Transcription of Bones #59
Dr. Lisa: This is Dr. Lisa Belisle and you’re listening to the Dr. Lisa Radio Hour and Podcast Show #59, BONES, airing for the first time on October 28th, 2012 on WLLB and WPEI radio, Portland, Maine. Today’s show will feature: Osteoporosis Specialist and Orthopedic Surgeon, Dr. Anne Babbitt; Greg Boucovalas of Apothecary By Design; and the Body Architect’s Strong Women Instructor, Kristen Thalheimer Bingham
You might be wondering why we thought we should offer a bones 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 are we supposed to make them stronger? How are we 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 integrative medicine doctor who have come in with diagnoses of Osteopenia, osteoporosis. They’ve told me they have brittle bones and they’ve been scared to thinking that they need to be on hardcore medication, their hips are going to break, they’re going to die from broken hips. It’s very scary and it’s very uncertain and in fact like many things in the field, we’ve 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 the season of the winter and you think about Maine in winter time and cold and you think about the fear of falling. 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. That’s what I think we need to think about bones as, as life and regeneration and a living organ system.
Right now, what we know about bones and osteoporosis, we’re going to hear a little bit more about from Dr. Ann Babbitt – Osteoporosis Specialist and Orthopedic Surgeon, Greg Boucovalas of Apothecary By Design and the Body Architect’s Strong Women Instructor – Kristen Thalheimer Bingham. These are individuals who are on the cutting edge of holistic way of looking at bones and the bone structure. I encourage you to go to our website learn more about them, enjoy the conversations that we have with them, enjoy the show.
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 segments we call wellness innovations. This wellness innovation come 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 for 4 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 are not. In a more recent study, people who got their calcium almost exclusively from supplements are 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 maybe less dangerous because calcium is absorbed in smaller amounts at various throughout the day. For more information on this wellness innovation, visit doctorlisa.org. For more information on the University of New England, visit une.edu.
Announcer: This portion of the Dr. Lisa Radio Hour and Podcast has been brought to you by the University of New England. UNE, and innovative health sciences university grounded in the Liberal Arts. UNE is the #1 Educator of Health Professionals in Maine. Learn more about the University of New England at une.edu.
Dr. Lisa: 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? 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 Joints 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: I am the sole provider I would say.
Dr. Lisa: 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. You have the great honor of doing my first knee surgery when I was in high school. See you and I have known for a while.
Dr. Ann: That’s right.
Dr. Lisa: Bones you’ve been interested in this. This has been your life’s work. How did this all start?
Dr. Ann: I’ve been interested in bones, muscles, joints, sports, movement, space things like that pretty all my life, I would say. 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: What happened when you were younger, 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 caused you start to be interested in bones and muscles.
Dr. Ann: I’m not really sure, I think I’ve always been kinesthetic, is maybe a term. I liked to keep moving and I liked sports when I was younger. I think it just all evolved from that.
Dr. Lisa: When I was going through I think you are the only female orthopedic doctor in Maine. Is that still true?
Dr. Ann: I may not be the only one but I was the only one on the greater Portland area. There are several other orthopedic surgeons who are women in the state of Maine now.
Dr. Lisa: That must have been pretty interesting though to be the one, the one in greater Portland area doing what you were doing.
Dr. Ann: The one in greater Portland was very interesting, Yes.
Dr. Lisa: Do you think that that led you to your interest in Osteoporosis left to something that ends up being largely female-oriented?
Dr. Ann: 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. Then two, who are older, predominantly women but 80% women 20% men and more as we get older.
Dr. Lisa: What did this lead you to do, you also have a bone densitometer in your practice which was, you’re one of the earlier practices that adopted this type of screening tool.
Dr. Ann: 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 come together and have a meeting to discuss bone wellness and osteoporosis and I made out the papers and applied. I was the only one from Maine who applied and went to the meeting. 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.
Dr. Ann: Eventually got a densitometer in 1996, so there was a little gap there as I moved more on that direction. Once I got the bone density testing machine, I was there and I became involved in the International Society for Clinical Densitometry, that is a mouthful. Shortly called the ISCD and I’ve been involved with them ever since and there a society that studies bone and hot to measure bone and how to evaluate bone. So I’ve been very busy with them and my technologist, Kathy LeCaidos, who’s also been very involved in that, so we try to emphasize good quality of bone measurement and evaluation. With that we think we can make better decisions to help people.
Dr. Lisa: There have been a lot changes in the field since you first started being interested and progressing along as one of Maine’s Osteoporosis specialist.
Dr. Ann: There have been lots of changes. Bone Densitometry has evolved into central Central Densitometry primarily which would be spine, hip. We also do forum. We can also do a technique that looks at the 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. It’s been established that that’s a very accurate and beneficial technique to evaluate bone strength. 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 paper work and some newsletters said that have been around for years and really a lot was written in those newsletters about good nutrition, exercise, calcium and vitamin D, was very on-target even compared with today.
Dr. Ann: 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+ years.
Dr. Lisa: That is really interesting because it is something that 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 being asked. I think it actually generated fear. One of the reasons I wanted to do this show is because I’ve had patients have come in who have osteoporosis and they’re now afraid. They’re afraid of their osteoporosis. Now we’re at this interesting place of what do we do next. How do we bring all of this together? I think this is what you’ve been working on.
Dr. Ann: Yes but I would say, that’s what I’ve been working on and many people are working on. The holistic approach, 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 family member who had it, usually a parent. They were afraid because there wasn’t really anything that we can do or they perceived to that beyond holistic measures and I can’t emphasize holistic measures enough. But there were no medicines. Now it’s flipped a little that we do have lots of different medicines but they have generated fear too. I think there’s a lot of medicines have over the last few years as we become aware of it, there are downsides to certain medications.
Dr. Lisa: Is it somewhat radical for an orthopedic surgeon to be talking about ‘holistic’ medicine?
Dr. Ann: I don’t know if it’s really radical but it seems to me to be a common sense approach. I was thinking about that today too. So many recent information is coming out again about hormones, estrogens, that is maybe they aren’t so bad as what we thought. It seems like a lot of things in medicine come back to common sense appropriate use of and 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 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 which goes to bad 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 wow to do exercise. When, duration intensity, most of the groups. That’s a good example.
Dr. Lisa: 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, decreased bone density and really significant hormonal changes, eating issues. I think you’re right that it is about the balance and about the individualized medicine. Do you that it has become harder for doctors to practice holistic and individualized medicine the way that health cares about these days?
Dr. Ann: 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 is that 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. How do we all sort that out and I find that difficult and sometimes frustrating as a provider and as a person if I am going to resort to even buy something is like, “Whoa there are so many choices with anything.” Trying to use those options effectively and safely I think it’s the challenge of this time period in medicine and pretty much everything else.
Dr. Lisa: If we were to broad it out and ask for general recommendations about bone density screening, let’s start with screening, what do you have to offer on that subject?
Dr. Ann: Generally, screening is suggested by the national osteoporosis foundation and others that about age 65 for women who do not have risk factors, that’s the question, what are risk factors. Then 70 with no risk factors. Many people have risk factors so the day-today common sense answer is most women get a bone density test by about the age of 50. If they have menopaused 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 calcium and D-deficient and have some other bad habits, have some family history that may contribute.
Dr. Lisa: People may who have had cancer and had to have their ovaries removed or people who have had some other something that could possible contribute to having poor bone health. They should be thinking about getting this done early.
Dr. Ann: Yes. Many medical problems and medications can contribute poor bone health in addition to smoking, alcohol. We’re finding like narcotic types of drugs, I call them mind-altering drugs the various type, can be problematic. There are questions about medicine that people take for heartburn that type of thing. They are 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: 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 you perform?
Dr. Ann: It depends where they are on that continuum, we divide it out normal osteopenia osteoporosis those are these very distinct lines. I’m not much of a line person, I think it’s a blending. When you hit that osteoporosis 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. Of course that’s the history, the physical one and 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 with have celiac disease and don’t know they have it. That’s a risk for osteoporosis. You get a Vitamin D on every one, lab tests, because we have good ball park idea of Vitamin D sufficiency and then depending on the person looking for other things.
Dr. Lisa: Can thyroid disease contribute to osteoporosis?
Dr. Ann: Thyroid disease can contribute to osteoporosis. I find that in modern day times, thyroid is pretty well-monitored and treated, we have better medicines we hit the laboratory test for more accurate if you’re person who is hypothyroid and on medication that’s usually where it going to get problematic. I think people used to take more crude I guess you’d say thyroid medicine years ago maybe would be taking too much of it. There’s not that much unrecognized hyperthyroidism in the United States right now. I don’t see that very often but that is on the risk factor list.
Dr. Lisa: What about kidney disease?
Dr. Ann: 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. We have a slightly modified recommendations for calcium intake and management of the kidney disease patient. The severe kidney disease patient is very difficult to know what to do. The nephrologist and the others, the kidney doctors, we’re all trying to figure that out.
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Dr. Lisa: 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 medication that are out there that are being used and what are some of the good and bad aspects of them?
Dr. Ann: 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 and lower dosing regimens in different delivery systems now compared to a few years ago. Evista Raloxifene is the estrogen, what we call agonist-antagonist so it has some estrogen 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.
Dr. Ann: The next is the big names day group bisphosphonate the second and third generate bisphosphonates which actually 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. 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 Risodrenate, boniva – which Is ibandronate, which is oral. Those are all the oral bisphosphonates. IV boniva every 3 months and re-classed IV once a year.
Dr. Lisa: This seems to have a positive impact on bone building.
Dr. Ann: 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 bones? 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 short term treatment, 3 yrs, 5 years, and in my practice I noticed that most peoples bone density does improves the first few years and then it kind of plateaus. So we’re using these medications now on what I call an ‘on-off’ sequence where you take them for a little while, we’ll watch it 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, we call it a holiday. The drug holiday, we like that better than a break, because a break sounds like could be a broken bone.
Dr. Ann: Sometimes we’ll use another medication. In there, if you have sever osteoporosis it all depends on, do you just have a number on the osteoporotic range or do you have fractures that risk profile is always very important to review. So 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. 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 a question.
Dr. Lisa: I guess my question now is, I alluded to this before that there’s this fear aspect because there are side effects or downsides taking these medications; What are some of the more common downsides that were concerned about these days?
Dr. Ann: The common downsides to the oral bisphosphonates which are fosamax, alendronate, actonel and boniva are heart burn. 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. It can create heartburn and chest symptoms usually mild but there are some people with 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 has been associated with an entity called osteonecrosis of the jaw which in icky awful term which usually isn’t as icky and awful at it sounds like, 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 or 1 in 100,000 of people who take the medications, I don’t know exactly where that statistic comes from, I don’t write 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. There are about 14 times the dose of osteoporosis medications because they get intravenous dosing of re-class rather than once a year usually about every three weeks. Now actually the oncologists are tempering the treatment to longer intervals. 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 on osteoporosis patients actually more in people who have underlying problems. Many of them are on cortisone, 40-60% 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 or 1 in 100,000, if you have it you’re not going to be happy. So those are our concerns that we are still looking at.
Dr. Lisa: If people do have osteoporosis or osteopenia or questions about osteoporosis you have the osteoporosis health care network here in the state. How do people learn about that or about your practice the Greater Portland Bone and Joint Specialist practice?
Dr. Ann: I’m so glad you asked the about the, we call it the OHN and the support group. The support group has been in existence since 1996 and is really mostly what the OHN does now. We used to more awareness events we had something called the bone density dash every spring for a number of years. When asked, we’ll give talks anywhere. But the support group has met the first Tuesday of every month since, I think it actually started at 1997 and it is a lecture series and support and healthy foods. It often talks about bone health or bone-related topics but sometime we branch out like we did talk about I health. We going to go to a gym this next Tuesday and check what to do with the gym. So that is a very good way to connect. We have a newsletter. We have an e-mail list. We don’t have a website at this point in time. We’ve talked about it but but don’t have one presently. That’s a good way to connect.
Dr. Lisa: So is there a phone number where people can call to reach you?
Dr. Ann: The best is to call our office which covers all those entities and that’s 207-828-1133.
Dr. Lisa: I appreciate the time that you have 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 Joints Specialist group in the Portland area and I think that anybody who is sitting 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: Thank you for having me come in.
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Dr. Lisa: 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 questions about calcium, about Vitamin D, about medications so we couldn’t think of a better person to come in maybe give us a little bit of educated thought on the matter than Greg Boucovalas from Apothecary By Design. He is a registered pharmacist with that wonderful organization which is recently expanded and I’ve spoken with Greg. I know that he’s got a wealth of information plus you 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.
Greg: Thanks for having me, my looking forward to this. As far as bone goes, it seems that, it’s been dumb down to just calcium Vitamin D. There’s way, way more to it than that. People think if they’re getting extra amount of calcium it’s going right to their bone when that isn’t necessarily the case. There are other cold factors involve, in fact bone is actually two different components. People don’t think of it as such. They think of it as a static type of organ or tissue where the visual is like a skeleton. It’s Halloween time coming up that’s what people think of bone as a skeleton when it actually a pretty dynamic tissue where old bone is being shed and replaced by new bone, I think that’s an issue with some of the newer class bisphosphonates. Their mechanism of action impedes that dynamic a little bit. Hence, they change the prescribing patterns on that where patients should only be on it for no more than five year. They’re finding weird incidences of fractures if you’re on it on a time even though bone density may be impacted favorably, bone quality may not necessarily improve.
Dr. Lisa: Is this something that happens regularly that we’ll prescribe the medication thinking it’s going to do one thing, have studies behind it but then not enough practical on the ground experience find that other things happen, then we need to change things as happen in the pharmaceutical industry?
Greg: It sadly, it does. I this is the class of bisphosphonates are classic examples that where some of the science got ahead of actually what the benefit expected benefit would be so yes, if you investigated that a little bit there’s a book called ‘Overdosed America’. There’s a pretty interesting chapter in that dedicated solely to the conspiracy theory behind that but yes, It’s an example of what you’re talking about.
Dr. Lisa: First I want to backup, sometimes this happens because we don’t seem to have another good answer so you 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: That’s I think the endpoint is off the mark. If the endpoint, if what they’re trying to achieve if the goal is increase and maintain bone density, then that therapy could be considered successful. But, if you’re actually trying to improve bone quality, it’s a different story, it’s a different endpoint. It depends on how you want to frame it and it’s not semantics. There is a difference, you can really have a good bone density the example they use is a piece of chalk. You probably heard that before, the density of chalk is high but its resiliency, the fracture, very brittle. The bone density aspect isn’t in of itself enough I feel to prescribe that type of medicine to millions and millions of women.
Dr. Lisa: So maybe we were asking the wrong question in the first place. It’s not how do we get more dense bones, it’s how do we get better quality bones?
Greg: Exactly
Dr. Lisa: Is that one of the reasons why we started talking about calcium because you’re thinking well calcium is used for bones and let’s prescribe calcium. Is that?
Greg: 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 OK from the FDA to make a certain claim which is unusual for dietary supplements, not many supplments have the blessing of the FDA to make a health claim that it might cure medicated disease. Once that was given then I think that’s why calcium got way, way too much publicity and say it’s partner in the body. Magnesium gets virtually no publicity at all.
Dr. Lisa: So what happened then? So we know now that people started prescribing calcium, probably over-prescribed calcium because again maybe we weren’t asking the right question or we just got very excited about some possibility and started using it for everybody, what are the studies finding with regards to calcium?
Greg: Well as far as dietary calcium goes, there was a recent study that came out of Sweden, about 60,000 women, elderly women, 60-ish to 90-ish following them for about roughly 20 years just strictly dietary intake and they broke that 60,000 into quarters. The bottom quarter intake of calcium around 700 milligrams had roughly thy had the highest incidents of hip fracture but that study didn’t show a linear fact where more was better because at the next highest incident happened in the top quintal the top 25%. So more isn’t necessarily better, so based upon that study and now there is this other studies that link calcium supplementation different than 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 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, as far as those studies go, some say there’s increased risk of a coronary event.
Dr. Lisa: Meaning a heart attack?
Greg: A heart attack, stroke something in the cardiovascular family. Some show no and some show trends that maybe that they’re not significant. 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 number, they’re saying they should be getting about 1200 milligrams a day but that’s total. But the issue I see is in the pharmacy health food store is someone will come in, a lady will come in looking for calcium, just calcium, maybe some D. She’s trying to hit that magic number say 1200 milligrams a day which based on the studies may not be such a good idea. Maybe a good idea to re-think we need to maybe find the sweet spot where it will lower it down to 800 total a day, where you get maybe 400-600 from your diet and then you supplement with the rest. That way hopefully your bones benefit but your heart won’t be or your cardiovascular system won’t be hurt that detrimentally. So that’s the key, it’s that balance right there.
Dr. Lisa: So where do people find you in Apothecary By Design?
Greg: We are located on 84 Marginal Way, we’re attached to the InterMed building, looking, we’re right across the street from Trader Joes, Eastern Mountain Sports. When I’m in the pharmacy I am looking right across the streets now you can see the kayaks attached to the Eastern Mountain Sports building. Free parking right in the parking garage anywhere you can find space or you can park right out front, Monday through Friday 8-6, Saturday 9-5.
Dr. Lisa: Wow 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: Yes, www.apothecarybydesign.com and we have provide us with an email, we can send you monthly newsletter. Feel free to call, I am there almost all the time, feel free to call or send me an email. Be glad to talk to you about the subject because I think there are some misconceptions that definitely need to be addressed out there.
Dr. Lisa: Wow, we’ve been speaking with Greg Boucovalas. Who was a registered Pharmacist with Apothecary by Design. Clearly a very knowledgeable individual on the subject so I encourage anyone who is listening who has questions about osteoporosis, calcium, vitamin D and really any other issues whether it’s health and possibly food and supplementation to go and visit with Greg.
Greg: Thank you Lisa.
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Dr. Lisa: Today on the Dr. Lisa Radio Hour our topic is Bones. 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. 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. We thought it would be a good idea to bring in Kristen Thalmer-Bingham who is a strong women instructor right here at the Body Architect in Portland. Hi Kristen, thanks for coming in.
Kristen: Hi Lisa, thanks for having me.
Dr. Lisa: Now Kristen why was it important to you to go into the strong women field?
Kristen: Well I have been an instructor for many years. I started teaching group exercise classes back in 1989 and I think Jane Fonda was popular then. The strong women classes came up after I have 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 researcher at Tufts University. Her idea after doing her research was that women of all ages can benefit from strength training. 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 looking out for years athletic or are just starting out.
Dr. Lisa: What are some of the benefits of being in a strong women class or strength for women in general?
Kristen: Well, benefits, certainly muscles strength, bone strength as you mentioned, general health and fitness. There 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: I can definitely attest to that I see patients at the Body Architect and I know that you have a very closely knit cadre of women that come in and experience your class. They all come in and they’re all very happy and smiling and they take you class and they leave and they’re happy and smiling and they really seem to enjoy each other’s company.
Kristen: Yes. They’re a great group of women I come in and they make me smile too so it’s really a mutual giving and taking so yes, there’s quite a bit of community that we’ve created at the Body Architect and then this particular class and the women are just wonderful people to be around.
Dr. Lisa: How does strong women class, how does that differ from say another type of class you’ve taught I the past. What would I expect if I was going to go into your class?
Kristen: 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. 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, shell be able to do more and more. We start everyone together, does the same activities but you do what you can so if I’m doing what 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 4 or half a dozen or 10 that’s really, really OK. We have to cover all the major muscle groups, lower body and upper body and try to get them all.
Dr. Lisa: If people come in and if women come in and they are a little concerned about a back problem or knee issue, are you able to talk to them and maybe help them tailor some of the exercises to their needs?
Kristen: I am Yes. I say that with a little bit hesitation because I am not a medical person, so my rule is don’t do it if it doesn’t feel right and I say that probably 5-10 times in class every time. I really like 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 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 and I’ll work with them and give modifications if needed. Yes definitely. If it still doesn’t work right then we move on to trying to find other reason for it but certainly I’ll help each individual find the way that works best for them.
Dr. Lisa: How has being a strong women instructor, how’s this impacted you personally in your own life?
Kristen: I’ve met amazing women that’s probably the best way that it has 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. 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. Just in terms of being very careful about my own health.
Dr. Lisa: How can people find out more about strong women or the strong women class that you offer?
Kristen: The strong women class I offer as you’ve 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 at Tufts university, you can see she’s got I think 10 or 12 books. 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: The Body Architect has a website?
Kristen: The Body Architect does have a website, thebodyarchitect.com I think.
Dr. Lisa: Also a Facebook page I believe.
Kristen: I think you’re right. Yes.
Dr. Lisa: 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 are doing in the community for helping women keep their bones in their bodies healthy and strong.
Kristen: My pleasure. Thank you so much.
Dr. Lisa: This is Dr. Lisa Belisle and you’ve been listening to the Dr. Lisa Radio Hour and Podcast Show #59, Bones, offered in honor of Halloween for the first time on October 28th 2012. Today’s guests have included: Osteoporosis Specialist and Orthopedic Surgeon, Dr. Ann Babbit; Greg Boucovalas, Registered Pharmacist with Apothecary By Design; and the Body Architect’s Strong Women Instructor, Kristen Thalheimer Bingham.
Dr. Lisa: I encourage you to go to doctorlisa.org 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 podcast. I know that you’ll 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.
Announcer: The Dr. Lisa Radio Hour and Podcast was made possible with the support of the following generous sponsors: Maine Magazine; Mike LePage and Beth Franklin at Re Max Heritage; Sea Bags; Dr. John Herzog of Orthopaedic Specialists; Marcy Booth of Booth Financial Services; UNE, the University of New England; Tom Shepard of Shepard Financial; Apothecary By Design; and the Body Architect.
The Dr. Lisa Radio Hour and Podcast is recorded in downtown Portland at the offices of Maine Magazine on 75 Market Street. It is produced by Kevin Thomas and Dr. Lisa Belisle. Audio production and original music by John C. McCain. For more information on our hosts, production team, Maine Magazine of any of the guest featured here today, visit us at doctorlisa.org. Download and become a Podcast subscriber of Dr. Lisa Belisle through iTunes. See the Dr. Lisa website or Facebook page for details.