Date post: | 07-May-2015 |
Category: |
Health & Medicine |
Upload: | hadley-wood-healthcare-ltd |
View: | 1,978 times |
Download: | 0 times |
The Secret Life of Bones Marcus Webb BSc ND DO Osteopath & Naturopath
By Edward Mitchell, engraver Edinburgh (1829)
What we shall discuss tonight
• A brief look at bones and bone density
• Common causes of poor bone quality
• Key nutrients and their use & controversies
• Key dietary issues & supplements
• A brief look at bones and bone density
• Common causes of poor bone quality
• Key nutrients and their use & controversies
• Key dietary issues & supplements
206 bones in the body
The smallest bones are in your ears
There are 14 bones in the face
Bones are 75% water
Your thigh bone is stronger than concrete and its hollow!
Tooth enamel is the strongest substance in the body
Your skeleton only makes up 14% of your body weight
Some bone facts
Hollow but strong
Excavations at a Chinese cave have yielded a 40,000-year-old partial human
skeleton, including this lower jaw.
In the right environment bones can last a very long time
National Academy of Sciences 2007
Age & bone density
Race & bone density
Osteoporosis types
Primary OsteoporosisJuvenile type (8-14year olds)
Rare, gonadal dysfunction, bone pain and fracture
Type-1 (50-65 year old, Postmenopausal)
Characterized by a phase of accelerated bone loss. This bone loss occurs primarily from trabecular bone.Fractures of the forearm, wrist and vertebral bodies are common.
Type-2 (70+ year old, age-related)
Fractures occur in cortical and trabecular bone.In addition to wrist and vertebral fractures, hip fractures are common in this group.
Secondary OsteoporosisGenetic Gonadal Endocrine Inflammatory Deficiency
statesDrug Other
Cystic fibrosis Androgen insensitivity
Acromegly Inflammatory bowel disease
Calcium deficiency Anticonvulsants Lymphome, multiple myeloma
Ehler-Danlos Female athlete syndrome
Adrenal insufficiency
Ankylosing spondylitis
Magnesium deficiency
Antipsychotics Leukemia, haemophillia
Haemochromatosis Hyperprolactinemia Cushings syndrome Rheumatoid arthritis
Protein deficiency Antiretroviral Thalassemia, sickle cell disease
Marfans syndrome Panhypopituitarism Diabetes mellitus Syetemic lupus erythematosus
Vitamin D deficiency Aromatase inhibitors
Metastatic disease
Prophyria Premature menopause
Hyper-parathyroidism
Sarcoidisis Coeliac disease Prednisone Immobility, depression
Osteogenesis imperfecta
Turners syndrome Hyperthyroidism Chronic liver disease Malabsorption syndromes
Lithium Multiple sclerosis
Homocystinuria Klinefelters syndrome
Prolactinoma Metabolic acidosis Primary biliary cirrhosis
Methotrexate Emphysemia
Idiopathic hypercalciuria
Anorexia nervosa Oestrogen deficiency
Amyloidosis Gastrectomy SSRI’s Alcoholism
Gaucher disease Bulimia nervosa Pregnancy Ochtonosis Bariatic surgery Thyroxine Chronic renal disease
Diagnosis
Bone density scan(DXA scan)
DXA results
Age, fracture risk & T-score
T-score range
T-scores & bone density
T-score w.r.t actual bone density
CrossLaps (CTx)
(DPD) deoxypyridinoline
90% of the organic matrix of bone is Type 1 Collagen
In mature bone the DPD Cross links provide rigidity
DPD is excreted un-metabolized in urine and is
unaffected by diet , making it suitable for assessing
resorption
How CTx is performed
Second void morning urine sample
Sampled before 10.00am
Second void morning urine sample
Sampled before 10.00am
What the results mean
Female 3.0 – 7.4
Male 2.3 – 5.5
Female 3.0 – 7.4
Male 2.3 – 5.5
Management
The bone cycle
Bone health fundamentals
Diet basics
Key points
Sugar: high intakes related to higher urinary calcium loss
Refined grains & flour: 60% calcium & 85% magnesium loss by refining process
Caffeine: high intakes related to higher urinary calcium loss
Alcohol: osteoporosis is common in chronic alcoholics, but other factors at play!
Protein: high intakes related to higher urinary calcium loss
Fizzy drinks: phosphoric acid intake linked with bone loss
Protein
Protein is essential for muscle function &muscle function is essential for bone health
Keep dietary ratio at 3:1 (produce:protein)
Protein is essential for muscle function &muscle function is essential for bone health
Keep dietary ratio at 3:1 (produce:protein)
Calcium
Recommended calcium intakeAge range Calcium intake
Children (7-12 yrs) 800mg
Teenagers: Girls (11-18 yrs) 800mg
Teenagers: Boys (11-18 yrs) 1,000mg
Men (20-60 yrs) 700mg
Men (over 60 yrs) 1,500mg
Women (20-60 yrs) 700mg
Women (over 60 yrs) 700mg
Pregnant woman 700mg
Breastfeeding woman 700 + 500mg
Source: UK Scientific Advisory Committee on Nutrition
Calcium in the dietVegetarian options
Food Amount of calcium
100g Tahini (sesame paste) 680mg
100g Sesame seeds 670mg
100g Tofu (steamed) 510mg
100g Dried figs (4-6 figs) 250mg
100g Okra (cooked) 220g
100g Watercress 170mg
100g Cooked spinach 160mg
100g Cooked Curly kale 150mg
100g Wholemeal bread 106mg
Information provided courtesy of The Royal Society of Chemistry, Ministry of Agriculture, Fisheries & Food publication "The Composition of Foods" 1992.
Calcium in the dietOmnivore options
Food Amount of calcium
100g Fried whitebait 860mg
100g Edam cheese 795mg
100g Cheddar cheese 736mg
100g Sardines in oil 500mg
100g Sardines in tomatoe sauce 430mg
100g Yoghurt (low fat) 122mg
100ng Tuna (tinned in oil) 12mg
Information provided courtesy of The Royal Society of Chemistry, Ministry of Agriculture, Fisheries & Food publication "The Composition of Foods" 1992.
Common calcium considerations
Types of calcium
Intake levels
Age / sex
Level of gastric acidity
Use of PPI’s
Calcium deposition issues
Drug interactions eg. antibiotics, alendronate
High or low blood calcium (2.05 – 2.60 mmol/l) indicated endocrine disease in most cases
Calcium & Heart Disease30 % increase in incidence of myocardial infarction (BMJ 2010; 341:c3691)
BMJ study looked at 15 RCT’s where calcium was taken as mono-therapy
Data obtained from studies relating to calcium & osteoporosis NOT calcium & heart disease
6 % decrease in cardiovascular related deaths (J Bone Miner Res 2011; 26:35-41)
BMJ double-blind trial: 1,200mg calcium taken for 5 years
Non-significant 6% decrease in cardiovascular disease-related death
Vitamin D
Vitamin D dose units
1 mcg of vitamin D = 40 IU
Eg. 1,000 IU vit D = 1,000 ÷ 40 = 25mcg (0.025mg)
Vitamin D intake
According to the Food Standards Agency;
“For guidance purposes only, a level of 0.025 mg (1000 IU) day supplementary vitamin D would not be expected to cause adverse effects in the general population.”Source: http://www.food.gov.uk/multimedia/pdfs/evm_d.pdf
According to the Food Standards Agency;
“For guidance purposes only, a level of 0.025 mg (1000 IU) day supplementary vitamin D would not be expected to cause adverse effects in the general population.”Source: http://www.food.gov.uk/multimedia/pdfs/evm_d.pdf
Vitamin D synthesis
Normal Vitamin D levels
What’s normal?
UK units measured in nmol/lUS units measured in ng/ml
In UK below 25nmol (10ng/ml) = deficient
Always test for 25-hydroxyvitamin Daka 25(OH)D
What’s normal?
UK units measured in nmol/lUS units measured in ng/ml
In UK below 25nmol (10ng/ml) = deficient
Always test for 25-hydroxyvitamin Daka 25(OH)D
Vitamin D levels
Recent work has indicated that 85% of those with levels less that 50 nmol/l
(20ng/ml) had poor response to bisphosphonate therapy
Aim for 75nmol/l (30ng/ml)See: www.vitamindcouncil.org
Recent work has indicated that 85% of those with levels less that 50 nmol/l
(20ng/ml) had poor response to bisphosphonate therapy
Aim for 75nmol/l (30ng/ml)See: www.vitamindcouncil.org
Common vitamin D considerations
Asian origin
Avoidance of the sun
Living in northern latitudes
Avoids meat
Avoids oily fish
Type of vitamin D (D2 / D3)
Structurally similar
Vitamin D3 vs Vitamin D2
Vitamin D3(Cholecalciferol)
Vitamin D2(Ergocalciferol)
Made in the body Not produced in land plants or animals
Naturally derived supplement from wool grease (lanolin) from sheep
Yeast/fungus/synthetic derived supplement
Significantly increases vitamin D levels in the body §
Moderately increases vitamin D levels in the body §§
Recommended for optimal bone health Alternative form appropriate for strict vegetarians or vegans
§ In a 2011 study: The results showed that Vitamin D3 is actually 87% more potent than Vitamin D2. Since it has greater potency and lower cost, D3 should
be the preferred treatment option when correcting vitamin D deficiency. The Journal of Clinical Endocrinology & Metabolism March 1, 2011 vol. 96 Vitamin D3 Is
More Potent Than Vitamin D2 in Humans
§ § In a 2008 study: A 1000 IU dose of vitamin D2 daily was as effective as 1000 IU vitamin D3 in maintaining serum 25-hydroxyvitamin D levels and did not
negatively influence serum 25-hydroxyvitamin D3 levels. Therefore, vitamin D2 is equally as effective as vitamin D3 in maintaining 25-hydroxyvitamin D status. The
Journal of Clinical Endocrinology & Metabolism. 2008 Mar;93(3):677-81. Epub 2007 Dec 18.Vitamin D2 is as effective as vitamin D3 in maintaining circulating
concentrations of 25-hydroxyvitamin D.
Dietary vitamin D
Food Amount of vitamin D
Cod liver oil (1 tablespoon) 1,360IU (34mcg)
80g Salmon 447IU (11mcg)
80g Mackerel 388IU (10mcg)
80g Tuna 154IU (4mcg)
100g Beef liver 49IU (1.2mcg)
1 large Egg (in the yolk) 41IU (1mcg)
100g Swiss cheese 6IU (0.15mcg)
Vitamin K
Vitamin K
Vit K Type Name Source
Vitamin K1 Phylloquinone(phytonadione)
Plant; spinach, Swiss chard, cabbage, kale, cauliflower, broccoli & sprouts.
Vitamin K2 Menaquinone Gut & fermentation, Natto
Vitamin K3 Menadione Synthetic
Vitamin K4 Menadiol Synthetic
Vitamin KKey points
Low K1 levels commonly found in patients with osteoporotic fractures
Vitamin K is known to promote bone mineralization
Vitamin K taken along side vitamin D significantly reduces bone loss
Increases osteocalcin production
Encourages blood clotting so care with anticoagulants
Antibiotics (over 10 days of use) reduces vitamin K because of the effect on gut flora
Dietary vitamin K1
Food Amount of vitamin K1
130g Cooked Curly kale 1,147mcg
180g Cooked spinach 889mcg
144g Cooked turnip 529mcg
156g Cooked broccoli 220mcg
156 Cooked Brussel sprouts 219mcg
10g Raw Parsley 164mcg
160g Cooked Okra 64mcg
Trace elements
Boron & StrontiumBoron & bones
Boron supplements (3mg) reduce the urinary excretion of calcium and magnesium
Effects on calcium & magnesium possibly via regulating oestrogen / testosterone levels
Naturally found in: almonds, hazel nuts, Brazil nuts, dried apricots, avocado, dates & especially high in raisins
Strontium & bones
Diet normally delivers 1-3mg per day, significant amounts lost in flour refining
Known to stimulate bone formation and inhibit loss
High intakes associated with thyroid and pituitary dysfunction
Naturally found in: spinach, lettuce, carrots, peas, beans, potatoes and celery as well as grains such as wheat & barley – amounts depend on the soil they are grown in.
Key supplements
Vitamin D3(by Enzymatic Therapy, USA)
1000 IU per tablet 2000 IU per chewable tablet
OsteoPrime formulated by: Jonathan Wright MD & Alan Gaby MD
OsteoPrime(by Enzymatic Therapy, USA)
OsteoPrime(by Enzymatic Therapy, USA)
Key points
1. Betaine HCL (20mg per day)
2. Mixture of calcium salts
3. 600mg elemental calcium (per day)
4. Balanced magnesium level
5. Vitamin K (as K1 phytonadione)
6. Vitamin D3
7. Boron & strontium
Dose: 2 capsules/tablets twice a day
OsteoPrime™ Calcium profile
Calcium delivered as;150 mg
Elemental calcium per
1 capsule
600 mg Elemental
calcium per 4 capsules
Carbonate 64.00 mg 256.00 mg
Tri-calcium phosphate 48.00 mg 192.00 mg
Lactate 13.50 mg 54.00 mg
Chelate 13.50 mg 54.00 mg
Citrate 11.00 mg 44.00 mg
150mg 600mg
OsteoPrime formula
Liquid Calcium, Vit D & phosphorus(by Webber Naturals, Canada)
Ingredients Amount per 30ml
Calcium (Tricalcium Phosphate, Calcium Citrate)
1000mg
Phosphorus (Tricalcium Phosphate)
200mg
Vitamin D3 (Cholecalciferol) 10mg (400IU)Purified water, glycerin, inulin, maltodextrin, citric acid, natural blueberry flavour, sodium ascorbate, sodium benzoate, potassium sorbate, xanthan gum.
Adult dose: 2 x 30ml per dayChild dose (under 10’s): 1 x 15-30ml per day
Accessible resource
Contact details
Hadley Wood Healthcare28 Crescent WestHadley WoodBarnet, Herts.EN4 0EJ
t. 0208 441 8352e. [email protected]. www.hadleywoodhealthcare.wordpress.com