Transcript Osteoporosis, Exercise and Cancer

Osteoporosis,
Exercise and Cancer
Laura A. James, ND, FABNO
Red Cedar Wellness Center Bellevue, WA
www.redcedarwellness.com
425.451.0999
Today’s Agenda
• Integrative Medicine Perspective on Cancer
• Osteoporosis
• Exercise
• Integrative Recommendations for Thriving
• Q&A
• Yoga
Laura A. James, ND, FABNO
Integrative Medicine
for Cancer
What is Integrative Medicine
for Cancer?
•
•
•
•
•
•
Science-based holistic approach treats body,
mind, spirit
Use of body’s innate healing power
Use of natural substances to promote healing
Herbs, nutrition, supplements, physical therapies,
natural drugs, counseling, homeopathy and
biofeedback
Pharmaceutical drugs if needed
Complementary to and supportive of conventional
treatment for cancer
Laura A. James, ND, FABNO
What is Integrated Medicine
for Cancer?
• Symptom management during treatment
• Nutritional and metabolic support
• Restoration of health post active treatment
• Provide the tools for proactive survivorship
• Focus on prevention
Laura A. James, ND, FABNO
Integrative Medicine Use by Oncology Patients
Up to 83% of cancer patients use CAM nationally (1)
Women more likely to use than men
Breast cancer patients more likely to use CAM
therapies
70.2% of cancer patients use CAM in western WA (2)
Nutritional, massage, herbs, spiritual, relaxation,
imagery, exercise, lifestyle, diet
(1) Richardson MA, Sanders T, Palmer JL, Greisinger A, et al. Complementary/alternative medicine use in a comprehensive cancer center and the
implications for oncology. Journal of Clinical Oncology 2000;18(13):2501-2504
(2) Patterson RE,Neuhouser ML et al. Types of Alternative Medicine Used by Patients with Breast. Colon, or Prostate Cancer: Predictors, Motives,
and Costs. Journal of Alternative and Complementary Medicine 2002:8 (4):477-485.
Laura A. James, ND, FABNO
Integrative Medicine Approach
• During active treatment: emphasize QOL, decrease side effects
and disease symptoms, support recovery
• Post active treatment: restore health, manage late effects of
treatment, prevent recurrence, reduce risk, emphasize QOL
• Utilize integrated medicine specialists, counselors,
nutritionists, physical therapists, fitness trainers, and continue
routine screenings and labs
• Turn surviving into THRIVING
Laura A. James, ND, FABNO
• Progressive bone disease
• Low bone mineral density of <2.5 SD below
mean peak bone mass
• Measured by DEXA: dual energy X-ray
absorptiometry
• Leads to increased risk of fracture
• Happens mostly in the trabecular bone at long
bone ends and in vertebrae
Laura A. James, ND, FABNO
What is Osteoporosis?
Laura A. James, ND, FABNO
What Is Osteoporosis?
Laura A. James, ND, FABNO
What is Osteoporosis?
• Several types: primary 1, primary 2, and
secondary
• Primary 1 is postmenopausal osteoporosis
• Primary 2 is senile osteoporosis, and occurs in
women and men 2:1
• Secondary is due to medications like
glucocorticoids
Laura A. James, ND, FABNO
What is Osteoporosis?
• Osteopenia means low bone mineral density
• Defined as between 1.0 and 2.5 SD below mean
peak bone mass
• Diagnosed using DEXA
• Not everyone with osteopenia develops
osteoporosis, but considered precursor
• You ARE losing bone!
Laura A. James, ND, FABNO
Do I Have Osteoporosis or
Osteopenia?
• DEXA: Accurate measurements made using
lumbar and trochanter evaluation
• Heel and forearm DEXA are not accurate for
evaluating total bone density
• DEXA shows changes in BMD over a several year
period
• N-telopeptide , which comes from collagen, is a
urine test that indicates rate of bone loss
Laura A. James, ND, FABNO
DEXA & N-telopeptide
• Silent disease
• Osteoporosis can be asymptomatic until you
break a bone!
• Vertebral column, rib, wrist, and hips are most
vulnerable
• Sudden back pain can indicate vertebral
collapse—a compression fracture
• Hip fracture can be debilitating for the elderly
Laura A. James, ND, FABNO
Signs & Symptoms
• Concurrent conditions can increase risk of falling
• Orthostatic hypotension
• Dementia
• Movement disorders
• Balance disorders
• Loss of skeletal muscle
• Vision problems
Laura A. James, ND, FABNO
Signs & Symptoms
Risk Assessment
• Get a DEXA
• http://www.shef.ac.uk/FRAX
• Evaluate overall health
• Evaluate living environment for fall risk, i.e.,
loose carpets, obstacles
Laura A. James, ND, FABNO
• Plug information into FRAX
• Heredity
• Female sex
• Estrogen and/or testosterone deficiency
• European or Asian ancestry
Laura A. James, ND, FABNO
Nonmodifiable Risk Factors
• Smoking!
• Excess alcohol
• Vitamin D deficiency
• Nutritional deficiency
• Very high protein
intake
• GI function
• Underweight
• Inactivity
• Overactivity
• Heavy metals
• Soft drinks
• Fluoride
consumption
Laura A. James, ND, FABNO
Modifiable Risk Factors
The Four Cornerstones
Sleep
Exercise
Stress
Management
Laura A. James, ND, FABNO
Diet
Diet
• Balanced, whole foods, antiinflammatory diet
• Top Ten cancer-fighting foods
• Mediterranean/low glycemic index
foods
• Healthy fats
• Greens drinks
• Green tea
• Limit alcohol
• Improve digestion and elimination
• Identify food sensitivities
• Balance hormones,
neurotransmitters, blood sugar
Laura A. James, ND, FABNO
Laura A. James, ND, FABNO
Diet
•
•
•
•
•
•
http://www.hsph.harvard.edu/nutritionsource/
http://glutenfreegirl.com/
http://www.ewg.org/
http://pccnaturalmarkets.com
http://wholefoodsmarket.com
Cynthia Lair at http://cookusinterruptus.com and
http://cynthialair.com
• Tom Malterre at http://wholelifenutrition.net
• Michael Pollan at http://michaelpollan.com
• “Forks over Knives” at http://forksoverknives.com
Laura A. James, ND, FABNO
• Websites for more information:
Laura A. James, ND, FABNO
• Lack of weight-bearing and resistance
exercise is well-documented risk for
osteoporosis
• Exercise stimulates osteoblasts, cells
that create bone
• Brisk walking >20 minutes daily
• Typical gain is 1-3% annually, but
without exercise loss is up to 2%
annually because sedentary people
lose BMD
• Use it or lose it!
Laura A. James, ND, FABNO
Exercise
Exercise
• Cardiovascular and bone
building benefits
• Manage excess weight and
abdominal fat
• Calming, restorative movement
like yoga, Tai Chi
• Helps to regulate hormones and
neurotransmitters
• Helps with quality sleep and
stress management
• Combats chronic health issues
• Feels great!
Laura A. James, ND, FABNO
• Be dynamic, not static
• Exceed a “threshold intensity”
• Exceed a “threshold strain frequency”
• Be relatively brief and intermittent
• Impose an unusual “loading pattern” on
your bones
• Work on balance
Laura A. James, ND, FABNO
Exercise
NIH Obesity Panel
45 minutes moderate intensity daily
500-1000kcal deficit
Institute of Medicine
60 minutes moderate intensity daily
Calorie deficit
USDA
60 minutes moderate to vigorous
intensity daily
Do not exceed calorie recommendations
CDC
30 minutes moderate intensity daily
Sensible portion sizes
ASCM
150-250 minutes moderate intensity per
week
Calorie restriction
HHS
60 minutes moderate intensity daily
UPSHOT
40 MINUTES DAILY
EAT LESS!!
Laura A. James, ND, FABNO
National Exercise Recommendations for Weight Loss and
Fitness
• Moderate intensity exercise is 60-70% of
maximum heart rate.
• Moderate to vigorous exercise is 70-85% of
maximum heart rate.
• Quick and Dirty way to calculate your maximum
heart rate:
• 220 – age = MHR
Laura A. James, ND, FABNO
Exercise
Sleep
• Lifestyle: good sleep hygiene, exercise,
healthy diet, limit stimulants, stress
management!
• Eight hours nightly
• Herbs: valerian, hops, passion flower,
kava, skullcap, chamomile, lavender,
lemon balm, oats
• Supplements: calcium, magnesium,
inositol
• NT/Hormones: melatonin, 5HTP, GABA
Laura A. James, ND, FABNO
Stress Management
• Stress alters body’s biochemical balance and can alter cancer
prognosis and bone health
• Stress hormones systemic inflammation and influence insulin
balance, which are cancer promoters
• Good practices can help whatever phase you’re in!

Laura A. James, ND, FABNO
Neurotransmitters:
Hormones:
•
•
•
•
• Cortisol
• Insulin
• Thyroid
hormone
• Estrogen
• Progesterone
• Testosterone
• DHEA
• Epinephrine
Dopamine
Acetylcholine
GABA
Serotonin
Cytokines:
• IL series
• CRP
• TNF-a
Laura A. James, ND, FABNO
Biochemicals Affected by Stress
• Change your attitude!
• Get at least 8 hours of sleep nightly
• Rest and relax! Engage PNS, turn off SNS
• Eat a whole foods diet
• Daily exercise
• Take supplements if necessary
Laura A. James, ND, FABNO
Healthy Response to Stress
Change Modifiable
Risks
Four Cornerstones
Laura A. James, ND, FABNO
Supplementation
Vitamins & Minerals
Vitamins
Minerals
Calcium  Magnesium  Boron
Zinc  Strontium
Laura A. James, ND, FABNO
D3  K2  C  B
Vitamin D
• Fat soluble vitamin that plays a role in:
Calcium metabolism  Bone and cartilage strength
Tooth and gum health  Insulin production
Lipid metabolism  Immune system function
Cancer development
• Without adequate D, only 10-15% of calcium is
absorbed
• Active form is 1,25(OH)D3
Vitamin D
Vitamin D Deficiency
• Lack of sun exposure
• Latitudes above 40°
• Fat-binding drugs like statins
• Fat malabsorption, problems with bile or
digestive enzymes
• Dark skin or dark tan
• Obesity
• Hormone imbalances
• Aging
Vitamin K
• K1 is needed for adequate clotting. Converts to K2 in gut.
• K2 activates osteocalcin, which is required for deposition of
calcium
• K2 activates matrix-Gla protein which prevents calcium from
depositing in soft tissue
• K2 lowers inflammation
• Comes from dark green leafy vegetables and supplements
• Must supplement with K2 (MK-7)
• Works in tandem with vitamin D on osteocalcin and matrix-Gla
Laura A. James, ND, FABNO
• Fat soluble nutrient
Vitamins B & C
• B6, B12, folate, and riboflavin
• Essential for adequate metabolism of homocysteine
• Homocysteine is a bad actor: can interfere with collagen crosslinking and increase inflammation
• Vitamin C
• Essential cofactor for collagen formation
• Stimulates production of osteoblasts (bone builders)
• Key antioxidant
Laura A. James, ND, FABNO
• B vitamins
• Gives bones strength and density as hydroxyapatite
• Essential for blood clotting, neurotransmitter release, nerve
conduction, and muscle contraction
• Regulates enzyme activity and cell membrane function
• Supplementation alone has only minimal impact on BMD
• Best forms:
•
•
•
•
•
Calcium citrate
Calcium malate
Calcium gluconate
Hydroxyapatite
Algae-derived calcium
Laura A. James, ND, FABNO
Calcium
• Trace mineral
• Required for conversion of estrogen into 17-beta-estradiol,
form that increases absorption of magnesium
• Helps to form crystalline lattice form of bone
• Necessary for turning vitamin D into active form 1,25(OH)D3
Laura A. James, ND, FABNO
Boron
•
•
•
•
•
•
•
Activates more than 350 enzymes
Helps produce ATP, the body’s energy currency
Key component of bone lattice structure
Helps convert vitamin D into active form
Stress uses up magnesium very quickly
Taking vitamin D increases need for magnesium
Best forms of magnesium:
• Magnesium citrate
• Magnesium malate
• Magnesium aspartate
Laura A. James, ND, FABNO
Magnesium
•
•
•
•
•
Trace mineral
Essential for immune system function
Helps cells respond to insulin
Deficiency leads to chronic inflammation
Required to activate DNA transcription factor needed for
development of osteoblasts
• Need to balance with copper
Laura A. James, ND, FABNO
Zinc
• Well studied as decreasing risk of vertebral fracture
• Chemically similar to calcium
• Helps slow down the development of osteoclasts and
enhances osteoblast production
• Form matters! Use Strontium citrate, not ranelate
Laura A. James, ND, FABNO
Strontium
Change Modifiable
Risks
Four Cornerstones
Laura A. James, ND, FABNO
Supplementation
Complementary cancer
care
Modulate immune
system
Stress management
Balance
neurotransmitters and
hormones
Rebuild adrenal glands
Improve sleep
Daily exercise
• Address depression and
mood changes
• Address cardiovascular
health and obesity
• Prevent Metabolic
Syndrome
• Mediterranean/low GI
diet
• Correct digestive
problems
Laura A. James, ND, FABNO
Integrated Medicine
Treatment Goals
Q&A
Laura A. James, ND, FABNO
Red Cedar Wellness Center
1601 116th Avenue NE  Bellevue  WA
425.451.0999
www.redcedarwellness.com