Bones #59

Dr. Ann Babbitt:

Bone is a very dynamic tissue. In fact, it's the only tissue that heals itself by making more of itself, and it's very interactive with other systems.

Greg Boucovalas:

When someone approaches me and asks about a bone supplement or it's usually they're looking for calcium. Just grabbing a bottle of calcium and vitamin D may be appropriate for one person, but it's not cookie cutter. It's not the same for everybody.

Kristen Thalheimer Bingham:

We are going to work our muscles and we're going to do it in a rigorous way. But we're going to start with some very simple exercises. But we're going to take any person that comes into the room and then over time, as each individual progresses through the class, she'll be able to do more and more.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show Number 59 Bones, airing for the first time on October 28, 2012 on WLOB and WPEI Radio Portland, Maine. Today's show will feature osteoporosis specialist and orthopedic surgeon Dr. Ann Babbitt, Greg Bukavalis of Apothecary By Design and the Body Architects Strong Women instructor Kristin Thalheimer Bingham. You might be wondering why we thought we should offer a bone show on this particular weekend of this year. Well, if you look around, the decorations on people's doors or maybe near your local cemetery should be an indication it's all about bones and skeletons and getting down to the root of things. And it's autumn and the leaves have fallen off the trees and leaving this very bare bones look about us in the landscape. But just like the trees, our bones are not dead. They're living. There's been a lot of controversy lately about how we're supposed to deal with these living bones, how we're supposed to make them stronger, how we're supposed to make them denser. I became really interested in this show because I've had patients come in recently. In fact, I've had many patients over the years as both a family practice doctor and an integrative medicine doctor who have come in with diagnoses of osteopenia and osteoporosis. They've told me they have brittle bones and they've been scared into thinking that they need to be on hardcore medication. Their hips are going to break, they're going to die from broken hips. And it's very scary and it's very uncertain. And in fact, like many things in the field, we talked about breast cancer last week. We don't know everything. It's an evolving situation. But we need to know because bones are our very foundation, our very living foundation. In traditional Chinese medicine, bones are the organ associated with fear and, and the season of the winter. And you think about Maine and wintertime and cold and you think about the fear of falling, and it's also the element water. It's this idea of falling into the depths and ice breaking. But it's also associated with wisdom and the organ system, kidney and life and regeneration. So that's what I think we need to think about bones as, as life and regeneration and a living organ system. So right now, what we know about bones and osteoporosis, we're going to hear a little bit more about from Dr. Anne Babbitt, osteoporosis specialist and orthopedic surgeon Greg Buccavallis of Apothecary by Design and the body architect, Strong Women instructor Kristin Thalheimer Bingham. These are individuals who are on the cutting edge of holistic way of looking at bones and the bone structure. And I encourage you to go to our website, learn more about them and enjoy the conversations that we have with them. Enjoy the show. The Dr. Lisa Radio Hour and Podcast is pleased to be sponsored by the University of New England. As part of our collaboration with the University of New England, we offer a segment we call Wellness Innovations. This wellness Innovation comes from the New York Times. While higher levels of calcium from food intake may yet prove to be good for the heart, research suggests that the same does not hold true for calcium purchased over the counter. A study from 2010, for example, a large meta analysis that looked at data on more than 8,000 adults over four years, found that those who are taking calcium supplements, a minimum of 500 milligrams a day, had nearly a 30% greater risk of heart attack than those who were not. In a more recent study, people who got their calcium almost exclusively from supplements were more than twice as likely to have a heart attack compared with those who took no supplements. The researchers speculated that taking calcium in supplement form causes blood levels of the mineral to spike quickly to harmful levels, whereas getting it from food may be less dangerous because calcium is absorbed in smaller amounts and at various points throughout the day. For more information on this Wellness Innovation, visit drlisabelisle.com for more information on the University of New England, visit une.edu.

Kristen Thalheimer Bingham:

Edu

Dr. Lisa Belisle:

Halloween is just a few days away and when we think about Halloween, we think about skeletons. When we think about skeletons, what do we think about? Well, we think about bones. When I think about bones, I think about Dr. Ann Babbitt, who is an osteoporosis specialist and an orthopedic surgeon and founder of the Greater Portland Bone and Joint Specialists Group in the Portland area. I should say group Ann, but you just mentioned it was sort of you're the group, you're the specialist.

Dr. Ann Babbitt:

I'm the sole provider.

Dr. Lisa Belisle:

I would say sole provider, yes, but it's a great office. I spent time there as a medical resident myself. I think I was fairly largely pregnant when I was doing that. I spent time doing the osteoporosis, getting a sense of what that was like within your practice. And you had the great honor of doing my first knee surgery when I was in high school. So you and I have known each other for a while, while.

Dr. Ann Babbitt:

That's right.

Dr. Lisa Belisle:

And bones, you've been interested in this. This has been your sort of life's work. How did this all start?

Dr. Ann Babbitt:

I've been interested in bones, muscles, joints, sports, movement, space, things like that pretty much all my life, I would say. And in medical school I just became more focused on orthopedics and fixing bones. The visualness and the hands on aspect of bone care back then and it just progressed.

Dr. Lisa Belisle:

And what happened when you were younger? Well, I don't know if anything happened. But when you were younger, this visual hands on thing, what did that look like when you were a kid or in high school? How did this cause you start to be interested in bones and muscles?

Dr. Ann Babbitt:

I'm not really sure. I think I've always been. Kinesthetic is maybe a term. I like to keep moving and I liked sports when I was younger. So I think it just all evolved from that.

Dr. Lisa Belisle:

And when I was going through, I think you were the only female orthopedic doctor in Maine. Is that still true?

Dr. Ann Babbitt:

I may not have been the only one, but I was the only one in the greater Portland area. There are several other orthopedic surgeons who are women in the state of Maine now.

Dr. Lisa Belisle:

So that must have been pretty interesting, though, to be kind of the one. The one in Greater Portland doing what you were doing.

Dr. Ann Babbitt:

The one in greater Portland was very interesting, yes.

Dr. Lisa Belisle:

Do you think that that led you to your interest in osteoporosis, something that ends up being largely female oriented?

Dr. Ann Babbitt:

I think in part it led me down that path. I've always wondered why mostly older women sustained fractures easily, and it piqued my interest or bothered me a little bit that that happened. And was there anything that we could actually do about it? Could we help these people not to fracture the way that I was seeing them fracture? And men, too, who are older. So it's predominantly women, about 80% women, but 20% men and more as we get older.

Dr. Lisa Belisle:

And what did this lead you to? What did this lead you to? Do you also have a bone densitometer in your practice, which was. You were one of the earlier practices that adopted this type of screening tool.

Dr. Ann Babbitt:

Right. I was actually interested somewhere inside of me about osteoporosis and bone health. But in 1991, the American Medical Women's association was looking for representatives, so to speak, in each state to come together and have a meeting to discuss bone wellness and osteoporosis. And I made out the papers and applied, and I was the only one from Maine who applied. And I went to the meeting, and that started the ball rolling with me getting more interested in actually doing something for bone health other than fixing fractures, so to speak, and fixing ligaments and doing arthroscopic surgery and those types of things. Shortly after that, I didn't really want to move that direction so much because I was very busy doing what I was doing and really liking what I was doing. But I found myself going in that direction of more prevention and trying to figure it out, and then eventually got a densitometer in 1996. So there was a little gap there as I moved more in that direction. And then once I got the bone density testing machine, I was there, and I became involved in the International Society for Clinical Densitometry. There's a mouthful shortly called the iscd, and I've been involved with them ever since. And they're a society that studies Bone and how to measure bone and how to evaluate bone. So I've been very busy with them, and my technologist, Kathy Lucados, has also been very involved in that. So we try to emphasize good quality of bone, measurement and evaluation. And with that, we think we can make better decisions to help people.

Dr. Lisa Belisle:

And there have been a lot of changes in the field since you first started being interested and sort of progressing along as one of Maine's osteoporosis specialists.

Dr. Ann Babbitt:

There have been lots of changes. Bone densitometry has evolved into central densitometry primarily, which would be spine, hip. We also do forearm. We can also do a technique that looks at a side view of your spine to assess to see if you have fractures that you may not know you have, because some fractures in the spine don't hurt. Some hurt like crazy, but some don't hurt. And it's been established that that's a very accurate and beneficial technique to evaluate bone strength. And, you know, I was just thinking before I came in, part of the history of getting the support group started happened when a woman came to me and said we used to have a support group for osteoporosis in the area. And she came to my basement one day and brought some paperwork and some newsletters that had been around for years. And really a lot what was written in those newsletters about good nutrition, exercise, calcium and vitamin D was very on target even compared with today. So we have more information and more knowledge, but a lot of the basics really remain the same. You asking that question made me think of that. Medicines have been added. Pharmaceutical agents have been on the scene now pretty much for the last 10 plus years.

Dr. Lisa Belisle:

Well, and that is really interesting because it's something that a long time ago was pretty inexpensive. You could exercise, you could get your vitamin D, you could eat. Well, we've added things that are expensive and now actually have significant side effects. And there are a lot of questions behind being asked. And I think I've actually generated fear. One of the reasons I wanted to do this show is because I've had patients who have come in who have osteoporosis and they're now afraid. They're afraid of their osteoporosis. And now we're at this interesting place of what do we do next? How do we bring all of this together? And I think this is what you've been working on.

Dr. Ann Babbitt:

Yes, I would say that's what I've been working on. And many people are working on. The holistic approach, I guess, is that's the term I usually use with all the things that we can do without pharmaceutical agents. Years ago you mentioned fear. Years ago, people were afraid of osteoporosis, if they even knew that much about it. Usually they were afraid of it if they saw a family member who had it, usually a parent. And they were afraid because there really wasn't anything we could do. Or they perceived that beyond holistic measures, and I can't emphasize holistic measures enough, but there were no medicines. Now it's flipped a little bit that we do have lots of different medicines, but they have generated fear too. I think, as a lot of medicines have over the last few years, as we become aware that there are downsides to certain medications.

Dr. Lisa Belisle:

Well, is it somewhat radical for an orthopedic surgeon to be talking about, quote, unquote, holistic medicine?

Dr. Ann Babbitt:

I don't know if it's really radical, but it seems to me to be a common sense approach. And I was thinking about that today too. Some recent information is coming out again about hormones, estrogens, that is saying, oh, maybe they aren't so bad as what we thought. And it seems like a lot of things in medicine come back to common sense. Appropriate use of at appropriate times in appropriate ways. And that can be said of medications, hormones, nutrition, exercise, all the holistic things. Sunshine is the one that comes to mind a lot. In regard to vitamin D, I think we tend to be very black and white. A lot of times about this is good and that's bad. And most of the time I find that that's really not the rest of the answer. The answer is more in the details than in the individualization of how you do certain things, which kind of goes back to that exercise thing. Exercise can be not so good for you in certain ways and exercise can be great for you, but it depends on you and all the body parts that you have and how they work and how your whole system works of how to do exercise, when duration, intensity, what muscle groups. I mean, that's a good example.

Dr. Lisa Belisle:

Well, that's a really interesting point because we talk about weight bearing exercises being important for bone strength, but if you do too much of it, you can fall on the other end of the spectrum with the female athlete triad, which actually can cause not having periods anymore and decreased bone density and really significant hormonal changes, eating issues. So I think you're right that it is about the balance and about the individualized medicine. But do you think that it has become harder for doctors to practice holistic and individualized medicine? The way that health Care is set up these days.

Dr. Ann Babbitt:

I think it is difficult to practice holistic medicine in the mainstream medical world because it usually does demand time and explanation and individualization of treatment. And that's very complex because one of my favorite statements I say to patients and others is that the good news in the year 2012, almost 2013, we have a tremendous amount of information. The bad news is we have a tremendous amount of information and how do we all sort that out? And I find that difficult and sometimes frustrating as a provider and as a person. If I'm going to the store to even buy something, it's like, whoa, there's so many choices with anything. So trying to use those options effectively and safely, I think is the challenge of this time period in medicine and pretty much everything else.

Dr. Lisa Belisle:

If we were to broaden it out and ask for general recommendations about bone density screening. Let's just start with screening. What do you have to offer on that subject?

Dr. Ann Babbitt:

Generally, screening is suggested by the National Osteoporosis foundation and others at about age 65 for women who do not have risk factors. And there's. That's the question, what are risk factors? Men 70 with no risk factors. But many people have risk factors. So the day to day common sense answer is most women get a bone density test by about the age of 50. If they have menopause earlier than that and they're estrogen deficient, then we suggest getting it at that time. Men probably around 50 or 60. Also, if they have some risk factors and most of us do, most of us maybe don't eat as well as we should, exercise as well as we should, maybe have been calciumin D deficient, have some other bad habits, have some family history that may contribute, and people

Dr. Lisa Belisle:

maybe who have had cancer and have had to have their ovaries removed, or people have had some other something that would possibly contribute to having poor bone health, they should be thinking about getting this done early.

Dr. Ann Babbitt:

Yes, many medical problems and medications can contribute to poor bone health. In addition to the smoking and alcohol we're finding, like narcotics, narcotic types of drugs, I call them mind altering drugs of various types can be problematic. There are questions about medicines that people take for heartburn, that type of thing. They're not usually as dramatic, but they can contribute to problems with bone health. So yes, there can be many other details regarding indications for bone density testing.

Dr. Lisa Belisle:

And if somebody comes in and they have had a bone density test and whether it shows osteoporosis or osteopenia, which is not osteoporosis but sort of before you get to that, what are some of the tests that, that you perform?

Dr. Ann Babbitt:

It depends where they are on that continuum. You know, we divided out normal osteopenia, osteoporosis, and those are these very distinct lines. I'm not much of a line person. I think it's a blending. So when you hit that osteoporosis number minus 2.5 T score, that should be a pretty specific trigger of looking at what could be going on that's contributing to that number. And of course that's the history, the physical and then medication review and risk factor assessment. Then I usually get laboratory tests to look for those other causes that aren't apparent that could be contributing. And sometimes there are things you don't think of, like people have celiac disease and don't know they have it, and that's a risk for osteoporosis. I get a vitamin D on everyone lab tests because it gives me a good ballpark idea of vitamin D sufficiency. And then depending on the person looking for other things.

Dr. Lisa Belisle:

Can thyroid disease contribute to osteoporosis?

Dr. Ann Babbitt:

Thyroid disease can contribute to osteoporosis. I find that in modern day times, thyroid is pretty well monitored and treated. We have better medicines. The laboratory tests are more accurate. If you're a person who's hypothyroid and on medication, that's usually where it can get problematic. I think people used to take more crude, I guess you'd say thyroid medicine years ago and maybe would be taking too much of it. And there's not that much unrecognized hyperthyroidism in the United States right now. So I don't see that very often, but that is on the risk factor list.

Dr. Lisa Belisle:

And what about kidney disease?

Dr. Ann Babbitt:

Kidney disease is definitely a risk factor for osteoporosis or problems with bone. The kidneys are very interrelated with bone. Bone is actually interrelated with many systems. Kidneys are one, gastrointestinal system is another, and cardiovascular system is another, which has to do with vitamin D and calcium and hormones and all kinds of complicated things that are difficult to understand. But kidney disease can be a factor. And we have slightly modified recommendations for calcium intake and management of the kidney disease patient. The severe kidney disease patient is. It's very difficult to know what to do. The nephrologists and others, the kidney doctors, we're all trying to kind of figure that out.

Dr. Lisa Belisle:

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Dr. Lisa Belisle:

For people who don't have any recognizable underlying cause of osteoporosis, or maybe they do, but they have really significant issues and you may need to treat them. What are some of the Medications that are out there that are being used and what are some of the, I guess the good and bad aspects of them?

Dr. Ann Babbitt:

The spectrum is hormone or hormone like medications. So estrogen, testosterone for men, not highly utilized because of other possible problems with estrogen and testosterone, although again they're being reviewed a little bit in lower dosing regiments and different delivery systems now compared to a few years ago. Evist or Raloxifene is an estrogen, what we call agonist antagonist. So it has some estrogenic qualities and some anti estrogen qualities, probably best used to prevent breast cancer and partly for bone health. But it's a small niche that that medication fills right now. And then the next is the big mainstay group which are the bisphosphonates, the second and third generation bisphosphonates, which actually have been around for years, known as compounds since the 1800s. The original one was Didronel. Some people were on that in Portland, Maine. It's very popular here. And then Fosamax, which now is generic. So as far as expense goes, it's pretty cheap now, generic, but we are not clear how generic drugs really fit in to quality. So Alendronate, Actonel, which is Resedronate, Boniva, which is Abandronate, which is oral. Those are all the oral bisphosphonates. And then IV Boniva every three months and reclassed IV once a year.

Dr. Lisa Belisle:

And these seem to have a positive impact on bone building.

Dr. Ann Babbitt:

Yes. All of these drugs, what they do is they act on the cells that take bone away and they slow them down. People say, do these really build bone? And the answer is, well, they don't act on the cell maybe a little, but not a lot. That makes bone. They act on the cell that takes bone away and slow that cell down. The net result is more bone. At least we know that for short term. What's short term treatment? Three years, five years. And in my practice I notice that most people's bone density does improve the first few years and then it kind of plateaus. So we are using these medications now on kind of what I call an on off sequence, where you take them for a little while, we watch you closely, we make sure all the other holistic pieces are in place for your health. And we work on medications that may not be so good for you or quitting smoking or adding more exercise. And then we modify what we're doing by it. We call it a holiday, a drug holiday. We like that better than a break because a break sounds like could be a Broken bone. Sometimes we'll use another medication in there. If you have severe osteoporosis. It all depends on, do you just have a number in the osteoporotic range or do you have fractures? You know, that risk profile is always very important to review. So it depends on the individual. So that leads us to the next medication, which is forteo, which is a daily injectable medication that you take only for two years. And that is the only medicine that we have right now that acts on the cells that make bone and stimulates them. So we'll sometimes use it for a while and then go back to that category called the bisphosphonates. And then one more, just the latest one is Prolia, which has been out about three years. It also acts just like those bisphosphonates on the cells that take bone away and slows that down. And that's an injection twice a year. That's pretty much what we have right now. Now you can ask me your question.

Dr. Lisa Belisle:

Oh, and I guess my question now is, well, I alluded to this before, that there is this fear aspect because there are side effects, there are downsides taking these medications. What are some of the more common downsides that we are concerned about these days?

Dr. Ann Babbitt:

The common downsides to the oral bisphosphonates, which are fosamatic, solendronate, actonel and boniva, are heartburn. These are phosphates. And if you think of phosphates, that's a little bit fizzy, even though it's a small pill, it can be a little bit fizzy in the esophagus. So it can create heartburn and chest symptoms and usually mild. But there are some people who've had some pretty significant symptoms. That's about 10% of the people. So it's not a lot, but it's there. We see it. The higher doses or long term use of bisphosphonates have been associated with an entity called osteonecrosis of the jaw, which is an icky, awful term, which usually isn't as icky and awful as it sounds like. But that's mostly seen in cancer patients who are very ill. 94.6 or something like that. Last I looked, percent of those cases are in cancer patients and they're rare. It's reported there are 1 in 10,000 to 1 in 100,000 of people who take the medications. I don't know exactly where that statistic comes from. I don't write the statistics. But those people are very ill. They have metastatic cancer to bone and in actuality, these drugs prevent what we call skeletal events that are related to cancer, which are usually fractures and bone pain. And they're on about, I say, 14 times the dose of osteoporosis medications because they get like intravenous dosing of Reclast rather than once a year, usually about every three weeks. And now actually the oncologists are tempering that treatment to longer intervals. And then the other complication that we've seen, which is very mysterious, is called unusual subtrochanteric fractures or femur fractures, which I find very interesting. We're not really clear. That's seen more in osteoporosis patients, actually more in people who have underlying problems. Many of them are on cortisone. 40 to 60% are on cortisone. Many of them, I believe, are probably vitamin D resistant or insufficient or have underlying metabolic bone problems that we may not really fully understand yet. So there's a subset of people that seem to be prone to those and that too is rare. 1 in 10,000 to 1 in 100,000. But if you have it, you're not going to be happy. So those are our concerns that we're still looking at.

Dr. Lisa Belisle:

And if people do have osteoporosis or osteopenia or questions about osteoporosis, you have the osteoporosis healthcare network here in the state. How do people learn about that or about your practice? The Greater Portland Bone and Joint Species Specialists practice.

Dr. Ann Babbitt:

I'm so glad you asked about the. We call it the OHN and the support group. The support group has been in existence since 1996. And it's really mostly what the OHN does now. We used to do more awareness events. We had something called the bone density dash every spring for a number of years. And we also, when asked, will give talks anywhere. But the support group has met the first Tuesday of every month since 1990. I think it started actually 1997. And it is a lecture series and support and healthy foods. It often talks about bone health or bone related topics. But sometimes we branch out like we had talk about eye health. We're going to go to a gym this next Tuesday and check out what to do at the gym. So that is a very good way to connect. And we have a newsletter, we have an email list. We don't have a website at this point in time. We've talked about it, but don't have one presently.

Dr. Lisa Belisle:

So is there a phone call that people can call to reach you?

Dr. Ann Babbitt:

The best is to call our office which covers all those entities and that's 828113.

Dr. Lisa Belisle:

Well, I appreciate your the time that you've taken to make sure that we have nice, strong, healthy bones within the state of Maine. We've been talking with Dr. Ann Babbitt who is an orthopedic surgeon, osteoporosis specialist, founder of the Greater Portland Bone and Joint Specialists Group in the Portland area. And I think that anybody who's listening is going to have a little bit more information on how to keep their bones healthy and well and pay attention to this really important part of our body. So thanks for coming in.

Dr. Ann Babbitt:

Thank you for having me. Come in.

Dr. Lisa Belisle:

This morning we're talking about bones and we know that one of the things that's going on out in the general population is, well, there's a lot of questions about calcium, about vitamin D, about medications. So we couldn't think of a better person to come in and maybe give us a little bit of educated thought on the matter than Greg Bukavallis from Apothecary By Design. He is a registered pharmacist with that wonderful organization which has recently expanded. And I've spoken with Greg. I know that he's got a wealth of information. Plus he just, he seems to have this great energy about him. So you're going to tell us all about medications, supplements that have to do with bones. Thanks for coming in.

Greg Boucovalas:

Thanks for having me. My looking forward to this. So as far as bone health goes, it seems that it's been dumbed down to just calcium and vitamin D. There's way, way more to it than that. And people think if they're getting X amount of calcium, it's Going right to their bone when that isn't necessarily the case. There are other co factors involved. In fact, bone is actually two different components. People don't think of it as such. They think of it as a static type organ or tissue where the visual is like a skeleton. It's Halloween time coming up. But that's what people think of bone as a skeleton when it's actually a pretty dynamic tissue where old bone is being shed and replaced by new bone. And I think that's an issue with some of the newer class. Well, the bisphosphonates, their mechanism of action kind of impedes that dynamic a little bit. So hence they change the prescribing patterns on that where patients should only be on it for no more than five years. They're finding like weird incidences of fractures if you're on it for X amount of time. Because even though bone density may be impacted favorably, bone quality may not necessarily improve.

Dr. Lisa Belisle:

Is this something that happens regularly, that will prescribe a medication, thinking it's going to do one thing, have studies behind it, but then not enough sort of practical on the ground experiment, find that other things happen, then we need to change things. Is this something that happens in the pharmaceutical industry?

Greg Boucovalas:

Sadly, it does. And I think the class of the bisphosphonates is a classic example of that, where some of the science got ahead of actually what the benefit, expected benefit would be. So, yeah, I mean, if you investigated that a little bit, there's a book called Overdosed America. There's a pretty interesting chapter and that dedicated solely to the conspiracy theory kind of behind that. But yeah, it's an example of what you're talking about.

Dr. Lisa Belisle:

Now, did this also. Well, first I want to back up. I think sometimes this happens because we don't seem to have another good answer. So we take an answer, we apply it to a problem such as osteoporosis and the bisphosphonates, and we use it as our best guess at the time. Does that seem possible?

Greg Boucovalas:

I think the end point is off the mark. If the end point, if what they're trying to achieve, if the goal is increase or maintain bone density, then that therapy could be considered, you know, successful. But if you're actually trying to improve bone quality, it's a different story, it's a different endpoint. So it depends on how you want to frame it. And it's not semantics. There is a difference. You could have a really good bone density. The example they use is a piece of chalk. You've probably heard that before. The density of chalk shock is high, but its resiliency to fracture, it's very brittle. So just the bone density aspect isn't in and of itself enough, I feel, to prescribe that type of medicine to millions and millions of women.

Dr. Lisa Belisle:

So maybe we were asking the wrong question in the first place. Place. It's not how do we get our bones more dense, it's how do we get better quality bones.

Greg Boucovalas:

Exactly.

Dr. Lisa Belisle:

And is that one of the reasons why we started talking about calcium? Because we were thinking, well, calcium is used for bones and let's prescribe calcium

Greg Boucovalas:

is that it's easy. Calcium, bones easy kind of ended discussion. But it's way, way more complex than that. As you know, plus, calcium has an FDA approval for being beneficial for osteoporosis. So once you get the okay from the FDA to make a certain claim, which is unusual for dietary supplements, not many supplements have the blessing of the FDA to make a health claim that it might cure or mitigate a disease. So once that was given, then I think that's why calcium got way, way too much publicity and say its partner in the body, magnesium, gets virtually no publicity at all when.

Dr. Lisa Belisle:

So what happened then? So we know now that people started prescribing calcium, probably over prescribing calcium, because again, maybe we weren't asking the right question or we just sort of got very excited about some possibility and started using it for everybody. And what are the studies finding now with regard to calcium?

Greg Boucovalas:

Well, as far as dietary calcium goes, there was a recent study that came out of Sweden, about 60,000 women, elderly women, 60ish to 90ish, followed them for about roughly 20 years, just strictly dietary intake. And they broke that 60,000 into quarters. And the bottom quarter, the bottom intake of calcium, around 700 milligrams had roughly. They had the highest incidence of hip fracture. But that study didn't show a linear effect where more was better because the next highest incident happened in the top quintile, the top 25%. So more isn't necessarily better. So based upon that study and others, there's other studies that link calcium supplementation different than and distinction definitely has to be made between dietary and supplemental calcium. Supplemental calcium. Few studies have come out. A few, and none of them are definitive. Some show increased risk of what they call a coronary artery calcium score, meaning calcium's ending up in blood vessels when it you really hopefully it ends up in your bones, like vitamin K. Helps get it where it belongs. But as far as those studies go, some say there's an increased risk of A coronary event, meaning a heart attack, a heart attack, heart attack, stroke, something in the cardiovascular family. Some show no, and some show trends that may be, but they're not significant. So you really. There's no definitive answer out there which should make us rethink how we should be utilizing calcium. Meaning the guidelines out there now Recommend Women over 50. I could be off slightly on the numbers, but they're saying they should be getting about 1,200 milligrams a day, but that's total. But the issue I see is in the pharmacy or the health food store is someone will come in, a lady will come in looking for calcium, just calcium, maybe some D. And she's trying to hit that magic number, say, of 1200 milligrams a day, which based on these studies, may not be such a good idea. Maybe a good idea to rethink. We need to maybe find a sweet spot where it'll maybe lower it down to maybe 800 total a day where you're getting maybe 4 to 600 from your diet and then you supplement with the rest. And that way, hopefully your bones benefit, but your heart won't be. Or your cardiovascular system won't be hurt detrimentally. So that's the key. It's that balance right there.

Dr. Lisa Belisle:

So where do people find you on Apothecary by Design?

Greg Boucovalas:

We are located on 84 Marginal Way. We're attached to the Intermed building. We're right across the street from Trader Joe's Eastern Mountain Sports. When I'm in the pharmacy, I'm looking right across the street and I can see the kayaks attached to the Eastern Mountain Sports building. So free parking right in the parking garage. Anywhere you can find a space, or you can park right out front. And Monday through Friday, 8 to 6, Saturday 9 to 5.

Dr. Lisa Belisle:

Wow, that was. That was impressive that you know your store hours. That's really impressive. For people who want to just review. Is there a website that they can go to?

Greg Boucovalas:

Yes. Www.apothecarybydesign.com and we have. Provide us with an email. We can send you our monthly newsletter and. Or feel free to call. I'm there almost all the time. Feel free to call or send me an email and, you know, be glad to talk to you about the subject because I think there's some. Some misconceptions that definitely need to be addressed out there.

Dr. Lisa Belisle:

Well, we've been speaking with Greg Buccavallis, who is a registered pharmacist with Apothecary by Design and clearly a very knowledgeable individual. On the subject. So I encourage anyone who's listening, who has questions about osteoporosis, calcium, vitamin D, and really any other issues related to health and possibly food and supplementation to go and visit with Greg.

Greg Boucovalas:

Thank you Lisa.

Dr. Lisa Belisle:

Today on the Dr. Lisa Radio Hour, our topic is bones. And as we know, bones are the things that hold our bodies up and we need them to be strong. Bones are something that I experience a lot of questions with in my practice, and one of the things that I tell pretty much every woman and every man that comes in to see me is that in order to keep your bones strong, you need to keep your body strong. So we thought it would be a good idea to bring in Kristin Talheimer Bingham, who is a strong women instructor right here at the Body Architect in Portland. Hi Kristen, thanks for coming in.

Kristen Thalheimer Bingham:

Hi Lisa, thanks for having me.

Dr. Lisa Belisle:

Now, Kristin, why was it important to you to go into the strong women field?

Kristen Thalheimer Bingham:

Well, I had been an instructor for many years. I started teaching group exercise classes back in 1989 and I think Jane Fonda was popular then. So the strong women classes came up after I had been teaching for many years and it just clicked with me. So I was certified to teach strong women. I got my certification from Miriam Nelson, who is the author of the Strong Women books and the researcher at Tufts University. And her idea after doing her research was that women of all ages can benefit from strength training. So that, as I said, clicked with me because what was important to me as an instructor is just to welcome all people into my classes, no matter where they are, whether they've been working out for years and are athletic or are just starting out.

Dr. Lisa Belisle:

What are some of the benefits of being in a strong women class or strength training for women in general?

Kristen Thalheimer Bingham:

Well, benefits certainly muscle strength, bone strength, as you mentioned, general health and fitness. There's certainly an effect on cardio, heart and lungs even in a strength training Class, it's good for your skin, it's good for your mental capacity. It's good for all sorts of things and including just being with other people and socializing and getting to know other wonderful people.

Dr. Lisa Belisle:

And I can definitely attest to that because I see patients at the Body Architect, and I know that you have a very closely knit of. Of women that come in and experience your class. I mean, they all kind of come in and they're all very happy and smiling, and they take your class and they leave and they're happy and smiling, and they really seem to enjoy each other's company.

Kristen Thalheimer Bingham:

Yeah, they're a great group of women. And I come in and they make me smile too. So it's really a mutual giving and taking. So, yeah, there's quite a bit of community that we've created at the Body Architect and in this particular class. And the women are just wonderful people to be around.

Dr. Lisa Belisle:

How does strong women, Strong women class. How does that differ from, say, another type of class that you've taught in the past? What would I expect if I was going to go into your class?

Kristen Thalheimer Bingham:

A strong women class is based on the idea that we are going to work our muscles and we're going to do it in a rigorous way, but we're going to start with some very simple exercises. So we're not going to hang from the ceiling or do anything crazy, but we're going to take any person that comes into the room, modify exercises to help her feel good about herself, and then over time, as each individual progresses through the class, she'll be able to do more and more. So we start, everyone together does the same activities, but you do what you can. So if I'm doing or the class is doing a series of squats or lunges, and by the end of the class, say, we've done anywhere from 24 to 30 squats. If that one individual who's new comes in and does four or half a dozen or ten, that's really, really okay. So we cover all the major muscle groups, lower body and upper body, and try to get them all.

Dr. Lisa Belisle:

And if people come in, and if women come in and they are a little concerned about a back problem or a knee issue, are you able to talk to them and maybe help them tailor some of the exercises to their needs?

Kristen Thalheimer Bingham:

I am, yes. I say that with a little bit of hesitation because I'm not a medical person. So my rule is always don't do it if it doesn't feel right. And I say that probably five to ten times in Class every time. So I really want women to listen to their bodies. If they have a knee injury, sometimes lunges work for them, sometimes they don't because the knee is so complicated. So I don't claim to know the medical reasons behind something, but I can help people figure out what form might alleviate some of that stress, for example, on the knee. And I'll help them, and I'll work with them and give modifications as needed. Yes, definitely. And then if it still doesn't work right, then we move on to trying to find other reasons for it. But certainly I'll help each individual find the way that works best for them.

Dr. Lisa Belisle:

And how has being a Strong Women instructor, how is this impacted you personally in your own life?

Kristen Thalheimer Bingham:

I've met amazing women. That's probably the best way that it's impacted my life. I perhaps set a tone in my class, but it's these other women who come in who are working hard and serious about being healthy, but joyful in their experience of that. So that's one really big way. And I think being an instructor in general has helped me to be more confident, helped me to feel more comfortable with my body, more comfortable with all kinds of people. So there are a lot of personal benefits to it, for sure. And just in terms of being very careful about my own health, how can

Dr. Lisa Belisle:

people find out more about Strong Women or the Strong Women class that you offer?

Kristen Thalheimer Bingham:

So the Strong Women class I offer, as you mentioned, is at the Body Architect, Monday, Wednesday, Friday at 9 in the morning. Everyone is welcome. In general, if you want to know more about the Strong Women series, you can just look up Miriam Nelson, Dr. Miriam Nelson Tufts University. And you can see she's got, I think, 10 or 12 books. And there are Strong Women programs, as far as I know, throughout New England and I'm guessing throughout the United States. Each one will be a little different because the instructor has some leeway as to how she might teach it or he might teach it. But you can certainly find out a lot by looking up Dr. Nelson.

Dr. Lisa Belisle:

And the Body Architect has a website.

Kristen Thalheimer Bingham:

The Body Architect does have a website, thebodyarchitect.com I think, and also a Facebook page, I believe. I think you're right. Yeah.

Dr. Lisa Belisle:

Well, thank you, Kristen, for coming in and talking to us today about the Strong Women class that you teach about strong women in general and about you yourself as a strong woman. I appreciate the work you're doing in the community for helping women keep their bones and their bodies healthy and strong.

Kristen Thalheimer Bingham:

My pleasure. Thank you so much.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you've been listening to the Dr. Lisa Radio Hour and podcast show number 59 bones, offered in honor of Halloween for the first time on October 28, 2012. Today's guests have included included osteoporosis specialist and orthopedic surgeon Dr. Ann Babbitt Greg Bukavalis, registered Pharmacist with Apothecary by Design and the Body Architects Strong Women Instructor Kristin Thalheimer Bingham. I encourage you to go to drlisabelisle.com and find out more about our guests. I also encourage you to go to our Facebook page and like us so that we can send you information about health, nutrition, supplements and general happy living. Be sure to tell your friends about our show and go back and listen to our past podcasts. I know that you will find a wealth of knowledge and insight that can't be found pretty much anywhere else. This is Dr. Lisa Belisle. May you have a bountiful life. Thank you for being part of our world.