Are MEN JUST as at Risk for Osteoporosis?

Real quick, before we dive into this episode, I have a little sleep secret I want to tell you about. Look, sleep is crucial for your fitness, but it's crucial for just plain old everyday life and function. And I find I sleep great unless I have a migraine. And I've had more than my fair share since perimenopause all the way through postmenopause. My secret weapon was Blue Sky CBD sleep gels. Each gel contains 25mg of CBD and 25mg CBN for deep restorative sleep. Something about it helps to reduce inflammation, which I believe for me was key in helping me get to sleep. But the biggest thing is so many of the over-the-counter solutions, whether for sleep or migraines, can ruin gut health, and liver health. Neither one of those did I want to be problematic for me. So this option is recommended by healthcare providers worldwide and backed by thousands of happy customers, many of whom come from our Flipping 50 community. There is zero THC, so it's non-habit-forming. It's made by a trusted family-owned company that we all can feel good about. Third-party tested for purity and potency. And if you're interested, you too can try a sample for just $6. But even better, you can get 30% off forever with discount code FLIPPING50. That's FLIPPING50. Just go to flipping50.com/blueskycbd. We'll put that link in the show notes and you'll find it everywhere on Flipping 50 at My Favorites. What are you waiting for? Good night. The episode I'm about to give is an episode with Kevin Ellis that we have aired before. Kevin Ellis is a favorite of mine, and very possibly because Kevin is a favorite of mine. You'll hear me say that. And if you joined us for the What, When, and Why to Exercise for Women 40 and Over Summit in May, or you visited Kevin's show on YouTube when he's interviewed me, you understand why. Kevin is articulate, he's heart-driven, he's just all American values kind of guy who would not strike anyone as a candidate for osteoporosis, yet he was. It's an eye-opening episode and he's got an eye-opening story. If you have doubted the value of elimination diets or you've settled and tolerated gut issues for years or even months, It's potentially time to take this seriously as your bone losses could be accumulating. During this re-release of this episode with Kevin, AKA the Bone Coach, it's National Menopause Awareness Month, and bone density is among the biggest topics that matter more during menopause. If you are fortunate enough to hear this before you are in menopause, don't go away, stay with me, or you influence daughters, and because of today's show, sons, my hope is that you'll be mindful of the opportunities that you have now that you won't later. Mitigating bone loss is possible. It's never too late, we now know that, but wouldn't it be far better to never have lost bone in the first place? And as you'll hear a little bit more about on the show, you personally want to be sure you've stopped losses. And you'll learn how to know very soon. I'm Debra Atkinson. You're listening to Flipping 50, where I address your top struggles and concerns. And I share what to eat, how to move now, and how to change your mindset so you can have the energy and the vitality that you want, need, and deserve. Everything we do here and talk about is science-based. On women in menopause just like you. Whether it's comparing women in peri or post or that mid-menopause transition to pre-menopause or to men, that's what we're doing. Because what really matters is you realize most science is featuring young athletic men and/or mice and some young women, but there's very little still to date Getting Better that features women just like you. And if it's not just like you with the hormonal changes and influences that you're under, training your muscle, your bone, and your brain health is not going to be optimized. So we need to get it right, and you want to start demanding and expecting, is this program based on women just like me? Me and start monitoring. Get that smart scale, monitor, do a bone scan regularly. That can also tell you your body composition at the same time, so long as you ask for it in advance. My guest today, Kevin Ellis, better known as Bone Coach, is a Forbes-featured certified integrative nutrition health coach, podcaster, YouTuber, bone health advocate, and is the founder of bonecoach.com. Through a unique 3-step process and a world-class coaching program called the Stronger Bone Solution. He and his team have helped people with osteopenia and osteoporosis in over 1,500 cities around the world get confident in their stronger bones plan. His mission is not just to help over 1 million people around the globe build stronger bones, it's to help our children and grandchildren prevent osteoporosis and other diseases in the future so that they can lead strong and active Lives. So here we go, let's rock. Kevin, welcome. I'm so glad to dive into this. Thanks for being here, Debra.

Thanks so much for having me. I'm great, it's great to be here. I think this is going to be really fun.

There is no listener who doesn't have bone health, osteopenia, or osteoporosis on their mind. It's funny, I started talking about this in 1995. I remember because it was the first time I left at night. I had an infant son to go and teach an adult education class, but I had to tell people what osteoporosis was. Nobody knew then. Everybody knows. It's a household word. It's like Zoom to us now. But here's the deal. Unfortunately, this is not video because this guy is really good looking. So just set yourself into that mode, listeners. But he's a really good looking guy. He has a great smile. He's from the Midwest. What not to love? But not every, you know, young male thinks, oh gosh, you know, I want to help midlife women with osteoporosis. How did this happen? How'd you get here?

Yeah, great question. Because for, for me— and thanks for the compliment too, that was really nice, Debra. But, you know, for me, most people, when they think of osteopenia and osteoporosis, you're not thinking of a young male, right? You're thinking of a woman a little bit later in life. Maybe you're thinking about your mother or your grandmother. Maybe they had fractures, maybe they didn't. Maybe they had a cane or wheelchair or something like that. Those are the kinds of things you think about. You're not thinking about a young male. And for me, I would say my health journey really started when I was much, much younger. When my mother was 5 months pregnant with me, my father was told he had cancer. And 2 months after I was born, he passed away. And he was 35 years old at that time. And he was in Vietnam. He was a Marine in Vietnam. He survived combat, made it through combat, but he got cancer from Agent Orange. And he passed away. So, as I was growing up, I always knew I was going to be a Marine. I was going to be a damn good Marine at that. And, I went in the Marine Corps, I got out of the Marine Corps, and I started having all these different health issues. And, I had, you know, poor sleep, high stress, digestive issues. I started having all these different issues. Some days I could barely even get out of bed because I just didn't have the energy to. And then I was told I had celiac disease. And celiac disease is this autoimmune condition where you ingest gluten and it damages these villi, these tiny little nutrient absorption centers in your small intestine. And these nutrient absorption centers are critical. You need them to function properly, and mine weren't. Mine were effectively damaged, so I wasn't able to take in the nutrients that I needed. To support a healthy body and to support healthy bones. And, because I was still going about my daily activities doing all these things, my body still needed those minerals and those nutrients. So, where did it go? It went to its largest reserve of minerals, which were my bones. And then, it wasn't even the doctors that I had been working with on celiac disease, nobody else suggested a bone density scan except for a physician's assistant. And they're like, "Hey, you have celiac disease. Has anybody done a bone density scan on you before?" And me, I'm a tough Marine, I worked out a lot. "Oh, that's not going to be an issue for me, but yeah, let's go ahead and do that." We ran the bone density test and it came back and they didn't even call me. They actually just sent me a letter in the mail that said, "Hey, you have osteoporosis. Go on a gluten-free diet." And I was shocked. Number one, I was shocked at how they delivered the news. What a horrible way to deliver the news. But when I opened it up, I remember the blood just kind of rushing from my face. And I looked up online, I was like, what does this even mean for my future? Medication dependence and fractures. Those were like the two things that stood out to me. And I had to go get a second opinion and they confirmed I had osteoporosis. So, here I am, young male, young daughter, son on the way, thinking that I'm going down this path that I always feared I was going to go down and passing away at an early age like my father. So, I was living basically my worst nightmare. And I realized at that point I had to do something. I had a strong impetus for change, which were my kids and being there for my family. But also, I started doing the reading, the research, consulting with people, spending a lot of money, figuring all this stuff out. And I realized along the way as I was making improvements in my health and in my bones I realize it is not the average 30-year-old male that's dealing with this. It's the woman 50, 60, 70-plus that has osteopenia or osteoporosis that's told you need to take calcium, vitamin D, go for a walk, here's your bone medication, we'll see you in a year for your next bone density scan. And that is woefully inadequate. And it's really for that reason that I became Bone Coach. I founded BoneCoach.com. I came into the health space. I, I became an integrative health coach, built out a team of credentialed experts, and we've gone on to help people in over 1,500 cities around the world through our programs and things like that. So that's— it's, it's really been a great journey and a learning experience helping and serving people and helping them prevent the things that I wish I would have known at the beginning.

Yeah, I think what you're doing really I mean, you're doing some health service, but what you're really doing is eliminating the fear that a lot of women have, that it becomes a reality when you see your own parents actually go through it and/or pass, you know, from complications of a fracture and fall. And even I, right, many of my listeners know my story, so I, I have taught about this for 38 years, and I watched my mother go through it, literally, you know. Now she was 95, so we assume, you know, at some point there will be an end to life. And I think the rest of us though are worried, you know, we think we're going to retire and we have saved some money, and now we're going to travel and do all those things, and we do not want that taken away from us. So You're giving hope to a lot of people.

And so many people, so many people that I speak with and work with, they are starting out at a place of overwhelm and fear and worry and thinking about, I'm not going to be here for this person in the future. I'm not going to be here for my kids or my grandkids, or I'm not going to be able to travel or go on adventures. These are the things that they're thinking usually when we're meeting them. And once we take them through and we walk them through, really what we're doing is we're just, we're focusing on education, empowerment, confidence. A lot of times the fear and the worry comes from not knowing, not knowing what to do and not being confident that the things you're doing are going to put you in the right place a year or two down the road. And that's really the focus of what we're doing.

Love that. Okay, let's, let's go back to square one for any listener because I don't want to jump ahead if if somebody is listening and they've heard both of these terms before but they're not sure which is which and what does this mean, let's just define osteopenia and osteoporosis for listeners.

That's great. I think that's a good starting point. So osteoporosis literally means porous bone, and it's a condition that's characterized by either not enough bone formation, excessive bone loss, or it's a combination of the two of those things. And in osteoporosis, both your bone density and your bone quality are reduced, which increases the risk of fracture. Now, the way you find out you have osteoporosis is through a DEXA scan. That's dual-energy X-ray absorptiometry. It's a painless test, kind of like an X-ray but very low levels of radiation. You lay down on this machine, the machine does a scan, and it tells you your bone mineral density, the actual mineral content of your bone., and then it generates a score, and that score is called a T-score. And a T-score is telling you how much your bone mass differs from the bone mass of an average healthy approximately 30-year-old adult. A score of +1 or -1 or anywhere in between there, that's considered normal and healthy. T-score of between -1 to -2.5, that's considered osteopenia. Also called low bone mass, and that's like a precursor to osteoporosis. And then a T-score of -2.5 or lower, so -2.6, -2.7, so on and so forth, that's considered osteoporosis. And the greater that negative number becomes, the more severe the osteoporosis. Now, most women are not getting these scans done until they're in their 50s or 60s as a check in the box, right?

Their doctors or until they fall and fracture.

Exactly. Yep, that's the other point. That could be the point of, of, um, them going to get this, but their doctors are going to order them. In my opinion, waiting till you're 50, 60, 70 is too late. I love to see people get them earlier on, when you're 30s, at around your peak bone mass, in your 40s. That would be a great time. So if you're listening to this and you have not had a bone density scan yet, I would take a note, jot that down, go get a bone density scan. You can ask your physician to do it, or you can go to an external radiology group. Then that charges $75, $100, $125, something like that, to go get one of these done.

And I'm going to inject here, but all of our listeners— or many, okay, many of our listeners have daughters, daughters-in-law, you know. And as we're talking about those 30-something girls, you know, that's information and legacy to pass on.

Yes, absolutely. Because that's— prevention is such an important part of this, right? It's so much easier to prevent than to react. And especially as it relates to bones, it's a lot easier to slow and stop and prevent more bone loss than to build bone once you lose it. Both are possible. You can build bone strength at any age, it just becomes more challenging the older you get and the more bone you lose. There are fewer cells involved in that process. That process becomes less efficient. So, I always encourage people be on the side of prevention and not reaction. If you've got daughters, you have to understand you are going to be their shepherd. Even if you're learning this information for you now, you're then going to pass that information on to them and that's going to set them up and they can then pass that on to their kids so they're set up even better. So it's a, it's a beautiful chain that we have the opportunity to take part in.

And you've painted a bit of a picture about what causes it, but I imagine there's a couple other things that you could throw in there or summarize. Do you want to revisit that?

Yeah, absolutely. So first, because we mentioned even 30 years old and peak bone mass and daughters and grandkids even, I want to talk about that for a second because part of what plays into somebody getting a diagnosis of osteoporosis could be that you never just built up enough bone in your younger years. 90% of your bone mass is put on by the time you turn age 18. And by the time you turn 30, that remaining 10% approximately is filled in. So, if when you were younger, you had poor diet nutrition, you led a sedentary lifestyle, you smoked or drank excessively, you took certain medications, you had an eating disorder. Those all could— they could have prevented you from achieving peak bone mass and starting with what I call a full bucket. So that's another reason you, you can be aware of that for yourself, but also look for those things in your own children too. Now, if you've got children, yeah.

So I'd like to say, you know, grandparents out there, and some of you are parents, so today you could be a woman in your 50s and have a kindergartner. I realize this is 2022, but, you know, I mean, great gifts for kids— jump ropes, right? I mean, give them a head start. And swimming, I always talk about this, it's such— it's a wonderful activity, but it doesn't do much for bones, right?

Yeah, you know, you brought up such a great point there in terms of what are we What are we giving to our kids and our grandkids to show love to or as give as gifts? I know a lot of grandparents and parents that we, we just want to give our kids sweet treats as like the reward for something. Sugar is not good for bones. Sugar depletes a lot of bone-healthy minerals. It reduces your vitamin D levels and it blocks the absorption of vitamin C. And vitamin C is key for that developing skeleton and maintaining a healthy skeleton. So looking for alternatives that can help improve our health that are still maybe just fun, it's just different, it's not candy or something like that. I would look for those things, find those things.

And just a reminder to those of you out there who yourself have a sweet tooth, I mean, that's just one more reason to figure out what we can do to get rid of that sweet tooth.

Yeah. And now let's talk about, let's talk about some of the other causes of bone loss and osteoporosis. So there's a lot of people don't know this. There, there are multiple causes of osteoporosis. There's, there's primary osteoporosis that's typically related to a decrease in estrogen in postmenopausal women. Estrogen has that protective effect on bone. As estrogen levels decrease, as they do during menopause, that causes an increase in the activity level of cells the breakdown bone. But then there's a whole nother cause of osteoporosis, and that's secondary osteoporosis. And that's where it occurs as a result of behaviors, disorders, diseases, medications, and other things. An important note I want to make here is that just because you're a postmenopausal woman does not mean that is the sole cause of your bone loss. It could be more than just hormones. There could be another cause. And I hear far too often that, you know, doctors are sharing with their patients. This is just a natural part of aging, and it's just your hormones, and we brush it off. And sometimes it takes you being the educated, informed, empowered patient that says, I, I respect that, but I'd like to do a little bit more investigation just to make sure. Right? You have the right to pause and say, I'd like to look a little bit more into this.

Perfect. And take control, be your own health advocate. I'm gonna link in our show notes to a previous episode with Susan Salinger who actually talks about this very thing, how women sometimes give up their control over their own health even though they're quite largely in charge of their family's health. Love that point that you bring up.

Yeah. And now let's go into when we're talking about secondary osteoporosis and bone loss. Let's talk specifically about some of the causes that may be low-hanging fruit for people to, to address or just to be aware of. The first one are medications. Certain medications can contribute to bone loss. The, the biggest one that I want to talk about is our glucocorticoids. These are steroid medications that are designed to suppress inflammation. You probably know them as prednisone and cortisone, but they mimic natural steroid hormones produced by your body, and they're often used to treat conditions like asthma, autoimmune disease like rheumatoid arthritis. And bone loss is a common side effect of these medications for a few reasons. The first one is that they reduce the gastrointestinal absorption of calcium. The second is that they increase urinary excretion of calcium. Your bones, the primary mineral constituent is calcium. So, that's going to lead to a calcium deficit. And then, the biggest issue here is that glucocorticoids act directly on the cells that break down bone to increase their lifespan, which is going to reduce your bone density. And most of the And the most precipitous bone loss is going to take place in that first couple months of use. So, if you're considering going on it and your doctor hasn't mentioned this to you or you're on it right now, you just have to be aware of that. The next medication would be— class of medication would be selective serotonin reuptake inhibitors. These are SSRIs. They're a class of drugs that are typically used as antidepressants. There was a review of 19 studies on the effect of SSRIs on bone that indicate they have a negative effect on bone mineral density and they will increase the risk of fracture. So, that's another big one. And then, this is another really important one, antacids. These are drugs that are designed to reduce the production of or increase the suppression of stomach acid. So, this would be your proton pump inhibitors like omeprazole, Nexium, Prevacid, your H2 receptor antagonist drugs like ranitidine or Zantac. And I personally took proton pump inhibitors for a number of years. To suppress my stomach acid because like most people who take PPIs, I mistakenly thought I had too much stomach acid. And a lot of people that think they have too much stomach acid because of reflux or heartburn or something like that, the issue is actually too little stomach acid in many cases. Yes. And the reason it's a problem to suppress the little stomach acid you do have is because you need stomach acid to properly break down and extract nutrients from your food. Like amino acids. Your bones are 50% protein by volume. Amino acids are the building blocks of protein. So, you have to have amino acids. Calcium, magnesium, iron, key nutrients for bone health, key minerals. B12, right? B12 is so important. If you don't have proper stomach acid, you're gonna— your body's not gonna have the nutrients that it needs to support stronger, healthier bones and a healthier body. Just not gonna happen.

So, so true. Yeah. And so many probably of our listeners, you know, are on one or more of those things. And, you know, love that you brought up the low stomach acid and the confusion with, I think I have too much and I've got heartburn, and so I'm taking this. And yeah, 9 out of 10 actually do have too low. Yeah. Are there any other causes, underlying causes, that we haven't revealed?

Some of the other bigger ones that I think are really important— when, when somebody has overt digestive issues, um, there's usually an absorption issue going on there, a nutrient absorption issue. Even if somebody doesn't have overt digestive issues, it could still be absorption, but almost certainly if they do, that's going to be a problem. If somebody has gastrointestinal disease, Crohn's disease, ulcerative colitis, celiac disease, that was my primary contributor for me, celiac. All of these can affect your absorption of nutrients. So, those can be contributors long-term to issues with your bone health. So, if you yourself have any of those GI conditions or diseases or autoimmune conditions, get a bone density test. If you know your kids do or you've got kids or something like that, encourage them to get one too. Because for me, 30-year-old Marine, you never would have known. I never would have known had I not gotten that done.

You know, and I'm sorry it had to work out this way, but, you know, the fact that this is your truth makes it such a great point you know, such a perfect example of you're never gonna know by looking at the hood. You have to look under the hood.

And don't, don't just see the check engine light and not look under the hood because you don't know what the damage is going to be or what, you know, what the bill is going to be for that. That would not be a good approach because eventually it will catch up. And once it catches up, it would be better. Like I said, prevention is way better than reaction. And then, in terms of other causes, autoimmune conditions, anything that's contributing to inflammation, especially if it's chronic, that's going to fuel and contribute to bone loss. So, ankylosing spondylitis is one autoimmune condition, rheumatoid arthritis, lupus. Those are some other ones that I would say. You just, you got to be aware of this and just take the preventative steps, and we could talk about what some of those steps are going to be here.

Well, let's talk about some of the typical steps first. So, you know, what about you? I mean, did anyone say to you, hey, you should, you should be on Fosamax, you should be on Boniva, you're going to need a supplement? Let's talk a little bit about some of the typical meds that are prescribed for osteoporosis. Their effect on it, and negative side effects.

Yeah, let's, let's talk about that because, um, I have— I'm sure you've probably heard of the saying, there's no such thing as a free lunch, right? It's, it's an old economic adage, and that always comes to mind when I think of, when I think of medications and osteoporosis medications specifically. But basically it says there's a cost to the decisions you make. You don't get something for nothing. And when we're talking about these osteoporosis drugs and medications, they have a dramatic effect on bone physiology. It's not like taking an aspirin. And the cost comes in the form of the side effects and the short and long-term implications of use. So, there are different types of medications that are probably going to be proposed. Fosamax is probably the most popular one that most people have heard of, but Fosamax is in a, a category of medications called antiresorptives. The other category is called anabolics. So, antiresorptives are drugs that are designed to slow down the activity level of cells that break down bone. There are bisphosphonates, which is what Fosamax is, bisphosphonate, and there are RANK ligand inhibitors, which is like Prolia. With bisphosphonates, bisphosphonates that obviously has side effects, short and long-term implications of use, but the safety and efficacy of bisphosphonates is not really well known beyond 5 years. Okay. And then, as you and I are going about our daily lives, we're doing our daily activities, and this is normal for every single person, you're starting to get these tiny little microcracks, microdamage, things like that, right? Maybe you're exercising, you're working out, you're walking, you're moving around, whatever. That's normal. And then, what happens is you have these cells within the bone that sense that damage and they transmit this signal to other bone cells. They communicate and say, "Hey, we need to repair this." So, these other cells come in, they're called osteoclasts. They come in and they scoop out, they break down that old worn damaged weakened bone. And then, another cell comes in behind it called osteoblast., and that cell comes in and fills in new, stronger, healthier bone. It's a coupled process. It happens together. Bisphosphonates, if you're— you can actually slow down the activity level of those cells too much where you can start to accumulate over time that old, worn, damaged, weakened bone, and that can lead to weaker bones over time. And a lot of people aren't aware of that before they start taking those medications. Another thing I'd point out is that when you're committing to one medication, you're usually committing to multiple medications.

Prolia, for example.

Say more about that. Yeah, Prolia, for example, which is, um, that is another antiresorptive medication. It's a RANK ligand inhibitor. And what happens is when you start that medication, there's a good chance you're going to be on that for a lifetime or for a very long time because if you try to come off, your risk of vertebral fractures actually increases. So then, you would have to use another medication to try to make sure that doesn't happen. And then, the other category of drugs are called anabolics. And these drugs are designed to build bone and build it faster. And they actually do that. They do their job. They build bone. They build better quality bone. But it's not without its short and long-term implications of use and its side effects. You can only use those drugs for a certain period of time, whether it be 13 months or 2 years or whatever. And then when you finish those drugs, you have to immediately follow it with an antiresorptive medication. Otherwise, you will lose all of the bone you just built. And that's why I said a lot of times you can get into a cycle of multiple medications when you start the first one. And in a 15-minute conversation, most people will not get the education that I just shared with them.

Wow. Okay, there's a lot there to unpack. Sure. Um, you know, and I'd like to kind of deviate from medication here and have you returned to, in part, to your story. You know, the connection with the gut and bone health, I think for a lot of women, is a bit of a surprise, right? I mean, I think listeners will tell me, you know, this is all about, uh, you know, calcium. And, you know, now they're educated enough, and, and 20 years ago this wasn't true, but to know, you know, weight-bearing exercise and maybe lifting weights, but they don't necessarily always distinguish between the value of one versus the other. Yeah. Um, talk a little bit though about gut health before we move on to anything else. Let's just return to— I mean, why are they not potentially absorbing all the goodness that they're taking in or trying to?

Yeah, this is such a big topic, such an important topic too. Healthy bones They are not built by what you eat, they are built by what you absorb. Now, if you think of our bodies and bones as being like plants, in order to grow, they need nutrients in the right conditions, right? Most people focus so much on the nutrients, the salads, the smoothies, the supplements that they fail to consider the soil. And, your gut is like the soil. You're absorbing almost everything there. So, when we take in food or supplements, you're starting to break them down into smaller pieces in our mouth. That food makes its way into our stomach where it's churned in this acidic mix to break it down even further. Then, it makes its way to the small intestine, our soil. And, this is where nutrients are broken down to their smallest form to be absorbed by us, the plants. But, in order to absorb anything, we need roots in our soil. And our roots are called villi. They're these tiny little hair-like projections that cover our small intestine, and they're responsible for absorbing nutrients. So they absorb the nutrients from the food that you eat and then shuttle those nutrients into your bloodstream so they can travel where they're needed in the body, whether that's for healing a cut on your hand, growing your hair or your fingernails, or in this case, rebuilding stronger bones. Now, the job of these roots— our roots is so important, our villi that the total surface area they use to absorb nutrients is the size of a football field. How amazing is that? But when we've got poor digestion and our gut health is not optimal, you, you're not gonna be able to properly break down your food. And when you can't properly break down your food, nutrients aren't gonna be available. And if nutrients aren't available, the villi won't be able to absorb them, and the body's not gonna have those raw materials and resources needed to rebuild anything inside your body. So, some of the things, low stomach acid, I think we already talked about and touched on that one. That's something that we need to look out for. If you have gut infections, so if you've got dysbiosis, that's kind of where you have this wrong balance of bugs in your soil. And then, gut infections, this is where you have maybe the presence of bad bugs in your soil. Or maybe you've got good bugs, but they're in the wrong place. So like small intestinal bacterial overgrowth, and that's where we might have some issues with the microbiome that need to be addressed. And the other issues could be with those diseases that I talked about earlier, the celiac disease, the Crohn's disease, the ulcerative colitis, anything affecting that nutrient absorption.

Yeah, I'm so glad you said that. And I— we are talking to a community of women who is so used to, as you well know I'm sure, put everybody else first. And, and often will answer questions from an intake form that, oh, that's normal for me. And it's like, no, no, let's talk about this, because, you know, if you're putting up with constipation or diarrhea, you know, on a regular basis, if you're experiencing gas or bloating, you know, a lot of those are an indication of some of these gut things happening. And they're your signs and your symptoms that, you know, like Kevin mentioned earlier, the check engine light's going on.

Yeah, yeah. You— and you don't want to pass those things up. You don't want to just ignore those. I've, I've talked to some women God bless them, but 70 years old and then they're sharing that they've had IBS since they were in their 20s. That's 50 years have gone by where we're not properly absorbing nutrients. And, that's an extreme example, but I would venture to guess that most people's digestive issues if they have them If you're ignoring them, think about how far back you've been ignoring them. Has it been 5 years, 10 years, longer? You just have to think about the impact that has on your body and then go try to address those things.

Don't just let them pass by. So good. Okay, so I want to ask you something. So we talked quite a bit about nutrition directly, indirectly, but I think listeners will, will want me to ask this of you. Yeah, you know, are there, are there any specific foods that can be helpful? I think everybody is going to go to, well, I need dairy products because they're rich in calcium. However, for a lot of our members, dairy products don't actually agree with them. And, you know, is there an ideal, you know, osteoporosis diet, quote unquote?

Yeah, and I would say this is, this is really important because if dairy, dairy, drink a bunch of milk is not a good approach, right? Just because it has calcium in it doesn't mean that should be the sole part of somebody's plan because a lot of times it doesn't agree with them. And if dairy is going to be a part of someone's plan, I would always encourage them to have cultured dairy. Something that's providing you additional benefits beyond just the calcium. So with cultured dairy, that would be your yogurts or your kefir or something that provides some additional probiotics or even additional nutrients that come with that. But not everybody can tolerate that, and that might not be a part of everybody's plan. So in those situations, how do we find other sources of calcium? I'll tell you two of my favorites. The first one, fish, but not just any kind of fish. This would be salmon, your mackerel, your anchovies, your sardines, your herring, those kinds of ones with the bones in. And, you can find them in cans that have the bones in. And gosh, I'm not going to really make the case here for sardines just yet, but give me a second to. But, you've got these fish in a can and they've got these bones. And, the bones aren't hard pokey bones that are going to hurt your mouth, They're almost going to kind of melt in your mouth. And the reason I like these, these fish is that they have protein. You need protein to stimulate muscle protein synthesis, to build stronger muscles and to build stronger bones. We'll talk about that more in just a minute. But then also, fish have all the minerals. Those bones have all the minerals in the right ratios that nature put them in. That are going to support your own stronger, healthier bones. And then fish also have omega-3s, and omega-3s are a type of fatty acid that are like dampeners of inflammation. So if anything is contributing to inflammation, especially long-term, it's going to contribute to bone loss. So having those omega-3s is really, really important. That is one of my favorite types of foods to incorporate. So that's a great source of calcium. And if you eat 1 can of mackerel or sardines, that's got about 20 grams of protein, and you're going to get 200 to 300 milligrams of calcium in that, and you're going to get a great dose, you know, of, of omega-3s, 1,500 milligrams maybe. So that's just a great overall food that you can incorporate. That's one of the first ones. Second one that I really like is arugula. Arugula is a leafy green, same cruciferous family vegetables as broccoli and kale. It's rich in potassium, folate, vitamin C, vitamin K, and bioavailable calcium. And all of those are important for your bone health. And this is also— it's super interesting— is there was a recent clinical study that found this bioactive compound in arugula called erosin that actually helps turn off osteoclasts. Which are the cells that break down bone. So, just some really interesting stuff. And also, arugula is a bitter. It's a bitter food. Most people's diets today are devoid of these bitter foods unless they're drinking coffee. But even that is still limited. And the reason why bitter foods are important is that bitters help stimulate bile. Bile is produced by the liver, stored in the gallbladder, and it helps support your digestion. So, getting these bitter foods can actually be a great thing too. And the last thing I'll point out is that arugula is low in something called oxalates, and spinach is really high in oxalates. Oxalates are an anti-nutrient that bind up bone-healthy minerals like calcium, and they'll prevent you from absorbing those nutrients. So, if you've got digestive issues and kidney stones, arthritis, and joint pain, those may be some indicators that you have a hard time breaking down and degrading that oxalate. So in those situations, you can swap that spinach for the arugula. So those are two really good sources of calcium that I like.

Yeah, I really love that. Love the point on arugula and, um, the fact that it is a bitter and it's so awesome. And I love too that you brought up the fact about, you know, the lack of a absorption, because so many of our members will use spinach over and over and over again in smoothies because it's so mild. And, you know, by alternative, they may use kale, but again, we got a lot of oxalates in that as well. And so, um, the very thing you're doing potentially for your goodness and your health may be sabotaging you. So you've got to look at all of the, all of the lights on the dashboard and see, are there any signs here that I need to tune into how this is affecting my body? So that you know for sure. Yeah, so you go ahead.

Oh no, I was even going to say, I've got— there are a few other foods that I would say your, your audience would— it should probably be a good addition to at least test. For your audience because it's got some great nutrients in it. One of them is cucumber. I like cucumber. It's a great source of vitamin C and potassium. The skin contains something called silica, which helps build— it helps mineralize bone and build and maintain healthy connective tissue. It's 95% water, so it's great for hydration. It's low oxalate, low sugar, low FODMAP, contains soluble fiber, so it's great for digestion. You can dice them for salads, slice them for fruit veggie trays, use them as a base for blending homemade dips, dressings, and smoothies. That's a creative way to use them.

They go into a smoothie really well too. I mean, it's a great substitute if you want a green or a veggie in there, but not necessarily spinach.

Yeah, that's right. So that's one. Blueberries, blueberries are another one that I really like. Uh, studies indicate that blueberries can, they can help prevent bone loss. They can show favorable changes in bone biomor— bone biomarkers. They've got a protective effect on bone, which is great. They're also— they also have a great source of vitamin C, vitamin K, fiber. And I don't know, there's just a lot of things that I like about blueberries. Plus, it's not some rare Amazonian fruit for the select few. Pretty widely available also. And they're great— a great replacement for those sugary sweet treats for kids and grandkids too, if you've got them.

So great. Blueberries, like an all-star.

Uh-huh. Totally an all-star. And then the last group is, I would say, is vitamin C-rich foods. And I talked about earlier the importance of vitamin C. We already know that it's good for blood pressure, heart disease risk, gout, iron deficiency, memory, cognition, inflammation. But the body needs vitamin C to form blood vessels, cartilage, muscle, and even collagen and bones. So your bones are made up of this collagen protein matrix. Upon which minerals are laid. Vitamin C is stimulating procollagen, it's enhancing collagen synthesis, and it's stimulating alkaline phosphatase activity, which is a marker for osteoblast bone-building cell formation, which is super cool. So some of the best sources: fruits, berries, citrus fruits like lemons, oranges, uh, kakadu plums, acerola cherries. Those are some great sources. You can also get vitamin C-rich vegetables too. Bell peppers, those are great sources. If you have an autoimmune condition, you might steer clear of the peppers though. Yeah, so yeah, but those are— I would say those are some of the most important ones that you could just test, test them out, see if they work for you.

Great ideas. And what I really love is that you have just given, well, a rainbow for sure, but sure, such a wide diversity, right? So it's not like a lot of things where I think women get to a point where it's like, oh my gosh, I can't eat anything anymore. You've just given a wide array and huge diversity, variety available for choice, which I think feels so empowering.

One thing I would say too, I did mention, because I mentioned sardines and mackerel, is sometimes people don't try those because they don't, they're like, I'm not just gonna eat something right out of the can. We put together some recipes that maybe, Debra, I can— we can share with your audience in the show notes too. Like, we've got some recipes that are part of this guide, so we'll definitely talk about that maybe in a little bit.

Let's do that, let's do that. So, you know, here's the deal. So back in 1995, you know, if a woman got the diagnosis, she was scared to death. You know, that life was gonna go downhill, that it was gonna get worse. And the recommendations for exercise are becoming more aggressive, more open, giving more freedom. And, you know, that's great for an already active woman who doesn't have to feel, you know, I can't, can't do the things now that I love to do. But today, women in midlife are increasing bone density with the right steps? I mean, tell us what you've seen in your programs.

Yeah, I mean, we've actually seen— and one of the things that I encourage people to do is understand what's actually possible in a given time period, right? There's a reason why bone density scans are only done every 1 or 2 years. It's because there's only so much that can be done in a given time period. Bone remodeling is a slow process. You can absolutely build bone density and improve your bone strength. That's absolutely— we have plenty of examples of that. If somebody has a 3 to 5% improvement in a year, that's pretty darn good. If they have a 10% improvement, probably means that they led a sedentary lifestyle, they got everything dialed in, they got really active, got a good exercise plan in place, maybe they were on bioidentical hormones too, and that that kind of was their picture for that year or two and they had a great improvement. That does have diminishing returns over time, but just know, I mean, you can absolutely make progress. What's most important to do and what we focus on are what are those leading indicators that give you the best shot of improvement and how do you go about addressing those things step by step so you don't miss really important pieces. And that, that's one of the most important things you want to do is you want to use the right information in the right order and you don't want to miss things as you're going through. So I always tell people, you first have to figure out what is the root cause issue contributing to bone loss in that conversation with your physician where they say, okay, calcium, vitamin D, walking, bone medication. You have the option to say, I'd like to get a little bit more information. Okay, that's where we need to figure out what are the right tests that we need to order, how do we go about asking for those tests, what do your results mean when you get those results back. A lot of times when people get lab results back, that's a really wide range, and if you're within that really wide range, you may be told that your results are normal. I'm doing air quotes here, you can't see that, but air quotes here, right? So, normal may not always be normal. Normal may still be indicating something is taking place in the body that has to be addressed. So, we have to make sure we're spotting those things and we're addressing those things. That's kind of the first part of that. The second part of that is nourish. You have to restore the raw materials and nutrients that you need for stronger healthier bones through diet, through digestion, through absorption. You have to make sure you're taking in the right nutrients because you can't rebuild something that's not there. And, a lot of times I hear people say, "Well, I'm eating healthy, I'm exercising, how did this even happen?" It's not like everybody has a lot of health issues that are taking place underneath the surface. And, part of it could be that you can be eating healthy and still not be getting the nutrients you need for your body and your bones. You may not be absorbing your nutrients, especially if you have those overt digestive issues. But the third layer of that is those nutrients still have to make it to the cell level. And a lot of times, even if somebody is eating healthy, they might not be hitting that first layer. And all three of those things just have to line up. So, And the third part, which we— you just touched on, exercise, so important for bone health. All the things that you teach, Debra, about improving your bone strength and your muscle strength and all the things you're teaching, so, so important. So if you're listening, make sure you're doing the things that Debra's walking you through step by step because she's so smart about how to do this. But then the other pieces are your stress. And, I'm not talking about just the physical threat of a lion. I'm talking about the psychological stress, the fear, the worry, the emotionally charged thoughts, the family conflict, the financial challenges, keeping up with the perfect lives of the Joneses on social media. All those things contribute to and drive that stress response. And, that kind of stress long-term is not going to be good for your health or for your bones. So, you have to address that. You got to come up with a plan for that. And then, your sleep. Your sleep is so important. It's pretty well documented. If you have poor sleep, it's going to reduce your bone quality. So, you got to make sure you're sleeping good, you're waking up, you have the energy throughout the day. All those things are important. Hormones obviously play a big role in this too. But, all of those things have to be addressed. And, we really just walk people through those things step by step.

There you have it. Was I right or was I right? I'd love to be right. I think probably even just from his voice, you can hear the passion that he's got. Of course, he's articulate, and you can hear just the strength and conviction that he's got behind it. And I think whenever we're in search of information or support It is that that pulls us all in, and I'm here to tell you he's the real deal. He is the guy you wish probably lived next door, truthfully. So if you'd like more information, I'm gonna put a link to prior episodes with Kevin, to the What, When, and Why to Exercise for Women 40 and Over Summit, in case you want not only his but all the recordings from those 40 experts. Catering to menopause and midlife. But if you want to jump on and really drill deep down for free in a masterclass with Kevin, you want to attend the Stronger Bones masterclass. And just in case you're listening and you do have a mind like a steel trap, you can go to the masterclass. I'm going to give you two links here. This is very dangerous. The masterclass is at flipping50.com/masterclass. Bone-coach-masterclass, Bone Coach Masterclass with dashes between. Today for the show notes, if that was a little too much, if you just go to Flipping 50, you can open up the tabs and you'll see how to get to the resources where podcasts are. You'll know him because he will be featured in an image right there, promise you that. Show notes for today will be at flipping50.com/flipping-50-masterclass. Risk for osteoporosis. And never forget, even your men, your boys, are at risk. We've got to watch how they're doing. How is their gut health? What are they putting in? Do they have a great deal of micronutrient diversity going into their gut? And are they digesting and eliminating well? It matters for them as well as for us. And What are you waiting for? Let's start Flipping 50 today.