Dr.%20Carolyn%20DeMarco%20is%20a%20general%20practitioner%20with%20a%20special%20interest%20in%20women's%20health%20and%20natural%20medicine%20(drdemarco.com)

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Dr. Carolyn DeMarco is a general practitioner
with a special interest in women's health and
natural medicine (drdemarco.com)
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(No Transcript)
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Dispelling Osteoporosis Myths
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Building the Foundation

• A healthy lifestyle
• is the best insurance for
• healthier bones.
• Dr. Carolyn DeMarco, MD.

Sponsored by Genuine Health
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Myth 1 Bone health is an old age concern

• FACT Its never too early to take care of our
  bones
• The period between adolescence and the early 30s
  is crucial for establishing bone mass
• Studies show we naturally lose bone mass after
  this period, affecting both men and women
• Girls who markedly reduce their activity levels
  after puberty lose bone in their femoral neck
  before their 25th birthday.
• Musts healthy diet, exercise with preventative
  supplementation
• (South-Paul. Am Fam Physician 2001)
• Scand J Med Sci Sports. 2007 Apr17(2)191.

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Bone Building Facts

• Our skeletal system is alive and vibrant
• Skeletal System Structural Growth
• 40 ages 1 to 10
• 40 ages 10 to 20
• 20 ages 20 to 24
• BMD VS. Bone Micro-Architectural Strength
• The Bone Building Internet Bone Is Adaptable
• Osteocytes, area-wide evaluators
• bone-repair at 8,000,000 sites every second
• bone-building peaks between 10 pm and 4 am
• Take bone building supplement 4 -5 hours before
  bedtime

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Osteoporosis

• Osteoporosis could be called a pediatric disease
  with a geriatric consequence
• More than 10 million North Americans have
  osteoporosis and more than 35 million have low
  bone mass (one risk factor of future
  osteoporosis)
• There are more than 1.5 million
  osteoporosis-related fractures in North America
  each year
• As life expectancy increases, these numbers will
  only increase
• (Keen. Curr Osteopor Rep 2003)

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Generation XXX Alarming Statistics

• 1 in 4 veggies consumed by children is French
  fries
• I in 14 eat 4 or more fruits and veggies daily
• 1 in 4 eat candy or chocolate bars daily
• 1 in 3 drink pop daily
• 1 in 4 schools provide phys-ed programs
• 50 of schools have contracts with Pop companies

Globe and Mail National School Survey, Jan. 07
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Contraception

• Take with caution!
• Women who dont ovulate have low serum
  progesterone
• Birth control pills deplete important nutrients
  including B6, B12, folic acid
• Canadian Medical Association Journal (Oct 16,
  2001) showed oral contraceptive users 2.3 to
  3.7 lower BMD than non-users
• Depo-Provera hormone shots also come with risk
• Study showed loss in bone mineral density by 6
  over 2 years
• While non-uses had a gain of 2 during the same
  period.

Obstetrics and Gynecology (May 2004)
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Myth 2 Bone health is separate from other
diseases

• FACT Heart disease and Alzheimer's are just 2
  examples linked to low bone density
• Calcification of soft tissue of the brain, eyes,
  ears, heart, veins and arteries is co-occurring
  with the silent epidemics of
• Bone loss
• Memory loss
• Posture loss
• Structure loss
• Loss of fluid movement
• In almost everyone, to various degrees, 34 and
  older

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Myth 3 Calcium alone is all we need for bone
building

• FACT Studies show relying on Calcium alone is
  not enough
• 50-60 of the population is calcium deficient
• Most are not absorbing sufficient calcium from
  supplements and/or diet combined
• Widespread lactose intolerance
• The body cannot absorb more than 500 mg of
  Calcium at one time
• More doesnt equal better
• Consuming over 3,000mg calcium daily exhausts the
  Age-Related Osteoblast Replicative Capacity
  (ARORC), down-regulating the ability to heal
  micro-fractures

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Calcium in Top Forms

• 3 most bioavailable forms of Calcium
  citrate/malate, formate, and bisglycinate
• Years of research had established Calcium
  citrate-malate as the gold standard in Calcium
  absorption
• Newly available forms of Calcium offer enhanced
  solubility Ca formate and Ca bisglycinate are
  2x more bioavailable than Ca citrate.
• (Hanzlik, et al. J Pharm Exp Ther 2005)
  (Heaney, et al. Cal Tissue Intern 1990)

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Calcium Absorption
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Age-Optimal Calcium Intakes50 to 60 fall
short of adequate calcium intake by food
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Calcium alone is not enough

• Important co-factor nutrients that work with
  calcium for healthy bones
• Vitamin D3
• Magnesium
• Vitamin C
• Folic Acid, B12, B6
• Silicon
• Boron
• Vitamin K
• Selenium
• Zinc, Copper, Manganese
• Lycopene

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Breaking research on the role of Vitamin D in
health Globe and Mail April 28, 2007
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Widespread Vitamin D Deficiency in Canada

• Canadians are most at risk due to location
• From October to March, sunlight too weak (40
  nannomoles/Lvs 125)
• By midwinter most Canadians have depleted stored
  vitamin D
• Researchers take between 1400 - 5000IU a day
• 1200 women in 4-yr. clinical trial reduced
  cancer by 60, taking 1100IU a day.
• (American Journal of Clinical Nutrition June
  2007)

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Vitamin D Deficiency Diseases

• 16 different types of cancer
• 62 increased risk of heart disease stroke
• Multiple sclerosis
• Juvenile Diabetes
• Influenza
• Osteoporosis
• Fracture Incidence
• Large population studies show that dietary
  Vitamin D3 (or sunlight exposure) is associated
  with protection against osteoporosis and
  fractures.
• (Nieves. Am J Clin Nutr 2005)
• (Circulation Jan 7, 2008)

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Vitamin D3 Recommendation

• Vitamin D3 continues to be overlooked despite
  standard medical care, research shows that over
  50 of North Americans with osteoporosis have
  inadequate Vitamin D status!
• Supplementation studies at 800 IU (the exact
  dosage in the bone builder blend) show reduced
  fracture incidence and decreases cancer risk
• National Osteoporosis Foundation recommends
  400-800 IU Vitamin D3 daily.
• Health Canada is now recommending increasing
  upwards to 2000 IU daily

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Vitamin D3 at work

• Drives bone health, measured best by 25OH)D test
• Helps calcium be absorbed into bone-building
  cells
• Inhibits formation of bone breakdown cells
• Helps to prevent Calcium loss through the kidneys
• Assists in the absorption of Calcium from the
  intestines.
• (Holick M. Mayo Clin Proc 2006)

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Magnesium

• Population studies show that higher Magnesium
  intake is associated with higher bone mineral
  density (BMD) in older adults.
• Over 60 of North Americans do not meet the RDA
  for Magnesium.
• Magnesium contributes to an alkaline environment.
• Bones with osteoporosis have low Magnesium
  content and supplementation improves BMD.
• (Tucker. Curr Pharm Des 2003)

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Folic Acid B12 B6

• Reduced folic acid, Vitamins B12 and B6 status is
  associated with a lower BMD and a higher risk of
  fracture.
• Low levels of these B Vitamins is associated with
  accelerated loss of BMD vs. normal aging.
• In addition to supporting the function of bone
  forming cells, all three of these vitamins lower
  homocysteine.
• Elevated homocysteine is now recognized as major
  risk factor for osteoporosis and fracture as it
  hampers bone cell formation and collagen linking.
• (Herrmann et al. Clin Chem Lab Med 2005)

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Myth 4 Diet alone cannot build stronger bones

• FACT Leading research shows a diet rich in
  alkalinizing foods, including phytonutrients may
  be the best bone-building strategy
• Much of my research has shown that dietary
  antioxidants including the polyphenols and the
  carotenoid lycopene found in brightly coloured
  fruits and vegetables play a very important
  role in bone health, which may be important in
  increasing bone density, development and repair.
• Dr. Leticia Rao, Director of Calcium Research
  Laboratory, St. Michaels Hospital and University
  of Toronto
• UWO researchers identified pH receptor that
  stimulates osteoclasts

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pH and Bone HealthBrazel,S. Journal of Bone
Mineral Research, Oct 10(10) 1431-1436
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Alkaline Bone-Building Diet

1. Water 8 full glasses a day with a squeeze of
   lemon or lime juice, 2 cups of herbal tea
2. Colour-Coded Vegetables Vary the seasonal
   colours textures, 4 or more cups a day
3. Colour-Coded Fruit Berries Vary the bright
   colours by season, 2 cups a day

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Alkaline Bone-Building Diet

1. Animal and/or Plant-Based Protein Eat lean
   protein at each meal children 15g/meal
   teenagers 20g/meal, women 20-25g/meal, men
   30-35g/meal
2. Whole Grains Brown rice, whole wheat, amaranth,
   spelt 1 cup/day
3. Starchy Vegetables Yams, sweet potatoes, squash,
   turnips 1 cup/day

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Alkaline Bone-Building Diet

• Good Fats
• Extra-virgin olive oil, 2 tbsp/day
• Cook with macadamia nut oil
• Try coconut oil instead of butter
• Use EPA- and bone-smart DHA-rich fish oils
• Use borage or evening primrose oil
• Combine the best of these fats by using an
  omega-3, -6, -7, -9 supplement daily
• Dairy and Dairy Substitutes Yogurt, kiefer, or
  soy yogurt 1 cup/day (organic, fat-free)

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Alkaline Bone-Building Diet

• Fermented Foods Sauerkraut, miso, tempeh,
  sour-dough, apple cider vinegar 1 cup total
• Unsalted Seeds Flax, hemp, sesame, sunflower
  seeds ¼ cup per day
• Unsalted Nuts Almonds, Brazil nuts, cashews,
  hazelnuts, pecans ½ cup per day
• Cell-Friendly Herbs Spices Garnish with
  parsley, rosemary, curry, etc.

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The Role of Vitamin K
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Myth 5 A DEXA Bone Density Scan is your best
option

• FACT Despite its popular use, it cannot tell the
  strength and architecture of the bone
• Measures the amount of minerals in a specific
  area of bone
• Only measures bone at hip and spine
• Varies according to body size, ethnicity, gender,
  machine, time of year

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T and Z Scores

• T scores compare your bone mineral density (BMD)
  to a normal young adult
• Z score compares your BMD to others of same age
  and gender
• T score of -2.0 means BMD about 20 lower than
  young normal person
• T score of -2.5 chosen as definition of
  Osteoporosis

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Useful Urine Tests

• When bone is broken down, protein fragments
  appear in urine
• Can tell you about rapid bone breakdown,
  response to medications
• Usually covered by medical insurance

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Who would benefit most from treatment?

• Low BMD
• Low impact fractures
• Family history of fracture
• Rheumatoid arthritis
• Lack of exercise
• Use of oral steroids
• Alcohol use
• Sedentary lifestyle

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Role of Medication

• Most effective when combined with exercise and
  lifestyle changes
• Some are proven more effective than others
• Good bone building supplement critical for
  overall health at any age

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Bisphosphonates

• Fosamax, Actonel, Bonviva- most prescribed
• Studied for 10 years or more
• Used for postmenopausal, steroid-induced, and
  male osteoporosis
• Increase bone density at hip and spine and reduce
  fracture rate 30 to 50
• GI side effects possible
• FDA warning (Jan 8, 2008) re severe joint and
  muscle pain jaw bone death (mostly with IV
  drugs)

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Calcitonin/ Parathyroid Hormones

• Calcitonin (miacalcin, calcimar) used for pm
  osteoporosis, painful spinal fractures for men
  and women, works only at the spine to increase
  bone density and reduce fracture rate.
• Parathyroid Hormone (forteo and preos), used for
  men and women with severe osteoporosis, increase
  spinal bone density, by 8 to 10 , very
  expensive and given by daily self injection only
  studied for two years.

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New Treatments

• Rank Ligand Inhibitors- block action of
  osteoclasts
• Strontium Ranelate stops bone breakdown while
  enhancing bone building
• Natural hormones, including progesterone and
  testosterone
• Human Growth Hormone, DHEA
• Dynamic Motion Therapy

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Strontium

• Abundant element in earths crust and sea water
• Human body contains 320mg of strontium found in
  bone and connective tissues
• First used in 1884, lower doses 200mg to 400mg
  daily, used for decades with no apparent toxicity
• Strontium and Calcium should be taken 12 hours
  apart

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Strontium Ranelate

• Appears to decrease bone resorption and stimulate
  bone formation
• Prevents new vertebral fractures, borderline with
  hip fractures
• 3-year study of 1,649 women with previous spinal
  fractures
• 139 had fracture vs. 222 in placebo group
• No major side effects
• Problem taken up by newly formed bone, is
  radoiopaque like calcium and thus may cause
  apparent and not real increases in bone density
• Appears to decrease bone resorption and stimulate
  bone formation

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Strontium Citrate

• No double blind research, however small scale
  studies done indicating bone effect
• Stontrium is strontium says Dr. Prior the
  pharmaceutical industry needed to be able to bind
  it to a synthetic molecule to make a patentable
  product. It is fair to assume natural forms could
  yield results similar to those obtained with
  strontium ranelate
• Dose 680 mg strontium daily on empty stomach
  away from calcium

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Natural Hormones

• Dr. Jerilynn Priors research shows that BMD is
  related to progesterone levels
• Women who maintain normal cycles and levels of
  progesterone gained BMD- 1 a year
• Women with anovulatory cycles or shortened luteal
  phases lose bone.
• Progesterone, a key bone-building hormone, will
  also convert to estrogen and testosterone as
  needed
• Measure blood or saliva levels of estrogen,
  progesterone, free testosterone, DHEA
• DHEA converts to testosterone and estrogen

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Natural prevention of bone loss

• Alkaline diet
• Ref UWO researchers identified pH receptor that
  stimulates osteoclasts
• Weight training, weight bearing and balance
  exercises (strongwoman.com)
• Weighted vest (christine.snow_at_oregonstate.edu)
• Positive mental attitude
• High quality bone building supplement
• Treat menstrual disturbances
• Natural progesterone
• Testosterone and DHEA if necessary

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Dynamic Motion Therapy

• Small device the size of a bathroom scale
• Low intensity high frequency vibration for 20
  minutes five days a week
• May increase bone density
• Useful for all those who cant take meds,
  including teenagers and children
• See www.juvent.com

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New Research Underway

• 2 trials
• Toronto study involving 160 post menopausal
  women not taking medication (to join the study
  call 416 340 4800 x8601)
• US study recruit 200 men women, aged 65 or
  greater in Boston area (funding to come from the
  National Institute on Aging)

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Colourful Fruits and Vegetables
Antioxidants
Antioxidants
lycopene
lycopene
Polyphenols
Polyphenols
Recommendation 5-10 servings a day
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Antioxidants Found in Colourful Fruits and
Vegetables

• Polyphenols
• Water-soluble antioxidants
• The blue, green and purple
• Sources
• Fruits, e.g., berries, apples
• Leafy vegetables lettuce, kale
• Green tea and red wine

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Antioxidants Found in Colourful Fruits and
Vegetables

• Lycopene
• Lipid-soluble antioxidant
• The red colour of tomatoes
• Sources tomatoes tomato products tomato
  paste. Sauce and juice and ketchup watermelon,
  guava, pink grapefruit, papaya
• Incorporated into Nutritional Supplements -
  greens bone builder

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Oxidative stress, antioxidants and chronic
diseases
ROS, Free Radicals
X
Oxidative Stress
Antioxidants Lycopene/ polyphenol
X
Damaged DNA, protein, lipid
X
Chronic Diseases
CVD
osteoporosis
cancer
diabetes
asthma
LG Rao
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Studies on the role of Nutritional Supplements in
osteoblasts (bone forming cells)
Nutritional supplements under study (in our
laboratory)
1. Original greens nutritional supplement - rich
in polyphenols
2. greens bone builder new formulation which
contains the original greens and the following
supplements Vitamins C, B6, B12,
D3 Minerals Ca, Zn, Se, Si,B, Cu, Mn Amino
Acids L-Lysine Lycopene, Folic acid
Shown individually to have beneficial effects on
bone health
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greens stimulated bone formation in osteoblasts
(Data are mean SEM of 6 replicates. Plt0.05.
Rao et al ASBMR 2005
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Clinical Study Effect of greens bone builder
on the risk of osteoporosis in postmenopausal
women
Intervention with 60 postmenopausal women
1. Diet - greens bone builder , or
- Placebo
Recruitment of participants on-going
2. Protocol - Record diet, week 1 - Washout,
week 2 - greens bone builder, weeks 3 to 10 -
Blood/urine sample after 1, 2, 6 10
3. Parameters to be measured - Oxidative stress
parameters - Bone turnover markers -
Antioxidant capacity will be determined
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Todays Messages

• Oxidative stress - risk factor for osteoporosis.

• The antioxidants polyphenols and lycopene are
  present in brightly colored fruits and vegetables
  and food-based nutritional supplements including
  greensbone builder

• Polyphenols present in greens stimulate bone
  formation in osteoblasts

• greens bone builder containing polyphenols,
  lycopene and other supplements that can be added
  to daily diet may play an important role in the
  prevention of osteoporosis.

LG Rao
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Nutritional Solution for all Ages

• greens bone builder Developed by Sam Graci with
  Dr. Leticia Rao based on leading research
• Extends on research-proven greens, containing 23
  plant ingredients and most alkalinizing food of
  its kind
• Contains 500 mg of highly-absorbable forms of
  Calcium Calcium formate, bisglycinate and
  citrate-malate
• Includes research-recommended dosages of
  Magnesium and Vitamin D3
• Copper, Manganese, Boron, Silicon and Vitamin K1
  - among other proven bone-building nutrients

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Nutritional Solution for all Ages

• greens bone builder works to
• Alkalinize the body to prevent Calcium loss from
  bone
• Directly stimulate bone-forming cells
  (osteoblasts)
• Inhibit the cells which break down bone cells
  (osteoclasts)
• Retain minerals in bone and prevent urinary loss
• Prevent the oxidative stress associated with bone
  loss
• Support the enzymes responsible for bone
  structure
• Maximize the integrity of the collagen linking
• Maximize calcium absorption from the GI tract

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Be Proactive

• Eat colourful fruits and vegetables
• Eliminate white foods from your diet
• Make exercise safe and fun
• Use a molecular-targeted, food-based,
  bone-building supplement
• Make time to laugh and play

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Healthy Bones Add Up

• Healthy Bones
• Healthy Heart
• Healthy Brain
• Healthy Organs
• Long and Healthy Life