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 StressNeurotransmitters: • 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