted elsewhere, both on this blog and on the National Osteoporosis Forum.

Here are the facts re the safety of AlgaeCal in regards to lead:

Numerous clinical studies using AlgaeCal, all of which include toxicology evaluations (which include ensuring safety from lead and any other toxic compound) have been published in different mainstream peer-reviewed medical journals. If you want to read them, just type “algaecal” into the search box on Pubmed.

Because AlgaeCal has been proven safe, Algaecal has received an NDI (New Dietary Ingredient) approval and GRAS (Generally Recognized As Safe) by the FDA (both are posted on AlgaeCal’s home page).

ALL calcium supplements contain tiny tiny amounts of lead; this will include ANY calcium supplement you might take. If consumption of no lead is your goal, then you should not ingest any calcium supplements, period…You’d also better stop eating FOOD, because every vegetable contains lead, too — even organically grown vegetables. According to FDA’s publication, Total Diet Study Statistics on Elements Results (December 11, 2007):

Food Amount of Lead in a 4 Ounce Serving
Mixed nuts, roasted 10.2 mcg
Brussels sprouts, fresh, boiled 7.9 mcg
Sweet potato, fresh, baked 7.2 mcg
Spinach, boiled 7.0 mcg

In comparison, AlgaeCal contains LESS than food — just 5.2 mcg in a daily serving. So, if this amount is sufficient to make you concerned about taking AlgaeCal, you’d best stop eating nuts and veggies. I haven’t researched meat, but almost certainly, it will contain microgram amounts of lead since the animals eat grass & grain, which are necessarily grown on soils – and all our soils contain tiny tiny amounts of lead. Lead is a natural element ubiquitous in the soil, water, and air, and we cannot escape ingesting tiny amounts of this toxin every day. The US Government’s Centers For Disease Control publication “Inorganic Lead Exposure, Metabolism and Intoxication” states that “…typical intakes of lead from food, beverages and inhaled air are in the order of 300 – 500 mcg per day.”

Fortunately, our bodies are capable of processing these tiny exposures, which as you can see, are many many times greater than the amount of lead found in a daily dose of AlgaeCal. We know how tiny the amount of lead is that is present in AlgaeCal — I feel very comfortable with this. Frankly, I’d like to see reports detailing how much lead is present is other calcium supplements being sold to us; such reports are glaringly absent. I am confident none will contain less lead than is found in AlgaeCal.

Much dis-information has been posted about this, and it has caused much needless distress — for you and many others. I do not understand why the people trying to frighten us from using a healthful product like AlgaeCal are doing so. They should be ashamed of themselves. It is a huge disservice. I hope knowing the actual facts puts your mind at ease, Lara


Hi Lori,
I am a 23year old female and have been diagnosed with osteoporosis. I found out after I had an accident on a four wheeler and broke my wrist. My ortho told me I needed a bone scan and sure enough they told me my T score was -2.7. I have seen my gyno for her opinion and she had none. I then went to see an endocrinologist who ordered tests for my thyroid, kidneys, CBC, vitamin D and calcium and they have all come back normal. I am still waiting for some results that a rheumatologist is doing (protein, bone marker tests, my thyroid again). I have been going through depression for the last 9 years and because of that I have been on Prozac, Zanax , Ambien and Ritilan). I am not taking the Prozac anymore and haven’t for the last couple of years but have continued the other medication. I am also on birth control (Ocella 3). I am concerned about the healing of my hand. I have lost my job and feel so down and helpless. No one is helping and I am terrified thinking what is going to happen to me. Please, I am begging you to help me. What other tests do I need to have done? Thank you so much for any information you can give me.

Lara Pizzorno

Hi Lindsay,
I am so distressed that I just saw your request for information — I expect you have given up hearing back from me and very much hope you will get a notification and see my reply. Both depression and the drugs used to treat it cause bone loss. Birth control pills also contribute to bone loss by preventing formation of the corpus luteum and hampering progesterone secretion. My best advice to you is to work with a functional medicine physician who is competent to help you discover the underlying physical causes of your depression help you recover your mental health and that of your bones. Obviously, something is off in your physiology! You can find doctors certified as functional medicine practitioners at the Institute for Functional Medicine’s website — here is a link to their “Find a Practitioner Page” http://www.functionalmedicine.org/practitioner_search.aspx?id=117 If you do not yet have a copy of the 2nd edition of Your Bones, I urge you to get one from Amazon or check it out from your library and read through the Labs Appendix — a number of the tests discussed there may be helpful to you. Two I would recommend are SpectraCell’s micronutrient analysis and Enterolab’s sIgA stool test — this latter test evaluates you for sensitivity to gluten (the allergenic protein in wheat). You do not have to have celiac disease to have an immune reaction to wheat protein, and it is becomingly increasingly recognized as a cause of depression and chronic inflammation that contributes to MANY diseases, including osteoporosis. I just returned from Dallas where IFM’s annual symposium, an international conference (1,200 physicians from all over the world, and the conference was sold out for several months in advance)was held this year. Discussion of health issues due to gluten sensitivity were a major part of the conference. You might consider going off all gluten-containing grains for several weeks at least to see if you notice any beneficial effects from gluten avoidance. Check out the website “Living Without” for help going gluten-free. Be well, Lara

Lara Pizzorno

Hello Lindsay,
I so hope you get this reply! I just received your questions — AlgaeCal’s blog has been undergoing an overhaul, and I have been in and out of town for the last 2 months because of attending a number of medical conferences — from Tempe, Arizona to Banff (Canada) to Dallas, TX. In addition, my computer died just before I left for AZ, so I was reduced to just my iPhone for several weeks. The end result is that I am just now receiving a number of queries I would ordinarily have received months ago. Please accept my apologies for not replying to you sooner!
Your situation is very complicated — SOMETHING is definitely off, and you need the help of a very good functional medicine doc to figure out what and assist you in restoring your health. Depression causes bone loss, so do virtually all the drugs used to treat it. The real issue here is WHY are you depressed? Again, something is out of whack — the good news is that a functional medicine doc can help you identify the root imbalances that have caused your depression, so you can restore your health. My best advice to you is to use the Institute for Functional Medicine website to find a certified functional medicine physician near you and get the help you need. Here is a link to this website — you can learn about Functional Medicine there, and they also have a “Find a Practitioner” resource: http://www.functionalmedicine.org
I also urge you to get a very recently published book by one of the top functional medicine docs — this superb physician was one of the presenters at the IFM Symposium in Dallas that I just attended last week – his name is Dr. Datis Kharrazian. The book is titled, “Why Isn’t My Brain Working?” It just came out and is published by Elephant Press. You will find much in this book to help you understand what might be off for YOU and how to go about regaining your health. I am sending you my personal contact information if you would like to call me or email me directly. Hang in there! Lara

Mary Fennelly

Can you tell me if Phenytoin, Zonisamide Zonegran, Clozabam Frisium can cause low blood pressure when interacting with Teriparatide (Forteo Injection)?

Than you,
Mary Fennelly.

Lara Pizzorno

Hi Mary,

No, I cannot tell you this. Ask your prescribing physician.


Susan Richards

Hi Laura – I have taken Primidone for about 10 yrs (for essential tremor), and will likely have to continue it for the rest of my life. I am 55. Currently my Vit D level is 42 and Dexa is showing -1.0 in femurs and -0.8 in spine. My doctors don’t know what supplementation or what amounts I should be taking to counteract the Vit D/calcium loss from Primidone. So right now I’m taking daily 900mg Calcium citrate, 3000 IU Vit D, & 400mg Magnesium citrate. Plus I have a very good diet, no smoking or alcohol, etc.

Do you think taking AlgaeCal Plus (4 caps = 720mg Calcium,1600IU Vit D, 350mg Magnesium, 100mcg M-7) is a good start? Plus I could add additional Vit D (approx 3000IU)? Would I also need additional M-7 in supplemental form? I know the AlgaeCal should be taken 2x/day, but when should I take any additional Vit D &/or M-7? I’ve read that Vit D is more well absorbed when you take it all at one time, with your largest meal. Thanks for your website – very glad I found it!!!

Lara Pizzorno

Hi Susan,

So glad you contacted me as I may be able to be of significant help to you.
I have some questions for you.

Regarding your essential tremor:
(1) Have you ever been tested for heavy metals — lead, mercury, cadmium? Toxic levels of all three are surprisingly common, and a toxic burden of any one of them can cause tremor. If you have not been tested, you should absolutely ask your doctor about ordering these tests for you.

(2) Have your vitamin B12 levels ever been measured? This is a blood test. Low B12 will also cause tremor. If you have digestive issues, you may not be absorbing B12 well; low B12 is also very common and its prevalence increases with age.
If you have a heavy metal burden or are low in B12, remedying these issues may resolve your tremor — and thus your need for Primidone.

Re supplements:
Yes, I would recommend AlgaeCal Plus for you. It’s significantly better than what you are currently doing. I take it myself because it is the only supplement that provides not just calcium, but calcium in the matrix of all the trace minerals the sea algae required to build its bony structure. The research is clear that many trace minerals are needed for healthy bones, not just the major minerals, calcium and magnesium. Conventionally grown foods produced with high phosphate fertilizers are no longer us with anything close to adequate amounts of these trace minerals.

If you must continue to take Primidone, then you need 1,500 mg of calcium per day — from your diet and supplements combined. You should keep a food diary to see how much calcium your diet is providing and then make sure you are getting the remainder of this 1,500 mg/day via supplements.
You say your vitamin D level is 42 — is this 42 ng/mL or 42 nmol/L — it makes a HUGE difference which measure is being used.
If 42 ng/mL then you are not optimal (which is 60-80 ng/mL) but you are not severely deficient.
If 42 nmol/L, this is equivalent to 16.8 ng/mL — SEVERE deficiency.
I am guessing the measure used was ng/mL — as the Vitamin D Council recommends, I would take 5,000 IU/day of vitamin D3 (D3 is much more effective than D2) for 3 months and then retest blood levels of 25(OH)D (the form in which vit D circulates in the bloodstream).
Re vit D absorption — I have seen the opposite, that it is best taken in divided doses daily, which is what you will be doing if you take AlgaeCal Plus. I personally require much more vitamin D than the “average” person because of my genetic inheritance, which includes faulty vitamin D receptors. I take AlgaeCal Plus and extra vitamin D3 morning and evening. You will need to do your own 3 month trial, retest your blood levels, and see where you are. Hopefully, you have good doctors who are both willing and competent to help you with this.
Re K2 (MK-7 form), recent studies have used 180 mcg/day in postmenopausal women with osteoporosis with no adverse effects and beneficial outcomes in preventing bone loss. It is very safe to take even greater amounts of K2 (MK-7); MK-7 has been shown to produce no adverse effects in doses of 865 mcg/day and Japanese eating a traditional diet regularly consume 425 mcg/day.

Lastly, it would be a very good idea for you to check the adequacy of your diet by keeping a diet diary for 3-5 days and then checking how much of the nutrients bones require that you are actually getting. If you have a copy of Your Bones, you can use the book to help you with this. I have provided tables listing the commonly eaten foods that are sources of each of these nutrients and how much a serving provides. I urge you to do this, so you can really know what you are getting — and what you need, so you can either change your diet a bit or supplement when needed.

adele capuano

I am writing my daughtet, who is 26 years old. She was disgnosed with epilepsy at 6 years old and has been on phenobarbital for20 years, and also depicote, trileptol, tegratol, vimpat, zonogran, and prefnazone. Please don’t mind the spelling of the medications. She is now on phenobarbital and lamictal XR.

several years ago her internist found her vitamin d low (about 14) gave her 60000 units for 6 weeks, had to do that twice. She now takes 5000 daily since that time. A recent blood showed the vitamin d at 51, which doctors said was normal.

To make a long story short, we attended a conference about women’s health and epilepsy. It was recommended that anyone taking phenobarbital for more than 3 years have a bone density test, which she immediately did. Unfortunately, it was done twice and mydaughter at 26 has osteoporosis, with readings of 3.2 at the hip. Her doctor belongs to a major seizure center in New York City and never once discussed this with us. I feel like the ball wad dropped and I always tried to look into side effects. But if you are notlooking into a particular thing, you may not find it. Everyone seems stunned by this diagnosis.

My question is this:

Is this unusual, even with her medical background? Or could there be an underlying cause as well? I should mention that I had a bone density test at the same time as mydaughter and, at 61 years old I also have severe ostioporosis (3.8), I stopped getting my period at 53 years old and was never on any medication.

More importantly, is there anything that my daughter can do now, short of taking more medication (they mentioned an injection, everyday for two years, which I really don’t want to do) to make her bones stronger or at least to slow down the process?

Any information you can give me would be greatly appreaciated.


Hi Adele,

We have seen some cases of young adults diagnosed with osteoporosis and osteopenia. Usually it has to do with genetics and long term medication use, or both. So taking into consideration your daughter’s medical background, it is not necessarily unusual.

In fact, here is a testimonial from a mother and her 15 year old daughter, who was diagnosed with osteopenia:

Karen Kobel
Lockport, NY
“…remarkably improved her dexa scan results!”

“I didn’t think anything would really help my daughter Caitlin. At 15, the doctors diagnosed her with osteopenia. Her dexa scan was horrible news, because she needed spinal surgery. She is allergic to just about everything! Using the AlgaeCal for 6 months has, as the doctors put it “remarkably improved her dexa scan results!”. Every calcium we tried gave her diarrhea, rashes, and wheezing. We are now using AlgaeCal with no adverse effects!! She can now have her surgery and get back to herself. Being handicapped in many puts limits on anything she does. Now with AlgaeCal’s help, she will be able to run and play like she used to!! So many, many thanks to you all at AlgaeCal!!!

My only hope is that you never go out of business!!!!”

This is from our success stories page, which you can see here: https://www.algaecal.com/algaecal-testimonials/

As for what both you and your daughter can do for your osteoporosis we recommend taking AlgaeCal Plus and Strontium Boost. Taking both AlgaeCal Plus and Strontium Boost, participants in our human clinical study increased their bone mineral density an average of 4% in only 6 months. This study has been published in prominent peer-reviewed journals (Nutrition Journal and Pudmed): http://www.ncbi.nlm.nih.gov/pubmed/21492428

Along with taking AlgaeCal Plus and Strontium Boost, you should also try to engage in a healthy lifestyle including regular exercise, carefully watching your diet (and as much as possible avoid smoking, drinking excessive alcohol, and eating processed refined foods). Also taking Fish Oil / Krill Oil and juicing with organic green leafy vegetables like kale, cucumber, celery etc. will also help improve your bone health.

Hope this is a good start, Adele.

If you would like to call in and speak with us, we would love to answer any other questions or delve further into your situation. You can call USA and Canada toll free: 1-800-820-0184. Hope to hear from you soon.

– Monica from AlgaeCal

Lara Pizzorno

Hi Adele,

It is unfortunately not uncommon that doctors are unaware, or do not consider the bone destructive effects on bone of the anticonvulsant medications used to manage epilepsy. I wrote about this problem in detail in Your Bones, 2nd. Edition, page 125 and following because osteoporosis does not have to be the future for those who must rely upon these drugs. Providing our bones with optimal amounts of all the nutrients they require from a healthy diet and supplements; getting regular, safe, bone-building exercise; and attempting to identify and eliminate as many of the numerous other factors in our modern environment and lifestyle that promote chronic inflammation (which leads to osteoclast activation and excessive bone loss), can greatly offset the harmful effects of the drugs.
In other words, not only the anticonvulsants she requires to manage her epilepsy, but an inadequate supply of the full range of nutrients her bones require, and/or some pro-inflammatory diet, lifestyle or environmental factor in her life may be (in fact is likely to also be) contributing to her bone loss. These conditions can be changed to support the health of her bones!
The injection they are recommending is for teriparatide (Forteo). While it has been approved for use for 24 months, research shows that its beneficial effects peak and then drop off after as few as 6 months, definitely after 12 months.(Reference: Uihlein AV, Leder BZ. Anabolic therapies for osteoporosis. Endocrinol Metab Clin North Am. 2012 Sep;41(3):507-25. doi: 10.1016/j.ecl.2012.05.002. Epub 2012 Jun 20 PMID: 22877427)
Cost for Forteo is not inexpensive — running around $1,573 per month, according to Consumer Reports Best Buy Drugs analysis: Drugs to Prevent Bone Fractures in People with Osteoporosis.(http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/Osteoporosis%20prevention.pdf)
Forteo reduces the risk of spine fracture and other non-spine fractures, but no evidence suggests that it helps prevent hip fractures. Side effects include headaches, nausea, dizziness, high calcium levels in the blood, chronically elevated cortisol levels (which cause bone loss) and an increased lifetime risk of bone cancer, particularly when taken at high doses.(Ref: Uihlein AV, Leder BZ. Anabolic therapies for osteoporosis. Endocrinol Metab Clin North Am. 2012 Sep;41(3):507-25. doi: 10.1016/j.ecl.2012.05.002. Epub 2012 Jun 20 PMID: 22877427)
If she does decide to use Forteo, I very much hope she (and you) will read Your Bones through and use it to identify all other potential bone damaging factors that you can eliminate or greatly lessen, and to determine if you are both getting optimal amounts of all the nutrients your bones must have to rebuild healthfully. For example, she does not just need vitamin D — it must be balanced with vitamin K2 to ensure the calcium she is getting from her diet (and supplements) is put into bone and NOT into soft tissues like her vasculature, kidneys, breasts or brain! This goes for you, too!

Hope this helps, Lara


Hi Lara,

I find your information very interesting but do have a question about the New Chapter Bone Strength. For some reason I seem to have excessive bloating & stomach churning (& gas) since taking these and it’s only been a week so far. I thought I’d try them because I read that magnesium oxide can cause stomach problems. This was in the Bone-Up that I’ve been taking for many years, which I thought may have been causing my minor stomach issues. I’ve tried probiotics but to no avail. However, the New Chapter definitely seems to have a far worse effect on me.

Backing up, I got osteoporosis soon after having a hysterectomy & not being told to add more calcium to my diet (or with vitamins). I was given estrogen & ended up with breast cancer, so took Tamoxifen for five years. By this time my dexa scan showed -3.9. However, since joining a Bone Builders exercise class, my bones have improved 12%. In fact, many of the participants, like me, do not take biphosphonates and have improved their bone density. We do weight bearing exercises based on the studies performed by Tufts University, and meet twice a week for an hour & 20 minutes.

I’ve only recently started researching the best foods to increase bone strength – I must read your book. So far I’ve been amazed at what I’ve found. Such as seaweed having 10 times more calcium than milk; peanuts & almonds containing potassium, which helps prevent loss of calcium in the urine. And we need protein for the amino acids – the building blocks of body proteins – & that the bones are made up of about 50% protein – although I do see that you mentioned too much protein is not good. We eat very little meat so this has made me increase my salmon, sardines & turkey (turkey being considered a SuperFood).

Is it possible the New Chapter Bone Strength could be affecting my stomach? It was a nutritionist that recommended Bone-Up. I’m wondering whether to go back on this product & would like your opinion on it’s contents:

Vitamin C (as calcium ascorbate) 200 mg 333%
Vitamin D3 (cholecalciferol) 1000 IU 250%
Natural MK-7 (vitamin K2 as menaquinone-7) 45 mcg 56%
Calcium (elemental)
(from microcrystalline hydroxyapatite) 1000 mg 100%
Magnesium (as magnesium oxide) 500 mg 125%
Zinc (as zinc L-monomethionine) 10 mg 67%
Copper (as copper gluconate) 1 mg 50%
Manganese (as manganese citrate) 1 mg 50%
Potassium (as potassium citrate) 99 mg 3%
Boron (as boron citrate) 3 mg *

I am lactose intolerant. These are milk, wheat, gluten, shellfish, egg & nut free. The other information on the label is:

Bone Up® Superior Calcium Formula Description
Microcrystalline Hydroxyapatite
Potassium Citrate & Natural MK-7
Promotes Bone Density

BONE-UP® provides ossein hydroxyapatite complex (OHC) (from free-range Australian/New Zealand calves), which includes the superior combination of the inorganic calcium lattice of microcrystalline hydroxyapatite (MCHA) within an organic protein milieu rich in naturally occurring growth factors. The OHC is combined with vitamin D3 and vitamin K2 as MK-7 (a more bioavailable form of vitamin K) to support the deposition of calcium into the bones as well as to assist in building up the organic bone matrix. Potassium citrate is also added for optimal osteo support.

Thank you for your help & also for the wonderful replies to everyone who asks questions of you.

Lara Pizzorno

Hello Alice,

I will reply in more detail next week. I am on the road right now, but will be taping a video clip next week on the issue of constipation caused by too high a dosage of supplemental calcium – which is what you are experiencing. The supplement you are taking contains 1,000 mg elemental calcium – yikes, this is way too much! If you eat foods containing calcium, you may be consuming more calcium than the upper limit of 1,500 mg that is recommended. The amount of K2 is insufficient –you need at least 120 mcg per day, maybe even more, to balance this much calcium!
I will also be taping a video clip discussing hydroxyapatite – I no longer recommend this type of calcium supplement for a number of reasons, which I will also discuss in full in a video clip. In brief, hydroxyapatite is calcium bound to phosphorus, and will disassociate from the phosphorus during digestion – as it will from any compound to which it is bound. So, you are paying more for nothing – and in fact, you are paying more for additional phosphorus, which you definitely do NOT need or want. I recently finished writing a review article on the excessive phosphorus intake in the US and Europe, which has been connected to an increase in osteoporosis, cardiovascular disease, and all-cause mortality – not just in those with kidney disease, but in the general population. This article will be in the next issue of IMCJ.
My advice to you is to take a calcium supplement that is properly balanced and does not contain phosphorus. If you look at AlgaeCal Plus, you will see it delivers a total of 720 mg of calcium per day, which you are to take in divided doses of 360 mg twice daily, and it also contains 90 mcg of K2 (MK-7), which is sufficient to balance this amount of calcium along with the 1,600 mg of vitamin D3 supplied. Because AlgaeCal Plus is properly designed, it will not cause constipation or bloating for you.
Hope this helps, Lara


Hello Lara,

Thank you so much for the benzodiazepine information! Have you done any more research on Clonazepam? From what I can find, it decreases prolactin unlike other benzos.

I arrived here searching for nutrients depleted by Clonazepam. I had already read that benzos can deplete biotin, vitamins D and K, calcium, and melatonin. I was on Clonazepam for 7.5 years and developed debilitating chronic fatigue about 4 years into it. I’ve been off of Clonazepam for almost 4 years but still suffer the fatigue and chronic neck/shoulder pain and tightness.

I’ve experienced periods of remission supplementing vitamin D but keep relapsing, so I’m looking into the other factors that are involved with vitamin D metabolism. I have a great reaction to MegaFood calcium, getting a ton of energy. Other calciums had no effect. I’ve also just added Garden of Life Raw Calcium (AlgaeCal) today.

I just started your book also to see if there is any additional info not presented here. I’d love to know why the side effects have lingered so long after discontinuing Clonazepam. But even more importantly I want to fix the damage.

Thanks again!


Hi David,

I have contacted Lara regarding your question and she is on vacation until next week. She will answer it when she gets back.

– Monica from AlgaeCal


Thanks Monica!


You’re welcome, David!

Lara has actually taken the time during her vacation to respond to your question. This was her response below:

Hello David,
Thank you for the info on Clonazepam decreasing prolactin, which I hadn’t known. It also decreases TSH – so perhaps caused thyroid dysfunction that is still contributing to your concerns?

Also, as you probably know, long term use of benzodiazepines can cause significant liver damage.
Here’s a good paper on this:Foster GR, Goldin RD, Freeth CJ, et al. Liver damage in long-term anticonvulsant therapy: a serological and histological study. Q J Med. 1991 Apr;79(288):315-22. PMID: 1852857

Here’s the abstract for this paper: The prevalence of liver damage in patients receiving long-term anticonvulsant therapy was determined, using a new marker of liver disease, the serum F protein concentration. Abnormal serum F protein concentrations were detected in 50 per cent of 34 patients receiving anticonvulsant therapy. A retrospective analysis of post-mortem liver samples showed common histological abnormalities in three out of seven patients who had died whilst receiving anticonvulsant therapy. These changes were not seen in control patients. We suggest that chronic anticonvulsant therapy may cause significant hepatocellular damage.

For this reason, checking your liver function and supporting detoxification may be very helpful for you. The benzodiazepines, and specifically Clonazepam, are cleared primarily via CYP3A in Phase I, and glucuronidation in Phase II liver detox. Have you had tests run to see if you have a slow CYP3A or issues with glucuronidation? If so, these might have contributed to your onset of chronic fatigue / neck & shoulder muscle pain & tightness. And support for more effective detoxification might be helpful for you as impaired detox could still be contributing to your issues.

Re other factors involved with vitamin D metabolism – have you been checked for heavy metals? Heavy metal toxicity is extremely common. Mercury and lead both prevent activity of the enzyme in the kidneys that is responsible for the conversion of vitamin D into its most active form.

Re AlgaeCal Plus – it may provide substantial benefit for you because it is not just calcium (although it contains 4 different forms of calcium). AlgaeCal provides the full, and very wide range of trace minerals absorbed by the marine algae, Algas calcareus, to build its bony structure. Many of these trace minerals are now insufficiently supplied in our modern Western diet. Foods grown with the use of phosphate fertilizers have significantly lower levels of many minerals than those grown organically. Our bodies require these trace minerals for optimal function.

I hope this gives you some new areas to explore, and that what you find helps you fix the damage and regain the vibrant health you deserve,


You’re welcome, David!

Lara has actually taken the time during her vacation to respond to your question. This was her response below:

Thank you Monica for helping out!

Hi Lara, hope you are having a fabulous vacation. And thank you so much for taking time out of your vacation to reply.

It also decreases TSH – so perhaps caused thyroid dysfunction that is still contributing to your concerns?

I’ve seen the references to Benzodiazepines inhibiting cold-induced TSH, but I don’t think it applies outside of the cold temperature. My TSH has usually been elevated (3.5+) over the course of this illness.

For this reason, checking your liver function and supporting detoxification may be very helpful for you. The benzodiazepines, and specifically Clonazepam, are cleared primarily via CYP3A in Phase I, and glucuronidation in Phase II liver detox. Have you had tests run to see if you have a slow CYP3A or issues with glucuronidation? If so, these might have contributed to your onset of chronic fatigue / neck & shoulder muscle pain & tightness. And support for more effective detoxification might be helpful for you as impaired detox could still be contributing to your issues.

Yes! I’ve had some success with this in the past. I had night and day improvement after starting Super Thisilyn (Nature’s Way). This remission lasted off and on for a few months, but I couldn’t get it consistent it and moved on to other supplements. Chronic constipation is hindering elimination of toxins. ALT/AST have never been out of range. Any suggestions?

Biotin and vitamin D, both depleted by benzos, are the other supplements that have triggered profound remission for me. But unable to maintain.

I see Wikipedia says Clonazepam is metabolized extensively via nitroreduction by cytochrome P450 enzymes, particularly CYP2C19 and to a lesser extent CYP3A4.

Re other factors involved with vitamin D metabolism – have you been checked for heavy metals? Heavy metal toxicity is extremely common. Mercury and lead both prevent activity of the enzyme in the kidneys that is responsible for the conversion of vitamin D into its most active form.

I’ve had RBC lead and mercury separately show up elevated in NutrEval tests. Quicksilver, which is supposed to be the best for mercury, didn’t show a mercury issue. I haven’t done anything to specifically target this.

I have so much testing over the last 6 years showing all kinds of things out of range, but nobody can seem to piece it together for a real diagnosis and treatment. For example: vitamin D 16-24 ng/mL; low TIBC and UIBC; almost all amino acids low; TSH high but in range; low but in range free T3 and T4; low neurotransmitters; low potassium; high small intestinal methane gas; low glutathione, MTHFT heterozygous; etc…

The MegaFood calcium that triggered a day or two of remission doesn’t seem to do anything at this point. Possible to much or not enough vitamin D, calcium, K2, or something else. I’ll see if the Super Thisilyn does anything at this point. Do you think it’s worth getting the 24 hour calcium test? And how about the DEXA scan?

Thank you!


I have ER+ breast cancer and am now on Arimidex. Bone density test showed osteoporosis. I refuse to take any of the Rx meds for this and would take AlgaeCal with D, K and magnesium, but am concerned about the Boron in it since Boron is thought to increase estrogen. I feel like I am in a catch 22 situation with this. Is there a “safe” amount of Boron that can be taken? Thanks


Hi Pam,

You can take AlgaeCal Plant Calcium, which does not have added boron like AlgaeCal Plus, instead.

– Monica from AlgaeCal


Hi Pam,

Following up your question regarding boron and safety, Lara has just recently filmed some videos on boron on our AlgaeCal YouTube Channel. I believe you will find them very helpful.

Why boron is essential for healthy bones: https://www.youtube.com/watch?v=GqdDT8m0bCI&index=12&list=PLLnG3zG5sc8JDmacgYDsDWBuw7QcOmdKP
Boron and Your Health (for breast cancer survivors who are taking aromatose inhibitors): https://www.youtube.com/watch?v=a7nyoXHlapU&list=PLLnG3zG5sc8JDmacgYDsDWBuw7QcOmdKP&index=14
Recommended Daily Allowance (RDA) of Boron: https://www.youtube.com/watch?v=lTPznEonlz8&list=PLLnG3zG5sc8JDmacgYDsDWBuw7QcOmdKP&index=15
The Many Benefits of Boron: https://www.youtube.com/watch?v=r4s6WxvAvbg&list=PLLnG3zG5sc8JDmacgYDsDWBuw7QcOmdKP&index=13

– Monica from AlgaeCal

Susan Richards

I am starting to take AlgaeCal Plus. In addition I will be taking 4000IU extra Vit D3, 600mg extra Magnesium Citrate, and 100 mcg extra K2 (MK-7). I have to take a higher dosage of D3 because of a long-term prescription drug that I must continue to take. My question is about Vit A. I read from multiple sources that more Vit D supplementation requires supplementing with Vit A. What is the recommended ratio of D & A, and what type should the Vit A be (retinol, carotenoids, etc.)? Could I use a plant-based Vit A supplement? Thanks.

Lara Pizzorno

Hi Susan,

Yes, vitamin A works with both vitamin D and vitamin K2 and the 3 nutrients must be in balance for healthy bone remodeling. Vitamin A has been maligned as causing bone loss, but, when in balance with vitamin D, it does not and in fact, promotes healthy bone rebuilding. I’ll be writing a lot more about all this and will explain the ways in which the 3 nutrients interact in future posts on AlgaeCal’s website, but to reply to your question ASAP, here’s the bottom line.

As of yet there is no established optimal ratio for vitamins A and D, but since they balance each other’s activities in the nucleus of your cells, it seems rational to consume approximately as much vitamin A as vitamin D. The UL (upper limit) for vitamin A is 10,000 IU per day (70,000 IU per week), so if you are taking 6,000 IU of D3 daily (from AlgaeCal Plus and the additional 4,000 IU of D3 you are taking), you can very safely take around 6,000 IU of vitamin A as well. Vitamin A supplements are most commonly available in doses of 5,000 IU – an amount that should be adequate to balance your vitamin D3 intake.

No, you cannot rely upon a plant-based supplement for your vitamin A.
Vitamin A deficiency is quite widespread both because of lack of this nutrient in the Standard American Diet [SAD] (the only really good source is liver), and also because many people (including medical professionals) believe, mistakenly, that everyone can convert beta-carotene into vitamin A. Beta-carotene is called “pro-vitamin A” because it has been thought that humans can convert beta-carotene into vitamin A. We have known for the last 10 years that this is not the case. In fact, the vast majority of folks cannot convert beta-carotene into vitamin A because of their genetic inheritance. Very common single nucleotide polymorphisms –SNPs– in the enzymes required to convert beta-carotene to retinoic acid (vitamin A) render these enzymes ineffective in making the conversion. At least 70% of us have one or more of these SNPs. Beta-carotene continues to be referred to as “vitamin A,” and you are likely to see “authorities” telling you that various plant foods, such as sweet potatoes, carrots or mangoes, are rich in vitamin A, when what they contain is beta-carotene, not retinoic acid. Let me underscore this: Beta-carotene is NOT vitamin A and does not provide balance for the actions of vitamin D and does not exert vitamin A’s effects. Only if you are among the small number of folks whose genetic inheritance includes the rare active versions of the enzymes that can convert beta-carotene into vitamin A will you produce some vitamin A from beta-carotene. AND you will still not convert all the beta-carotene you consume into retinoic acid.

Human clinical studies suggest that real vitamin A — in balance with vitamin D — is beneficial, not harmful to bone. The most recent papers indicate that high vitamin A intake combined with low intake of vitamin D is what favors a decrease in BMD and increase in fracture risk. Current thinking is that it is the ratio between vitamin A and vitamin D that determines vitamin A’s effects on bone, not vitamin A alone.
Furthermore, vitamin A is required for immune tolerance, and vitamin A insufficiency promotes inflammation, and chronic inflammation activates osteoclasts and promotes bone loss. A recently recognized subset of immune cells, the helper T cells of the TH17 lineage, generate highly inflammatory messenger molecules called IL-17 cytokines, which turn on a key player in the inflammatory cascade called NFκB, thus really ramping up inflammation. Retinoic acid (vitamin A) inhibits the differentiation of these TH17 cells and promotes the generation of other immune cells (regulatory T cells) that produce an anti-inflammatory cytokine called IL-10.

It’s great that you are now taking AlgaeCal Plus – if you’ve read the latest research on this unique trace mineral-rich, plant-derived calcium supplement, you already know that it will definitely help you build bone. And you are absolutely correct in wanting to also supplement with sufficient REAL vitamin A to balance the amount of vitamin D3 you require.
Be well!

Conaway HH, Henning P, Lerner UH. Vitamin a metabolism, action, and role in skeletal homeostasis. Endocr Rev. 2013 Dec;34(6):766-97. doi: 10.1210/er.2012-1071. Epub 2013 May 29. PMID: 23720297
Henning P, Conaway HH, Lerner UH. Retinoid receptors in bone and their role in bone remodeling. Front Endocrinol (Lausanne). 2015 Mar 11;6:31. doi: 10.3389/fendo.2015.00031. eCollection 2015. PMID: 25814978
Caire-Juvera G, Ritenbaugh C, Wactawski-Wende J, et al. Vitamin A and retinol intakes and the risk of fractures among participants of the Women’s Health Initiative Observational Study. Am J Clin Nutr. 2009 Jan;89(1):323-30. doi: 10.3945/ajcn.2008.26451. Epub 2008 Dec 3. PMID: 19056568
Pizzorno L. Vitamin A: tolerance extends longevity. Longevity Medicine Review. 2009 http://www.lmreview.com/articles/view/vitamin-a-tolerance-extends-longevity/
Pizzorno L. Common genetic variants and other host-related factors greatly increase susceptibility to vitamin A deficiency. Longevity Medicine Review. 2010 http://www.lmreview.com/articles/view/common-genetic-variants-and-other-host-related-factors-greatly-increase-susceptibility-to-vitamin-a-deficiency/

– Lara


Hi Susan,

Lara has reached out directly to answer this 🙂

– Monica from AlgaeCal

Susan Richards

Lara – Thanks for the information above. I have a copy of Your Bones (2013), and after reading about the need for other vitamins/minerals along with Ca, D, Mg, & K2 I was considering this multi vitamin/mineral supplement http://www.lifeextension.com/Vitamins-Supplements/item02001/One-Per-Day-Tablets
It says Vit A is 5000IU, but is listed beta-carotene & acetate. So no telling what percentage is what. Can you recommend a multivitamin containing Vit A (retinoic acid) OR can you recommend a multivitamin with Vit A being purchased separately? I’d like to avoid having multiple supplements to buy, cost being a big factor. I currently will have AlgaeCal Plus, extra Vit D, extra Mg, extra K2, Fish Oil, and was hoping to use the multivitamin listed above to cover the rest. Please email me if you don’t want to put specific product names on this website. THANKS!

Patricia Martin

It is my husband that has osteoporosis and is on alendrona 70/vitD3 5600.once a week. He is also on prednisone 2mg daily for polymyalgia rheumatica. I recently started him on algae cal plus. Is this too much vit D3?


Hi Patricia,

The only way to know for sure is to have your husband get his levels of 25(OH)D tested. The Vitamin D Council will now send you a test kit in the mail. It’s easy and very accurate– a tiny finger prick is all that’s needed to get a drop of blood for this test – and then you just pop it back in the mail. Otherwise, you can ask your doctor for this test.

Everyone is different and has different needs, therefore, testing must be done before you can know how much vitamin D3 is ‘too much’ for the individual.

– Monica from AlgaeCal

Lara Pizzorno

Hi Patricia,

No, your husband is not getting too much vitamin D by adding in AlgaeCal Plus, and may still not be getting enough.

Your husband is taking alendronate in a 70 mg dose once a week — alendronate is the bisphosphonate best known under its patented name of Fosamax. Alendronate does not help build new healthy bone; it causes retention of old, worn out bone — and has many adverse side effects, including causing fractures and osteonecrosis of the jaw and atrial fibrillation and plenty more. Alendronate — or any of the other other drugs used to manage osteoporosis — are not the answer! I have reviewed the research showing this-beyond any doubt in Your Bones in depth. Your husband needs a healthy whole foods diet plus targeted bone health supplements to provide his bones with the nutrients they require to rebuild, plus regular weight bearing exercise to stimulate bone formation. Alendronate provides none of this; it just poisons osteoclasts causing the retention of old, brittle bone, and prevents normal, healthy, necessary bone rebuilding.

If he is only taking 5,600 IU of vitamin D3 once a week, this is far too low a dose to help. It averages out to just 800 IU per day. Adding AlgaeCal to this will add 1,600 IU of D3 daily.

Most people require at least 2,000 IU of D3 every day to get their vitamin D levels into decent range. In just a couple of hours of sun exposure on uncovered skin — when not wearing sunscreen — humans make around 10,000 IU of D3.

Vitamin D Council recommends taking 5,000 IU of D3 daily for 3 months, then testing to see what your blood levels of vitamin D are, then adjusting your dosage up or down depending upon your test results. To do this, your husband should have his blood levels of 25(OH)D — the form in which vitamin D circulates in the bloodstream — checked; his doctor can order this blood test for him, and it should be covered by his medical insurance. Or you can go on-line to the Vitamin D Council website and order a finger prick test from them that will be sent to you in the mail & is very easy to do.

Optimal blood levels of 25(OH)D are between 50 & 80 ng/mL Your doctor may tell you that 30 ng/mL is fine, but it is not. 29 ng/mL indicates frank deficiency. 30 ng/mL is NOT adequate, much less optimal, and he needs optimal (as do we all). Blood levels of 25(OH)D over 100 ng/mL are excessive, but are not seen unless someone is taking huge doses — like 100,000 IU/day — for many months.

To manage (not cure, just suppress symptoms of) his polymyalgia rheumatica, a condition that indicates very high levels of chronic inflammation, your husband is also taking prednisone, which is harming his bones greatly via a number of mechanisms. I explain them in detail in an article I just finished on “Prescription Drugs that Cause Osteoporosis” that will be available on AlgaeCal’s website shortly if it’s not already there. One of the ways through which prednisone destroys bone is by depleting vitamin D3, so your husband may require even more than the 5,000 IU/day recommended by the vitamin D Council. Please take a look at this article and discuss the recommendations I make there for combatting the adverse effects of prednisone on bone with your husband’s doctor. I have provided the references for the most recent PubMed papers discussing these issues; please share them with his doctor. I very much hope his doctor will get up to date and give your husband the help he needs to protect his bones.

AlgaeCal Plus will provide your husband with the key nutrients his bones must have to rebuild. He should also consider taking Triple Power because it will greatly help in lowering his inflammation. Chronic inflammation causes continual activation of osteoclasts, the specialized cells that break down bone, and too much osteoclast activity promotes bone loss. The way to deal with this is not to poison osteoclasts and prevent needed bone remodeling, but to figure out WHAT is causing so much inflammation in the body and to correct it, not just manage it with other drugs that destroy bone. One example of a very common reason in our lives for excessive inflammation is that we do not get anywhere near the amount of anti-inflammatory omega-3 fatty acids we need, and get way too much of the pro-inflammatory omega-6 fatty acids. Triple Power will supply these omega-3s along with 2 potent, natural anti-inflammatory agents, curcumin and astaxanthin, and — unlike prednisone – will not destroy your husband’s bones.

Be well,


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