Bone Health for Athletes: Performance Today, Longevity Tomorrow Ep 147

Welcome to the Find Your Edge podcast. I'm your host, Chris Newport, founder, head coach, sports nutritionist, and exercise physiologist at The Endurance Edge. Our mission is to empower people to reach and sustain peak performance and health. So get ready to dive into all things training, nutrition, recovery, and more. We hope to give you detailed information and inspiring stories to help you be your best. Let's do it. All right, welcome back friends. A fun topic for you today. Uh, we are on the Find Your Edge podcast. My name is Coach Chris and I'm here with my amazing dietetic intern Emily Q who has been a machine cranking out some great information for all of you folks out there who are active and doing amazing things in the endurance community. And here to talk about bone health, something that we probably don't talk enough about. So bone health for athletes. So Emily, What's up? How's, how's the internship going?

Hi, Chris. It's been going so well, and I'm not just saying that because you're right here.

I was gonna say that sounds a little canned.

I've been, I've been really loving it. I've been learning, learning a ton and just getting to see a lot of super cool things. So it's been such a cool experience. Good.

We have had her doing everything from deep dives into various sports nutrition things, integrative and functional nutrition. You've been seeing labs. Lactate testing and VO2 testing and all the things.

So, and I've been, I've been working out with you guys too.

And, and of course, how could I forget? She's also doing strength training. Speaking of bone health, Emily, that was such a great segue. It's like we planned it or something.

Yeah.

No, why athletes need strong bones. I feel like this is a topic where most people are like, oh, this is only for like growing children. Right? So, Tell us about why athletes, no matter what their age, need strong bones.

For sure. I feel like we are always talking about our muscles mainly, like how to build muscle, how to maintain it and whatever. But we need to remember that the framework for all those wonderful muscles are our bones. And so if we want to generate the most power and speed from our muscles, we need to have strong bones. And we're not, all necessarily thinking about this at every moment, but in addition to bones being important for growing, like you said, in the growing children, in our older age, strong bones really help us prevent injuries and detrimental falls and things like that. Mm-hmm.

Yeah, for sure. I love this little tip you give down below in terms of bone mineral density. Tell us about that, like peaking in early adulthood and then what? And then it slowly declines.

Yeah. This is something I didn't learn until a few years back in one of my nutrition classes. But bone mineral density is basically the indicator of how well your bones are doing and how healthy they are. If you have a higher bone mineral density, that's a good thing. Mm-hmm. And we actually build our peak bone mineral density in early adulthood, like 20s. It usually peaks around the age of 30. And then just there's a natural decline, like a slow decline as you keep aging, which is why you see a lot of osteoporosis and things like that in your older age because it kind of like has this shape of it, it peaks and then it slowly comes down and there's not too much you can do after a certain point to bring it back up. So the more you build your peak bone mass, bone mineral density, like in your early adulthood, I guess the further it has to decline before hitting the danger zone. Of osteoporosis, if that makes sense.

Yeah, for sure. I love for folks, if you don't have access to one, try to find one. A DEXA scan is not only so great from a body composition perspective, 'cause you know, I'm all about the metrics and especially folks who are looking to, they want to lose some body fat and they want, you know, and the scale's not moving and what the heck, and then they get super frustrated. Having that additional metric of knowing how much lean body tissue do you have and how much fat mass do you have? But also part of a DEXA scan is what is your bone mineral density? And then especially tracking that after the age of 30, in my mind, allows us to be more proactive about the food choices that you're making, about the activity choices that you're making. Because I, you know, I have some people who in their genetics, it shows that their bone health is of greater concern, but they're getting adequate vitamin D and calcium. We're gonna talk about that here in a minute. And they're doing super heavy lifting and they're running. It's like, okay, well you're doing the things and your DEXA—

All of them, yeah.

Says that you're fine. So, you know, but then there's like, but I'm gonna get osteoporosis 'cause my family had it. And I'm like, no, that's not a guarantee 'cause you are literally doing the things. To mitigate that process. So yes, I hear you saying how there's a natural decline, but we can be part of the process to slow that decline.

Exactly.

Or even, you know, because bone is turning over all the time. We take it out, we put it back in, we take it out, we put it back in. Anyway, stop me on the soapbox.

No, it's great. I would have the same soapbox. I think especially in our athlete population here, this is not just something you have to keep in mind for your older age, but maintaining your peak bone mineral density and trying to slow that decline plays a huge part in prevention of stress fractures, which I'm sure a lot of you have dealt with and have suffered. Yeah.

Yeah, for sure. And we get so many PTs who are sending us athletes who are, have repeated stress fractures and, you know, they're obviously looking at it from a mechanical perspective, like are there mechanics such that they're moving in a way that is saving, quote unquote, saving their bones or, or preserving them, but also what's going on on the inside. Like, what does their nutrition look like? Are they too acidic? Are they getting enough vitamin D? What is their nutrient status, etc.? But, um, yeah, I know the slide that we're on, if you guys are watching this on YouTube, we're talking about building that peak bone mineral density. So this is probably not news to our folks, but you know, we can put in the general recommendations anyway. So what do you got, Emily?

Yeah, so the number one thing you can do to like make sure you're building your peak bone mineral density is weight-bearing exercise. And I wanna emphasize this specifically for female athletes cuz I feel like generally there's less of an emphasis on strength training in a lot of women, but your most impactful activity to build your bone mineral density is going to be impact activities, kind of against going against gravity. So that can include running, that can include jumping stairs, anything where you're kind of—

you're pounding a bit.

Yeah, pounding. And like you're really— your bones are feeling that, absorbing that impact, and they're going to adjust and strengthen because of that. Yeah. Non-impact Things are also very important. Weightlifting, if you're like constantly like lifting things that are like resist— the resistance training, that's really, really good for your bones as well.

Mm-hmm.

That's just an example. The recommendations say that you should be doing weight-bearing aerobic exercise 3 to 5 times a week and resistance exercise for about 2 to 3 times a week. So a combination of both is the best.

Yeah, for sure. And of course those ACSM recommendations are more general population, and I know all of you out there are probably exceeding that by like a lot.

For sure. For sure.

Which, which is great. But I do wanna point out is that from a non-impact perspective, if you are a cyclist only, you are at greater risk of losing bone density. So I know that you're going to whine and complain at this statement, but your rear end needs to be in the weight room, like, please don't argue with me. Just go lift heavy things. You know, I mean that I don't get 250 miles this week. Shut your face and go to the gym. Like, it will help your cycling-specific strength. It will improve your performance and it will save your bones because cyclists only, and this is in compar— the research I've seen is in comparison to runners, they have a greater decline in their bone density. Than—

And if you, yeah, if you think about it, it's because you're sitting on the bike and your, your legs are going, but you're not really— the pounding that we talked about earlier isn't just, isn't there.

No, it's not happening. And I get it. Some people are like, oh, well, I've got, you know, a knee replacement or hip replacement, like I can't run anymore. That's fine. You can still pick up heavy things that are gonna stress the bones. There's also very interesting research that I've seen. Emily, have you heard of something called heel drops?

Yeah. Like in your shoes.

Yeah. Yeah. Yeah. Sure. So not, not necessarily like a, like a heel, you know, cup or something like that. But if you stand barefoot, this is research-based, promise you guys, and you stand like a cute little old lady or man on the back of a chair, or it doesn't matter where you stand and you, you have to be barefoot and you have to be on a hard surface. So, you know, hardwood floors is fine, just not carpet. Or something like soft and squishy, and you lift up on your tippy toes. Maybe I'll do this in strength class tomorrow. And you stand up on your tippy toes and then you literally drop your heels forcefully on, on the ground. And then you rise up on your tippy toes and then drop your heels forcefully onto the ground. And then you do that over and over again. That will build your bone, that you are stressing your spine and your pelvis in a way that helps with this. Turnover, even if you can't physically run or jump or do stairs. But if you can do heel drops, and we're talking like 20 to 50 a day, so it's, it's not this extraordinarily time-consuming thing. So, so I cannot wait to see cute little cyclists in their kits sending me videos of them doing heel drops instead of going to the gym. It actually it will support your bone density.

So yeah, your body will thank you later.

It totally will. It totally will. Okay. Nutrition's role. I love nutrition, of course. So what, uh, tell us about nutrition's role in bone health. So what, what nutrients do we have playing around in here?

I mean, you guys probably all heard this growing up. The calcium is probably the most important. The second most important is probably vitamin D. Because it helps absorb calcium. So your bones are primarily made of calcium, like 99% of your body's calcium is stored in your bones and teeth actually. But beyond that, calcium's also required for muscle contraction and nerve transmission and blood clotting. So it's doing, doing a lot for you. The— your body—

I hope that everybody out there, especially now that it's hot, is hearing that because muscle contraction is massive. If you are having issues with cramping, Usually most people are gonna go to magnesium, but you gotta make sure you're getting enough calcium in there too. Like it's really critical.

Yeah. It's not just kids that need to be drinking milk, but we're, we're talk, we'll talk about that. Yeah. In just a little bit.

Yeah, for sure.

Vitamin D, like I said, it helps you absorb the calcium and then it also regulates your calcium and phosphate levels in your blood, which is super important for all that other function, the muscle contraction and whatever else. Yeah. So those, the primary, like adequate consumption of those two are probably the most important in bone health. There are some other nutrients that also play, play some roles here. Vitamin K is one, vitamin C is one, protein as well. That's important for just building bone. Yes.

And then, and then so many people are like, oh, if I eat too much protein, I'm gonna hurt my bones. No, it's actually the opposite. Yeah.

So the There are also a lot of other smaller micronutrients that play some roles. Just some examples are copper, potassium, phosphorus, magnesium, vitamin A, the list goes on. But a lot of these foods have overlap. The foods that are rich in these more primary nutrients also have a lot of the micronutrients. So it's not like you need to revamp your entire diet to—

Yeah.

Account to account for your bone health.

Yeah. Yeah. Good point there. Okay, so now getting into what nutrition pitfalls that are harming, potentially harming your bone health. So let's go. What you got?

Yeah. All right. One of the, the, you might have seen this coming, but one of the, uh, if you've got heard of the newer-ish diagnosis called REDS, relative energy deficiency in sport, that low energy availability. If your body's not getting enough energy to do its like most important work in like the immediate present, then it's probably gonna focus less on things like bone formation because it might not be relevant to what you're doing like right at that second. So if you're not getting enough food period, you're also probably not getting enough calcium or vitamin D or all those other nutrients that we talked about. So make sure you're eating enough for what you're doing. And then going along.

Yeah, let's see. Low carb intake. What, what do we got?

That kind of, that kind of goes with the low energy availability cuz chances are you're not consuming enough carbs if you're not consuming enough overall. And we know from research that eating enough carbs prevents bone resorption, which is basically like degrading. It, it prevents that from happening.

Mm-hmm. Okay. Carbs do more than just give you energy, you guys. So cool.

They're very important. Yep.

Yep. And then low vitamin D intake.

Yes. This is more common than, than you think it might be. We, I think it's about like a third of adults in the US, maybe a little bit more. Mm-hmm. Don't intake enough vitamin D. And a lot of us are, indoor all day, not really out in the sun, and there's just not a lot of foods that have vitamin D naturally, so it can be hard. So that's just one of them. And we'll again talk about some more of those food sources in just a little bit.

Yep. And then calcium and sweat losses. Just like I was saying, look out, guys. All you heavy sweaters, where you at? I know you're out there.

We know that we lose calcium and sodium through sweat, like we just mentioned. And when you lose calcium and the levels in your blood goes down, your body is actually going to pull extra calcium from your bones to maintain the right levels in the blood. Mm-hmm. So you don't really want that to happen.

Mm-hmm.

So you wanna make sure you're getting in, in enough calcium so that, so that your body doesn't turn towards the bone for that source.

Yeah. Yeah. And then what do you have here for that last bullet point there?

Yeah, we touched on this a bit earlier actually, but running, cycling, swimming, and ballet are associated with lower bone mass than other sports. And it's because we talked about how cycling is not really, you're not getting that weight-bearing pounding impact. Mm-hmm. But, and same thing with swimming when you're just like, when you're in the water all the time, But I think swimmers are better in general about making sure that they lift than they, at least they do strength training.

At least from what we see at the Triangle Aquatic Center, which is the Titans team. I mean, you know, mm-hmm. Our lab is located inside their gym, so obviously we see them doing their dryland quite a bit and they obviously put a big emphasis on it. But that being said, that facility is freaking amazing.

Yeah.

And not every swimming organization has access to something like that or are necessarily putting an emphasis on it. So, 'cause swimming is non-weightbearing, great for, it's great cardiovascular exercise, amazing cardiovascular exercise, but not loadbearing at all. So you have to balance that. Exactly.

And then running, running and ballet are usually associated with lower energy availability. Those are the sports where we see a lot of underfueling basically.

Yes. Yeah. So yeah, better way of saying that for sure. In our world, low energy availability, but in their world, you ain't eating enough, y'all.

To put it in simpler terms.

Exactly. Yes. Right? Same thing. I do see a lot of, you know, 'cause all of those sports and, you know, perhaps we could add gymnastics to this, we could add diving to this, we could add some of those more body-focused sports that tend to want to achieve a certain look or like in cycling, a certain power-to-weight ratio. Especially when you're looking at pros, for example, especially the pro men, you know, who have like these little tiny sticks for arms and these like massive quads. You know, they're, they're trying to achieve as much power-to-weight ratio as they possibly can. So, you know, there is a degree to which they are manipulating their diet and their training to try to be the best performer they can. And, You know, I feel like we've come quite a long way with nutrition, especially in professional sports and just sports in general. You know, we were like begging people to pay attention to nutrition and now I feel like they're, you know, they're paying attention, which is great. But you know, to what end? Are you benefiting yourself in the long run? Because man, your bones gotta last a long time, you guys. Yep. So performance is part of the equation, but then longevity is massive.

Yeah. And I feel like that kind of the concern for longevity kind of falls to the wayside sometimes if you're really like training for the right now. Mm-hmm. But I think a lot of people might not be thinking about what certain like dietary patterns of not eating enough might be doing to their chance of injury, which could affect the right now. Sure. And then their bone health later on. So just, yeah, just things to think about for sure.

Things to think about. Totally. And again, DEXA scans are great so that you can actually see metrics on what is my bone mineral density? Density, what is my lean mass, and then what can I do to actually, um, impact that, which is real cool when, you know, people are eating more of their protein. And oh, which, speaking of supportive foods, love it. Yes.

Yes.

So, so what do we got for all of our sources?

All right. For calcium, we've got a lot of fish are high in calcium, but here's the kicker.

Mm-hmm.

You need to be eating fish with bones, kind of like canned salmon or sardines or something like that. And I'm guilty of not eating these myself. I just didn't— I didn't grow up really eating fish with bones inside, like, so it just didn't really, like, occur to me. But the calc— the fish bones, like our human bones, is where the calcium really is.

Yes. Now don't, like, choke on a bone.

Right, right. Be careful with them.

Yes. Usually it's like the like if you get a can of salmon, use— and oftentimes it will say it on the, on the label, but you know, you'll, you'll see 'em in there. You know, they're usually little. They're not the spiky ones that you're gonna like, you know, choke yourself or something. But yeah, it's a different texture. We'll just call it that. We'll call it that. And there have got to be ways around this, but you know, keep going for what we have of good calcium sources.

We know that there, that dairy, Dairy has a lot of calcium. You grew up hearing about needing to drink milk. Yogurt and cheese also have a great, great calcium content. We don't think about this, but our leafy green vegetables also have some calcium in there, and some nuts and seeds as well.

Yeah, tahini, which are sesame seeds. So if you're sprinkling sesame seeds, or they're like sesame seeds in your whole grain bread Or you're using, eating tahini in a smoothie or tahini in your hummus. Okay, so here's one for you. Let's say we've got a vegetarian or somebody who's just like hard pass on fish and maybe they're lactose intolerant. So they're not gonna do dairy. Yes, you've mentioned leafy green vegetables, nuts and seeds, but is there anything else that we can do to get our calcium?

This is a great hint for our next slide, which is, okay, so, you know, yes, fortified food.

We're gonna go back and forth because we're gonna go, okay, so yeah, here.

So there's luckily all your milk alternatives, your soy milk, almond milk, oat milk, there's probably more that are all fortified with calcium. They, I think they fortify milk out of, honestly, I know, I know. I think in my food science class last fall, we had a tasting of a ton of different plant-based milks. Uh-huh. There were so— there were some of them were so strange. There was like macadamia nut milk and pea milk and, um, hazelnut milk. Uh-huh. There were, there were all these things I've never heard of. Cashew milk.

Uh-huh. Yeah. And it— because you would— you say you're a self-proclaimed picky eater.

I would. Yeah, 100%. Okay, I'm a biggie.

Try them all.

I did try them. I'm always willing to try.

Yeah. And what— and like, did you have any favorites? Or it sounds like several of them were just weird. It's—

they— a lot of them were just weird. I think I remember really disliking the pea milk. I think I remember the cashew milk wasn't that bad.

And not P-E-E milk, you guys. P-E-A milk.

P-E-A milk, like the, the little green bean. Yeah, yeah. Or I don't— yeah. Yeah. Um, I'm, I'm usually, I, I don't mind like soy milk, almond milk, oat milk, all those like big ones. I don't mind those usually. So I was just really curious. I think that, yeah, the cashew milk, I think I liked. Um, I probably had coconut milk.

The hemp milk. Not the canned, right? The dairy aisle coconut milk.

Yeah. Coconut milk. I remember liking the hemp milk. I don't know if anyone's ever tried hemp milk with like hemp seeds and stuff, but it was, it was, that one was pretty good.

Okay. Okay, cool. So milk alternatives, generally speaking, are fortified with additional calcium, right? And vitamin D for that matter. So, and you have a couple other things that are listed in here.

Yeah. So your typical breakfast cereals, orange juice, those are also fortified with calcium. Usually one big, one big one is tofu. Tofu usually is packed with calcium when, and they like fortify it. It's really good.

Yeah. Okay. I'm gonna flip back because now we need vitamin D supportive foods. I like how you call them supportive foods. Yeah.

Yeah. Okay. So revisiting fish for this one. There's a lot of vitamin D in fatty fish. You've probably heard like trout, salmon, sardines, tuna. Like these ones aren't as important. Like you don't need to have the bones with these necessarily. And fatty fish, like they're really great because you're also getting your omega-3s from them too.

Mm-hmm. Anti-inflammatories. Yes. So good.

Uh-huh. Yeah. Egg yolks have a lot of vitamin D. Um, beef liver, a little controversial there.

Yes. A lot of times I'm a hard pass on beef liver, so there's that.

Beef liver is like, liver basically has everything. Yeah. They have everything, but they're a little off-putting. So I'm just putting it out there. But, and red meat also has some vitamin D. Cool. But again, you, you run into the issue of like, you know, you, you don't eat meat, you're lactose intolerant, whatever. Yeah.

Uh, so you're, and then of course there's the good old fashioned sun. So, and I, exactly. If I had a dime for every time I've heard this, but I'm outside in the sun all the time, why is my vitamin D low? So there is a genetic component for which when you get it from the sun, it absorbs through your skin and then you have to convert it on the level of the kidneys. Genetically, some of us don't do that well, which means that you are gonna be chronically low in vitamin D, and then that's a whole host of other issues. So either fortified and/or most likely supplemental form is gonna have to be your route to go. But how do you know unless you test it, you guys? So, soapbox. You gotta know your metrics. Uh, I have the perfect client who is popping in my head right now. She has probably one of the worst genetics I've seen in terms of like, she has like all the markers of poor vitamin D absorption. And I believe we have her up to about 6,000 IU per day to get her into like the lower range of normal. And you know, runs in the family obviously cuz it's genetic, but how would you know? Unless you tested. That we— and then we recently got her numbers back and that's when we made another tweak to her supplement strategy. And of course, the sun varies throughout the seasons, especially we're like right in the— we're like right in the middle. North Carolina, that is, is right along the line of we're probably going to be okay getting most sun that we need throughout the entire year. But anybody who's north of us, is, uh, gonna have a harder time getting enough vitamin D from the sun.

I was just gonna mention that. Yeah, if you live in like Alaska or Canada, like, you're gonna have a— you could stand out all day and you still might struggle because the sunlight's just not as direct.

Yeah. And then there's that whole skin cancer thing.

Oh yeah.

Oh yeah. So yeah, it's like Okay, so I can get— because you can't overdose from vitamin D from the sun, but you can overdose on, uh, too much sunshine. That's going to cause cancer, obviously.

Yeah.

Um, anyway, so we need more vitamin D supplemental, uh, or fortified foods. Emily, because I keep interrupting you, so you're welcome.

Oh, you're fine. I mean, the, the vitamin D fortified foods are very similar to the calcium fortified foods because they, they, you know, go together. The milk and then the milk alternatives as we talked about, yogurt, breakfast cereal, and orange juice come back again. But yeah, a lot of people just need to, to supplement instead. Mm-hmm.

Yeah, definitely. And then I know you mentioned here oversupplementing.

Yeah. Yeah. That can be, that can be an issue.

Okay.

Where is calcium?

Like, so you mentioned here oversupplementing can cause GI distress, especially calcium carbonate, which is Tums. Whoa. Yeah, right? So like, I mean, not to call out a specific brand, but like any sort of, uh, antacid in general, calcium carbonate. And, uh, some of your milk alternatives, you just have to check what kind of calcium and what kind of vitamin D they're fortifying with, because calcium carbonate is cheap. But yeah, and then it, it, if you are prone to kidney stones, then we can have another potential issue on our hands there. So there are different types of calcium. Oh my gosh, I feel another rant coming on, but not a, not a rant, but like an educational opportunity because so many people are like, oh, I don't get enough calcium, therefore I'm just gonna take Tums or I'm gonna take, um, antacids, which then affects the nutrient absorption of other things. Further on down the line and neutralizes some of that stomach acid, which is important for intrinsic factor to do its magic on iron absorption and B12, which we need adequate amounts of B12 to do exercise. Like all of you athletes out there, you need to be getting enough B12 because it unlocks the energy from food. We need it. So there are different types, lots of different types of calcium options that are not just carbonate that don't necessarily have to be super expensive, that can also be, you know, good quality. And maybe that's another, maybe that's another podcast. Anyway, tell us about magnesium and vitamin K.

Yeah, so it's, if you're, if you're deficient or maybe you don't think you're eating enough from food, magnesium and vitamin K supplements can be great supporters as well because they are both cofactors for bone mineralization, which is the process that we just, we wanna keep continuing.

So, yes, for sure. Do you remember the amounts that adults, we'll focus on adults because that's most of the folks that we are working with, of what they need in terms of their optimal daily value in vitamin D and in calcium?

Do you remember these? I believe magnesium's like 400 milligrams.

For men it's like 400, 420. Yeah.

Okay. Yeah.

So, which honestly is a lot of leafy greens. And every time I say that to men, they kind of look at me like I have 6 heads because it's like 6 servings of leafy greens. It's a lot. And then on top of that, then they're sweating. Right. So then they need to make sure they're getting enough magnesium. So magnesium, I feel like has been hotter in like more popular in the news as of late, which again, I'm, I'm here for, like, I, I think that's great. It's good for cardiac function too. So is calcium. So are we doing the right Are we doing a little— do we need to do a little bit of both depending on what's happening in your diet?

Right. I think calcium, calcium's like 1,000 milligrams or something.

Yeah.

Yeah.

So, you know, that's not a little, we'll just call it that because a glass of milk is like about 400. And then I hear, okay, but what about, what about me if I'm lactose intolerant? What about me if I'm allergic to dairy or can't do any dairy? Again, we talked about out all those milk alternatives, you're pretty much gonna get the same amount in there. But then, you know, it just takes an eye to look at like a broader view, like a bigger picture of what are you getting on a more regular basis for your bone health nutrients. And then also what are the demands of your sport? Right. And, you know, just the overall quality of your diet. And then again, looking at your metrics. What's your vitamin D? Where are you getting it from? Your food? Are you wearing sunscreen? Are you not wearing sunscreen? Like, what are you doing with that? What's your, um, uh, dentition like? What's the health of your teeth? And I know I was telling you this, Emily, a couple of, a couple of days ago I had in some x-rays by a chiropractor, and you know, I think there is a certain assumption that like, oh, you're a dietitian, you must know, you must, you must A, eat perfectly. If that is just not true, which is it? It's like not, it's not a thing, you guys.

I'm sorry. No, you can't do it.

So nutrition varies throughout the life cycle. It also varies based on the demands of your sport. So, uh, make a good friend with a dietitian. Make sure you're checking in on somewhat of a regular basis to align your supplement strategy, your food strategy, any like functional foods, genetics. And, you know, we're like the, the, the secret miracles, I think, of the healthcare community to sort of— I agree. Yeah, well, of course, you know, that's why you're going into this field. I love it. So, uh, man, all the soapbox today. It's great to like take that zoom out of what's going on in my diet, what's going on in my um, body. But then I saw x-rays and my chiropractor was pointing out like, hey, do you see in this neck of your greater trochanter? So like the, the, the femur bone, which is one of your largest bones in the body, which is that thigh bone. And then it comes up and, uh, attaches to your hip joints. And there is what's called your neck of your femur bone. So it's between the hip capsule, uh, and the rest of the bone. And she was like, I'm seeing some little striations there. Which means that you're starting, like, your bones are starting to weaken there. And then I was like, wait, what? And then I had to kind of step back and be like, okay, well, where are my calcium, vitamin D sources coming from? Am I getting enough? And is this something that maybe I need to tune into? Because I also have a history of anemia. So if you're focusing on one nutrient, it's hard to stay focused on other nutrients. So, and in that case, it's iron and calcium, and those two compete for the same binding site. You can't take them together. So it's, it's not ideal to take them together 'cause somebody's gonna win. And then like, you know, now we're just going in circles of, are we trying to benefit bone health? Are we trying to, you know, prevent anemia? So anyway, all that to say is work with a dietitian. It doesn't have to be mine.

Work with a dietitian. Yes.

Exactly. Like, like find somebody who is versed in your sport who can support you in terms of overall energy intake, in terms of nutrients. And we take a genetic lens, we look at that too, and then looking into various metrics and all that kind of stuff. So, um, anyway. Oh, Emily, you just got me started.

I'm so— hey, I'm here for it. I'm here for it. We don't have a— we don't have a script to follow.

We don't know.

We're just chatting.

I know. Uh, poor Emily is like, wait, so am I— I'm like, no, we're just gonna pretend like We're, you know, we're just having a cup of coffee, or in this case, we're sitting around having a cup of plant milk. So, oh yeah, take your pick, take your pick, take your pick of plant milks. So I don't wanna overcomplicate it, but at the same time, like, zoom out. What's quality of your diet? What do your metrics look like? Get your DEXA scan, uh, make sure you're taking care of your bones. You're doing that heavy lifting literally so that you can support your bones. 'Cause, because this becomes even more important for any of our perimenopausal, menopausal women like that., you know, begins like this, this sort of steep decline. And, you know, pick up heavy things, y'all. So Emily, anything else you wanna say as it relates to bone health and athletes and energy and calcium and vitamin D and vitamin K and all the things?

I mean, you kind of hit the nail on the head. If you're unsure about any of these things, go work with a dietitian. They'll help you take the guesswork out of it in like in terms of how much you should be eating in general, how much of each nutrient you're getting, if there are any contraindications to supplementing, you know, all that good stuff.

Yes, for sure. Definitely. And then of course, you know, shameless plug, you can check us out at theenduranceedge.com. We're licensed in multiple states and available to work with you, uh, for a quick 30-minute start. And we ask you to fill out a lot of paperwork beforehand because I just don't wanna spend 30 minutes asking you questions. No offense, you guys. I wanna, I wanna do my homework beforehand. I wanna go in and get all the information about you. And then when we sit down and have a serious conversation about what, what metrics do you need to be doing? What do you wanna get out of our session? How do you wanna be best supported? And like, you know, do your homework first. That way we can like get at it cuz y'all's time is valuable. So anyway, yay calcium. Thanks, Emily. That was fun.

Of course. So fun. Yes.

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