Strong Bones After 40: Hormones, Menopause, Stress, and Strength Training

Welcome to the Balanced Body Podcast, where Sherri Griggs, owner of Balanced Body Health and Wellness in Omaha, talks to us about health, wellness, and balancing hormones.

Health and Wellness Podcast. I am Sherri Griggs with Balanced Body Health and Wellness, and Rupina Mir here with Zen Trishan, my co-host. So today, as promised, We're going to talk about bones. Not the kind you eat, not like rib bones, but bones. What about bones, right? I mean, they're so important.

They're absolutely skeleton.

And as you said earlier, they're the strength of our body, right?

It's a scaffolding, right? I think most people think that bones is like a structural— it's like a steel frame. Set it once, do some occasional maintenance, and done. Not the case. It's actually a living metabolic organ. And so the analogy I like to give is like, think of your bones as a construction site building that's constantly under renovation. And every single night that construction crew comes in, the osteoblasts, they repair the microdamage, they remineralize the bone and all of that, and they do their job. So to keep that scaffolding active. But then if there's chronic stress that's running sort of like a fire alarm, then the construction crew is on pause. They can't do their job.

Right. And as you mentioned, At night. So ladies and gentlemen, this is where we talk about sleep. Now we're not going to talk about that today.

Mm-hmm.

Talk about that next week, about sleep. Because when we talk about sleep, we can talk about how important it is, what can happen to you if you don't get enough sleep. Do you know that you can have early dementia? But then Rapina can tell us about what happens with Yeah.

And actually, yeah, we've covered that more. But if you— most people think that if you get one night of wrecked sleep, that just makes you tired. But it actually— there is a repair window. Your osteoblasts get a green light to actually do their repair work. And so, but if your sleep is disrupted, that repair window collapses.

Right.

So now it has far-reaching ramifications for bone health.

Yes. So we'll talk about sleep next week and all the things, the ramifications. It's, it's crazy. Your brain, everything. Okay. Okay. Bones, right? Osteoporosis, bones. Osteopenia is where we've started to lose some of our scaffolding, some of our density. But, but in relationship to hormones, because as you guys know, That's what we talk about, and I always like to remind you about the car. So the tires, estrogen, progesterone, testosterone, and DHEA, the tires of your car. The motor is cortisol. So I tell people, you can have a couple new tires. Many times in hormone replacement, you get estrogen and progesterone. So, okay, 2 new tires, your car's not going very well. You need 4, all 4. You need your motor to be running properly. You need your transmission, your thyroid, to be in the right gear. Insulin is your electrical system. You can't have a short in your electrical system. We've joked that, you know, but what about the gut? Because the gut is important in all of that, and that could be the garage door opener. The car is not going to get out if the garage door opener doesn't work. So talking about hormones and bone health, we know that As we age, men and women both, we start to lose hormones. Our hormone levels start to go down. Now, not everyone will their DHEA or their testosterone go down because our adrenals have a part to do with that as well. Men's gonads, testes, women's ovaries can make testosterone, but so can the adrenals.

Mm-hmm.

So I've had more than one 70-plus-year-old patient, a female, with a wonderful testosterone level. She didn't need replacement. And I bring up testosterone because that's one of the very important hormones that we really start to lose at the age of 25. We peak out about 25 in testosterone. From that point on, it drops. More about that. In another talk. I have graphs on that. Yeah.

That's such a great point you brought up, Sherri, about the adrenals. I kind of say they're the backup generator, right? And so then when your ovaries start sputtering and decline around age 50, then all of the work of producing your sex hormones passes onto the adrenals up to 40%, I believe.

Right.

And so that makes the huge difference between those ladies who sail through menopause And those who have that emergency crash landing is whether their backup generator is online. If the backup— if the adrenals are in good shape, then you're going to sail through it. If they're not, then you're going to be in the dark.

Because the adrenals can make that testosterone that can be converted to estrogen. Now, they don't really do progesterone and estrogen as much as the ovaries do, but what does Is fat. Fat doesn't make progesterone, but fat can make estrogen, and estrogen makes fat.

Yeah.

That's why someone can get the weight in the middle, right? So, so we'll go back to the bones. So one of the things that testosterone does— now think about this. Now we know that, let's say estrogen, we know estrogen protects you against the bone loss. It prevents you from losing the bone itself. Testosterone helps you build it.

Build it.

So when you're losing testosterone, most people start to dwindle at 25. I've got testosterone women on 29 years old with testosterone replacement because it's dropped so much. And they're so fatigued and they feel horrible. But testosterone helps us build. Because I had to look up— there's somebody in our Mindshare group that talks about they reverse osteoporosis without pharmaceuticals. And I thought, how can you really do that? Well, one of the ways is to stop the loss of bone, right? I mean, if you've already lost a certain amount, Can we get some of that bone back? Is there a reversal?

Possibly.

It depends on how severe and, and what the reason is, and if you're consistent and the amount of time. So there are a lot of things that feed into that. Obviously, we know there are scans that we can do, a DEXA bone scan, and I've had to make sure I say DEXA bone scan because now DEXA also does Body composition.

Body composition. Exactly. Yeah.

I'll go to get a DEXA, but to me, you know, I'm old school. I'm 90s medicine, right? A DEXA was only a bone scan, but now it's not necessarily so. A DEXA bone scan, so we can see the density of your bone. And you really, I do believe, want to say insurance will start paying for that at 60 years old. I'm not positive. I forget. 60 or 65. It's late.

Yeah, it's pretty late.

And by then it's too late. By then, think about this, if you are— if you start in perimenopause as a female in your 40s, you— and an average age of menopause is 51, you're 9 years out.

You're all—

you'll already have osteoporosis potentially. I've had women, and it's sad, come in at 48 years old with osteopenia already. They've already started to lose bone.

And—

That's probably— we had talked earlier before we started this podcast about how cortisol can really break down and steal and not allow your body to rebuild the bone. So for somebody at that young of an age, probably very much cortisol-related to their bone loss because their hormones, certainly unless they had early menopause, They still are making enough estradiol.

Absolutely. That, that was the question I had, that the clients you had that you said that were 25-year-olds, that their testosterone had tanked. What was their picture like? Are they— were they under egregious stress? Were they aware of it? Or was it, you know, long-term illness? So what was it that kind of created their testosterone? Yeah.

She was also going through perimenopause symptoms at 29. Her cortisol was fine. Um, she didn't have any other illnesses. There wasn't anything that made me think that she could potentially have toxin buildups. Um, some women just go through— I know women that go through menopause, full-blown menopause, at the age of 40. So that can take— perimenopause can last 10 years.

That's early.

So for her to start perimenopause at 29, yes, that's early, but it is possible. And, and then not necessarily related to an illness or some adverse effect from something else, right? She, um, but, but things that we can do— resistance training. Resistance training is huge. I tell every one of my ladies over the age of 40, No more cardio. None of this, none of this sitting there on the treadmill, or, you know, I gotta run, I gotta do this, I gotta— you know what, resistance training. And when you do some good resistance training, you can get your heart rate up. You can get your heart rate up with lifting weights, but we need to keep that muscle. We need to keep that muscle. We need muscle weight resistance, helps with our bones. If you think about it.

Absolutely.

Yeah, you think about it tends to be thinner women and, and not always, but main— much of the time because they don't have the extra bearing of weight on their bones as somebody who is heavier does.

Have you found that the women that, that come in who are really depleted in their 40s, that they were doing a lot of cardio and not resistance training?

What I find is women in their 40s have high cortisol levels that are doing a lot of cardio.

Yeah, yeah.

And if they don't have high cortisol levels, if it's too late— I had a 60-year-old, no, 65-year-old who was doing cardio 5 days a week who came in and had already completely— her body had shut her adrenals down to— I'm not sure how she got out of bed. There was practically zero left. I thought she possibly had autoimmune Addison's because it was zero.

Yeah, or she's in that exhaustive phase of the HPA axis.

Exactly, she's in stage 3, 3.5, on her way to 4, which is death. Right, right.

Seriously.

So, um, but, but what we don't know is, is it an exhaustive stage or is it an autoimmune Addison's? We can't assume. Yeah, she had Hashimoto's autoimmune disease. So with an autoimmune disease already Do we assume she's just in a fatigued state, right? We don't want to because we can treat that state, but if we are treating it improperly, it's going to lengthen the amount of time she suffers till she finally gets— she gives up and goes to an endocrinologist and she's had Addison's for, you know, 12 months. We've been trying to fix her adrenals. So, because it can take that long. I did give her glandular, which did make her feel better and started to, and it was not Addison's. And so she chose to go the pharmaceutical route, do the hydrocortisone, and get better quicker and be weaned off that. But in the meantime, we had her stay— the endocrinologist and I had her stay on the— had her stay on that. But you wonder— I wonder, wonder what her bones look like because she wasn't on— estrogen to prevent the bone loss. She wasn't on testosterone to help build the bone back up. And she obviously went through a period of time that she had severely elevated cortisol, and for a long period of time, if her body shut it down, right?

What, what is the average time frame that you've seen in your patient base when they come and say with osteopenia? And then they start BHRT, and then you do the second DEXA for them to initiate that bone remodeling process and to get out of those— what is it, the -2 scores on the DEXA— and start climbing back up. What have you found is the typical?

I have not had anyone like that. I had one gal that came in, told me she already had osteopenia. I've not seen her back to go over results or anything.

Crazy.

So far, the other patient I've had was somebody with severe, severe, and I do not know off the top of my head what her DEXA score was. She came to me already with severe osteoporosis. She had put her hand down on a desk and put weight on it, and her wrist broke. She was seeing an osteoporosis specialist, Um, and he had said to her that he was very happy to hear that someone had put her on testosterone because he knew that would help her bones build back up.

Yeah, right.

She's still on that Prolia, um, and, and I'm— I've— I have not done a lot of research on that injection. I don't know a lot about it, honestly. My understanding is that it helps Strengthen the bone, which if the bone is harder, that can also in a sense, if it doesn't build it back up, which like the testosterone can build it back up, I don't know if that builds it back up or it just hardens it. Because the problem with a hardened bone is that it can also break easier.

It's brittle, right?

Right, exactly. So I don't know, and I don't want to misspeak and say I do. I don't.

So, so the testosterone, does its action work on the osteoblasts that are sort of the bone-building crew that we talked about that come in every night and repair that micro damage and the architecture?

Yes. So that's what actually the testosterone does. It supports osteoblast activity.

Okay.

So, where estrogen prevents the loss, those are the osteoclasts, right?

Correct. I believe so. Yeah.

I'm sure. I'm pretty sure, because when you and I were talking, I'm like, osteoblasts build, right? BBB.

Yeah.

So estrogen suppresses osteoclast activity, so it inhibits the, the cells responsible for breaking down your bone tissue. So it's gonna slow the rate of bone reabsorption, right? Bone reabsorption meaning these osteoclasts break bone down, bone gets reabsorbed back into the body as calcium. It also supports osteoblast survival.

Mm-hmm.

So estrogen extends the life of the osteoblasts, the ones that build And so that gives more time for bone to be formed. So we talked about that window, like you talked about that sleep window. If you have your estrogen, replace it. So I'll tell women, we're going to protect you against osteoporosis, dementia, and cardiovascular disease.

Right.

Osteoporosis, we're preventing the bone loss. Cardiovascular and dementia, we're preventing the inflammation that takes place inside of the arteries when you lose your estrogen. So, um, the other thing estrogen does is it enhances calcium absorption. So it actually helps your intestines— there's your gut, right?

Right.

Absorb calcium more efficiently, and it— and so then it reduces the calcium excretion out of the kidneys. So You think about that. Wow, it does so much. And then I'm going to—

There's actually— I think there's a subset of the microbiome, the estrogen-producing bacteria called the estrobolome.

Yeah, your estrobolome.

Yeah, their activity also impacts the osteoblasts. And how well they're laying down.

And if we don't have estrogen, what happens to our estrobolome?

I guess it would, it would, you know, be in some kind of dysbiotic state, right? Because there's not enough of the friendly bacteria that are producing that robust estrogen. Right, so, and then it creates room for more of the pathogenic species to come in.

Yeah, and we know that, I mean, women experience that through their vaginal microbiome. When they start having issues with, you know, I'll have women say, oh, things don't smell right, I'm getting infections, I'm getting urinary tract infections, I'm getting, you've lost that estrogen, you don't have it anymore.

Exactly.

And it can happen to everybody, Not everybody has the same symptoms, but that's one of the things. So estrogen does one other thing to prevent osteoporosis. So there is something called this RANK, don't ask me what it stands for, or RANKL pathway. And this particular signaling pathway, it controls the formation and activity of the osteoclast, the breaking down Cells. And without estrogen to control that, that activity increases and it accelerates the bone breakdown. So estrogen is really about prevention. So when I say to ladies, we want to prevent the osteoporosis, I literally mean prevent the osteoporosis. Now, if you don't replace your estrogen, you're not— doesn't— it's not guaranteed you'll get osteoporosis. There are other things you can do, right? There's, there's the— there's weights, there's resistance, there's testosterone.

Yeah.

So like yourself, if you guys have been following and listening to us and Rapina told you about her breast cancer story, which is amazing, um, you know, she may not want to— if there's somebody out there with breast cancer Put estradiol. They may not— you may not want to do that. And so then what do you do to protect your bones? You can replace your testosterone.

Yeah.

You can. And I'm not certain that estriol can do the same. I didn't break them down, estradiol and estriol, as far as bone is concerned. Estriol has many, many great benefits. I don't know if it benefits the bone or not.

To my understanding, it does. I think we talked about Dr. Lindsay Berkson, who's a cancer survivor. And so I think she speaks about that with estriol attaching to the beta receptor. It's the less proliferative form of estrogen as opposed to estradiol.

Right.

And so it actually can. And she's like 70 years old and she's been cancer-free since she was in her 30s. So Yeah, she's known as the biased.

I believe she does estradiol and she does the biased.

Okay.

Yeah.

Okay.

Look up Lindsay Berkson. Just so you know, that is not a filter. She really looks that way. That is exactly amazing.

Yeah. Yeah. Yeah. She was she was quite an inspiration to me when I came across her her substack. Yeah.

Yeah. We met about a year and a half ago, and um. She's a really neat lady. She's a lot of fun. I think she has more energy than I do. She really, really looks like that. Yeah, she's— yeah, I always tell people that is not a filter.

Yeah, it's remarkable.

Yeah.

And that speaks to what topping off hormones can do for a 70-year-old. I mean, yeah.

And she's got muscle. I mean, she's lean. Yeah, it's, it's, it's amazing. She's great. So, um, and but yes, of course she has to work out, but you know what? She doesn't have any bone issues, right? She's a thin lady and she looks amazing. So—

She really does. Yeah, very inspiring.

She's so cool. So, okay, so let's talk a little bit Um, about this other thing, progesterone. When progesterone is also replaced, when combined with progesterone, estrogen, it's more bone protective. And I want to say that because just because you don't have a uterus doesn't mean you don't need progesterone. There are medical providers out there.

Yeah.

I swear, one more patient comes in and tells me this, I'm gonna ask them who it is and go slap them.

That is such antiquated BS. Oh my God. Honestly.

I don't have a uterus, I don't need progesterone.

I'm like, yeah, that is ridiculous.

Yeah, yeah. So you need to live with anxiety and not sleep well at night? Okay.

Yeah, right, right, exactly.

You know, who told you this? So, but, but that's one of the things that When they did that Women's Health Initiative study—

WHI. Yeah. The WHI, the study that was so wrong, wrong, wrong, wrong on so many levels.

Yeah. What they did find, estrogen therapy significantly increased bone mineral density and reduced fracture risk by up to 30%. 4% at the hip and 24% overall.

And that was with the synthetic estrogen. That was not— that was before the bioidenticals. So, okay, so you said 24% with the synthetic overall. So I'm curious—

24% in the hip alone.

That's— those are some pretty significant gains. So I'm curious, do we have any figures of What BHRT can do in full if you put all 3 of them in?

Mm-hmm. So right now I just got estrogen. Um, okay. Uh, let's see. So if estrogen— um, well, if we think about this, if estrogen prevents the loss and testosterone helps build it, if you get estrogen, progesterone, testosterone, And, of course, DHEA to help support our wonderful adrenal glands, we wouldn't have any bone loss. Why would you?

Yeah, no, I was just curious as opposed to the synthetic.

Oh.

Because the study they did on— wasn't it on Premarin and progestin or the—

It was on Premarin and the abortion pill. The Depo-Provera.

Yeah.

And so, what happened is, so there was an arm— so when they stopped The study, um, there were still some women that continued to take the hormones. There was, there was, and I know that they still did some women on the Premarin. I always called it the horseshoe pill, which we don't prescribe because it increases your risk of blood clots. By the way, if somebody has you on that, I would highly recommend that you talk to them about it or find a hormone specialist, because a hormone specialist will not put you on oral estrogen. Period. Not even a bioidentical oral estrogen. It increases your risk of blood clots first pass through the liver. So, right, um, the women that stayed on the horseshoe and pill only had 22% less breast cancer. The women that stayed on the horseshoe and pill and the synthetic progestin had a 28% increase. So yeah, some did stay and were followed. It was— we have to talk about that. I believe it was 2008, or no, it was '06 that they realized they screwed up, and it wasn't until '14 or '16 that they made it public. Um, but they knew, they knew that the numbers were wrong. They knew.

The other caveat was with the WHI, weren't all of those women 60-plus-year-olds who were outside that 10-year window, which is the most optimal bone repair window?

That's the most optimal.

And so they were past that.

Yes, yes. Once you get past that, here's what we know. Once you get past that 10-year mark, The very, very significant benefits you get for hormone replacement go down. Yeah, they don't go away.

They don't go away, but they plateau a little bit. And so you have the opportunity to have the most significant gains within that 10-year window. Although now I think it is a bit— they're saying a lot of women who were kind of robbed of that, and they're like, it's too late.

It's not.

It's never too late. You can still do it. You're just not going to have as significant of the gains as somebody who does invest in it within that 10-year window.

Correct. And that tends to be more around the estrogen side of it. The testosterone, you can get your testosterone back and build your muscle back. That patient I told you about, that her osteoporosis specialist said, I'm really glad you're on testosterone. We started her on testosterone at the age of 72.

Hmm, so fascinating.

So it's more the estrogen side of it than it is the progesterone or the— and the reason is, um, once you get past— so estrogen, we talk about preventing cardiovascular disease. Estrogen is your anti-inflammatory hormone and it keeps inflammation out of your arteries. Inflammation within your arteries is what is one of the precursors to help plaque build up. So if you've gone 10 years with no protection against plaque buildup, odds are pretty good you probably have plaque. Uh, the line of thinking has been, well, let's do a coronary calcium scan and see if there's any calcified plaque in there. Our risk isn't so much the calcified plaque, because that's hard, it's going to stay, it's a piece of soft plaque, as we soften those arteries back up, take that inflammation out, might a piece of that That break off. That is now also being debunked, that this 10-year window is bunk, is we can start women past 10 years. There's— if they're in, if they're healthy, if they exercise, they have a good weight, there's no reason not to. Now, if you get somebody in ill health, not doing well, then it's probably not a good idea.

Okay, so that's good to know. So the 10-year window primarily applies to estrogen, not so much for testosterone and DHEA. Not at all. Okay.

Yep, it's really the estrogen.

Yeah, that's, that's an important distinction.

Yes, yes. And, you know, it does, you know, there is some— so let's just say if you have that osteoporosis already and you could go on the estrogen, it's going to keep you from losing any more bone. It will protect you from that. One of my mentors Um, Dr. Rosensweet, Dr. David Rosensweet, who happened to be Dr. Lindsay Berkson's cancer doctor.

Oh yeah.

So he's who I learned a lot of stuff from. He's very wonderful. And I brought up that concern to him and he said, Sherri, I've been doing this and never in 35 years has a single woman had a blood clot. Don't worry about it.

Oh, interesting. So is he an oncologist, Dr. Rosen? Uh, yeah, but he does hormonal oncology. I mean, you said he treated, uh, Dr. Lindsay.

He was her doctor, so he was a primary, a general. I'm not certain what— he probably was an oncologist then. I know that you think traditional doc, right, who tells you It was a friend sitting on his porch, and she was— and then we're gonna let you guys go because we're— she was managing her thyroid and saying— he's like, so what were your levels? She goes, I don't know, I go by how I feel. And he goes, you do what? I go by how I feel. And he said, that's insane.

Yeah, that's insane.

Of dosing hormones. It's how you feel. We have a whole chart. We start you here. We work you up, but we say, if you feel this, this, and this, you need more. If you feel this, you need less. And when you get your dose, you tell me what it is, and then I'll do the blood work to make sure you're in a safe level. That's how Dr. Rosensweet does it.

Interesting, but it's highly subjective. I mean, I think, yeah, I think it takes an aware patient or client, right? Because—

But they have to be aware. You want them to be aware.

Yeah, exactly.

You give them this chart to go off of— too much, too little, what to watch for.

Exactly.

Again, when I say, okay, so above 55 and the estradiol level is the optimal level, but what if somebody tries to— they're sitting again at 40, their FSH needs to be where it's at, they feel amazing, they have no symptoms of low, Why would I push them up to that 55 level?

Yeah.

They're not a number.

Exactly, exactly. That's— yeah, you— it's the, it's the impression and the patient and the personality. It's versus just treating the labs and the numbers. Yeah, I, I feel very strongly about that.

I have married the BHRT Training Academy training with Dr. Rosensweet's training in that His— I think his stuff is amazing. I love it. I prescribe it.

But then I— I think that's such an intuitive approach, right? Because— and then it puts the— it makes the patient the CEO of their own health because they're calibrating and fine-tuning that sweet spot. That's kind of what I do with macros for clients, right? Like, I find their metabolic type. And then I'm like, OK, but to really know, OK, instead of just random, like everybody needs 100 grams or everybody needs 140 grams of protein. No. How do you feel? What makes you the most satiated? Or what— when did you feel your energy was strongest? And so the clients that do that detailed record keeping and we're able to dial in that sweet spot, those are the ones that have runaway success because they have that high level of awareness. As to how food is medicine and how it's impacting their state in every moment and how they show up. And, that's precisely what BHRT can do. So, I kind of really like that approach. It's—

yeah. Well, we'll have to talk about that more. So, come back next week, you guys. We're going to talk about sleep because you're going to be amazed at— so, if you don't get enough sleep, again, dementia, yeah, it's going to happen. And even more studies about death and dying sooner, and if you don't get it, 7 or more hours, and if you get 9 or more, and oh my, we can go on. So if you want to get a hold of me, uh, go to balancedbodymedical.com. You can sign up for a free call if you have questions about what we've talked about, about bone health. If you, um, disagree or agree or have more information, I'd love to learn. I always like to hear about it. You can also call me at 407-807-5333. And, if you want to talk a little bit about your nutrition and your food, Rupina, how can they reach you?

Yeah, absolutely. And nervous system regulation, that's the missing piece.

Last week, you guys go listen.

Yeah, we'll talk about that. But yeah, Zen Nutrition, zen-nutrition.com/book-now, and you can get a complimentary call to kind kind of really understand all these metabolic cues and dive in and figure out a root reset. So I would love to support you with that. And the link will be in the show notes.

Oh, very good. All right, we'll see you guys next week.

Thank you for listening.

This has been the Balanced Body Medical Podcast with Sherri Griggs, owner of Balanced Body Health and Wellness. If you're looking to find Sherri, go ahead and look for the website balancedbodymedical.com. If you're looking for the business and you want to find Sherri at her office, you can find her at 10815 Elm Street in Rockbrook Plaza. Thank you.