Increasing Soft Tissue Flexibility

Flow Chart to Help Doctors Create Protocol

Acute injury

Sub-acute injury

Chronic injury

Minor pain pack

Matrix metallo-

proteinases

Joint Relief Pack

If pain is present

Injury

Collagen synthesis

Omega-3 fatty acids

Matrix metallo-

proteinases

Collagen synthesis

glucosamine sulfate &

chondroitin sulfate

Joint injury

UC-II® & Hops

extract PHASE 1

PHASE 2

PHASE 3

Nutrition pack

Online store with foundation nutrition

On-going care phase

Evidence of nervous system sensitization in commonly presenting and persistent painful tendinopathies

Conclusion: There is an association between persistent tendon pain and sensitization of the nervous system. This evidence is primarily from studies of upper-limb tendinopathy, and caution should be exercised with inference to lower-limb tendinopathy

J Orthop Sports Phys Ther 2015;45(11):864-75

Are inflammatory cells increased in painful human tendinopathy?

• Increased number of macrophages and mast cells in tendinopathy versus healthy control tissues

• Existing evidence supports hypothesis that increased numbers of inflammatory cells are present in pathological tendons

Br J Sports Med 2015

High cholesterol linked to heightened risk of tendon abnormalities and pain• Chronic low-level inflammation, prompted by cholesterol build-up in

immune cells, may be key

• People with unfavorable lipid profile much more likely to have tendon injuries and higher levels of pain associated with musculoskeletal problems in their arms

• They also had thicker tendons (Achilles tendon thickness) than those with lipid levels in the normal range

BMJ, Oct 15, 2015

Effect of hypercholesterolemia on quality of tendon-to-bone healing in rotator cuff tearsConclusion:

• Hypercholesterolemia resulted in deleterious effect on quality of tendon-to-bone healing

• Assessed by EMG, biomechanical and histological evaluation

• Controlling high cholesterol halts these harmful effects

American Journal of Sports Medicine. May 2016:1153-1164

Harvard Gazette: Mechanical Stimulation Shown to Repair Muscle

• Muscle regeneration through mechanical stimulation may one day replace or enhance drug- and cell-based regenerative treatment

Journal Proceeding of the National Academy of Sciences. January 26, 2016

Rotator Cuff (Impingement Syndrome)

• Rotator cuff – sits muscles

• Dynamic stabilizers and compressor of the humeral head

• The cuff helps to lift and rotate the arm

Nutritional Protocol for Rotator Cuff

Nutritional protocol for the first 72 hours:

• Proteolytic enzymes:• Trypsin Chymotrypsin Bromelain: TID

• Natural anti-inflammatory:• Boswellia, turmeric, ginger, vitamin C: TID

• Nutrients to relax muscle tissue:• Calcium, magnesium, lemon balm, valerian: TID

Nutritional Protocol for Rotator Cuff (cont’d)

Nutritional protocol Day 4 8 weeks

• Nutritionally modulate matrix metalloproteinases:• 2 tablets initially, then 1 TID:

• Hops, berberine, B vitamins & minerals

Nutritional Protocol for Rotator Cuff (cont’d)

Nutritional protocol Day 4 8 weeks

• Formulation providing targeted nutritional components involved in the biochemical processes that support growth and construction of connective tissue:

• Amino acids — Research shows that providing specific amino acids (predominately glycine, proline, and lysine) supports healthy collagen fiber formation

• Micronutrients — Vitamin C, B6, B5, L-taurine, silica, zinc, iron, copper, and alpha-ketoglutarate are examples of the micronutrientsrequired for healthy collagen formation

• A specific formulation including L-arginine, magnesium, and folate. 2 scp. daily

Day 4 and on• If joint/cartilage is also comprised:

• Formulation designed to provide broad support for healthy joint function

Daily:

Glucosamine sulfate 1500 mg

Chondroitin sulfate 1200 mg

MSM 1000 mg

Selenium 300 mcg

Copper (as copper citrate) 1500 mcg

Manganese 1500 mcg

Zinc (zinc glycinate) 15 mg

Nutritional Protocol for Rotator Cuff (cont’d)

Intervertebral Disc Disease

IVD – the largest structure in the body without vascular supply

Nutritional Support

I. Daily:Glucosamine sulfate 1500 mg

Chondroitin sulfate 1200 mg

MSM 1000 mg

Selenium 300 mcg

Copper (as copper citrate) 1500 mcg

Manganese 1500 mcg

Zinc (zinc glycinate) 15 mg

Nutritional SupportIf outer annulus is compromised (damage to type-I collagen)

• Vitamin D

• Calcium (as MCHC)

• Phosphorus (as MCHC)

• Microcrystalline hydroxyapatite concentrate (MCHC)

Muscle relaxation formula: supplies minerals involved in muscular contraction and relaxation responses:

• Calcium, magnesium, passion flower, valerian root extract

• 2 tablets TID

Nutritional SupportAid in further degeneration

For metabolism at the central nucleus pulposus, which is anaerobic due to very low O2 con, and also has increased lactic acid content and low pH:

• Nutritional support for cellular energy production

• Bioavailable magnesium supports multiple aspects of energy production

• Malic acid, minerals and multiple vitamins support proper creation and utilization of cellular energy

Sciatica

Nutritional Support

• Hops, rosemary leaf extract and oleonolic acid. 1 BID:• An herbal dietary supplement that provides natural joint relief that is easy on

the GI tract• Works by interfering with signals in the body that initiate productions of

damaging compounds that cause minor pain and negatively impact cartilage and other joint tissue

• A formula that has unique combination of nutrients that support healthy nerve tissue integrity, nutritive blood flow, and nerve conduction: 2 softgels BID

• Includes:• Gamma-linoleic acid• Vitamin C• Select B vitamins• Beta carotene

• Alpha lipoic acid: 1 tablet BID

Ankle Sprains

Nutritional Protocol for Ankle Sprains

Nutritional protocol for the first 72 hours of sprained ankle

• Proteolytic enzymes:o Trypsin Chymotrypsin Bromelain: TID

• Natural anti-inflammatory:o Boswellia, turmeric, ginger, vitamin C: TID

• Nutrients to relax muscle tissue:o Calcium, magnesium, lemon balm, valerian: TID

Nutritional Protocol for Ankle Sprains (cont’d)

Nutritional protocol of sprained ankle Day 4 8 weeks

• Nutritionally modulate matrix metalloproteinases:o 2 tablets initially, then 1 TID:

o Hops, berberine, B vitamins & minerals

• If swelling still present:o Proteolytic enzymes taken in-between meals – 2 tablets TID:

o Trypsin

o Chymotrypsin

o Bromelain

Nutritional protocol of sprained ankle Day 4 8 weeks

• Formulation providing targeted nutritional components involved in the biochemical processes that support growth and construction of connective tissue:

• Amino acids — Research shows that providing specific amino acids (predominately glycine, proline, and lysine) supports healthy collagen fiber formation

• Micronutrients — Vitamin C, B6, B5, L-taurine, silica, zinc, iron, copper, and alpha-ketoglutarate are examples of themicronutrients required for healthy collagen formation

Nutritional Protocol for Ankle Sprains (cont’d)

Nutrition Protocol to Improve Telomere Length• Mediterranean diet/Lifestyle Changes

• Vitamin D3: 2000-5000 IU daily

• Omega 3 fatty acids: 2-4g daily

• Multivitamin/mineral with phytonutrients

• L-5 methyltetrahydrofolate, vitamin B6, B12, choline to support methylation and homocysteine metabolism

• A powder designed to support healthy functioning mitochondria: 1 scp. daily

• Zinc: 40mg to aid in energy metabolism

Functional Medicine, Inflammation and Chronic Pain:A New Modality for YOU?

“As a result of the common origins of immune cells and

osteoclasts, when chronic

inflammation ramps up our immune response, osteoclast activity gets

ramped up, too.”

http://www.womentowomen.com/bonehealth/inflammationandbones.aspx

INFLAMMATION PROMOTES BONE LOSS

“The receptor activator of nuclear factor κB ligand (RANKL)

(along with its receptor), the receptor activator of nuclear

factor κB and its natural decoy receptor, osteoprotegerin, are the final effector proteins of

osteoclastic bone resorption.”

Trends in Endocrinology & Metabolism 29 January 2009,20(2):88-94

Bone resorption

Peak Bone Mass (PBM)

• Peak bone mass is reached during young adulthood and contributes (positively or negatively) to a person’s risk to developing osteoporosis later in life

• A higher PBM during childhood may offset osteoporosis risk in adults

• Optimal calcium intake should begin in childhood

Anderson JJB. Calcium, phosphorus and human bone development. J. Nutr. 126: 1153S-1158S, 1996

Diet and fracture risk in post-menopausal (PM) women• Healthy dietary pattern including adherence to Mediterranean diet

lead:• A role in maintaining bone health in PM women and lower the risk of

fractures

• These women had an absolute risk reduction of 29%

• The MCHC-treated group showed a 6.1% increase in bone density; controls lost 5.5% during the 14-month treatment period; the calcium group showed no significant change

• The net difference in bone density in the MCHC group over controls was 11.6%

Epstein O, et al. Vitamin D, hydroxyapatite, and calcium gluconate in treatment of cortical bone thinning in postmenopausal women with primary biliary cirrhosis. AJCN 1982 Sep; 36(3):426-430

“Hydroxyapatite compound (OHC), derived from bone of bovine origin, contains an organic and an inorganic component. The organic componentconsists of collagen and non-collagenous peptides/proteins with growth factors and bone-specific proteins insulin-like growth factors I and II...”

Ruegsegger P, et al. Comparison of the Treatment Effects of Ossein-Hydroxyapatite Compound and Calcium Carbonate in Osteoporotic Females. Osteo Int. 1995;5:30-34

“These results indicate that ossein-hydroxyapatite compound has a beneficial effect on the process of bone healing but that this effect is lost if the organic components of the compound are destroyed or if pure calcium carbonate treatment is substituted.”

Annefeld M, et al. The influence of ossein-hydroxyapatite compound (‘Ossopan’) on the healing of a bone defect. Cur Med Res Opin 1986;10:241-250

Nutritional Therapy for Bone Health

• A Mediterranean style Food Plan

• Nutrients for promoting a healthy gut

• Bone mineralization and density:• MCHC, vitamin D, Calcium, Phosphorous

“….one third of what we eat keeps us alive.

Two thirds of what we eat keeps doctors alive”

Unknown

• Antibiotics:a) Turned from saving lives into the drug of choice for

treating symptoms of various conditions

b) Success rate as a prophylactic drug that are chronic in nature or multifactoral has produced unfavorable results

Using lab test to create Winning Nutritional Strategies

• Nutrition may be single most influential component of health

• Diet/supplementation/exercise may be best solution for modern Canadian diseases:

a) Obesity

b) Diabetes

c) Hypertension

d) CVD

e) Celiac disease, etc…

Using lab test to create Winning Nutritional Strategies (cont’d)

Why?

Medical world – great strides:

a) Reducing mortality

b) Treating acute illnesses

c) Extending life expectancy

Result: An increase in chronic, degenerative diseases amongst the Canadian population

Using lab test to create Winning Nutritional Strategies (cont’d)

• Concept: biochemical individuality to genetic potential with nutrigenomics and lifestyle vary from person to person

• Biochemical individuality influences not only the individual need for nutrients but also the expression of nutrient insufficiency

Using lab test to create Winning Nutritional Strategies (cont’d)

• Nutrient insufficiency: etiology of various modern conditions

Using lab test to create Winning Nutritional Strategies (cont’d)

• Question: How to detect and restore function and wellness?

• Answer:1) Plasma and in-office tests are first choice for early

detection

2) Asymptomatic and symptomatic individuals may have similar plasma/in-office test results

3) Remember: many factors influence nutrients status in both types of individuals

4) Lab tests/in-office tests can be used as clear indicators for nutritional supplementation

Using lab test to create Winning Nutritional Strategies (cont’d)

The Search Is On

Laboratory Tests

Laboratory Tests to Consider

• Systolic and diastolic blood pressure

• ESR-erythrocyte sedimentation ratio (r/o certain inflammatory diseases, e.g. RA, polymyalgia, rheumatica)

• Levels of vitamins (C, B1, B6, B12, folic acid)

• Liver enzyme panel

• (Cardio-CRP) C-reactive protein

• AA/EPA ratio (analysis of fatty-acid) – ideal ratio 1.5

• Homocysteine

• ANA

• Tissue pH-urine/saliva – 7.0 optimum reading

• BIA-body composition, phase angle, hydration status

Laboratory Tests to Consider (cont’d)

• Fasting glucose, 2-hour glucose• Fructosamine• Hemoglobin A1C• Fasting insulin• Fibrinogen – increased in diseases involving tissue damage or inflammation• Cholesterol:

• Traditional• VAP – vertical auto profile

• Exercise physiology evaluation:• Strength, balance, flexibility, aerobic capacity, endurance

• Vitamin D

Inflammation Testing

• MPO – myeloperoxidase – early indicator of patient’s CVD risk:• Elevated MPO indicates presence of unstable plaque in the artery wall

• HOMA-IR – homeostatic model assessment of insulin resistance. Marks for both the presence and extent of any insulin resistance that the patient might currently express:

• Fasting blood sugar and responsive insulin

• Lp-PLA2 – assess risk of CAD, stroke:• An enzyme that appears to play a role in inflammation of blood vessels

Cholesterol: a friend or a foe?Is cholesterol a cause of heart

disease or a misunderstood messenger

Cholesterol: The Good, the

Bad, and the Healthy Diet

Cholesterol: The Basics

• Cholesterol: Soft-wax lipid that occurs naturally in bloodstream, cell walls and membranes

• Liver produces approximately 1,000mg of cholesterol daily from other fats, which is all the cholesterol the body needs

• Because the body doesn’t need dietary cholesterol, particularly not cholesterol with “no place to go”, it means that consumption of cholesterol-laden foods can cause plague formation/buildup and result in cardiovascular problems

Cholesterol Facts:

• Cholesterol is a part of every cell membrane• Cholesterol is a precursor of:

1. Steroid Hormones (Estrogen, Testosterone, Progesterone, Cortisol)

2. Bile Acids (fat digestion)3. Vitamin D (osteoporosis)4. Cholesterol only appears to be problematic when oxidized

VLDL

Cholesteryl Ester

Transfer Protein

Swenson FL. The role of the cholesteryl ester transfer protein in lipo-protein metabolism.Diabetes Metabolism Review. 1991;7:139-153

INSULIN

INSULIN

HMG-CoA

reductase

HDL

LDL

Free Radicals and Oxidative Stress

• Free radical pathology central in the CVD “response to injury” hypothesis:

• Injury to endothelium produces chronic inflammation

• Triggers proliferation and transmigration of vascular smooth muscle cells, oxidation of LDL

• Stimulates migration of monocyte/macrophages into vessel walls

• Macrophages then engulf oxidized LDL and transform into streaks of lipid filled “foam cells”

• Form the initial fatty streak of atherosclerosis

Free Radicals and Oxidative Stress (cont’d)

• “…it is the oxidation of LDL, which is now believed to be the focal pivotal step in the process of atherosclerosis.”

• “Preventing the oxidation of LDL may be the most powerful means of preventing cellular injury leading to atherosclerosis.”

Sinatra ST, DeMarco J. Free radicals, oxidative stress, oxidized low density lipoprotein (LDL), and the heart: antioxidants and other strategies to limit cardiovascular damage. Conn Med 1995; 59 (10):579-88

ApoB/ApoA-I Ratio: Strong New Risk Factor for CVD

“An elevated apo-B/apo-AI ratio may constitute an important feature of the metabolic syndrome and may provide an additional mechanism to explain the increased cardiovascular risk in subjects with this syndrome.”

“The cholesterol balance determined as the apoB/apoA-I ratio has repeatedly been shown to be a better marker than lipids, lipoproteins, and lipid ratios. The results indicate that the apoB/apoA-I ratio is a simple, accurate, and new risk factor for CV disease – the lower the apoB/ApoA-I ratio, the lower the risk.”

Chol

CholTG

CholTG

Chol

Lipid Pick-up TruckLipid Delivery Truck

Artery Wall

Artery Wall

Legend:

TG Triglycerides

Chol Cholesterol

Blood cells

Blood flow

Blood cells

CholTG

TG

Apo B, Apo A animation Credit: Jeff Bland, Ph.D.

Apo A’s remove lipids, Apo B’s deposit lipids

Elevated Cholesterol Is An Important Risk Factor For Heart Disease And Stroke

Prevalence Data Available at: http://www.cdc.gov/nchs/fastats/cholesterol.htm. Date accessed: 12/21/2015 http://www.nhlbi.nih.gov/health/educational/hearttruth/downloads/html/infographic-riskfactors/infographic-5.htm. Date accessed 1.3.2016

Raised total cholesterol is highly prevalent, affecting 13.4% of US adults2

The prevalence of high cholesterol increases with age

Clinical Biomarkers Plot the Trajectory of Cardiovascular Risk

↑ Weight

↑ WC

Insulin resistance (e.g. ↑ HOMA-IR)

↑ TG, Small Dense LDL/HDL

↑ LDL, oxLDL

↓HDL

↑ BP

Endothelial dysfunctionC

ard

iova

scu

lar

Ris

k

Time (years)

CVD

Inflammation (e.g. ↑ hsCRP, Lp-PLA2)

Adverse Diet

↑ oxidative stress

Development of Atherosclerosis

The Interaction of Dyslipidemia and Oxidative Stress/Inflammation, Contribute to Vascular Disease

Tabas et al. Nature 2012;487:306-308Skaggs et al. Nature Reviews Rheumatology 2012;8, 214-223

Atherosclerosis

Inflammation Oxidative Stress

Raised Lipids Hypertension

Endothelial Dysfunction

Cholesterol is like the body’s “band-aid” – when there is inflammation it tries to patch things up

Status – they lower inflammation and also act as antioxidants

Urinary Analysis

Observe:- Appearance- Color- Odor

- Clear- Amber yellow- Aromatic- Cloudy, dark, foul smell may indicate infection (bacteria,

pus, blood)- Sweet smell may indicate diabetes

Protein - None- Present may indicate kidney disease

Specific Gravity - 1.005-1.030- Hydration, protein, glucose

Leukocyte Esterase

- Negative- Positive = leukocytes in the urine (UTI)

Introducing the perfect 10

Omega 7 + 3 Combination = Heart Health

Perfect 10 – for Heart Health

• Delivers a powerful combination of purified omega-7 and omega-3 fatty acids to provide targeted support for cardiovascular health

• The unique levels and ratios of omega-7 and omgea-3 fatty acids are designed to reduce serum triglycerides and blood levels of CRP

Purified Omega-7

• Each softgel provides 105mg of palmitoleic acid from omega-7, purified to remove palmitic acid

• Palmitic acid is a saturated fatty acid which has negative effect on important aspects of metabolic syndrome

• Many unpurified palmitoleic acid preparations, such as those from sea buckthorn, may contain high concentrations of palmitic acid

Concentrated Omega-3

Provides a concentrated dose of 500mg of combined EPA and DHA in each enteric, easy-to- swallow, softgel with a natural lemon flavor

Health Benefits of Omega-3s

• Widely studied, with over 20,000 published scientific papers that support health benefits

• Benefits include support for cardiovascular health, healthy brain development and improve cell membrane structure

Omega-3 Health Benefits

A large, consistent beneficial effect of omega-3 fatty acids was found for triglycerides

Balk E, Chung M, Lichtenstein A, et al. Evid Rep Technol Assess (Summ). 2004;(93):1-6.

Metabolic Pathways of EFAs

Alpha-Linolenic Acid (ALA)(e.g., green vegetables, flaxseed oil)

Steridonic Acid

Eicosatraenoic Acid

delta-5 desaturase

EPA/DHA(e.g., fish oils)

Cyclooxygenase Lipoxygenase

Delta-4 desaturase(DHA critical)

PGE3 LTB5(anti-inflammatory) (anti-inflammatory)

Linoleic Acid (LA)(e.g., corn, safflower, sunflower oil, grains)

Gamma-Linolenic Acid (GLA)(e.g., evening primrose, borage, black currant seed oils)

Dihomo-Gamma-Linolenic Acid (DGLA)

delta-5 desaturase

Arachidonic Acid (ArA)(e.g., grain-fed meat)

Cyclooxygenase Lipoxygenase

PGE2 LTB4(pro-inflammatory) (pro-inflammatory)

Competing

Delta-6 desaturase

Blocked by insulin, trans fats, alcohol,

Stress

OMEGA-3 EFA

PGE1(anti-inflammatory)

OMEGA-6 FA

Competing

B3, B6, C, zinc, mg. (nutrient co-enzyme)

Ginger, turmeric,

bioflavonoids, boswelia (co-

enzyme)Cell membrane

Simple strategies first!

Incorporating Natural Approaches

for Detoxification and

Improving GI Health

The Hidden LoadWhat’s invisible ishurting us!

More than 287

toxic

chemicalshave been found in newborn cord blood“Specific genes are turned on and off at certain time intervals, and any

disruption of this finely-tuned DNA methylation regulation may persistently alter gene expression. The fetal epigenome is most susceptible during this

developmental period to epigenetic modifiers in the maternal environment. An error during such a crucial time might lead to an abnormal phenotypic outcome

in the offspring.

Kanherkar, et al. Epigenetics across the human lifespan. Frontiers in Cell and Developmental Biology September 2014 (2):49

Exposure to Toxins

• Polybrominated diphenyl ethers (PBDEs): used as flame retardant

• Bisphenol A (BPA): packaging plastics

• Perfluorooctanoic acid (PFOA): non-stick cookware

• Acrylamide: a) carbs at high temperature; b) coffee

• Mercury: seafood

• Methyl tert-butyl ether (MTBE): a) second-hand smoke; b) gasoline additive

Association between urinary Bisphenol A concentration and obesity prevalence in children and adolescents

Conclusion: Urinary BPA concentration was significantly associated with obesity in this cross-sectional study of children and adolescents

JAMA 2012:308(11):1113-1121

Bisphenol A may cause

testosterone reduction by adversely

affecting both

testis and pituitary systems similar to estradiol

Toxicol Lett. 2010 Apr 15;194(1-2):16-25. Epub 2010 Feb. 6

Cash Register Receipts – A Source of BPA

http://dx.plos.org/10.1371/journal.pone.0110509

BPA is an Ovarian Toxicant

• “I think more scientists working today agree that BPA is an ovarian toxicant” – Dr. Flaws

• Review research published in Environmental Health Perspectives: ovarian toxicity among the most consistent and strongest effects found “in both animal models and in women”

BPA has adverse effects on in-vitro fertilizationConclusion: Exposure to BPA may lead to reduced quality of embryos during reproduction. This study shows that BPA could be the cause for decreases in the frequency of implantation pregnancy and live birth rates in couples seeking in-vitro fertilization

Endocrine disruptors: Manmade and natural estrogens: opposite effects on assisted reproduction. Nature Reviews Endocrinology 2016

Higher concentrations of common plastics – BPA –in pregnant mother’s blood may be a contributing factor in preterm births

Journal of Maternal Fetal and Neonatal Medicine. 2016

BPA linked to preterm birth

BPA alternative disrupts normal brain-cell growth, is tied to hyperactivity

University of Calgary: Thinks it’s research is first to show that bisphenol-S – ingredient in many products bearing “BPA-free” labels – causes abnormal growth surges of neurons in an animal embryo

Health & Science

BPA substitute can trigger fat cell formation: Chemical used in BPA-free products exhibits similar endocrine-disrupting effects

The Endocrine Society, Mar 22, 2016

Fast food may expose consumers to harmful chemicals called

phthalates

The Journal Environmental Health Perspectives

Reduce Your Exposure

Detox Your Body

26 Seconds.

Is all it takes

for the chemicals in your

personal care products to enter your bloodstream.

What’s in YOUR products?

Metabolic Detoxification

Toxic Exposure

Following their entry into the body, some toxins may remain in the intestine and are eliminated via the stool,

sweat, or urine, while others are transported to

the liver.

Detoxification, Alkalinization & Heavy Metal Metabolism SupportFeatures a low allergy potential rice protein and balanced solubility designed to reduce the translocation of toxins to the liver

Phase IFunctionalization

Enzymes released by the liver breakdown

xenobiotics, a process that

produces harmful free radicals

Benefits Phase I & IIEnhances activities of several liver detoxification enzymes and provides antioxidants to support the clearance of reactive intermediary compounds

Phase IIConjugation

Large molecules join together with modified xenobiotics to

produce harmless, water-soluble substances. These

water-soluble substances are then excreted from the body

via urine and stool.

Metabolic Detoxification