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

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

3. Dispelling Osteoporosis Myths

4. Building the Foundation “A healthy lifestyle is the best insurance for healthier bones.” Dr. Carolyn DeMarco, MD. Sponsored by Genuine Health

5. Myth #1: ‘Bone health is an old age concern’ FACT: It’s 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 Apr;17(2):191.

6. 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

7. 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)

8. 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

9. Contraception Take with caution! • Women who don’t 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)

10. 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

11. 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 doesn’t equal better: • Consuming over 3,000mg calcium daily exhausts the Age-Related Osteoblast Replicative Capacity (ARORC), down-regulating the ability to heal micro-fractures

12. 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)

13. Calcium Absorption

14. Age-Optimal Calcium Intakes50 to 60 % fall short of adequate calcium intake by food

15. Calcium alone is not enough • Important co-factornutrients 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

16. Breaking research on the role of Vitamin D in health Globe and Mail April 28, 2007

17. 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)

18. 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)

19. 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

20. 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)

21. 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)

22. 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. Michael’s Hospital and University of Toronto UWO researchers identified pH receptor that stimulates osteoclasts

23. pH and Bone HealthBrazel,S. Journal of Bone Mineral Research, Oct: 10(10): 1431-1436

24. Alkaline Bone-Building Diet • Water: 8 full glasses a day with a squeeze of lemon or lime juice, 2 cups of herbal tea • Colour-Coded Vegetables: Vary the seasonal colours & textures, 4 or more cups a day • Colour-Coded Fruit & Berries: Vary the bright colours by season, 2 cups a day

25. Alkaline Bone-Building Diet • 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 • Whole Grains: Brown rice, whole wheat, amaranth, spelt – 1 cup/day • Starchy Vegetables: Yams, sweet potatoes, squash, turnips – 1 cup/day

26. 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)

27. 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.

28. The Role of Vitamin K

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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)

35. 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.

36. 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

37. Strontium • Abundant element in earth’s 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

38. 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

39. 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

40. Natural Hormones • Dr. Jerilynn Prior’s 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

41. 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@oregonstate.edu) • Positive mental attitude • High quality bone building supplement • Treat menstrual disturbances • Natural progesterone • Testosterone and DHEA if necessary

42. 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 can’t take meds, including teenagers and children • See www.juvent.com

43. 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)

44. Colourful Fruits and Vegetables Antioxidants Antioxidants lycopene lycopene Polyphenols Polyphenols Recommendation: 5-10 servings a day

45. 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

46. 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

47. 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

48. 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

49. greens+ stimulated bone formation in osteoblasts (Data are mean + SEM of 6 replicates. * = P<0.05. [Rao et al ASBMR 2005]

50. 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