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Osteoporosis and Nutrition

Article Summary

Renata Trister DO

Osteoporosis is a disease that thins and weakens the bones. Osteoporosis is characterized by fragile bone and an increased risk fractures. Women and men with osteoporosis most often break bones in the hip, spine, and wrist, but any bone can be affected. You can’t “catch” osteoporosis or give it to someone else. In the United States, more than 40 million people either already have osteoporosis or are at high risk due to low bone mass (osteopenia), placing them at risk for more serious bone loss and fractures. . An estimated 1 in 2 women and 1 in 8 men over age 50 will suffer a bone fracture due to osteoporosis in their lifetime. Although osteoporosis can strike at any age, it is most common among older people, especially older women.

Bone is living tissue. Throughout our lives, the body breaks down old bone and replaces it with new bone. But as people age, more bone is broken down than is replaced. The inside of a bone normally looks like a honeycomb, but when a person has osteoporosis, the spaces inside this honeycomb become larger, reflecting the loss of bone density and strength. The outside of long bones — called the cortex — also thins, further weakening the bone. In fact, the word “osteoporosis” means “porous bone.” Osteoporosis is often called “silent” because bone loss occurs without symptoms. People may not know that they have osteoporosis until a sudden strain, bump, or fall causes a bone to break. This can result in a trip to the hospital, surgery, and possibly long-term disability. Fortunately, experts agree that this type of suffering may be preventable. Studies show that lifetime maintenance of adequate nutrient intake, including calcium and other nutrients important to bone health, along with regular exercise and a healthy lifestyle may reduce the risk of developing osteoporosis.

Are You at Risk?

There are a variety of factors – both controllable and uncontrollable – that put you at risk for developing osteoporosis.

Uncontrollable Risk Factors

Being over age 50.
​​Being female.
​​Family history of osteoporosis.
​​Low body weight/being small and thin.
​​Broken bones or height loss.

Controllable Risk Factors

​ ​Not getting enough Calcium, Vitamin D, Magnesium
​​Unhealthy diet, with not enough vegetables.
​​Consuming too much protein, caffeine and sodium.
​​Sedentary lifestyle.
​Prolonged use of some medications (corticosteroids, antacids)

Can Osteoporosis Be Prevented?

There are many steps you can take to help keep your bones healthy. To help keep your bones strong and slow down bone loss, you can:

Eat a diet rich in calcium and vitamin D.


Not drink in excess or smoke.

Calcium: What are the Recommendations?

The Reference Daily Intake (RDI) provides recommendations for daily nutrient requirements. The current RDI for calcium is 1,000 mg per day. Unfortunately, about 65% of the U.S. population consumes less than the RDI for calcium.

The ability to absorb calcium declines with age in both men and women. Certain medications, and nutrient deficiencies (e.g., vitamin D, magnesium) can interfere with calcium absorption. Hypochlorhydria, a condition of low gastric acid production, can also impair calcium absorption and is quite common in the elderly. Patients encountering any of these factors may need to make dietary adjustments and be sure they are consuming forms of calcium that are easily absorbed.

Gluten Intolerance and Bone Loss

Chronic gas, nausea, bloating, diarrhea, constipation and brain fog could all be signs of gluten intolerance. Gluten is a protein found in grains such as wheat, rye and barley. According to statistics from the University of Chicago Celiac Disease Center, an average of one out of every 133 otherwise healthy people in the United States suffer from celiac disease but previous studies have found this number could be as high as 1 in 33 in at-risk populations.

Those with undiagnosed gluten intolerance often have malabsorption of nutrients due to chronic intestinal damage. This means that your body is unable to optimally take nutrients from food and distribute them throughout your body. The malabsorption of nutrients and the systemic inflammation due to chronic intestinal damage can lead to osteoporosis (and many other conditions, please see the Inflammation article for more on this topic).

If you experience the above-mentioned symptoms, a gluten free diet may be of great benefit.

Foods that Lead to Bone Loss

Processed foods such as potato chips, soda and candy contain very little nutrients; but do contain indigestible fats and dangerous additives (such as high fructose corn syrup, aspartame and preservatives). Cooking with oils such as corn, safflower or soy should be avoided. These oils contain highly processed, damaged omega 6 fats, which contribute to inflammation in your body. Olive oil and coconut oil are great alternatives.

Foods that Prevent Bone Loss

Organic vegetables are the best way to get vitamins and minerals into your body. An easy way to increase the amount of vegetables in your diet is vegetable juicing. It is a highly effective way to obtain the most potent nutrition that is easy for your body to digest and absorb.

Vitamin D and Sunshine Exposure

Vitamin D plays an essential role in maintaining optimal bone mass by acting primarily to assist calcium absorption. Despite what you may have heard, appropriate sunshine exposure is not bad for you. It is healthy and necessary. Just 15 to 20 minutes of sun daily can make a dramatic improvement in your health, and appropriate sun exposure is the ideal way to maintain your vitamin D levels in the optimal range.

An oral vitamin D3 supplement may useful in certain situations. Prior to taking supplements of Vitamin D, it is very important to get your vitamin D levels checked to avoid under- or overdosing.

Omega-3 for Strong and Healthy Bones

Omega 3 is another essential nutrient your body needs in order to prevent both inflammation and osteoporosis. The British Journal of Nutrition recently published a study stating that the Omega fat, DHA appears to constitute marrow and enhance bone mineral content. Omega 3 fats also slow cognitive decline. Plant-based omega-3 fats such as those found in flax seed are highly beneficial, on account of their high alpha-linolenic acid (ALA) content, animal-based omega-3 fats contain two crucial ingredients you are not getting from plants: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Ideally, omega-3 would be obtained from eating seafood. Unfortunately, industrial pollution has changed this; fish are now loaded with mercury, industrial toxins, PCBs and PDEs. The same goes for most of the oil that is made from these fish. There is another source of animal-based omega-3 fats available, namely krill oil. Krill are very tiny shrimp-like creatures that exceed the number of all animals (including humans) in the world. Krill oil contains antioxidants called astaxanthin that protect DHA and EPA fats until they are consumed.

Bone-Supportive Nutrients

Magnesium is required to properly utilize calcium, and calcium intake does not ensure normal bone mass if magnesium levels are low.

Trace Minerals including zinc, manganese, fluoride, boron, and silicon are important for bone health. A 2-year clinical study, postmenopausal women who increased their intake of both calcium and trace minerals experienced an increase in bone mass. While women who only increased calcium or trace minerals alone experienced bone loss. This suggests that a combined nutritional regimen is more effective.


Insulin Resistance

Insulin Resistance and Nutrition
Article Summary
Renata Trister DO
Glucose is the basic fuel that all cells in the body use to make energy. It is a simple monosaccharide found in plants; and is one of the three dietary monosaccharaides, along with fructose and galactose, that are absorbed directly into the bloodstream during digestion. Glucose is a common medical analyte measured in blood samples. A high fasting glucose blood sugar level may be a sign of pre-diabetes or diabetes mellitus. Glucose can only be put to work and transformed into energy once it is in the cells, not when it is circulating in the bloodstream. Ideally, blood glucose level is maintained in a fairly narrow range. Low blood sugar level is referred to as hypoglycemia; high blood sugar level is termed called hyperglycemia. Proper blood sugar level is important and inability to maintain a proper level leads to illness. Chronically elevated blood glucose levels result in the development of diabetes.
Insulin Resistance
Insulin is a hormone, produced by the pancreas, and is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, skeletal muscles, and fat tissue to absorb glucose from the blood. Insulin resistance is a physiological condition in which cells fail to respond to the normal actions of the hormone insulin. The body produces insulin, but the cells in the body become resistant to insulin and are unable to use it as effectively, leading to hyperglycemia. In response to this hyperglycemia, the pancreas produces even more insulin. This often remains undetected and is a risk factor for Type 2 Diabetes, hypertension and heart disease. Additionally, elevated insulin may be associated with weight gain and difficulty with weight loss.
It is well known that insulin resistance commonly coexists with obesity. However, causal links between insulin resistance, obesity, and dietary factors are complex and controversial. It is possible that one of them arises first, and tends to cause the other; or that insulin resistance and excess body weight might arise independently as a consequence of a third factor, but end up reinforcing each other. Some population groups might be genetically predisposed to one or the other. Genetics are one cause that predisposes people to develop insulin resistance, however, lifestyle and diet changes can have a profound effect on diminishing and eliminating these conditions. Diets of processed sugars, foods, and fats; along with obesity, lack of exercise, and smoking all contribute to insulin resistance and other serious health problems. Regular moderate exercise can helps regulate blood sugar and increase insulin sensitivity it also helps lower blood pressure, improve cholesterol levels, and result in weight loss.
Nutritional Support and Insulin Resistance
Diet along with vitamins, minerals, and phytonutrients can improve the sensitivity of the body to insulin.
The glycemic index (GI) provides a measure of how quickly blood sugar levels rise after eating a particular type of food. The effects that different foods have on blood sugar levels vary considerably. The glycemic index estimates how much each gram of available carbohydrate (total carbohydrate minus fiber) in a food raises a person’s blood glucose level following consumption of the food, relative to consumption of pure glucose. Glucose has a glycemic index of 100. A low-GI food will release glucose more slowly and steadily, which leads to more suitable postprandial (after meal) blood glucose readings. A high-GI food causes a more rapid rise in blood glucose levels and is suitable for energy recovery after exercise or for a person experiencing hypoglycemia. Thus the lower the GI the less the pancreas needs to work to keep blood sugar levels in the normal range. Consuming foods with a low glycemic index decreases the risk for development of type 2 diabetes. For those with type 2 diabetes, eating low GI foods and eliminating high GI foods is essential to controlling and reversing the disease.
Dietary fiber is the indigestible portion of food derived from plants. It plays an important role in promoting a healthy insulin response. There are two fiber types/components:
Soluble fiber dissolves in water. It is readily fermented in the colon into gases and physiologically active byproducts, and can be prebiotic. Soluble fibers tend to slow the movement of food through the system.
Insoluble fiber does not dissolve in water. It can be metabolically inert and provide bulking or prebiotic, metabolically fermenting in the large intestine. Bulking fibers absorb water as they move through the digestive system, easing defecation. Fiber appears to slow digestion, which helps to prevent a surge of blood sugar and resulting insulin response.
Fats The type of fats that are consumed can play a role in insulin resistance. Trans-isomer fatty acids, or trans fats, are a type of unsaturated fat, which is uncommon in nature but can be easily created artificially. Research indicates that trans fatty acids (TFAs) may increase weight gain and abdominal fat, despite a similar caloric intake. A 6-year experiment revealed that monkeys fed a trans fat diet gained 7.2% of their body weight, as compared to 1.8% for monkeys on a mono-unsaturated fat diet; concluding that “under controlled feeding conditions, long-term TFA consumption was an independent factor in weight gain. TFAs enhanced intra-abdominal deposition of fat, even in the absence of caloric excess, and were associated with insulin resistance, with evidence that there is impaired post-insulin receptor binding signal transduction.” When healthy fats, such as omega-3 essential fatty acids, are substituted into a high fat diet, insulin resistance in skeletal muscle may be prevented. These omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), demonstrate a beneficial effect on insulin and blood sugar by improving the function of insulin receptors and blood sugar transporters in the cell. They may also increase cell membrane fluidity, thus promoting insulin action. EPA and DHA also support cardiovascular health.
Magnesium is required for both proper glucose utilization and insulin signaling. Metabolic alterations in cellular magnesium, which may play the role of a second messenger for insulin action, contribute to insulin resistance. Thus, magnesium affects insulin secretion and action. Daily magnesium supplements appear to improve blood sugar transport into the cell. Type 2 diabetics frequently develop a low magnesium level.
Chromium promotes glucose uptake by the cell and may affect the action of insulin. Chromium deficiency is associated with elevated blood sugar levels, high cholesterol, and the development of plaque on artery walls. Beneficial effects of supplemental chromium on blood lipids such as cholesterol have been reported in controlled trials. Recent studies have also suggested that chromium can significantly reduce blood sugar levels in type 2 diabetics.
Biotin is a coenzyme for carboxylase enzymes, involved in the synthesis of fatty acids and in gluconeogenesis. It is a vitamin that is found in small amounts in numerous foods. There is some evidence that diabetes could result in biotin deficiency. Animal studies suggest that a biotin intake can improve the utilization of glucose without increased insulin secretion from the pancreas. Biotin has been shown to substantially lower fasting glucose in type 2 diabetic patients.

Conjugated Linoleic Acid (CLA) is a naturally occurring fatty acid that may support healthy blood sugar and insulin metabolism. It can also help reduce body fat deposits and improve immune function.
Alpha-Lipoic Acid (ALA) is an antioxidant. Antioxidants protect against damage to the body’s cells. There is some evidence that ALA may have at least two positive benefits for individuals with diabetes (type2diabetes). A few studies have suggested that alpha-lipoic acid supplements enhance the body’s ability to use its own insulin to lower blood sugar in people with type 2 diabetes. ALA may also help reduce the symptoms of peripheral neuropathy — nerve damage that can be caused by diabetes. In Europe, ALA has been used for years to provide relief from the pain, burning, tingling, and numbing caused by diabetic neuropathy.
Antioxidants An increase in the generation of damaging free radicals and resulting oxidative stress may be associated with insulin resistance. Antioxidants such as vitamins E and C, zinc, and selenium have been shown to protect against free radicals and reduce oxidative stress.


Immune system. Brief review. By Jon Trister MD

The Immune System, brief review

 To defend as form invaders  body has two immune systems:

The first defense system is an innate immune system we are born with. This is a  first defense against any foreigners-microbes, viruses, funguses. This is antigen non-specific defense mechanisms which respond to invaders immediately or within several hours after exposure to every foreigner. Cells associated with innate immune system are Macrophages, Dendritic cells and  B-lymphocytes

 The second defense system is an adaptive immune system (acquired) immunity refers to antigen-specific defense and require  several days to become protective and are designed to react with and remove a specific antigen. Adaptive immunity is the immunity one develops throughout life. Cells associated with adaptive immune system are T- and B-Lymphocytes

One of the function of the innate  immune system is an APC ( antigen presentation cells)-is an identification, isolation  of the antigen-specific protein -epitope-actual portions or fragments of an antigen that react with receptors on B-lymphocytes and T-lymphocytes, as well as with free antibody molecules) and presentation it in the from of complex : MHC I/epitope  or MHC ii/epitope on the surface of the APC ( Macrophages, Dendritic cells, B-Lymphocytes).Epitope is a fragment of the antigen which will provide adaptive immune system a specific  information about invader ( antigen).Without ability to perform this function as an APC innate immune system will be unable to “educate” adaptive immune system about structure of the antigen.

Polysaccharides antigens( 3-4 sugar residuals)  usually have many epitopes but all of the same specificity.

Proteins antigens (5-15 amino acids )usually have many epitopes of different specificities.

Immune responses are directed against many different epitopes of many different antigens of the same microbe.

The body recognizes an antigen as foreign when epitopes of that antigen bind to B-lymphocytes and T-lymphocytes by means of epitope-specific receptor molecules having a shape complementary to that of the epitope.


                     MHC molecules

MHC-I molecules are made by all nucleated cells in the body

MHC-I presents epitopes to T8-lymphocytes; MHC-II presents epitopes to T4-lymphocytes.

MHC-I molecules are designed to enable the body to recognize infected cells and tumor cells and destroy them with cytotoxic T-lymphocytes or CTLs.

CTLs are effector defense cells derived from naïve T8-lymphocytes.

MHC-I molecules are made by all nucleated cells in the body; bind peptide epitopes typically from endogenous antigens; present MHC-I/peptide complexes to naive T8-lymphocytes and cytotoxic T-lymphocytes CTL.


MHC-II molecules are made by antigen-presenting cells or APCs, such as dendritic cells, macrophages, and B-lymphocytes; bind peptide epitopes typically from exogenous antigens; and present MHC-II/peptide complexes to naive T4-lymphocytes or effector T8-lymphocytes that have a complementary shaped T-cell receptor or TCR

Exogenous antigens enter antigen-presenting macrophages, dendritic cells, and B-lymphocytes through phagocytosis, and are engulfed and placed in a phagosome where protein antigens from the microbe are degraded by proteases into a series of peptides. These peptides are then attached to MHC-II molecules that are then put on the surface of the APC.


Cholesterol Conundrum

Cholesterol Conundrum
By Renata Trister, DO

Most people who are even a little bit concerned about their cholesterol know that there is a“good/Healthy cholesterol” – known as HDL, and a “bad/Lousy cholesterol” – known as LDL. Although, research shows that the higher the amount of HDL and the lower the amount of LDL in the blood, the less likely a person is to suffer a heart attack or stroke, the “causal” relationship between cholesterol and these illness has not been determined. Roughly one in six Americans with “unhealthy” cholesterol levels. In the past 15 years, prescriptions of cholesterol lowering medications has soared. In 2011, 260 million prescriptions were dispensed in US alone.

Scientific opinions differ on cholesterol issues, and there is contrary evidence to theories. Two major clinical trials in the past three years have greatly complicated the picture. The first study, from 2008, shows that lowering LDL levels does not always decrease the risk of having a heart attack. Similarly, results from the second study, show that raising HDL levels does not always translate into fewer heart attacks or strokes. These perplexing findings do not mean that people should stop taking their cholesterol medications. The results have, however, underscored the danger of indulging in a common logical shortcut – assuming that artificially producing normal test results in a patient is the same as conferring good health on that patient. For one thing, drugs typically do not mimic normal conditions perfectly. For another, heart attacks and strokes occur after a complex series of processes that may take years to unfold. Simply altering one of these processes does not necessarily fix the whole problem.
Understanding Cholesterol Testing and its Functions.
Cholesterol is a crucial building material in the body. It helps maintain the structure of cells and vessels, improving overall health and function in the body.

About 80% of cholesterol is produced in the body. Liver, brain and other cells produce cholesterol. About 20% of cholesterol comes from food.
The cholesterol screening test that is usually performed is a blood test called a lipid profile. Results of a lipid profile will come in the forms of numbers. The values of LDL, HDL, trigycerides and total cholesterol are measured.
There is no such thing as “bad cholesterol”.
HDL and LDL are actually proteins that carry cholesterol. Cholesterol can’t dissolve in the blood (like oil and water). It has to be transported to and from the cells by carriers called lipoproteins – HDL, LDL. These carriers have different and crucial functions, they are not “good” or “bad”. Low-density lipoprotein, or LDL carries cholesterol made in the liver to other tissues. The liver synthesizes cholesterol based on need. High-density lipoprotein, or HDL carries cholesterol from peripheral tissue back to the liver.
The following is a few vital functions of cholesterol:
Cholesterol is a precursor to important sex hormones like testosterone, estrogen, androgen and progesterone. It is also a precursor to corticosteroids, hormones whose primary function is to protect the body against stress and disease.

Used as an insulator around nerves, cholesterol is absolutely essential for brain function.

Bile salts are made from cholesterol, adequate cholesterol is needed for proper digestion.

Cholesterol is a precursor to vitamin D, an important nutrient which supports a healthy immune and nervous system, reproduction, insulin production and the metabolism of minerals.

Serotonin receptors in the brain require cholesterol in order to function properly. Serotonin is an important neurotransmitter, low levels of serotonin are linked to depression.


Triglycerides make up about 95% of your body’s fat and are the chemical form in which most body fats exist. The fat produced from triglycerides is used for energy production, provides your body’s organs with insulation, and is a central component in the structure of cell membranes.  Unused triglycerides are transferred to fat cells for storage.  When energy is needed, hormones can cause the release of the stored fats.  Excess triglycerides increase the risk of stroke, heart attacks, fatty liver, pancreatitis and obesity.
Since triglycerides are part of a serum lipid blood test, and lipids are fats circulating in the blood, most people assume high fat diets increase triglycerides.  They are surprised to learn sugars, refined grains, and fruit sugars cause elevated triglycerides.     
High blood sugar levels lead to high triglycerides levels. Sugars and refined grains stimulate insulin production.  Insulin stimulates the liver to produce triglycerides. Triglycerides in the blood are not made from dietary fats but made in the liver from excess sugar, which has not been used for energy.  Eating more calories than your body can use for energy contributes to higher triglycerides.

Vascular Damage
The LDL cholesterol is made in response to damage and stress. When blood vessels are damaged, LDL-carried cholesterol “patches up” the arterial lining with a buildup of fatty material, or atherosclerotic plaque. Much of the time the plaque stabilizes without creating too many immediate problems, but sometimes it bursts, triggering blood clots that lead to heart attacks and strokes if the clots prevent blood from delivering critical oxygen to heart or brain tissue. Without oxygen, the affected tissue dies.
People with high LDL levels may form arterial plaques that are more likely to burst. Some people develop extremely high LDL levels because of a genetic disease called familial hypercholesterolemia that severely limits their ability to clear cholesterol from their blood. They suffer heart attacks in their thirties or forties, which is several decades earlier than the average for the general population. On the positive side, those who maintain normal cholesterol levels (LDL less than 100 milligrams per deciliter of blood and HDL cholesterol levels greater than 40 mg/dL) throughout their life without medication are much less likely to suffer heart attacks or strokes.
A Shortcut ?

With all this evidence linking heart disease to cholesterol levels, it is no wonder that researchers in general and pharmaceutical companies in particular reached a fairly straightforward conclusion: anything – such as a medication – that reduces LDL levels and raises HDL levels must also reduce heart disease risk. By the 1980s the drug industry began marketing a whole family of cholesterol-lowering drugs called the statins, which work by blocking a liver enzyme that is essential for forming cholesterol. Clinical studies proved that statins do in fact reduce the number of heart attacks in people with high cholesterol. Might statins provide benefits unrelated to cholesterol reduction? There is some evidence that they also decrease inflammation. (When inflammation occurs in the arteries, it is thought to increase the risk of heart disease.) A 2008 study called the JUPITER trial tested statins in about 18,000 people with normal LDLs but elevated C-reactive protein, a measure of inflammation. Statins reduced the risks of heart attack and stroke. That led proponents to conclude that by working through an additional mechanism—lowering inflammation, not just LDL—statins were helping even people with normal LDL levels. Cholesterol lowering drugs also have anti-inflammatory properties Inflammation is strongly suspected of contributing to atherosclerosis.
To some extent, as long as the statins were working, few people worried too much about why they were helping. But statins are not for everyone. Some people cannot tolerate the drugs’ multiple side effects, including muscle pain and, more rarely, liver damage. Others cannot lower their LDL levels enough simply by taking a statin. In addition, at least one in five people whose LDL levels are well controlled by their medications still experience heart attacks or strokes.
Food and Lifestyle:

Elevated blood cholesterol may be a response to stress and injury (damage repair, cell formation, hormones production…). Trans fats, refined sugars, artificial sweeteners, industrial meats, genetically modified foods can cause total and LDL cholesterol rise because they stress and injure tissues. Therefore, diet and lifestyle changes can be very beneficial.
Weight loss. Even a modest amount of weight loss can lower cholesterol levels.
Reduce the amount of sugar and flour in your diet. Recent evidence indicates that added sugar – in the form of table sugar (sucrose) or high-fructose corn syrup – is probably a greater contributor to heart disease than is consumption of saturated fat. This suggests that the inflammatory hypothesis may in fact have more validity than the conventional lipid hypothesis, although the debate is far from settled. As a general rule, avoid processed sugars, particularly soft drinks and highly processed snack foods, which can cause rapid spikes and dips in blood sugar levels. The result can be overeating, obesity and heart disease.
Avoid trans-fatty acids.
These heart-damaging fats can reduce HDL (“good”) cholesterol levels and raise levels of LDL (“bad”) cholesterol. The tip-off that trans-fatty acids are present in foods is the listing of “partially hydrogenated oil” on a food’s ingredient list. Trans-fats are found in many brands of margarine and in most heavily processed foods, as well as in snack foods such as chips, crackers and cookies, and in the oils used to cook fast-food French fries, doughnuts and movie popcorn.
Decrease toxic load by eating fresh organic foods when possible.
Exercise. Daily aerobic exercise can help increase HDL levels.
Don’t smoke. Smoking itself is a risk factor for heart disease. It can also significantly lower HDL cholesterol.
Stress. Emotional stress may prompt the body to release fat into the bloodstream, raising cholesterol levels.


Medical foods and supplements

Good health maintenance requires the right nourishment to feed the factories in the body’s billions of cells.  The food intake for the cells, tissues and organs often lacks some of the items needed for efficient cell function and energy output.  Brain cells require some different nutrients than the skin or liver, for example.  Prescription drugs are often used to compensate for abnormal cell or organ function or to suppress symptoms, but they may be inefficient and accompanied by more symptoms and side affects.

Medical foods and supplements furnish the missing ingredients for specific cell function and correction of the deficiencies and symptoms.  There are many supplements and natural ingredients that cannot be duplicated by pharmaceuticals and can correct many of the causes of disease and even prevent most viral infections altogether.

Inherited genetic defects are often related to the body’s inability to produce or utilize certain nutrients, vitamins or minerals.  Disease is inevitable in these conditions, unless the correction can be made by using the specific medical food or supplement.  We are able to see that the inherited condition is compensated for and when the gene expression is prevented, the disease condition is prevented.

Dr. Trister has had extensive training in this field and makes it a regular part of his practice. He completed his training at the Institute for Functional Medicine under direction of Doctor J. Bland


FAQ about Prolotherapy and PRP

Am I a candidate for Prolotherapy and PRP?

A: Many problems related to musculoskeletal conditions are can be successfully treated with Prolotherapy (Regenerative Injection Therapy):
1.Degenerative Joint Diseases (Osteoarthritis)-OA:all locations:
neck, TMJ, shoulders, scapulaes, clavicles, ribs, elbows, wrists, fingers, thoracic and lower back pain, “disc’s problems”, hips, knees, ankles, feet, toes.
2.Consequences of ligamentous, cartilagenous and tendinous injuries (with some limitations). Partial tears of tendons, muscles and ligaments can be successfully treated with combining various techniques :
Prolotherapy + PRP (Platelets Rich Plasma)
Prolotherapy + Mesenchymal stem cells + PRP
Prolotherapy + Neural prolotherapy.
3.Some form of arthritis may have infectious, allergic, autoimmune or metabolic causes. In such cases we will order special diagnostic tests to help patient in selection of appropriate treatment.
4.Patients with infected joints,non-healing wounds around joints,cancerous spread into the bones(metastasis,multiple myeloma, leukemias) ARE NOT A CANDIDATES FOR PROLOTHERPAY.
5.Elderly and debilitated patients may not respond well to prolotherapy.
6.Degree of joint damage (stage of the OA), age, weight, smoking status, nutritional status, use of certain medication (Steroids , NSAID) will negatively affect prognosis of the treatment.
6. Patients with illnesses related to medico-legal problems (Motor Vehicle and industrial Accidents) must have official pre-authorization from their insurances or Court order for treatment.
7. Other factors may play role too: anticoagulation therapy, anti-platelets therapy etc
During initial consultation we will perform detailed physical examination, review imaging tests, and available laboratory tests,will perform diagnostic musculoskeletal ultrasound in the office .
This will help us select right strategy for treatment.

How much does it cost?

A.: The initial evaluation cost depends on the complexity of the problem and how much time is needed to do the evaluation.  One hour is usually the time set aside for the first visit.  A few first visits are less complex, taking 30 minutes, while a few may require 90 minutes.  A call to the office will allow us to give an estimate of a consulation/evaluation fee.

When treatment is given during the office visit, there will be an additional charge for the treatment.  Charges vary according to the area(s) treated.

Will my insurance pay for this treatment?

A.:  Insurance companies vary a lot. Most insurances including Medicare and Medicaid DO NOT pay for this services. Some pay well for prolotherapy treatments.  Some pay part of the time and not other times.  Some companies will not pay for it at all. Please contact your insurance and ask this question . CPT code for Prolotherapy  is “ M0076 “

How many treatments will I need?

A.:  It is not possible to tell ahead of time how many treatments a patient might need before they are pain-free.  The doctor will give  an estimated range of the number of treatments that you will need, depending on the severity of your condition.

How far apart are the treatments?

A.:  Treatments are usually given at three-four weeks intervals.  There are exceptions to this, depending on other circumstances.

How soon after treatment can I work out or play sports?

A.:  If your sports or work-outs involve the area that is being treated, you will get the best results with treatment when you avoid exercising or stressing the area until 3 or 4 weeks after the last treatment.  If you must continue to exercise the treatment area, it may take a lot more treatments to get the desired result.  You may continue to re-injure it with the exercise or sports activity, preventing it from getting strong enough to protect it.

What is in the medicine that is used in the injections?

A.:  There is no cortisone used in prolotherapy.  The solution is normally a mixture of a very concentrated dextrose (glucose) with a local anesthetic like lidocaine.  A small amount of sodium morrhuate ( a water soluble form of cod liver oil) is added for extra stimulation of the healing reaction in some cases.

What is the success rate with prolotherapy?

A.:  Prolotherapy generally has about a 70% good to excellent response among the doctors across the country that keep track of their patients’ responses to treatment.  About 10% of the patients are in the poor response, or less than 50% improvement category.

Is there a guarantee that prolotherapy will work for me?

A.:  There is nothing in medicine that is guaranteed.

How do I contact the office for an appointment?

A.:  Please call our office at 508-754-9950 for an appointment.  The staff will be happy to schedule your appointment and give you further information.

What are the office hours?

A.:  Our office hours are 8:00 AM to 12:00 NOON and 1:00 PM to 5:00 PM, Monday through Friday.

What should I bring to the doctor’s office for the initial evaluation?

A.:  Please bring the completed paper work that the office sends to you and any X-ray or films of any other studies that you may have had.

What happens at the first visit?

A.:  Medical assistant will greet you, collect your paper work and take you to the examination room.  The doctor will review your paper work, ask you questions about your problem, examine you, read your X-rays and explain them to you, give you his opinion about what he believes is causing your pain or other problems, order any new studies that may be needed and make recommendations for treatment.  He will explain the treatment and answer your questions. You will be given Consent form for treatment and estimated cost. No treatment will be performed during consultative visit.

Will I need a driver?

A.:  Most of the time patients do need a driver. You will receive a treatment which may affect your ability to drive safely for 12-24 hours.

Will I need to be off work after the treatment?

A.:  Most patients do not need to be off work the day after the treatment if it is sedentary work.

What are the risks with prolotherapy?

A.:  There are risks with all treatments and medications, not just prolotherapy.  If the doctor feels that you are a candidate for prolotherapy, he will explain the risks to you and try to answer all of your questions.


Intravenous therapy (Myers Cocktail)

Anti-aging efforts for looking and feeling younger, being healthier and living longer are all part of an anti-aging program.

Youthful vitality is noted by freedom from pain, returning to normal activities, enjoying more energy, having better and happier relations with your loved one and family, having better sex, improving your memory and being happier with yourself.  Anti-aging treatment benefits both men and women.

Everything that we do in this office is directed toward these anti-aging goals.

Bio-identical hormones are often useful in the anti-aging program.  A physical examination is done in the office.  Mammograms and pap smears may be ordered.  Special laboratory test are ordered see if there are any medical problems and to determine the type and amount of hormones that should be prescribed.  Natural supplements may be used to enhance the hormones or to benefit other anti-aging needs.

Memory and brain function are strengthened by a number of the natural supplements and medical foods.  The memory can be enhanced with nutritional supplements for people who are in college to people of Medicare age.  There are supplements that increase the rate of growth of the connections between the cells of the brain, that improve the chemical functions at the cell junctions in the brain, that increase the circulation in the brain and that help Alzheimer’s disease by helping to reduce the amyloid tissue that is developing in the brain.  Amyloid deposits are seen in the brain MRI’s of these patients as white spots.  It is believed that the brain connections are lost wherever these deposits are found.  Alzheimer’s disease can be prevented in offspring of Alzheimer patients by the use of some of these supplements.

Weight loss is often an important aspect of the anti-aging program.  Good health and good appearance are both important.  Weight loss treatment is supported by diet, nutritional supplements, safe and natural appetite suppressants and advice on an appropriate exercise program.

Nutritional Intravenous Vitamin and Mineral Protocol

About the Therapy

“Myers’ Cocktail,” an intravenous vitamin nutrient supplement, was formulated more than 30 years ago by John Myers, MD, a Baltimore physician. This potent solution contains a specially balanced combination of vitamin and minerals. It is given intravenously to help the treatment of a range of ailments and increase energy. In the last few years, Alan R. Gaby, MD, president of the American Holistic Medical Association, has modified the ingredients and popularized the protocol.

The standard Myers’ Cocktail consists of magnesium, calcium, vitamin B-5 (dexpanthenol), vitamin B-6 (pyridoxine), vitamin B-12 (hydroxycobalamin), vitamin B complex, and an average of 25 grams of Vitamin C. Two time Nobel Laureate Dr. Linus Pauling was a staunch supporter of Vitamin C for healing a wide variety of health problems. Vitamin C is an important antioxidant that helps the immune system ward off bacterial and viral infections. It also makes certain metabolic processes in work better. Other vitamins or ingredients may be added to the Myers’ Cocktail protocol, depending on the patient’s diagnosis and overall health as well as the condition being treated.

Many people who have benefited from this protocol claim that the intravenous shots of vitamin B12 in Myers’ Cocktail are even more beneficial than Vitamin B-12 intramuscular injections in restoring their energy and stamina. Intravenous treatments are more effective than oral therapy for increasing blood levels of nutrients. According to some experts, intravenous delivery may improve the transport nutrients from the blood into the cells

The standard ingredients in Myers’ Cocktail

* Vitamin B complex 100 (B complex)

* Vitamin C

* Magnesium

* Vitamin B5 (Dexpanthenol)

* Calcium (Calcium gluconate)

* Vitamin B12 (Hydroxocobalamin)

* Vitamin B6 (Pyridoxine hydrochloride)

Conditions that may be improve with Myers’ Cocktail

* Chronic Fatigue Syndrome with or without Epstein-Barr virus

* Chronic depression

* Acute or chronic muscle spasm

* Fibromyalgia

* Migraine headaches- often within minutes

* Tension headaches

* Narcotic withdrawal

* Seasonal allergic rhinitis

* Respiratory problems

* Acute of chronic asthma

* Sinusitis

* Bronchitis

* Cardiovascular disease

* Ischemic vascular disease

* Congestive heart failure

* Athletes who need quick recovery for athletic events

* Acute viral illness/colds

* Acute infections

What is the duration of Treatment?

Patients vary in the number of treatments needed, but most require infusions 1 to 2 times per week. Some patients experience improvement after only one treatment, and many report significant healing by the fourth infusion. People who have chronic conditions may need ongoing treatment of several IV’s per week, or periodically every few weeks to regain their energy.

How is the protocol given?

Dr. Trister mixes all the ingredients with 200mL sterile water in an IV bag. It is infused slowly over a period of 30 to 45 minutes. There is another version of the which can be completed in 15-20 minutes.

Is It Safe?

Myers’ Cocktail is a safe, effective, and minimally invasive therapy that is well tolerated by most people. It carries a low risk of serious adverse side effects. if the protocol is administered quickly there may be a sensation of warmth and flushing. This is due to the rapid rise of magnesium. Some patients may also have the taste of vitamins in their mouth shortly after they are given the infusion. Potassium level should be checked periodically.

Patients taking digoxin (Lanoxin®) or potassium-depleting drugs should be cautious and should inform Dr. Trister that they are using these medications before beginning the Myers’ Cocktail protocol.


Platelet rich plasma (PRP) therapy

New Treatment Provides Lasting Musculoskeletal Pain Relief

Platelet rich plasma (PRP) therapy is a revolutionary new treatment that relieves pain by promoting long lasting healing of musculoskeletal conditions. This rapidly emerging technique is showing exciting potential with osteoarthritis of the knee, shoulder, hip and spine, rotator cuff tears, chronic plantar fasciitis, anterior cruciate ligament (ACL) injuries, pelvic pain and instability, back and neck injuries, tennis elbow, ankle sprains, tendonitis, and ligament sprains. How does PRP therapy help?

The body’s first response to soft tissue injury is to deliver platelet cells. Packed with growth and healing factors, platelets initiate repair and attract the critical assistance of stem cells. PRP therapy’s natural healing process intensifies the body’s efforts by delivering a higher concentration of platelets. To create PRP therapy, a small sample of your blood is drawn (similar to a lab test sample) and placed in a centrifuge that spins the blood at high speeds, separating the platelets from the other components. The concentrated platelet rich plasma (PRP) is then injected into and around the point of injury, jump-starting and significantly strengthening the body’s natural healing signal. Because your own blood is used, there is no risk of a transmissible infection and a very low risk of allergic reaction.

How long does it take?

The procedure takes approximately one to two hours, including preparation and recovery time. Performed safely in a medical office, PRP therapy relieves pain without the risks of surgery, general anesthesia, or hospital stays and without a prolonged recovery. In fact, most people return to their jobs or usual activities right after the procedure.

How often should this procedure be done?

Up to three injections may be given within a six-month time frame, usually performed two to three weeks apart. You may, however, gain considerable to complete relief after the first or second injection.

What are the expected results?

Because the goal of PRP therapy is to resolve pain through healing, it could prove to have lasting results. Initial improvement may be seen within a few weeks, gradually increasing as the healing progresses. Research studies and clinical practice have shown PRP therapy to be very effective at relieving pain and returning patients to their normal lives. Both ultrasound and MRI images have shown definitive tissue repair after PRP therapy, confirming the healing process. The need for surgery can also be greatly reduced by treating injured tissues before the damage progresses and the condition is irreversible.


Natural Therapies for Rheumatoid Arthritis and Other Chronic Inflammatory Conditions

Natural Therapies for Rheumatoid Arthritis and Other Chronic Inflammatory Conditions
Renata Trister DO
Chronic inflammatory conditions are affecting a growing number of people, especially in “Western/developed” countries. Rheumatoid arthritis (RA) is one of these chronic inflammatory illnesses. Rheumatoid arthritis (RA) is an autoimmune disease in which your body’s immune system – which protects your health by attacking foreign substances like bacteria and viruses – mistakenly attacks your joints. The abnormal immune response causes inflammation that can damage joints and organs, such as the heart. The body mistakenly attacks its own tissue as if it is an invading pathogen. Although one true cause of RA has not been identified, multiple factors such as infection, genetics and immune dysfunction may contribute to the development of this condition.
Rheumatoid arthritis typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing redness; warmth and painful swelling that can eventually result in bone erosion and joint deformity. Research suggests that one possible underlying cause of this disease may be an autoimmune reaction to antigens originating from the intestinal tract. An antigen is any substance that causes your immune system to produce antibodies against it. An antigen may be a foreign substance from the environment such as chemicals, bacteria, viruses, pollen and certain “inflammatory foods”. Antigens may also be formed within the body, as with bacterial toxins or tissue cells. Exposure to these antigens and “inflammatory” foods can increase the activity of the intestinal immune system. These reactions can then cause systemic inflammation that is associated with a variety of chronic diseases. Many people are intolerant to the proteins in foods such as wheat and dairy (or fats found in corn or peanut oil), and this can initiate an inflammatory cascade that starts in the gut but can have far-reaching, systemic effects consequences.
Elimination diet or anti-inflammatory diet program can reduce exposure to these “inflammatory foods”. This can thereby reduce immune system stimulation and help improve symptoms in some patients with RA. The most common examples of inflammatory foods are dairy, wheat, trans fats and refined carbohydrates. Furthermore adding certain natural foods and substances can help to protect joint tissues and relieve RA symptoms by controlling inflammation, reducing the associated free radical damage, and supporting the integrity of the intestinal tract.
Modulating the Inflammatory Response Naturally
The anti-inflammation diet is comprised of healthy, wholesome, unprocessed foods.
Anti-inflammatory fats are a cornerstone of this diet. Foods high in omega-3 fatty acids, such as wild salmon, sardines, herring, anchovies, flaxseed, hempseed and walnuts. In addition, other anti-inflammatory fats include extra-virgin olive oil, avocado oil, flaxseed oil, hempseed oil and walnut oil. Omega-6 and omega-3 fatty acids are essential nutrients as well as precursors to both inflammatory and anti-inflammatory molecules. A balanced consumption of each group helps maintain a healthy balance of these molecules. Unfortunately, the consumption of omega-6 fatty acids far outweighs that of omega-3 in the standard American diet, which can result in an overproduction of inflammatory molecules. In RA patients, supplementation with fish oils (omega-3) has resulted in a reduction of pro-inflammatory molecules approaching 90%, and at least 11 double blind, placebo-controlled studies have shown beneficial clinical effects.
Fruits and vegetables are high in inflammation-reducing antioxidants. Fruits and vegetables high antioxidants are important, especially onions, garlic, peppers and dark leafy greens, These are high in inflammation-fighting carotenoids, vitamin K and vitamin E.
Herbs and spices include compounds to fight inflammation. Turmeric, oregano, rosemary, ginger and green tea contain bioflavonoids and polyphenols that reduce inflammation and limit free radical production. Some of the most potent anti-inflammatory vegetables are peppers and the spices derived from them, such as cayenne pepper. All chili peppers include capsaicin (the hotter the pepper, the more capsaicin it has), which is a potent inhibitor of substance P, a neuropeptide associated with inflammatory processes.
Niacinamide & N-acetylcysteine (NAC) Niacinamide has been shown to be effective in relieving symptoms of RA and osteoarthritis in both human and animal models. Niacinamide inhibits the synthesis of a pro-inflammatory molecule that plays a decisive role during the development of RA. NAC also stimulates the synthesis of glutathione, a principal defense within the body against free radicals.
The Role of Free Radicals and Antioxidants
The excessive free radical production associated with immune overreaction and inflammation is an area of concern in RA and similar conditions. Free radical damage may be responsible for the degradation in the rheumatoid joint. Therefore, vitamins E and C and superoxide dismutase may be beneficial in reducing free radical injury to joint tissues. Vitamin E supplementation at levels from 200-600 IU per day can also provide some pain relief in RA patients, and vitamin C supplementation is needed for collagen production.
Gut Ecology
Alterations in the bowel flora and its activities are now believed to be contributing factors to many chronic and degenerative diseases. Irritable bowel syndrome, inflammatory bowel disease, rheumatoid arthritis, and ankylosing spondylitis have all been linked to alterations in the intestinal microflora. The intestinal dysbiosis hypothesis suggests a number of factors associated with modern Western living have a detrimental impact on the microflora of the gastrointestinal tract. Factors such as antibiotics, psychological and physical stress, and certain dietary components have been found to contribute to intestinal dysbiosis. Substances that support the proper intestinal flora include probiotics and prebiotics.
Probiotics Bifidobacterium lactis and Lactobacillus acidophilus are two common species of “friendly” bacteria. These microorganisms help with digestion and offer protection from harmful bacteria, just as the existing “good” bacteria in your body already do. Supplementation with these friendly bacteria may support healthy gut ecology and keep undesirable bacteria in check.
Prebiotics are nondigestible carbohydrates that act as food for probiotics. When probiotics and prebiotics are combined, they form a synbiotic. Fermented foods are considered synbiotic because they contain live bacteria and the fuel they need to thrive.
Nutritional Support of Gut Integrity
Above and beyond sustaining healthy gut ecology, supporting the structure and function of the intestinal lining is critical for proper barrier function and intestinal health.
L-Glutamine is an essential amino acid that is anti-inflammatory and necessary for the growth and repair of your intestinal lining. L-glutamine acts a protector and coats your cell walls, acting as a repellent to irritants.
Deglycyrrhizinized Licorice (DGL) is an extract of licorice (Glycyrrhiza glabra). DGL enhances the resistance of the gastric mucosa against the eroding action of bile, promotes growth of cells that line the stomach, and enhances protective mucus production and secretion.
Aloe Vera (Aloe barbadensis) helps in healing of the epithelial cells of the gastrointestinal lining. Aloe has been shown to reduce inflammation.
The integrity and health of the gastrointestinal system plays a significant role in modulating RA and other chronic inflammatory conditions. Taking the above steps can attenuate symptoms of RA and improve quality of life.


History of vitamin D

Vitamin D
Dr. Renata Trister DO

History of vitamin D

Vitamin D was categorized as a vitamin when it was discovered in 1922. It is not a true vitamin because an ongoing nutrient source is not required to sustain normal levels in the body. Vitamin D is properly classified as a secosteroid (derived from steroid) hormone precursor. A hormone is a chemical substance produced by one organ and then transported in the bloodstream to a target organ, where it causes a specific biological action.
D-metabolites: 25-D and 1,25-D
Vitamin D has several metabolites (forms). This summary is limited to two metabolites: 25-D and 1,25-D.
25-D (also known as calciferol, 25-hydroxycholecalciferol) increases calcium absorption in the gut and at high levels, acts as an antagonist on the Vitamin D Receptor. 25-D is produced in the liver and synthesized in the cells of the skin in reaction to sunlight. 25-D dietary sources (fish, fish oils, eggs), foods that are supplemented with vitamin D (dairy products, cereals.) and vitamin supplements.
 25-D is the major circulating form of vitamin D. It is used in the production of (1,25-D) in the kidneys.
1,25-D (also known as calcitriol or 1,25-dihydroxycholecalciferol or 1,25-dihydroxyvitamin-D3) is a potent secosteroid paracrine mediator and virtually affects all cellular activity.
1,25-D is primarily formed in the kidneys; but may also be formed skin, macrophages and other tissues.
Vitamin D dysregulation
1,25-D can 1nduce the innate immune system. Elevated levels can be found in patients with chronic conditions.
25-D can suppress the innate immune system.
Normally, production of 1,25-D is tightly controlled by the kidneys in response to a complex system of hormonal regulation. However, when nucleated cells are infected with bacterial pathogens, 1,25-D is generated by the inflammatory response. This causes the level of 1,25-D to exceed the upper limit normally controlled by the kidneys.
It is essential to measure both 25-D and 1,25-D to evaluate vitamin D levels and dysregulation. The low level of 25-D doesn’t directly reflects the deficiency. Low D- 25 could be a result of down regulation of its production in the liver by high 1.25 D.
Patients with Th1/Th17 inflammation often have a low level of 25-D while the level of 1,25-D is high. T helper 17 cells (Th17) are a subset of T helper cells producing interleukin 17 (IL-17) discovered in 2007. They are considered developmentally distinct from Th1 and Th2 cells and excessive amounts of the cell are thought to play a key role in autoimmune disease such as multiple sclerosis, psoriasis, autoimmune uveitis, juvenile diabetes, rheumatoid arthritis, and Crohn’s disease.