osteoporosis, exercise and cancer laura a. james, nd, fabno red cedar wellness center bellevue, wa ...
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Osteoporosis, Exercise and CancerLaura A. James, ND, FABNORed Cedar Wellness Center Bellevue, WAwww.redcedarwellness.com425.451.0999
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 cancerLaura 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
Osteoporosis
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What is Osteoporosis?
• 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
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What Is Osteoporosis?
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What is Osteoporosis?
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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
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Do I Have Osteoporosis or Osteopenia?
• 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!
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DEXA & N-telopeptide
• 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
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Signs & Symptoms
• 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
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Signs & Symptoms
• Concurrent conditions can increase risk of falling• Orthostatic hypotension• Dementia• Movement disorders• Balance disorders• Loss of skeletal muscle• Vision problems
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Risk Assessment
• Get a DEXA
• Plug information into FRAX• http://www.shef.ac.uk/FRAX
• Evaluate overall health• Evaluate living environment for fall risk, i.e.,
loose carpets, obstacles
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Nonmodifiable Risk Factors
• Heredity• Female sex• Estrogen and/or testosterone deficiency• European or Asian ancestry
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Modifiable 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
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The Four Cornerstones
Diet Exercise
SleepStress
Management
Diet• Balanced, whole foods, anti-
inflammatory 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 sugarLaura A. James, ND, FABNO
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Diet
• Websites for more information:• 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
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Exercise• 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!
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
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Exercise
• 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
National Exercise Recommendations for Weight Loss and Fitness
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!!
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Exercise• 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
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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
Biochemicals Affected by Stress
Neurotransmitters: • Dopamine• Acetylcholine• GABA• Serotonin
Cytokines:• IL series• CRP• TNF-a
Hormones: • Cortisol • Insulin• Thyroid
hormone • Estrogen• Progesterone• Testosterone• DHEA• Epinephrine
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Healthy Response to 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
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Supplementation
Change Modifiable Risks
Four Cornerstones
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Vitamins & Minerals
VitaminsD3 K2 C B
MineralsCalcium Magnesium Boron
Zinc Strontium
Vitamin D
• Fat soluble vitamin that plays a role in:Calcium metabolism Bone and cartilage strength
Tooth and gum health Insulin productionLipid 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
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Vitamin K• Fat soluble nutrient
• 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
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Vitamins B & C• B vitamins
• B6, B12, folate, and riboflavin• Essential for adequate metabolism of homocysteine• Homocysteine is a bad actor: can interfere with collagen cross-
linking and increase inflammation
• Vitamin C• Essential cofactor for collagen formation• Stimulates production of osteoblasts (bone builders)• Key antioxidant
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Calcium• 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
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Boron• 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
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Magnesium• 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
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Zinc• 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
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Strontium• 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
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Supplementation
Change Modifiable Risks
Four Cornerstones
Integrated Medicine Treatment GoalsComplementary cancer
careModulate immune
systemStress managementBalance
neurotransmitters and hormones
Rebuild adrenal glandsImprove sleepDaily exercise
• Address depression and mood changes
• Address cardiovascular health and obesity
• Prevent Metabolic Syndrome
• Mediterranean/low GI diet
• Correct digestive problems
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Q & A
Laura A. James, ND, FABNO
Red Cedar Wellness Center1601 116th Avenue NE Bellevue WA425.451.0999www.redcedarwellness.com