1. Osteoporosis, Exercise and Cancer Laura A. James, ND, FABNO Red Cedar Wellness Center Bellevue, WA www.redcedarwellness.com 425.451.0999

2. Today’s Agenda Integrative Medicine Perspective on Cancer Osteoporosis Exercise Integrative Recommendations for Thriving Q & A Yoga Laura A. James, ND, FABNO

3. Integrative Medicine for Cancer

4. 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

5. 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

6. 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

7. 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

9. 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 Laura A. James, ND, FABNO

10. What Is Osteoporosis? Laura A. James, ND, FABNO

11. What is Osteoporosis? Laura A. James, ND, FABNO

12. 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

13. 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! Laura A. James, ND, FABNO

14. 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 Laura A. James, ND, FABNO

15. 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 Laura A. James, ND, FABNO

16. 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

17. 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 Laura A. James, ND, FABNO

18. Nonmodifiable Risk Factors Heredity Female sex Estrogen and/or testosterone deficiency European or Asian ancestry Laura A. James, ND, FABNO

19. 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 Laura A. James, ND, FABNO

20. The Four Cornerstones DietExerciseSleep Stress Management Laura A. James, ND, FABNO

21. 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 sugar Laura A. James, ND, FABNO

23. 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.comhttp://cookusinterruptus.com http://cynthialair.com Tom Malterre at http://wholelifenutrition.nethttp://wholelifenutrition.net Michael Pollan at http://michaelpollan.comhttp://michaelpollan.com “Forks over Knives” at http://forksoverknives.comhttp://forksoverknives.com Laura A. James, ND, FABNO

25. 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! Laura A. James, ND, FABNO

26. 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

27. 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 Laura A. James, ND, FABNO

28. National Exercise Recommendations for Weight Loss and Fitness NIH Obesity Panel45 minutes moderate intensity daily500-1000kcal deficit Institute of Medicine60 minutes moderate intensity dailyCalorie deficit USDA 60 minutes moderate to vigorous intensity daily Do not exceed calorie recommendations CDC30 minutes moderate intensity dailySensible portion sizes ASCM 150-250 minutes moderate intensity per week Calorie restriction HHS60 minutes moderate intensity daily UPSHOT40 MINUTES DAILYEAT LESS!! Laura A. James, ND, FABNO

29. 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 Laura A. James, ND, FABNO

30. 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

31. 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 

32. 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 Laura A. James, ND, FABNO

33. 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 Laura A. James, ND, FABNO

34. Supplementation Change Modifiable Risks Four Cornerstones Laura A. James, ND, FABNO

35. Vitamins & Minerals Vitamins D3  K2  C  B Minerals Calcium  Magnesium  Boron Zinc  Strontium Laura A. James, ND, FABNO

36. 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

37. Vitamin D

38. 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

39. 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 Laura A. James, ND, FABNO

40. 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 Laura A. James, ND, FABNO

41. 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 Laura A. James, ND, FABNO

42. 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 Laura A. James, ND, FABNO

43. 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 Laura A. James, ND, FABNO

44. 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 Laura A. James, ND, FABNO

45. 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 Laura A. James, ND, FABNO

46. Supplementation Change Modifiable Risks Four Cornerstones Laura A. James, ND, FABNO

47. Integrated Medicine Treatment Goals 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

48. Q & A Laura A. James, ND, FABNO Red Cedar Wellness Center 1601 116 th Avenue NE  Bellevue  WA 425.451.0999 www.redcedarwellness.com