DEAR DR. BLONZ: My doctor determined that I have osteoporosis in my back and hips. (I am 67.) She now wants me to take a prescription bisphosphonate drug. I do not take any medications, and would prefer not to begin. I do take many vitamins and supplements, including calcium and magnesium. Is there anything I can use instead of a drug? -- J.B., Oakland, California

DEAR J.B.: I am not a medical doctor; my training is in biochemistry and nutrition, and my focus is on food, nutrition and health. I cannot therefore give you any medical advice.

I respect your preference for not relying on medication, but it is important to understand that osteoporosis is a nasty ailment. It involves a reduced bone-mineral density that takes decades to develop. Ironically, it develops at a time in life when the body’s ability to build and fortify its bones is on the wane. The class of medications known as bisphosphonates have a demonstrated ability to help the body in this regard.

Our bones are being made and disassembled (resorbed) throughout our lives. From infancy toward adulthood, the process favors the net building of bone, but from midlife toward our senior years, the balance shifts and our total bone mass begins to wane. Osteoblasts are the cells that help build bone, and osteoclasts are the cells that help resorb existing bone, releasing its calcium and other components back into the bloodstream.

The bisphosphonate compounds slow bone resorption by inhibiting the action of the osteoclasts. They have an extremely long half-life, which is science-talk for saying that they are slowly broken down by the body. Depending on the particular bisphosphonate compound selected, they may only need to be taken weekly or monthly. Newer bisphosphonates may only need to be given once a year.

These are medications, and while there is research-based evidence to support their efficacy, there are potential side effects. I advise you to do some research and bring all your issues to your physician so that you can make the right decision for your case. Check out the review by Berkeley Wellness at tinyurl.com/y93l7oz9.

In addition, you need to be eating well and possibly take additional supplements to provide the nutrients needed to build and maintain bones. Aside from calcium, the body relies on magnesium, phosphorous, fluoride and vitamins A, B-6 and D for calcium absorption and healthy bones. “Food first” is an essential philosophy: Eating healthful foods provides benefits far beyond the named nutrients in a supplement bottle.

Finally, our bodies get conservative with resources as we age, lowering the priority of things that aren’t used on a regular basis. The “use it or lose it” theme applies to our bones, and weight-bearing exercise sends a message that you expect your bones to remain strong and on the job. Exercises such as walking, stretching and weight training can help strengthen the body, no matter what age they are begun. However, activities need to be appropriate for your particular situation. Don’t overdo it; seek the guidance of a professional before you begin.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: Soon after eating something sweet or starchy, I become a bit groggy with an urge to doze off. When out, I can fight it, but sometimes I get nervous and shaky. A friend said that I might have “reactive hypoglycemia,” but I thought those theories were discounted decades ago. -- S.T., Oakland, California

DEAR S.T.: Sugars and other carbohydrates are a source of energy for the body, but they can also be associated with drowsiness, and even, ironically, with the shakiness you describe. One possible explanation is the way simple sugars affect the body and the brain, coupled with inadvertent miscues we give the body through the way we eat.

The body needs to maintain its blood glucose level within narrow limits to keep metabolism on an even keel. Multiple systems kick into gear if glucose gets too high or too low. All the digestible carbohydrates we eat are broken down to simpler sugars, and most end up as glucose in the blood. If it’s from a balanced meal, glucose will rise at a moderate level, but the rise can be rapid if the glucose comes from sweets or a can of soda -- especially if consumed on an empty stomach.

Rising blood glucose is the “I am fed” signal; this then causes insulin to be released by the pancreas. Insulin is the hormone that facilitates the exit of glucose from the blood into the cells, where it provides energy to perform work, build new tissue or create needed substances. A potential connection with drowsiness is the fact that elevating blood glucose and insulin release is paired with the production of relaxation-inducing substances in the brain. (This helps explain the urge to “veg” after a big meal.) The situation becomes more complex in those with Type 2 diabetes, as there can be “insulin resistance” where normal levels of insulin are unable to produce the needed blood-glucose-lowering effect.

You mentioned reactive hypoglycemia, which, although not as common as it was once thought, can develop in some individuals. Reactive hypoglycemia occurs when the body releases too much insulin for a given amount of glucose in the bloodstream.

When blood glucose drops too low, a defense mechanism gets triggered. A hormone involved in this process is adrenaline: the body’s “fight or flight” hormone. Aside from helping provide a small amount of glucose (stored in the liver), adrenaline also revs up the body’s muscles and gets them ready for action. Under the influence of adrenaline, you can feel your heart -- a muscle -- pounding in your chest as it pushes blood into the working muscles to prepare them for action. It is not a pleasant sensation, and the nervousness and shakes you mention could be connected to this phenomenon.

You don’t say much about your general health. I have tried to outline some basic issues, but one certainty is that you need to contact a medical doctor to find out what is going on in your body. There are tests that can provide answers, and it is in your best interest to find out ASAP.

In the meantime, try to stay off the sweet stuff -- especially on an empty stomach.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: I am not very active and do not eat enough fruits and vegetables, so I have tried taking a powdered wheatgrass supplement product for a few months to cover my bases. Is this the best thing to take as a fix for my situation? -- S.T., Casa Grande, Arizona

DEAR S.T.: The product you are referring to is a powder made from dehydrated wheatgrass. It, and other products like it, supplies a modicum of nutrients and a bevy of healthful phytochemicals.

Aside from testimonials, there is little peer-reviewed scientific evidence to support any health benefits to such a supplement. As would be expected, it has a “grassy” taste, but it certainly won’t hurt you. Assuming the company follows good manufacturing processes, I have no problem with dehydrated greens or other such dried-food dietary supplements. The only people who need to be cautious are those with wheat or grass-related allergies.

That being said, such supplements should not be thought of as a substitute for good eating. You need to rethink your complacency with the “I do not eat enough produce” stance. I would guess that you already know that healthful foods, along with regular physical activity, are the way to go. It is not that hard to get on track; it’s all a matter of priorities. Consider it an investment -- one with a science-grounded, long-term payoff you will realize as the years pass.

Pardon the blatant sermonizing, but a wheatgrass supplement is not a fix. The effects of our day-to-day decisions are often subtle and unnoticed, whether beneficial or negative. Chronic diseases, such as heart disease and certain cancers, are cumulative affairs; the manifestations don’t come to the fore until the disease process has been ongoing for years, if not decades. Taking care of yourself increases the odds that your body will be better able to fend off ill health and chronic ailments.

Put simply, there is no evidence that wheatgrass, or any other supplement, would be sufficient to counter the tide of an ongoing unhealthful diet and lifestyle.

DEAR DR. BLONZ: I was hoping to get your opinion on the safety of drinking Kava, a brand of “acid-neutralized” instant coffee. I read mixed safety reviews online. -- D.K.

DEAR D.K.: The information you found on the internet was likely a mix of details about the coffee brand (Kava) and a similarly named tropical herb (kava, or kava-kava). The herb, scientific name Piper methysticum, is associated with liver damage.

I know of nothing wrong with, or dangerous about, the reduced-acid Kava coffee. In this product, the acid normally present in coffee is neutralized by a potassium compound (potassium hydroxide), so it will contain more potassium than regular coffees. Those who need to avoid too much potassium would therefore be wise to rethink this brand, but that is about the only issue.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.