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Dr. Carolyn DeMarco is a general practitioner with a
special interest in women's health and natural medicine
(drdemarco.com)
Dispelling Osteoporosis Myths
Building the Foundation
“A healthy lifestyle
is the best insurance for
healthier bones.”
Dr. Carolyn DeMarco, MD.
Sponsored by Genuine Health
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.
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
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)
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
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)
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
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 AgeRelated Osteoblast Replicative Capacity (ARORC), downregulating the ability to heal micro-fractures
Calcium in Top Forms
• 3 most bioavailable forms of Calcium:
citrate/malate, formate, and bisglycinate
• Years of research had established Calcium citratemalate 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)
Calcium Absorption
Age-Optimal Calcium Intakes
50 to 60 % fall short of adequate calcium intake by food
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
Breaking research on the role of
Vitamin D in health
Globe and Mail April 28, 2007
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)
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)
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
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)
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)
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
pH and Bone Health
Brazel,S. Journal of Bone Mineral Research, Oct: 10(10): 1431-1436
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
Alkaline Bone-Building Diet
4. 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
5. Whole Grains: Brown rice, whole wheat,
amaranth, spelt – 1 cup/day
6. Starchy Vegetables: Yams, sweet
potatoes, squash, turnips – 1 cup/day
Alkaline Bone-Building Diet
6. 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 omega3, -6, -7, -9 supplement daily
7. Dairy and Dairy Substitutes: Yogurt, kiefer,
or soy yogurt – 1 cup/day (organic, fat-free)
Alkaline Bone-Building Diet
8. Fermented Foods: Sauerkraut, miso, tempeh,
sour-dough, apple cider vinegar – 1 cup total
9. Unsalted Seeds: Flax, hemp, sesame,
sunflower seeds – ¼ cup per day
Unsalted Nuts: Almonds, Brazil nuts,
cashews, hazelnuts, pecans – ½ cup per day
10. “Cell-Friendly” Herbs & Spices: Garnish with
parsley, rosemary, curry, etc.
The Role of Vitamin K
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
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
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
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
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
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)
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.
New Treatments
1. Rank Ligand Inhibitors- block action of
osteoclasts
2. Strontium Ranelate stops bone
breakdown while enhancing bone
building
3. Natural hormones, including
progesterone and testosterone
4. Human Growth Hormone, DHEA
5. Dynamic Motion Therapy
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
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
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
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
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 ([email protected])
• Positive mental attitude
• High quality bone building supplement
• Treat menstrual disturbances
• Natural progesterone
• Testosterone and DHEA if necessary
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
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)
Colourful Fruits and Vegetables
Antioxidants
Antioxidants
lycopene
lycopene
Polyphenols
Polyphenols
Recommendation: 5-10 servings a day
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
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
Oxidative stress, antioxidants
and chronic diseases
ROS, Free Radicals
X
Oxidative Stress
Antioxidants
Lycopene/
polyphenol
X
Damaged
DNA, protein, lipid
X
Chronic Diseases
CVD
asthma
LG Rao
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
Number of nodules/well
*
200
Vehicle
*
*
*
**
100
*
*
*
0
* *
*
* *
*
* *
*
13.0
15.0
17.0
EC 10 -6M
EC 10 -5M
Greens+ 0.4mg
Greens+ 0.8mg
Greens+ 1.2mg
Greens+ 1.6mg
Greens+ 2.0mg
Days in culture
greens+ stimulated bone formation
in osteoblasts (Data are mean + SEM of 6 replicates. * = P<0.05.
[Rao et al ASBMR 2005]
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
2. Protocol
on-going
- 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
Today’s 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 greens+bone 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
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
Nutritional Solution
for all Ages
greens+ bone builder works to:
1.
2.
3.
4.
5.
6.
7.
8.
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
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
Healthy Bones Add Up
•
•
•
•
•
Healthy Bones
Healthy Heart
Healthy Brain
Healthy Organs
Long and Healthy Life