Women's Health

Osteoporosis Affects Everyone

Note: this is a lecture tape transcription. To obtain a copy of this tape, contact the RFHC.

The beginning of our presentation this evening is going to be what we call our new patient orientation lecture on principle centered leadership in healthcare. I repeat this often because one of the biggest problems that I find when I meet with new people in a consultation situation is this is a completely different paradigm. It's a different way of looking at the body, it's a different way of looking at health, it's a different way of looking at doctors. And so therefore it can't be reiterated often enough, because it is really a reality shift, it's a paradigm shift. I actually like to call people clients because we're in a working relationship. I have a few patients who are quite ill and need really a lot of supportive care, but for the most part I like to look at this as a partnership where we work together and as we go through you'll see why. Raymond, would you keep an eye on me and I will point at you when I want you to turn. Oh, it's you? Okay. I'll get it straight. So, principle-centered healthcare is just what is suggests, and for those of you who are familiar with Covey, principle-centered leadership, Stephen Covey, the 7 Habits of Highly Effective People. He also, I happen to adore his tape series, principle centered leadership, it's wonderful. But this principle-centered healthcare goes on these principles. There are natural principles or laws which govern our function and health. Which makes sense, doesn't it? You know, we've got the law of gravity. We've got the law of homeostasis in the body. And all these things work according to principles that have been established for a very long time. And when you understand them and when you adhere to the principles they allow you to access more of your health potential. One of the things which is poorly understood in American healthcare or in terms of the way American healthcare functions although we're beginning to understand it more and more, they aren't working with the natural physiologic principles of your body. Everything they do is to suppress something, change a symptom, usually by suppression. And that is not necessary the way that you heal.

So, here's our first principle. The creative intelligence, God, Higher Power, whatever you're comfortable with, which made the body is what heals the body. And it's your thoughts, emotions and lifestyle which either allow for this process to unfold or which interferes with it. You know, Stephen Covey talks about that moment between the stimulus and your automatic response where your choice lives. This is very much the same thing. You may get an irritant and want to fly off the handle, right? But you always have a choice. You may be driving down the street and see McDonalds and be hungry, but you always have a choice. And it's in that moment of choice where you can start making changes that coordinate with the way our bodies are designed to function. It's very empowering, I think. That's my personal opinion. Now, signs and symptoms are interesting. Have you ever gone into a doctor and start telling him your signs and symptoms and you get the feeling that he just wants you to shut up? This ever happened to you? It's happened to me. Because the way the medical profession looks at this, well these are just things that are beyond your control, and I don't want to hear about it, let me just give you a drug, right? Naturopathy, homeopathy, all kinds of alternative healthcare takes a very different point of view. 85 percent of your diagnosis will be made in the person's story. You have to listen. And you have to listen with an ear to hear the distinctions and ask the right questions. But if you think that's it's nothing but your genes, a germ or some kind of disease that you're inevitably going to get like osteoarthritis, where can you go with that? Medically you can't go anywhere. So as I said, the way we look at it is the majority of these things are about factors that are within your control. So my job as the official chief detective is to determine which those factors are and share that with you and then you can start making choices around them. What usually happens to cause a symptoms is some kind of stressor or even a combination of stressors that exceed your body's ability to readily adapt. I had this situation this morning. On Sunday when I came back from Seattle the car park place left my air conditioner running and burnt out my compressor. I have no air conditioning in my car. This morning I had to drive to Canoga Park to see my dentist and rush hour traffic with no air conditioning and no way to close the car up, because I run an air purifier in my car because I'm so allergic to exhaust fumes. I had a symptom this morning. I was falling asleep on the freeway from the fumes. So I thought, hm, I know what this is, right? So, there's a combination of stressors, a burnt up compressor and car exhaust. Let's go to the next one.


Then you get these purposeful changes, I'm falling asleep, my body is trying to tell me, "this is toxic, I hate it," right? And it represents your body's best attempts to adapt to the stressor, okay? So where some people, you know we have a whole group of people in this generation currently who think that a fever is a disease, that a fever is an illness by itself. All it is is your immune's system attempt to get you better, it's not an illness. And then your body has to communicate with you somehow and the only thing it has is the language of signs and symptoms. Going to sleep, running a fever, getting a headache, having an ache or a pain, it's your body trying to tell you something. Irritable bowel syndrome, good example of this, diarrhea and constipation, your body's saying "get this stuff away from me, I can't stand it, get it out of here!" Then we have to find out what "it" is, right?

Next. So, here is a new interpretation, let me see, make sure I get the right one. Oh, good. See when I do that, see what happens? So I've got to push the right button. So this is a new model. Here is your health potential, your absolute maximum genetic potential if you were in optimum nutrition, optimum rest, everything. And down here is disintegration which is somewhere after death, right? We, all of us, exist somewhere in this spectrum. We like to stay up here, right? Most of the people I see, and most doctors see, are here. And then the doctor says, come back, we'll watch you. What he's waiting for is for it to get to here because he can't put a name on it until it does. And he doesn't know what to do Ôtil he's got a name. Seriously. They've got a Kahn's Current Therapy, I don't know what they're using at this point, but that used to be the book, if you have a name for a disease it tells you what to do for it. And until you have a name you don't know what to do. So we have this stress and trauma and toxicity living in this area, this is a biggie, which comes up against our own internal resistance and our internal stores, most of us being insufficient and that's why you get dysfunction and/or disease. And after your signs and symptoms develop then you get into pain and inflammation and degeneration and it goes downhill from there. So, here's a very important principle: your interpretation determines your response. Yours, not mine, not Melissa's, not your husband's or your wive's, yours. So you have several choices, the first one being, this is being the most common, especially unfortunately amongst the male gender although more and more women are doing the same thing, you ignore it! You make no changes, dysfunction, disease and degeneration are the logical and natural outcome. In over 50 percent of men who die of myocardial infarct, heart attack, their first symptom is sudden death. And that statistic has not changed in the last 20 years. It's still the same, isn't it? I mean, despite all of the publicity, all the talking, all the public awareness, all the ads, everything, the first symptoms is sudden death. Now, you and I both know that's not the first symptom he had, it's the first one he chose to pay attention to. That's the most extreme example of this, it happens in a lot of other areas as well. Your second choice, you want to seek a therapy that only relieves the signs and symptoms, doesn't identify the underlying cause, isn't too hard, this is part of it, right? I've given many people programs who've walked away. It's too hard. It's what I hear. Then they come back, four or five years later, they're worse. The situation hasn't changed, they still have to do the program, only now they have to do it from worse instead of where they were before. And these therapies which don't address the underlying causes contribute to further degeneration and disease, so it's just kind of like this. Now, your third choice is you actually go through an effective evaluation to understand the fundamental causes of your signs and symptoms and engage in some practical coaching on how to best address these causes. Now, here's the kicker, finding someone who can evaluate and understand the processes that are going forward. I've spent the last 13, 14 years studying this and so I feel pretty confident that at this point in time someone can come in, tell me their story, we can trace it down. If I don't know what it is we can trace it down. But unfortunately in the medical profession, still, and I don't want to sound like I'm wailing on medical doctors, because the same thing is true of people in my profession who don't do this kind of approach, they focus on the minimum. What they can see right in front of them. For one thing it feels safer, it's not as overwhelming, there's not as much to do, and they know that thing and they take care of it and they don't go any further. So finding the right person in this instance is really the key issue. And finding someone who can coach you. It's very good to have someone who has lots of experience, or who's had lots of health challenges, like myself, I've had to learn some of these things in order to keep functioning. I have other friends who have lots of education so they can coach well as well. But it certainly isn't every doctor, unfortunately. So as you make your choices you can stay where you are or you can get worse, they didn't put that on this picture, or you can make responses in a kind of a stepwise fashion so little by little get better. I like this graph for one particular reason. My favorite word is achievable, okay? So we don't try to take you from here to here in one step. It has to be achievable. You start with something you can do, maybe like you had an accident so we get rid of the trauma for you. But you still have some toxicity and you may be taking a little nutritional support just for the trauma but there's still some issues with your internal resistance so we get that taken care of, we go to the next stage. We improve your toxic status, you get more rest, more exercise, and you get a holistic comprehensive nutritional program, and pretty soon before you know it, you've made all these changes and you're way up here. It took me three and a half years to change everything about my lifestyle. I've now lived it for so long that I don't realize how different it is until I travel like I did last weekend. And you have to forgive me if I seem just a little fuzzy because Sunday, you know there's nothing to eat in Seattle? What I discovered in Seattle is I starve or I eat things I'm allergic to so I opted for things I was allergic to. In Portland I had a great time there were lots of health food restaurants and things I could eatÉI couldn't find that where I was in Redmond. So I had an interesting weekend, and I'm better today, but Monday was a disaster, wasn't it, I came home, "hiÉ" I was just barely able to function. So there's nothing to eat in Seattle. And every time I do that it reminds me of how much my lifestyle is different from the average. So now we face a challenge in our culture and the greatest challenge especially living in Southern California is managing toxins. And there are microbial toxins everywhere although I'm not as uptight about this as most medical people are because if you have a strong immune system that's not the issue. The real issue is the chemicals. We live in a chemical soup, from the air to the water to the ground to the foods that we eat, everything is chemically adulterated. And learning about that is one of the most valuable things you can do to preserve your health. So here is a picture of toxic waste management, starting with optimum health again and down to disintegration, as we take in toxins because you can't not, it's going to happen, you have to be able to get rid of them, real efficiently. If you can't, then they start to get deposited in your tissues and finally they lead to disintegration and degeneration. So the issue is to keep moving up this ladder instead of down. Next, thank you.


This is a picture of weight management and preventive care. It's another version of what we've been talking about, the foods we eat and how they impact our vitality and wellbeing. Your body fact to lean mass ratio, your ability to heal. All of these things, food, macronutrients which are proteins carbohydrates and fats and your micronutrients which include vitamins, minerals, hormones, fats and oils all have to be of good quality in order for your body to stay over here in anti-fat, anti-fatigue, anti-aging and disease and anti-inflammatory pathways. Too many of us are over here, constantly in toxic overload, constantly eating antigens, like I had to this weekend, and this is where we end up, inflamed, always tired, and constantly gaining weight. This is a picture that tries to explain how important gut permeability and bowel toxicity is to this system. Last December I did an intense and in-depth lecture about this topic because the gut wall is the beginning of your immune system and it's the single most important part of getting you well and keeping you well. When the small intestines and colon become compromised, undigested food particles which are these big guys, get into the bloodstream and the first thing you know your body's making antibodies and treating it like a foreign invader. This is the genesis of autoimmune disease and it happens to many of us because we have a multitude of things in our culture, everything from chlorinated water to antibiotics added to our food supply that constantly are destroying our gut lining, so it requires maintenance which most of us don't know about. The Discover magazine last summer in its "Breakthrough" columns was stating that "what do you know? M.D.'s may start giving probiotic bacteria to people, they've figured out it might be important. We've only been doing it for like 30 years. And here we are, our friendly bacteria, this is what probiotics are, the friendly gram positive bacteria that maintain the health of the digestive tract. That's a picture of a healthy gut cell with good bacteria all over it, it's plump, it's healthy, you can just see that good blood flow, everything about is appropriate, we call that eubiosis. And when you have good bacteria, eubiosis, in your gut, you have a healthy intestinal wall, you make your own antibiotics so pathogens come and go, they visit, they don't stick around, you don't get sick from them. You get normal bowel pH, good synthesis of your B vitamins, as well as vitamin K, it keeps pathogens from populating the gut and you get good digestion as a result. Dysbiosis on the other hand is when you have unfriendly toxic bacteria, maybe parasite, maybe yeasts, that's what these white things are, invasive yeasts digging into the gut wall, and they contribute to leaky gut syndrome. You notice how these cells are small and shriveled up and pulling apart. That's a picture of an unhealthy gut. So the goal is to re-establish a healthy intestinal microflora, to help prevent pathogens which are omnipresent to have more than the opportunity to just visit.

This is a whole different topic on pain and inflammation. Did you know that pain killers are the largest selling class of over-the-counter medications in America? Everybody's in pain. Isn't that sad? And yet when I do topics or talk about pain, nobody bothers to come. It's like, "Éwell, I just take an aspirin." However the problem with aspirin is it suppresses your healing process as well. Inflammation is a complex process that you can actually influence by means of diet. This is a cell wall. This is, I can't read this from this angle, excuse me, um, omega-6 fatty acids, thank you very much. These are anti-inflammatory. These are omega-3 fatty acids, anti-inflammatories. Fish oils, have you heard of those? Omega-3's. Warm weather vegetable oils are omega-6's, things like soy and safflower and those good guys, sunflower, all of that. And coming down from the cell wall when inflammation is present, there's a switch right here that goes into pro-inflammatory building blocks resulting in inflammation in the body and this switch is turned by vitamins and minerals and the proper fatty acids. You can eat this pathway which a lot of us do, a lot of us eat a lot of warm weather oils, and actually switch over to inflammation because you don't have enough of the right co-factors. So here's what the drugs do, remember I mentioned that aspirin? They inhibit everything. Aspirin is a non-steroidal anti-inflammatory. So it wipes out both of your good pathways and one of your inflammatory pathways and interestingly leaves the other one. And steroids wipe out everything because they act much closer in. But of course steroids have terrible effects on your immune system as we know. So with nutritional modulation there are a variety of nutrients including ginger, zinc, vitamin E, EPA which is your fish oil, selenium, bioflavonoids, more natural approaches resulting in wiping out both of the inflammatory pathways and switching you over into an anti-inflammatory lifestyle. And there are a variety of products which can be customized to each individual person depending on what they're able to take. I for myself, I use this, ___? Because it does very well for me. I'm very allergic to pineapple which is one of the major anti-inflammatories. I can't take it, bromelain, bromase. So you have to customize this to the individual metabolic profile. So in conclusion, do you think that your choices play a role in your health? Did I do my job tonight? Do you think it's important what choices you make? Good. So once you have made this decision to stay healthy we can guide you in the steps required based on your personal metabolic profile, in fact, we would consider that to be a privilege.


I would like to go directly into osteoporosis unless someone has big questions about what we just went through. Okay? Alright, let's undertake our topic for the evening. They titled this slide presentation which was prepared for us by the Metagenics people, "Do All You Can To Build Strong Bones." I prefer my title which was, "It Affects Everybody." Because truly in our culture here in the United States we have an epidemic of osteoporosis. I don't like the word epidemic, and I avoid it at all costs, but we have the single highest incidence of osteoporosis of anywhere in the world, and it's all about lifestyle choices. So tonight we hope you've learned something to avoid this. We also have a mindset in this country that as we get older things are going to happen and there's nothing we can do about it. I was struck by this when I was in Louisiana visiting my father. There's a whole group of these men that are in this cardiac rehab together where they do exercises. My father's the only one there who even looks healthy. He's not taking any of their drugs. The rest of these men look like ghosts, they're white as sheet and they're all like, almost like invalids. It's the most interesting thing I have ever seen. And my father is taking a variety of nutrients and everytime the doctor hands him another pill he says, no thank you. And the doctors are like, what do we do now? But he's doing better than almost any of them. And of course all the drugs they want to give him are wrong for him because he's atypical, he doesn't have standard heart problems. So the problem is what we so glibly call the golden years may not in fact be golden for some people. This x-ray where the doctor's pointing right there is a compression fracture, this side of that vertebra has collapsed and as a result of that you can see the spinal curvature and that will never heal. That's going to be a source of continuing pain for this particular person for the rest of her life. And when you get to the stage of compression fracture, osteoporosis is extremely, extremely painful. Why don't you shift that while I finish talking about this slide just a little bit. Osteoporosis is one of the things that dramatically decreases the quality of life. It is a disease which is characterized by decreased bone mass, increase bone fragility, and increased susceptibility to fractures. And there are more than 20 million people in the United States that have osteoporosis. I have interweaved this with some statistics that I did for my lecture some years ago that I wanted to share with you. This disease was unknown before 1940. And in many developing nations in the world it's unheard of, nobody has it, okay? So there are several important points here that I want you to see and to notice. Remember in my little flyer I mentioned that the optimum age for preventing osteoporosis is 18 to 35? Because if your bone density is high before menopause and you can slow the rate of bone loss after menopause the onset of bone demineralization may not clinically appear until the person is older than 150 years. So far isn't the record 136? I think. Nobody's currently alive that is that old, the oldest person currently alive is 118. But you could put it off, Ôtil you were 150! Wouldn't that be cool? I could go there. So, here's what happens in America. These statistics are from 1986, and I have some later from 1994, 200,000 osteoporotic women over the age of 45 fracture one or more bone. And of these 200,000, forty thousand die of the complications of fracture. Hip fractures kill, whether it's because of the pneumonia that develops or the embolism, hip fracture is a very very dangerous event in the life of an elderly person. That's 20 percent of them die. Then fewer than half of all the women who suffer a fracture will ever regain normal function and 15 percent will die just very shortly after the injury. And of those who recover, half of them will have disability. This is a 1980 study of 108 patients, 81 of whom were women as you can see there's a huge preponderance of women in this category, although men are fast catching up as men are leading more sedentary lives. This was published in the Clinical Orthopedica in 1980, 41 percent of these people went directly to a nursing home after a hospital stay, and the remaining 59 percent went home, went to another hospital or died. So not everybody went home. At the end of one year out of this study, only 23 percent of them had been able to go home. Sixty percent of them remained in the nursing home and 11 percent of them had died.

So here's our next transparency. Since 1986 we've had a lot of media attention about osteoporosis, you know, Fosamax, and protect your bones and it goes on and on and on. And a lot of women are receiving estrogen prescriptions to "prevent the development of osteoporosis." This is a sideline, I'd just like to say to you, there is no proof that estrogen prevents osteoporosis. All of the proof is that natural progesterone is what prevents bone loss, not estrogen. But remember that the next time somebody says to you you have to take estrogen to make sure your bones are okay. So we would think that the situation would be getting better, right, I mean look at all the things that we're doing. Well in 1994 Dr. Gabby? Who's a really well known M.D. who does alternative health care, wrote this book Preventing and Reversing Osteoporosis. 1.2 million women suffer fractures each year as a direct result of osteoporosis and the situation is getting worse. More than twice as many major fractures occur now compared with 30 years ago and this difference cannot be explained by the aging of the population, you will often hear that. Oh, a lot of us are a lot older. This situation with osteoporosis is skyrocketing and I'm going to share with you some of the factors that feed right directly into it.


Now we're ready with the slide. So, we're going to talk a little bit about the aging of our population. The costs of the health care system is estimated to be billions of dollars every year and it doesn't even take into account personal suffering, loss of function, any of that, and of course us guys, the baby boomers, are going to increase this whole demographic significantly. Some of the direct costs include hospitilization, surgery, convalescence, expensive diagnostic and treatment procedures, but there's no way to put a price tag on self-reliance and mobility. So it's very difficult to try to estimate the true cost of all this. There's a lot of good news. The irony is that it can be prevented. It's almost totally preventable. They're being safe when they say "largely preventable." I believe osteoporosis to be totally preventable if you do the right things for yourself. And you can reduce your risk of fracture by your lifestyle choices. Now we know there's a genetic component, a little bit later in the presentation I'm going to show you the risk factors for different demographic groups, but actually the fact is it's what we do with what we're given that's more important than the genetics themselves. Osteoporosis and fracture is almost unknown in Italy, but in my family I've had two or three of my aunts who've had hip fractures who are Italian, so you see, there's something else going on here, right? And, it's the decisions that we make now that will determine how strong and healthy an old age we have. The best time to take steps is as early as possible, preferably in childhood, but since nobody here seems to be under 18, we'll start now, okay? We can certainly improve our chances by making good choices from now on. Go ahead to the next one.

I love this slide. The FDA has been in existence for 60 years. And the FDA is the cr¸me de la cr¸me about everything, right? Do you know there's only a few health plans that they've even approved, there's like four or five, total, and one of them is for calcium and osteoporosis, that calcium helps prevent the development of osteoporosis. Now, we haven't heard a lot about it, we've heard a lot about Fosamax because Fosamax is a new drug that they've developed that's patentable, so it brings them a lot of money. But calcium is unpatentable, so nobody talks very much about it. But one of these statements approved by the FDA revolves around the role of calcium in reducing the risk of osteoporosis and because they recognize how important calcium is to bone health they took this major step and issued an approval on it. So what we're going to do right now is look at the problem produced by osteoporosis and how it develops through life and what a role calcium will play in it. Okay, this is the part that I was talking about about the 18 years olds, peak bone mass, right? Your cells of your body go through their own lifecycle, they form, they age, they're replaced. The older we get the less well this process works. When you're an infant, under two years old, you can watch a baby's capillaries grow, did you know that? If you get like a little baby's ear or a finger or something that's fairly transparent under one of those microscopes, the double ones that you look at larger things with, you can watch the capillaries grow, they grow that fast. Now that isn't happening for you and me. Now that isn't happening for you and me, we're way past that stage. But in childhood and adolescence you can really strengthen and build this

Éthe estimates are your body replaces itself on an average of every 18 months. So your gut cells replace themselves every 4 days. Every 4 days you have a completely new gut lining. But the bone cells it's slower, it takes about 18 months. That's why damage from a mammography study takes 18 months to heal. If you have radiation damage from having your breast mammography done, you need to wait 18 months, but what is the current recommendation? Every 12. So they're working against your body's healing process with that recommendation. That's why I like thermographies so much. There's no radiation. But anyway, we're talking about bones here, and they take 18 months to replace themselves. And you want to be while they're in that replacement process making sure they've got everything they need, all the right nutrients, so they can form healthfully and strong, okay? So a diet that's really healthy in calcium and other nutrients as well as regular exercise is essential to this process.

So here is our peak bone mass age, sometime between 28 and 35, depending on the individual, you reach peak bone density. And at this point the bones are as strong and as dense as they will ever be and from then on bone loss exceeds bone formation, that's just a natural physiologic process. And if you don't provide your body with the right things it accelerates that bone loss. One of the most important features to this is lifestyle. This is one of the reasons why the sedentary nature of the American population is such a worry. Because bones form in response to stress. It's called Wolf's law. They calcify and put down extra calcium when they're weightbearing and loaded. It's also the reason why swimming is not a good exercise for someone who has osteoporosis. There's no weightbearing. You want weightbearing to build bone mass. Okay, let's go to the next.


Alright, for just a moment now, I'd like to refer you back to your handout. Does everybody have this? Okay. We're going to discuss features of this little by little on each of the slides and I thought it would be nice if you had something up close that you could refer to. Okay. So these are the strong and healthy bones. On your handout it's the bone on the left side. That's a very strong section, it's a section of strong and healthy bone. They have a structure that's similar to reinforced concrete, interestingly enough, there's this very strong protein fiber right along in here, you see that? And it exists in a dense crystal matrix that surrounds the bone, that's what of this is, okay? See that there? Now, we're talking about calcium, but gosh, doesn't that look like it has more in it? And you're right, it does, because there's bunch of minerals that go into the formation of bone. But they all collect around this collagen strand which gives the structural integrity and the template for the bone to form. And that's why it has such tencel strength as well as structural integrity. This is the thing about Fosamax that worries me. And we haven't had it out there long enough to know for sure yet but I predict (I like making predictionsÉusually I'm right, we'll see, check me in 5 years, okay? ) what we're going to find is an increase in fracture with Fosamax. Fosamax prevents the bone from being resilient, it makes it rigid, and that's the worst thing you can do to a bone. A bone should be spongy, it should bounce back when it has trauma on it. Fosamax doesn't allow that to happen, it literally solidifies your skeleton. And so, they're so excited about it that I predict that we're going to have some trouble with it. Next slide.

Now, as we age, we get to start looking like this bone over here. Isn't that groaty? That's really nasty. Look at how eroded it is. See that? It's all weak, there are holes in the matrix, the protein filaments aren't even continuous anymore, they're starting to break down. So the bone is getting more porous and it's getting weaker. The things that cause this to happen are multiple. Environmental stresses, poor diet, aging, a whole bunch of things like that including lack of proper exercise.

Okay, so at some point the bones become so porous and fragile that they can't support the weight and that was what had happened to our lady in the first slide. She had a compression fracture in her spine. That's the most common place that you see it. And it occurs at the places where the curves change. So usually they start out down here, the first ones, and then they move their way up because everytime there's a fracture it changes the curvature of the spine and puts more weight on the one above it. So it's a continuous process. Sometimes nothing more than stepping down off a curb will cause a bone to break. It's a really sad process. I had a wonderful friend, she was an M.D. from Russia and she had worked with Dr. Kenny in the big polio epidemics doing physical therapy, she was this fabulous person, and she got to the point where she couldn't be upright. Everytime she'd sit up another bone would break. So, she spent the last five years of her life in bed in a convalescent home in pain. Very sad. She was a brilliant woman.

And women of course are the ones who are most at risk. They're about 3 more times more likely than men to develop osteoporosis and if you think about what we've said so far this kind of makes sense. It isn't just the hormones. It's also the lifestyle. Far more men than women do heavy labor, are on their feet, are weightbearing, are lifting heavy loads, their muscle mass, their testosterone, promotes that. And women tend to be a little more sedentary, not doing as much to build their bones. There's this one lady that has this book out about weightlifting to keep you young. Well, maybe slightly, light weights might not be bad. And some of this is related to the changes in the hormones that occur at menopause. But as I said, it isn't about estrogen, it is about progesterone. Bone loss begins before menopause. They've now tracked it and they show, you know how when a young girl starts her cycle she's anovulatory. She's just putting out estrogen, no progesterone, she's not making eggs. Well the same thing happens to a women at the end of her cycle, she's not producing eggs, she still has estrogen. So she has her monthly menses, but when she starts becoming anovulatory is when the bone loss starts with the loss of the progesterone, okay? Let's go to the next slide, please.

Let's talk now a little about those things that are within your control. Remember I promised. These are they. Diet, so, what about diet? Well, a lot of us have a long habit of consuming a diet which is very low in calcium and other important minerals. This is one of the most common risk factors. I have some really startling statistics. Let me just go back, you stay where you are I'm going to go back, I wrote it one one of the other slides. The average woman over 45 in the United States has a daily intake of calcium of 550 mg. Does that sound like a lot? If a woman weighs 120 lbs. or less she needs 1100 mg a day. That's less than half of what she needs. If she weighs between 120 to 200 pounds she needs 2,000 mg a day. And if she's on the heavy side and is over 200 pounds she needs 4,000 mg a day. So that 550 starts looking pretty puny, doesn't it? And that's on the average. And the other piece you need to know about that is we only absorb about two thirds of the calcium we need to take in. There's a gut barrier, that's all that we can take in. So if you eat a lot of refined foods (and I hope no one in this audience does if you've been listening to me to any length of time), you're in this category. The things that are high, we'll go into a little bit the things that are highest in calcium and you can do a self-check. High carbonated beverage consumption. I know that soda pop used to be called phosphate of soda because in the Music Man they talk about phosphates, remember? 76 Trombones? That's where I learned it. But that's the main ingredient in soda pop is phosphorus. Phosphorus leaches calcium out of your bones. Takes it right out. And so does red meat. Red meat is very high in phosphorus. And that's what both of these things do, they're very similar. Now we need about 80 mg of protein a day. Excuse me, 80 grams of protein a day. 75 grams of protein is approximately 10 ounces of meat. But I would hope that not all of your protein would be red meat, right? Things like yogurt or eggs or turkey or chicken or whatever or fish are also good choices, keeping your red meat to maybe once or twice a week, right? And people who are strict vegetarians in this culture (let me emphasize this), in America, people who are strict vegetarians tend to be very very calcium deficient. And that's because they're stupid vegetarians (pardon me for saying so) but people in America don't know how to be vegetarian. They don't eat the kinds and the variety of foods that are eaten in cultures that are vegetarian like India and so because of the food choices they make they never get enough calcium. Good sources of calcium in the vegetarian world include dark green leafy veggies and I don't mean lettuce. We're talking about collard greens, kale, and turnip greens. Now how many people do you know in our culture who eat those greens? Some of the É and you do, I know, and so do IÉand in the South and in the black culture although the black culture is now changing, in the Southern black culture they still eat those things, I'm not so sure about out here in California. And then there's broccoli which maybe some vegetarians may be eating, and blackstrap molasses, but for the most part vegetarians do not eat an adequate diet for many nutrients, amongst them being calcium. The other problem with vegetarians in America is their diet is probably 90 percent grains and carbohydrates. Have you noticed how people who like a vegetarian diet, they eat all kinds of breads and pastas and all that kind of stuff? Well grains contain a chemical called phytate and what phytate does is it binds with the calcium in whatever foods you're eating and you can't absorb it. So there's another double whammy in that, okay? This right here I think is probably the biggest risk factor in our culture for young girls because adolescent girls are drinking diet pop, right, when they should be building their bones? And then they get pregnant. And of course pregnancy puts a huge demand on their calcium reserves and they don't have anything to spare because they didn't get it in the first place. So we're going to go to the transparencies now. So if anything else in your family, never serve soda pop. Just that would be a big help. Try to get people off of soda pop. This is an interesting, actually, I love this graph. This is a picture of the insufficient accumulation of bone mass in young adulthood. It came out of The Journal of the American Dietetic Association in 1986. It's an intake of calcium as a percentage of the 1980 RDA. Now, the recommended daily allowance of 1200 mg isn't adequate as you already see from what we talked about so far but that's what this is based on. So these are boys who don't drink soda pop, boys who drink a little soda pop, and boys who drink a lot of soda pop. And the same thing for the girls. So in this classification the only people getting enough calcium are the boys who don't drink any soda pop. Do you see that? The girls are pathetic. Even amongst the non users they're only getting 75 percent of 1200 mg. They've got growing bones, they need closer to 2,000 mg. And the girls who drink the most soda pop are getting only 59 percent of 1200. So what we have here is the group who has the most need for calcium considering the risks of pregnancy to your calcium status are having the least intake of calcium and most of them are drinking lots and lots of soda that's taking away whatever calcium they are taking in anyway. We're going back to the slides, Raymond.


Now let's talk about the next slide. The other risk factor (for osteoporosis is) lack of exercise. This is a huge problem. One of the things I noticed when I was in Europe is how everybody walks everywhere, you know? You just go out and you think nothing of it. You walk up to the greengrush? And you walk up the hill and you walk here and you walk thereÉwe tend to take the car if it's longer than a block, right? So regular moderate exercise increases your muscle strength and adds to your bone density. So it's very important. If nothing else go out and walk in the evening. It's wonderful for you. Now smoking is a huge risk factor for osteoporosis. Women more than men. Men who smoke have 10 to 20 percent less bone mass than non-smokers and in women it's 15 to 30 percent. So it really hits us hard. Caffeine also affects bone mass. It's a diuretic and it tends to take calcium out in the urine. So if you drink a lot of caffeine you're having a lot of diuresis and you're losing calcium that way. And excessive alcohol consumption and by that I mean more than 2 drinks a dayÉwith men it causes malabsorption of all the nutrients but in women it decreases your estrogen level, so it actually impairs calcium absorption. The other thing about tobacco smoke, I'm sorry, I had this noted and I forgot to talk about it, tobacco smoke contains all kinds of things that interfere with calcium amongst them being cadmium. Cadmium is a heavy metal and it keeps your body, the enzyme which helps you absorb calcium is inactivated by cadmium. So smoking is really a double whammy.

We have age, of course. As we've already spoken, your body stops building bone as efficiently after about 35, and in the genetic picture, small-boned, small-statured women, these are Caucasian and Asian women, are more likely to become osteoporotic as they age, and women whose mothers have developed osteoporosis are at higher risk than those whose mothers didn't. That's a very misleading statement. You have to think in terms of did they nurse, was there an inadequate supply of calcium in the breastmilk becomes the women had inadequate calcium to start with, what were the lifestyles in the family, what was the nutrition in the family, there's a huge number of factors that go into this statement apart from genetic by itself so I just wanted to make you aware of that, okay? Now we're going to our overheads for one minute. We have two more and then we're done with the overheads. This is a risk factor chart. It's easier to see than it is to say. It's the incidence of osteoporosis. Those women at highest risk are white women who have the least skeletal density and the most fractures. Those who are at least risk are black men. And they only, by the way, in this study compared Caucasian and blacks, no other races were included. And the most skeletal density and the least fracture and black women are a little bit more at risk than white men but not a whole lot. So the greatest risk is women of north European, British and Oriental descent. And I think they just through the Oriental in there because it wasn't in this study. I'd like you to take a look at this next chart. There will not be a quiz. I just want you to see it. There's a reason. Probably the most common question I'm asked is, "Doctor, should I take calcium? And what kind should I take?" I would like you to look at this graph of calcium metabolism and then you'll know why it gives me a headache to hear that question, okay? First of all you have to be able to absorb it through the gut and you need all the right nutrients for that. You need adequate amounts of vitamin D plus sunshine because if you don't get sunshine it doesn't convert. Then your liver needs all the right nutrients so that it can convert vitamin D into its active form so that in the kidney you can save your calcium and excrete your phosphorus. And this is all interrelated, okay, and notice all these arrows? Finally, the calcium gets to your bones. My standard answer to this question is I don't know until you take the right blood test for me and people don't understand why. It's right here. Calcium metabolism involves everything in your body and the piece that's not here is your brain and central nervous system. We all think that we have calcium in our body for our bones, don't we? The truth is the calcium in your bones is a reservoir for your brain, because calcium buffers your body to keep your blood at the correct pH so that you don't have seizures or go into a coma. So I have people in my practice who have really high serum calcium but the ratios and the factors are all off so I know they're taking calcium out of their bone to protect their brain. Okay, so that's the last of our transparencies, thank you very much. We're going to go back to the slides now to finish our presentation.


So, calcium and phosphorus are the major ingredients of bone but there are other trace minerals that play a role as well, there are things like manganese and boron and other elements. And a great deal of attention has actually been focused on calcium in maintaining the health of the bone, there's been a lot of research. Calcium is actually the most abundant mineral in our body, and it exists in the bone as part of a mineral complex called microcrystalline hydroxy apatite which for purposes of this presentation and for everybody in general we abbreviate MCHC. You'll see that on some of the supplement bottles, MCHC, because microcrystalline hydroxy apatite is a mouthful and half the time you can't remember what it is anyway. So in this form there are other minerals and all the trace minerals present. And in order to build bone the body needs all of these trace minerals. So there's now a consensus at long last among scientists that adequate calcium intake when you combine it with regular exercise, 20 minutes of sunshine a day and other risk reduction strategies can have a positive impact on reducing the risk of developing osteoporosis as we age, okay? Remember that. Twenty minutes of sunshine a day. Doesn't have to be in the middle of the day, could be at the end. But you need that to convert your vitamin D to its active form. Yes ma'am, you have to be outside. I go out and do my garden first thing in the morning, when it's cool and the sun isn't too burning? That's how I get mine. And because most of us don't get enough calcium through our regular diet, calcium supplementation is actually a must for most people. This will help us get adequate amounts. And one of the most often quoted studies about the deficiencies in our diet is the Health and Nutrition Examination Survey and it led to a massive government effort to educate people about the importance of eating a healthy diet, so they revisited this study 10 years later and found out that the problem had gotten worse not better. So much for education, people weren't paying attention. So now more and more people are taking calcium supplementation but the question is always which calcium? We now have microcrystalline hydroxy apatite (MCHC) as a supplement. For many years it was not available. The problem with it is it has to be high quality. If it's improperly prepared, it degrades and it isn't useful to the body. It also has to be from a very pure source, the MCHC we use in our practice comes from New Zealand where the herds are organic. In New Zealand they have very strict requirements, they don't use any pesticides, they don't use hormones, they don't use drugs, nothing. New Zealand has built its whole country on this industry where they provide products for vitamins and minerals and health food companies and so they're very stringent about it. And there's a lot of MCHC out on the market, Metagenics developed it, brought it to market, and other people tried to copy it but not with the same quality control. If you'll turn your handout over, I'd like you for a moment to look at the back of it, and you'll see a little (you can read this at your leisure) but you'll notice there's a little chart on the right hand side about the types of calcium. And what I have found in my practice, I used to use exclusively calcium citrate, and then this bone resorption study we talked to you this evening about, this test came out, it's only been available for about a year and a half. And so I ran it on some of the people that I've had on good quality calcium supplementation for years and I found out that although for their age they were doing well they were still losing bone. So I added this MCHC product together with additional calcium citrate to get enough of the elemental calcium and what do you know? The bone loss stopped. So I am now of the opinion that you need both. One by itself won't do enough. And then it lists out all the most common types of calcium, and most people take calcium carbonate because it's inexpensive, oyster shell calcium, dolomite, that's all calcium carbonate. It is the least absorbable and the most adulterated form of calcium there is. There's a lot of heavy metals in it and worst of all, it's cement. Your body has a terrible time breaking it down. I had a patient bring us a bottle of something, Cholestaway or something? It's a product that is supposed to reduce cholesterol by binding it to calcium and when you put this stuff in water, it climbs up the side of the jar to get away from the water. It's averse to liquid. So how can it even dissolve so that you can get the benefit from it. It was fascinating to do that and watch it climb the glass. So bone meal, if anybody's taking bone meal, please stop immediately. Bone meal is incredibly toxic in this country. It's loaded with strontium 90, it has all kinds of heavy metals in it, and I don't, I'm not aware of any clean or good bone meals products. It used to be but it isn't anymore. So you really have to watch it. Alright, could we go to our next slide please.

This is one of the problems with bone meal, lead. Lead accumulates in the bone, so because we have such a high exposure to lead in our culture, all the bone meal products are contaminated with lead. And the other one that is real prone to lead is oyster shell calcium because it concentrates lead out of sea water, the oysters do, when they're building their shells, okay?

So the recommendations in our practice is that you increase your dietary sources of calcium, get regular, moderate exercise along with 20 minutes of sunshine a day, (that's the missing piece on this slide) eliminate your smoking, reduce your consumption of carbonated beverages and alcohol, keep your alcohol to a moderate level, and take a good quality calcium supplementation which has all the other nutrients important to bone like MCHC. The products we have in our office there's three of them and two that I use the most. One's called Cal Apatite and the one that I take is called Cal Matrix and what I call them is bone food because they have all the parts in them and you don't have to worry about a lot of different things, it's all there, and then you add a little bit of extra calcium to get enough calcium. Cal Matrix is most used for fractures, people who have actually broken their bones and reason I take it is it's very alkaline and it works very well with my allergies. I do better with it than I do with Cal Apatite. But that's another choice that you make based on the individual. That's the conclusion of our presentation this evening, and as Melissa mentioned to you we would be more than happy to screen anyone if they're concerned about osteoporosis and all you have to do is call the office or speak to my staff this evening and they'll make arrangements for that test.

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