Osteoporosis: Getting to the Bones of the Problem

By

Dr. Patrick Donovan

What Is Osteoporosis?
Osteoporosis is a silent, slowly developing disease in which your bones become progressively less calcified and therefore, more fragile and more likely to break. This is most particularly dangerous when the bones involved are the bones of your spine and larger bones of your hips. If these bones are fractured, you can become seriously debilitated and commonly in need of hospitalization and major surgery. These fractures can further impair your ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity. The sad fact is often osteoporosis progresses quietly and painlessly to the point where it is finally diagnosed only after a fracture occurs.

Can I Prevent Osteoporosis?
Yes you can! The good news about osteoporosis is that it can be prevented and, at the very least, diagnosed early before any fractures occur. The first thing to do is begin early, learning the risk factors for osteoporosis and changing the ones you can change. There are a number of risk factors you can change and others you can’t change. For instance, women are four times more likely to develop osteoporosis than men and people with a sedentary lifestyle are at higher risk than their active counterparts. Well, you can’t change being a woman but you can change your activity levels. Below is a list of risk factors you can change and risk factors you can’t change:

Risk Factors You CAN Change

• Low calcium intake: Low calcium intake leads to poorly formed and calcified bones. Only 50-60% of adults and only 10-25% of adolescents in the United States get the recommended amount of calcium. Nearly 90% of a person’s bone mass is built by the age of 20. So, starting early to make sure you and your children are getting enough calcium to build those bones and then maintain that bone mass is recommended. Also, realize some of the best sources of calcium are not just from dairy. Beans, true nuts, sesame seeds, and many “greens” such as turnip greens, collard greens, spinach and others are high in calcium. Canned sardines and salmon also are a great source of calcium.

1. How to change it: Since the body's calcium needs change with age, calcium intake should be adjusted as necessary. Depending on age, an appropriate daily calcium intake is generally between 1000 and 1300 milligrams (mg) a day with 800 to 1300 mg. daily from ages 4 to 18 and 1000 to 1200 mg. daily for adults. The best way to assure adequate calcium intake is to supplement. The best forms of calcium for supplementation are calcium citrate (40% more absorbable than calcium carbonate from Tums) and microcrystalline hydroxyapatite concentrate (“MCHC”).

• Low vitamin D levels: Vitamin D is a hormone in our bodies that helps regulate calcium absorption and utilization among numerous other valuable functions. Low levels of vitamin D cause calcium to not be put into bones. Vitamin D refers to two biologically inactive precursors - D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive. Our bodies manufacture vitamin D on exposure to sunshine. However, sufficient levels of sun exposure are needed to assure adequate levels. In many areas of the world such as the northern latitudes, adequate exposure to sunlight is so lacking during the winter months that our body makes no vitamin D at all. We must then rely on dietary supplements and fortified foods to boost intakes of vitamin D.

1. How to change it: We doctors in the pacific northwest commonly find many of our patients' vitamin D (25 OH) levels below the normal range of 32.0 - 100.0 and actively replete these low levels with oral doses of vitamin D3 in the range of 1,000 IU - 5,000 IU daily and then recheck levels in 8 - 12 weeks. Based on the latest research, we prefer to get vitamin D (25 OH) levels in the blood into the range of 60. Vitamin D3 is the best absorbed and utilized form of oral vitamin D. We STRONGLY suggest vitamin D supplementation over 1,000 IU daily be done under the guidance of a licensed health care provider. We also suggest vitamin D levels be checked once or twice yearly depending on what part of the world you live in and your sun exposure.

• Low intake of bone-supporting nutrients: Numerous micronutrients help with the absorption and utilization of calcium. These include magnesium, silica, vitamin K2, boron and fluoride to name a few. The optimal daily intake of these micronutrients is commonly deficient in most people throughout the world especially those eating a standard, western diet and fast foods.

1. How to change it: Supplementing with a calcium product that includes these micronutrients is important. Two of the most important of these micronutrients for maximizing bone health is water-soluble silica (orthosilicic acid) and vitamin K2. Water-soluble silica is present in surface and well water. It is the form predominantly absorbed by humans and is found in numerous tissues including bone, collagen and connective tissues, tendons, aorta, liver, and kidney. Although no Recommended Daily Allowance (RDA) has been set for silica, compelling scientific evidence suggests it is essential for health with a myriad of beneficial effects being discovered. Deficiencies cause bone deformities; brittle nails; thin, brittle hair that lacks luster; damaged, early aging of skin with reduced elasticity and wrinkling; poorly formed joints; reduced levels of collagen and cartilage; and disruption of mineral balance in the femur and vertebrae. In clinical studies, supplementing calcium and vitamin D3 with water-soluble silica (choline-stabilized orthosilicic acid) improved bone calcification and density far better than just supplementing calcium and vitamin D3 alone. Although vitamin K is not deficient in most diets, its form of vitamin K2 has been shown to markedly improve calcium incorporation into bone while slowing the breakdown of bone.

• Tobacco use: The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.

1. How to change it: Don’t smoke!

• Eating disorders: Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density. This is usually due to nutritional deficiencies that occur as a result of those eating disorders and the stress it puts upon their bodies and the resultant lessened body mass.

1. How to change it: If you or someone in your family has an eating disorder, get them into treatment with an eating disorder clinic and or therapist.

• Sedentary lifestyle: People who spend a lot of time sitting have a higher risk of osteoporosis than their more-active counterparts. Too much computer work at a desk, playing video games, watching TV, etc. can contribute to this.

1. How to change it: When you stress your bones they get the message to put more calcium in and build more bone. Active, weight-bearing exercise is most essential to counterbalance a sedentary life style. Weight-bearing is beneficial for your bones. Walking; running; jumping; dancing; weightlifting and many aerobic, outdoor sports seem particularly helpful for building and maintaining strong bones. So, get active and stay active.

• Excessive alcohol consumption: Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis, possibly because alcohol can interfere with the body's ability to absorb calcium.

1. How to change it: Keep your alcohol intake to a minimum of two drinks a day or less. When you do drink, try not to drink “harder” alcohols and stick to red wine and beer as these can be healthier than harder alcohols.

• Use of Corticosteroid and other medications: Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications are common treatments for chronic inflammatory conditions, such as asthma, rheumatoid arthritis, lupus, inflammatory bowel disease and other autoimmune disorders. Long-term use of aromatase inhibitors to treat breast cancer, the antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), the cancer treatment drug methotrexate, some anti-seizure medications, the acid-blocking drugs called proton pump inhibitors and aluminum-containing antacids are all associated with an increased risk of osteoporosis.

1. How to change it: If you cannot reduce your dependence or need for any of these medications, your doctor should monitor your bone density (using a DEXA scan) and your vitamin D and calcium levels and recommend therapeutic medications other than the ones listed to treat those conditions whenever possible. You should certainly maintain optimal doses of calcium, vitamin D3 and the other supportive nutrients as mentioned above while taking these medications. Also using drugs such as Fosamax to help prevent bone loss is quite reasonable if these medications must be continued and you are developing osteoporosis.

• Celiac disease: Celiac disease is a risk factor for osteoporosis due to the associated malabsorption of micronutrients and macronutrients such as calcium. It is now recommended that all patients with osteoporosis, especially when prematurely occurring, be screened for celiac disease.

1. How to change it: Get screened for celiac and if you have it, follow a strict gluten-free diet and supplement calcium and related nutrients as stated above.

Risk Factors You CAN”T Change (but you can modify)

• Being a woman: Fractures from osteoporosis are almost twice as common in women as they are in men. But you can lessen this risk if you change the risk factors above that can be changed.

• Getting older: The older you get, the greater your risk of osteoporosis. But you can lessen this risk if you change the risk factors above that can be changed.

• Race: You're at greatest risk of osteoporosis if you're white or of Asian descent.

• Family history of osteoporosis: Having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures. But this can also be due to some degree to a learned family pattern of eating habits and sedentary living that puts you at risk. That piece can be changed.

• Frame size: Men and women who are exceptionally thin (with a body mass index of 19 or less) or have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age.

• Thyroid hormone: Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism). If you have thyroid disease, your Thyroid Stimulating Hormone (TSH) should be measured and monitored regularly by your doctor. The best and safest levels to maintain are between 1.0 and 2.0.

• Medical conditions and procedures that affect bone health: Stomach surgery (gastrectomy), some intestinal surgery (partial removal of small intestines) and weight-loss surgery can affect your body's ability to absorb calcium. Disorders associated with malabsorption such as Crohn's disease and celiac disease can cause osteoporosis by limiting absorption of calcium and other nutrients. As a matter of fact, all patients with osteoporosis should be screened for celiac disease. Hyperparathyroidism and Cushing's disease are two other disorders that can cause osteoporosis.

How is Osteoporosis Diagnosed?
Reviewing all of your risk factors both personal and familial and an initial physical exam is the first step. Most importantly, however, is predicting your chances of future fracture, as this is your greatest health risk. Various x-rays to detect skeletal problems can be done and laboratory tests that reveal important information about the metabolic process of bone breakdown and formation can be done including vitamin D and calcium levels. Ultimately, a bone density test called a DEXA scan is done to detect if there is low bone density.

How is Osteoporosis Treated?
The best treatment for osteoporosis is prevention. That means following all of the guidelines for changing your risk factors as listed above. Even if you have been diagnosed with osteoporosis or osteopenia (mild loss of bone density), you should institute the guidelines given above for prevention. With this done, you may want to consider treatment with low-dose testosterone and or the hormone DHEA. These hormones must be prescribed by a knowledgeable, licensed, healthcare practitioner who should also monitor your progress. Finally, you may want to consider treatment with various prescription, bisphosphonate medications such as Fosamax. However, these medications come with risks of their-own. These risks include: ulcers of the esophagus and stomach; gastritis (stomach irritation); irregular heartbeat; fractures of the femur; low calcium in the blood; skin rash; joint, bone, and muscle pain; jaw bone decay (osteonecrosis) and, rarely, ncreased parathyroid hormone (PTH).

Summary
By far, the best treatment for osteoporosis is prevention. For the most part, it is a preventable disease. The choice is in your hands. You can start today by implementing the recommendations suggested here.

TURMERIC: THE "SPICE OF LIFE" AND CANCER PREVENTION

By

Dr. Patrick Donovan

Spice as Medicine

Curcumin is a polyphenoIic flavonoid compound derived from the rhizome of the herb Curcuma longa better known as the cooking spice turmeric. Turmeric has a very long history of use as a cooking spice and as a medicinal or healing herb in various traditional healing systems. Extensive research over the last half century has revealed some important medicinal qualities of its flavonoid compound curcumin. In vitro (cell cultures) and in vivo (animal and human) research has shown curcumin to have various medical activities. It is a very potent anti-inflammatory agent reducing the pain, swelling and tissue damage due to acute and chronic inflammatory responses. It does this by modifying the release of various pro-inflammatory chemicals such as cytokines and cytokine releasing factors like NF Kapa B. It is also a very potent antioxidant and has immunomodulatory capabilities. Most recently, extensive research has indicated curcumin to also be a strong anticancer agent not only useful for preventing cancer but also useful in treating cancer.

Curcumin as an Anticancer Agent

The anticancer potential of curcumin stems from its ability to suppress activation and proliferation of a wide variety of cancer cells by: 1) Down-regulating transcription factors and the expression of pro-inflammatory chemicals that stimulate early cancerous changes in normal cells; 2) Down-regulating growth factor receptors and inhibiting certain enzymes (kinases) that stimulate the transformation and proliferation of cancer cells. This results in curcumin’s ability, as evidenced in many studies, to suppress three important and primary phases of cancer development: tumor initiation, promotion and metastasis. Curcumin also “turns back on” the cancer cells’ “self-destruct” switch (apoptosis) that was tuned off by the cancer process. When this self-destruct mechanism is turned back on, the cancer cells are less proliferative and become more responsive and less resistant to chemotherapy and radiotherapy treatments. This means more cancer cells will die in response to chemotherapy or radiotherapy if curcumin is given before and throughout those therapies.

Actual clinical trials have shown curcumin to be a strong chemoprevention agent in colon and pancreatic cancer, cervical neoplasia and Barrets metaplasia (early cancerous changes in the esophagus). Clinical research with curcumin, along with the anti-metabolite, chemotherapeutic drug gemcitabine in the treatment of patients with advanced pancreatic carcinoma, produced an impressive response. Curcumin's potent anti-proliferative activity appears to potentiate the anti-tumor effect of gemcitabine.

Meriva: Safe and Effective

Accumulating experimental evidence suggests that curcumin interferes with a variety of molecular targets and processes involved in cancer making it a promising natural agent in the prevention and co-treatment of cancer. Further, data obtained in multiple preclinical models, as well as in preliminary clinical trials, have documented minimal toxicity of curcumin, even at relatively high doses. However, some clinical studies with healthy volunteers revealed a low bioavailability of curcumin as it was not well absorbed from the bowel into systemic circulation or easily incorporated into the cells. This could be a problem when a therapeutic dose is needed in specific tissues of the body. So, research into methods to increase absorption and utilization of curcumin has been done and a particular form of curcumin named Meriva has been developed. Meriva is curcumin formulated with phosphatidylcholine (a naturally occurring fat-soluble agent). The studies that followed showed Meriva to deliver higher systemic levels of the curcumin than simple, unformulated curcumin. Further studies have shown Meriva also increases the efficacy of curcumin as an anticancer agent because of its improved absorption and systemic delivery.

Summary

Curcumin as Meriva can be a simple and nontoxic way to prevent cancer on a daily supplemental basis. If you have cancer and are undergoing treatment, Meriva can also be a reasonable and effective adjunct to that treatment. Talk to your health care practitioner about this. See what is possible for you.

References

Kunnumakkara AB, et al: “Curcumin inhibits proliferation, invasion, angiogenesis and metastasis of different cancers through interaction with multiple cell signaling proteins.” Cancer Letters. 2008; 269: 199-225.

Bar-Sela G, et al. “Curcumin as an anti-cancer agent: Review of the gap between basic and clinical applications.” Curr Med Chem. 2010 Jan; 17(3): 190-7.

Ravindran J, et al: “Curcumin and cancer cells: how many ways can curry kill tumor cells selectively?” AAPS J. 2009 Sep;11(3):495-510. Epub 2009 Jul 10.

Marczylo T, et al: “Comparison of systemic availability of curcumin with that of curcumin formulated with phosphatidylcholine.” Cancer Chemother Pharmacol. 2007 Jul;60(2):171-7. Epub 2006 Oct 19.

Bisht S, Maitra A: “Systemic delivery of curcumin: 21st century solutions for an ancient conundrum.” Curr Drug Discov Technol. 2009 Sep;6(3):192-9. Epub 2009 Sep 1.

Inflammation: The Unifying Theory of Disease

By

Dr. Patrick Donovan

The cause of aging and disease

Chronic inflammation is now considered the “unifying theory” for the cause of disease. Over the past 20 years, a plethora of scientific literature has shown inflammation to be the underlying pathology to nearly all diseases and illnesses. It is involved in the development and progression of age-related degenerative diseases such as diabetes, stroke, cardiovascular disease, muscle wasting, and neurodegenerative disorders. It is the primary causal pathology underlying all autoimmune disorders such as rheumatoid arthritis, thyroid disease, Crohn’s disease and ulcerative colitis, Multiple Sclerosis (MS), systemic lupus, and others. It is also at the very core of the aging process.

The cause of cancer

Now, the most recent scientific research is also showing chronic inflammation to be a primary risk factor and causative agent for cancer. A variety of cancers including cancers of the prostate, breast, cervix, esophagus, stomach, liver, colon, pancreas, and bladder are associated causally with chronic inflammation. Inflammation typically results in the generation of free radicals and the stimulation and release of pro-inflammatory chemicals (cytokines) and various cell growth factors that stimulate cell proliferation and increased blood supply to the developing cancer. Free radicals not only damage the local tissues by oxidation reactions but also directly damage DNA and the DNA repair machinery. This enhances the genetic instability of affected cells and thus contributes to the first stage of cancer (neoplastic) transformation and development known as "initiation". Cytokines and growth factors also enhance the metastatic potential of later stage cancers. Finally, the tumor cells themselves may promote an inflammatory state by producing inflammatory mediators that further promote the neoplastic process.

Natural anti-inflammatories as cancer prevention

Antioxidants: Most naturally occurring antioxidants are also strong anti-inflammatory agents in nature and in our bodies. Oxidation is a natural process of energy production in cells but when it is out of control it can damage our tissues and our DNA. This free radical damage plays a major role in aging and inflammation and the development of cancer as discussed above. Preventing out of control oxidation reactions in your body with adequate intake of antioxidants can slow the aging process and, as we can see from the information above, reduce our risks for the development of cancer. Many of the naturally occurring, plant-based antioxidants are also strong anticancer compounds based on the scientific studies. Some of the most active of these compounds and certainly my favorites include:

Curcumin (the yellow pigment from the root of the herb Turmeric)
Curcuminoids are strong anti-inflammatory compounds that have been well studied in the scientific literature. They are able to inhibit major pro-inflammatory chemicals in our bodies that not only cause pain and swelling but also stimulate cancer induction, initiation and vascularization. These chemicals include the nuclear factor kappa-B (NF-kB) family of transcription factors and cyclooxygenase type 2 enzyme (COX-2). Curcuminoids block the NF-kB mediated gene expression responsible for the chain of events leading to tumor development, progression and expansion. These chemicals are also involved in the promotion of inflammatory bowel disease and arthritis.

Many pioneering Investigational New Drug studies have been granted by the Food and Drug Administration (FDA) and funded by the National Institutes of Health (NIH) for the investigation of curcumin and its derivatives in treatment of patients with cancer. Some of the leading cancer research centers in the United States, including M.D. Anderson Hospital in Houston, TX, are involved in pre-clinical and clinical research of the anti-cancer mechanism and applications of curcuminoids.

Green tea polyphenols
Tea polyphenols are known to be strong antioxidants. Observational, and clinical human studies suggest that green tea can reduce the risk of cardiovascular disease, neurodegenerative disorders, dental cavities, kidney stones, and cancer, while improving bone density and cognitive function. Dietary polyphenols from green tea, turmeric, soybeans, broccoli and others have shown to possess multiple cell-regulatory activities within cancer cells. More recently, researchers have begun to understand that some of the dietary polyphenols may exert their chemopreventive effects in part by modulating various components of the genetic machinery in humans.

Studies in animal models of cancer formation have shown that green tea and EGCG can inhibit the developments of tumors during the initiation, promotion and progression stages of cancer development. Prevention of oxidative stress, modulation of the metabolism of cancer-causing chemicals, and prevention of DNA damage have been suggested as possible cancer preventive mechanisms for green tea and green tea polyphenols as well as induction of the antioxidant systems in normal tissues that offer protection against carcinogenic insult.

Resveratrol (the polyphenol in red wine)
Resveratrol, a naturally occurring polyphenol from the plant kingdom, has been shown to have multiple beneficial health effects, including anti-oxidant, anti-inflammatory, anti-aging, cardioprotective and neuroprotective activities. A number of preclinical findings suggest resveratrol is a promising nature's weapon for cancer prevention and treatment. Remarkable progress has been made in the last few years in elucidating the molecular mechanisms underlying the anti-cancer properties of resveratrol. Many studies focus on its antioxidant capacity as well as on its ability to trigger and favor the cell self-destruction (apoptotic cascade) in malignant cells. In addition to these important functions, resveratrol is reported to exhibit several other biological/biochemical protective effects on heart, circulation, brain and age-related diseases.

Sulphoraphane (sulfur-containing antioxidant from broccoli and cabbage family)
Discovered in 1992 at Johns Hopkins, sulphoraphane now has over 500 scientific papers published on it. It is one of the most potent inducer of detoxification and antioxidant enzymes in the human body. It is an indirect antioxidant in that it induces specific antioxidant systems in our bodies and by so doing, dramatically reduces the overall oxidative stress to our bodies It also acts as a strong anti-inflammatory and anticancer agent. It has been shown to inhibit various phases of cancer development, protect against the development of cardiovascular disease, retinal diseases, Parkinson’s disease and other neurodegenerative disorders. It also slows the aging process and the development of age-related degenerative disorders. The list of cancers for which it has shown protective effects and for which it is being researched as possible anticancer drug include cancers of the: colon, prostate, bladder, breast, skin, mouth, ovaries, lung, kidney, liver, pancreas and stomach.

Omega-3 Polyunsaturated Fatty Acids (DHA and EPA)
Omega-3 fatty acids (DHA and EPA) have long been shown to be active anti-inflammatory compounds through their inhibition of the production of pro-inflammatory chemicals know as prostaglandins. Currently, the Western diet contains a disproportionally high amount of n-6 PUFAs and low amount of n-3 PUFAs, and the resulting high n-6/n-3 ratio is thought to contribute to cardiovascular disease, inflammation, and cancer. Studies in human populations have linked high consumption of fish or fish oil to reduced risk of colon, prostate, and breast cancer as well as other inflammatory diseases. The available epidemiological evidence, combined with the demonstrated effects of n-3 PUFAs on cancer in animal and cell culture models, has motivated the development of clinical interventions using n-3 PUFAs in the prevention and treatment of cancer, as well as for nutritional support of cancer patients. When used supportively in patients with cancer the n-3 PUFAs reduce weight loss and modulate the immune system.

Summary

New research is being done into the role antioxidants and anti-inflammatories as anti-aging and anticancer agents. The results are quite promising. Be ahead of the game. Start now to prevent cancer and slow the aging process by supplementing your diet with some of the natural anti-inflammatory compounds discussed above. Also, eat a diet full of colorful vegetables and fruits with special focus on berries and cabbage family vegetables.

Healing the Gut - and Rehabilitating the Suspect

This is Part 2 of this article. Click here to view Part 1.

by Dr. Patrick Donovan

Gluten-free Diet

The first thing to do is remove ALL gluten and gluten-containing products, supplements and medications from your diet. This commonly means NO gluten in the household because of easy cross-contamination, i.e. someone spreads peanut butter on bread dipping the butter knife in the peanut butter jar two or three time leaving behind a few crumbs of bread in the peanut butter or a sandwich is made on the same cutting board or counter top surface you latter use to prepare some food.

Numerous products contain hidden sources of gluten such as lip balms and lipsticks, seasonings and spices, gravies and sauces, flavorings, and more. The rule of thumb is: It contains gluten unless proven otherwise. I always recommend calling or emailing a product’s manufacturer if there is a question.

There are a number of helpful web sites and blogs to visit for more information about celiac disease, gluten-free products and medications, and gluten-free recipes and cooking. Here are some of my favorites:

www.celiac.com
www.celica.org
www.glutenfree.com
www.taylorstable.blogspot.com
www.wholelifenutrition.net
www.glutenfreegoddess.blogspot.com

Nutritional repair

Based on scientific studies, it can take up to 18 months to heal the gut on a fully gluten-free diet alone. But, there are nutrients you can take to further support and encourage faster healing of your gastrointestinal tract. These nutrients have been researched and shown effective in the published medical literature to be quite regenerative to the gut. They include such nutrients as the amino acid L-Glutamine, zinc, probiotics (healthy bacteria) and fish oils. L-glutamine is the oxidative fuel or “food” for the small intestinal mucosa and stimulates regeneration and repair of the absorptive surface of the small intestine as does zinc. Probiotics produce short chain fatty acids and other immunologic products that further stimulate gut health and healing as do fish oils.

Correcting Nutritional Deficiencies

As the malabsorption associated with celiac disease is slowly corrected, the repletion of essential micro and macronutrients is essential to establishing wellness and optimal health as soon as possible. To achieve this, I suggest supplementing with a gluten-free, high quality, pure, pharmaceutical-grade multivitamin and multi mineral formula offering the most absorbable forms of nutrients in optimal doses. Basic Nutrients from Thorne Research is an excellent example of what I mean.

To resolve the anemia commonly occurring with celiac disease, an organic form of iron (iron glycinate, iron fumerate, or iron citrate) may be needed along with other supportive nutrients such as folic acid, B12, copper, and vitamin B6. Supplementation of calcium is also commonly needed in children and adult women with celiac disease because poor bone development and osteoporosis is a risk. The best form of supplemental calcium is calcium citrate and/or microcrystalline hydroxyapatite calcium. Calcium supplementation should always be given with other supportive factors such as vitamins D3 and K2, boron, magnesium, water-soluble silica, and others to assure optimal absorption and utilization.

Summary

If celiac disease is the suspect in your health problems, build your case well with the appropriate information and testing. If it “looks like a duck,” call it so. Then begin treating it as such using an aggressive dietary and nutritional approach as described above. Also, educate yourself using the resources and links provided. The more you know about this disease and hidden sources of gluten, the better you will do.

This is Part 2 of this article. Click here to view Part 1.

Celiac: Building The Case

This is Part 1 of this article. Click here to view Part 2.

by Dr. Patrick Donovan

What Is Celiac Disease?

Celiac disease is an inherited autoimmune disease in which the lining of the small intestine is damaged from eating the gluten protein (gliadin) found in wheat, barley, rye, and commonly oats. If you have celiac disease, the consumption of any flours made from those grains or products containing them such as breads, pastas, cookies, baked goods, pizza crust, sauces, gravies, and flavorings, is detrimental to your health. Celiac disease can develop at any point in life, from infancy to late adulthood. The symptoms (see below) can be mild to severe depending on the degree of your genetic expression of celiac.

Who Is at Risk?

If you have a family member with celiac disease, you are at greater risk for developing the disease. The disorder is most common in Caucasians and those of European ancestry particularly Irish, Scottish, Welsh, English, German, Italian, and Nordic descent. Women are affected more commonly than men. Latest estimates of occurrence in the population of persons at greatest risk are estimated to be between 1 person in 100 to 1 person in 300. More people are being diagnosed later in adulthood.

What are the Health Problems Associated with Celiac Disease?

Malabsorption and Nutritional Deficiencies: If you have celiac disease and eat products containing gluten, an immune, inflammatory reaction occurs in your small intestine causing damage to its mucosal surface leading to an inability to absorb essential nutrients like iron, vitamin B12, zinc, calcium, and other vital micro and macro nutrients.

The decreased absorption of nutrients (malabsorption) that occurs with celiac disease eventually causse vitamin and mineral deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment leading to osteoporosis, stunted growth in children, and many other illnesses.

“Leaky Gut” and Systemic Inflammation: The intestinal reaction caused by celiac disease also causes the development of a “leaky gut” by damaging the intact, intestinal barrier and immune surveillance systems of your gastrointestinal tract. This, in turn, leads to systemic exposure to and “bombardment” of your whole body by large, immune-reactive, gut-associated proteins that should not normally be circulating in your blood. These immune-reactive proteins from food and gut bacterial byproducts coming from your gut cause inflammation wherever they go. They commonly end up causing inflammatory havoc in the connective tissues of your joints and vascular system and can initiate autoimmune inflammatory reactions throughout your body especially in your joints, stomach, intestines, liver, kidneys, thyroid and pancreas. The result of these inflammatory reactions is detrimental to your health causing many of the following disorders and diseases.

Diseases and Conditions Commonly Associated with Celiac Disease:

• Anemia
• Asthma
• Thyroid disease
• Eczema and psoriasis
• Psoriatic arthritis and other reactive arthritic conditions
• Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosis, mixed connective tissue disorders, and autoimmune liver diseases
• Inflammatory bowel disease (ulcerative colitis, Crohn’s disease, microscopic colitis)
• Irritable bowel syndrome (IBS)
• B cell lymphoma and certain types of intestinal cancer
• Dermatitis herpetiformis
• Down syndrome
• Lactose intolerance
• Miscarriage or unexplained infertility
• Neurological conditions
• Autism, ADD and Asperger syndrome
• Depression and schizophrenia
• Osteoporosis or osteopenia
• Diabetes
• Developmental delays and retarded growth in children

Most Common Symptoms of Celiac Disease

• Gastrointestinal
• Abdominal pain and cramping
• Gastroesophageal reflux disorder (GERD)
• Abdominal distention, bloating, gas, indigestion
• Constipation
• Decreased appetite (may also be increased or unchanged)
• Diarrhea, chronic or occasional
• Lactose intolerance (common upon diagnosis, usually goes away following treatment)
• Nausea and vomiting
• Stools that float, are foul smelling, bloody, or “fatty”
• Unexplained weight loss (although people can be overweight or of normal weight upon diagnosis)

Systemic symptoms

• Anemia (low blood count)
• Bone and joint pain
• Bone disease (osteoporosis, kyphoscoliosis, fracture)
• Breathlessness (due to anemia or asthma)
• Bruising easily
• Dental enamel defects and discoloration
• Depression
• Fatigue
• Growth delay in children
• Hair loss
• Hypoglycemia (low blood sugar)
• Irritability and behavioral changes
• Malnutrition
• Mouth ulcers and recurrent canker sores
• Muscle cramps
• Nosebleed
• Seizures
• Short stature, unexplained
• Skin disorders (particularly dermatitis herpetiformis)
• Swelling, general or abdominal
• Vitamin or mineral deficiencies, single or multiple nutrient (for example, iron, folate, vitamin K)

Testing for Celiac Disease

Biopsy: Historically an endoscopy (scope looking into your stomach) with biopsy of the mucosal lining of the intestine has been the “gold standard” for diagnosing celiac disease. However, recent medical studies have shown a number of people with celiac disease to be biopsy negative for the disease. This can happen when a person has avoided eating gluten for a few months or longer. But new evidence suggests the pathological changes in the intestine may be more “patchy” and not as confluent as was previously believed. This can make it more difficult to obtain a “positive” specimen by missing the patches.

Blood tests (serology): There are blood tests (serological screening) that can detect several special antibodies and immunologic reactions to gliadin. The most sensitive of these tests is the transglutaminase or tTG test. However, in my years of clinical experience since these tests have been available, I have seen this test come back negative in some people with true celiac disease even when they have been continually ingesting gluten. Like the biopsy testing, however, these tests can also be negative if the person has not been eating gluten for some time.

Genetic testing: For me, the best testing to do if celiac disease is suspected is the genetic testing which can be done via a simple blood test. There are two genes associated with celiac disease. They are the HLA-DQ2 and HLA-DQ8 genes. Approximately 97% of people with confirmed celiac disease will have either one or both of these genes present. 3% of persons with celiac disease will have variants of these genes.

Diagnosing Celiac Disease (Building the Case)

Through my over 20 years of diagnosing and treating celiac disease and keeping up with the latest research on celiac, I believe the best way to diagnose celiac disease is by “building a strong case against the suspect.” First we must look at the evidence:

• Is there a sufficient symptom picture both gastrointestinal and systemic? (See the symptoms listed above.)
  
• Does the person have any of the related diseases or conditions as described above?
  
• Is there a family history of celiac disease or related conditions/disorders?
  
• Is the person in the high risk groups as described above?
  
• Is the genetic testing positive for any of the genes or their variants?
  
• Are any of the serology tests positive?

If the majority of these questions are answered in the affirmative (yes) and the genetic tests are positive, the suspect needs to be picked up and questioned and the witness must come forward to testify. What is the witness? “The witness” is FULL and COMPLETE elimination of gluten from the person’s diet for at least three months or more before following up. If the person is feeling markedly better and symptoms have significantly begun to resolve, we have our witness!

In other words, if it looks like a duck, quacks like a duck, waddles like a duck and swims in the pond, it must be a duck…not a turtle.

In our next blog post we'll talk about how to heal the gut (and rehabilitate the suspect).

This is Part 1 of this article. Click here to view Part 2.

Antioxidants: What are they and why do we need to care?

by Dr. Mona Fahoum

There is no escaping the buzz about antioxidants.

Antioxidants are featured in magazines, on the Internet and on television. But what are they? What do they do? Why do we need them? Which ones should a person take, if any?

What is Oxidation?

First, we have to understand what oxidation and free radical damage means before we can appreciate the role anti-oxidants play. A growing body of research shows that oxidation and free radical damage to our tissues plays a major role in aging and inflammation leading to various illnesses such as cardiovascular disease, autoimmune disorders and cancer. It is vital, however, to understand that oxidation is not entirely evil.

Oxidative reactions are necessary within our bodies to fight off bacteria and other foreign invaders and are part of the natural inflammatory reaction secondary to injuries. For example, when you get a cut in your skin, it is oxidation that causes the old, damaged cells to die and new fresh cells to grow. Yet, in an uncontrolled situation, oxidation can cause damage to healthy cell membranes and other molecules, including those that make up the DNA of our genes.

What Does That Damage Mean for You?

• It means that messaging systems won’t work as well (i.e., the cell-to-cell communication may not work very well and the cells involved may no longer “listen” to the rest of the body’s instructions). This can cause a cell to become cancerous.
• It could mean that cell membranes are damaged to an extent that makes it easier for plaque to stick to the blood vessel wall.
• It could also lead to something as simple as that stubborn cellulite and the breakdown of healthy collagen leading to wrinkles and those pesky dimples that start showing up as we age.

I am simplifying, but you get the picture, unhealthy molecules lead to unhealthy cells that develop into bigger and bigger problems.

When Does Oxidation Occur?

Oxidation occurs when a molecule become ‘unstable’ and, in turn, robs another of electrons in order to repair itself. Stable molecules usually have electrons in pairs of two. But exposure to pollution, cigarette smoke, excessive sun exposure, fried and barbecued food, and rancid fats and oils start a domino effect of electron stealing.

Plinko

A great way to illustrate is using the example of Plinko, a game from the TV show: The Price is Right. As the chip, or electron, slides down the board it bounces from peg to peg (the molecules) causing damage as it goes. Under controlled conditions, like how our cells make energy for us to work, this is a good thing. Electrons are moved from low-energy molecules to high-energy molecules to give us the energy to make the building blocks for our bodies. However, when this reaction is out of control, as it can get to be in cell membranes, there is no money at the bottom of the Plinko board. Instead, when the electron finally lands somewhere, damaged molecules (the pegs) are left in its wake.

Antioxidants Stop Oxidative Damage

Antioxidants are just what the name states. They act to stop oxidative damage, they effectively swoop in, find free radicals or damaged molecules and donate one of their electrons to plug the hole or pick up an extra electron to create stable molecules. Lucky for us, anti-oxidant molecules are stable with that extra electron and don’t need to steal electrons in order to be stable. They do, however, have to be recycled. This is why we need multiple sources and types of antioxidants. For example, vitamin C and vitamin E work together. The vitamin C stops a free radical in its tracks and then vitamin E recycles the vitamin C so it can do the job again. We see this relationship between antioxidants over and over in nature and throughout our bodies. This is why we should be getting our antioxidants from multiple sources.

Antioxidants in Our Food

The best sources of antioxidants are our food. A diet rich in colorful fruits and vegetables including broccoli, kale, carrots, tomatoes, sweet potatoes, winter squashes, grapes and berries, especially blackberries and blueberries can supply many different types of antioxidants. These plants contain numerous flavonoids (Many of the flavonoids makeup the purple, blue, red, and yellow colors of the plant kingdom.), vitamins C and E, carotenoids, and selenium as well as other minerals that assist our antioxidant systems within the body. By eating a healthy diet we are consuming a variety of antioxidants, each of which acts in concert with the others.

Antioxidants in Supplements

If you are not always getting a good mix of fruits and vegetables (approximately 1/2 - 2/3 of your daily intake of food), then supplementation would be of benefit. When supplementing, consider a formula with a mix of various vitamin and mineral antioxidants, like A, C, E, carotenes, zinc and selenium.

I highly suggest including supplement formulas that have extracts of plant-based antioxidants such as green tea polyphenols, curcumin from turmeric (the Indian spice), grape seed and blueberry extracts, resveratrol (the beneficial antioxidant in red wine), and carotenes especially lutien and lycopene. Commonly, a good “greens powder” can provide much of these compounds.

Antioxidants Reduce the Inflammatory and Radical Breakdown of Our Bodies

Oxidation is a part of life, that can be very useful, but also damaging to the system as a whole. We would all benefit from adding more colorful foods to our plates at breakfast, lunch and dinner. In addition, we will find the use of supplemental resveratrol, curcumin and other antioxidant vitamins helpful in balancing out our diets and keeping us looking younger while reducing the inflammatory and “radical” breakdown of our bodies.

On Health and Healing

by Dr. Patrick Donovan

Healing Arises From The Transmutation of Illness

"Our purpose is not to resist illness but to use it... (because) healing arises exclusively from the transmutation of illness never from conquering symptoms." (Dethlefsen and Dahlke from The Healing Power of Illness)

• Illness is the destructive trend implied in every self-sustaining process of a living organism. It is the balancing, disintegrative counterpart to every integrating process. Without the potential for illness and disease, life could not proceed on its path of continuous creation because continuous creation is dependent upon continuous destruction.
• Life, in the physical sense, is what it is only within the context of the reality of physical death.
• Health exists as an existential phenomenon only in juxtaposition to the phenomenon of disease. Therefore, the time-honored motto of healing - Vis Medicatrix Naturae (The Healing Power of Nature) - is only a half truth. Within this concept lies its 'shadow side,' the full paradoxical, hidden truth of the 'destructive power of nature.' Without a full understanding of this full dialectic in its wholeness, we are left with only a partial truth.
• The Universe as we experience it, exists in its wholeness because of the paradox of duality and maximal contrast. Life can not be denied its death as light can not be denied its darkness and visa versa.

The Hero's Journey

Through the process of transformation, the illness itself becomes the healing path...the vehicle through which life is transmuted into greater life. As the 20th century philosopher, Paul Tillich writes, "Life must risk itself in order to win itself." Illness is the physical evidence of life risking itself to win itself. It is the very process through which one must pass to experience one's healing. This is "The Hero's Journey"... the transition from life through death/illness to new life. It is the journey of life's continuous creation.

"We have only to follow the thread of the 'the Hero's path.' And where we had thought to find an abomination, we shall find a god; where we had thought to slay another, we shall slay ourselves; where we had thought to travel outward, we shall come to the center of our own existence; where we had thought ot be alone, we shall be with all the world." (Joseph Campbell from Hero With A Thousand Faces)