In this episode, I am speaking with Kevin Ellis – also known as The Bone Coach. After a diagnosis of osteoporosis in his early 30s, he went on to not only heal himself but he’s now dedicated his life to helping people fix their bone health, overcome osteopenia and osteoporosis and strengthen their bones which is what we are discussing in this interview.
Get access to Kevin’s Free Stronger Bones Masterclass here.
Table of Contents
In this episode, Kevin and I discuss:
- What is osteoporosis (and how prevalent is the condition)?
- The best tests for bone health
- The most common causes of osteoporosis.
- One of the most powerful tools to improve bone health (it is one of my preferred pastimes)
- Does animal protein really reduce bone health?
- The science on calcium from dairy and bone health
- Much, much more
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Transcript
Ari Whitten: Hey, this is Ari. Welcome back to The Energy Blueprint Podcast. With me in this episode is Kevin Ellis, also known as The Bone Coach, and he has a really interesting story after a diagnosis of osteoporosis in his early 30s. He went on to not only heal himself but he’s now dedicated his life to helping people fix their bone health, helping people overcome osteopenia and osteoporosis and strengthen their bones. I really enjoyed this episode. I found Kevin to be a very, very insightful guy with a lot of knowledge and he has a lot of novel insights to share. I think you’ll get a lot of value from this whether you have osteoporosis or osteopenia, or you’re just looking to learn about this topic and learn how to maintain optimal skeletal health as you get older. Enjoy the episode.
Welcome to the show, Kevin. Such a pleasure to have you.
Kevin: Ari, thanks so much for having me. A pleasure to be here.
Why Kevin got into working with women on improving their bone health
Ari: First of all, I have to ask, how did a young fit guy such as yourself get involved in helping women deal with their bone health? This seems like a fairly unusual thing for a man in your demographic.
Kevin: I know, right? It’s not typically your 30-year-old male at the time that’s told they have osteoporosis and bone health issues. That’s really how my journey started. Actually, I’ll even back up and start… my health journey started a long time ago when my mother was five months pregnant with me, my father was told he had cancer. He was a Marine in Vietnam. He got cancer from Agent Orange of all things. He made it through 22 months in combat, but he got cancer from Agent Orange. He passed away when I was two months old.
My entire life, I had this fear in the back of my mind that he passed away at 35 and I just had a feeling that my time was going to come somewhere around there. I couldn’t help that. Just before that happened, right around my late twenties or so, after I had gotten out of the Marine Corps and I was doing some other things, I started having all these other health issues that were coming to fruition. I had poor energy, could barely get out of bed every single day, was not sleeping well. I was then diagnosed with celiac disease. Then subsequently, I was told I had osteoporosis.
If it weren’t for a physician’s assistant, all the other physicians that I had gone to, they never did a bone density scan. They never even proposed that even once we found out I had celiac disease. Then a physician’s assistant said, Hey, have you had this done? I thought, okay, let’s just go get it done. We did the bone density scan. I thought it was going to come back and just be a check in the box, like, okay, your bones are fine. They wrote me a letter in the mail and said, you have osteoporosis go on a gluten-free diet and that was it. I was shocked at that point. I actually didn’t even believe it.
I went and I got a second opinion and they went and confirmed that in fact, I had osteoporosis. I was immediately like, what is osteoporosis? What do I need to do about this? I had young kids on the way and I was just worried that I wasn’t going to be there for them and I was going to follow in the same footsteps as my father did. I had this really strong desire to figure things out so I could be there for my kids. That was really my reason for making improvements. I started doing all this reading and research and consulting with a lot of different people and spending a lot of money and trying to figure all those stuff out. I eventually got to the point where I was making progress and I was making improvements.
I was improving my health, my energy, improving my bones and finally getting to a point where I realized it’s not the average 30-year-old male that’s trying to figure all this stuff out. It’s usually the woman 45, 50, 60 plus that’s diagnosed with osteopenia, osteoporosis. At that time they’re diagnosed, they’re told, Hey, take some calcium, take some vitamin D, go for a walk and take a bone drug. That’s woefully inadequate. That’s really the reason why I got into this field and I created bonecoach.com and really have been helping people all over the world at this point.
What are osteoporosis and osteopenia?
Ari: First of all, what is this, for people who don’t actually know? Maybe they’ve heard the term osteoporosis or osteopenia, but they don’t actually know physiologically what is actually happening in the body. What is this crazy-sounding word? Osteo means bone. What’s penia or porosis? What do these terms mean?
Kevin: 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. What happens in osteoporosis is both your bone density and your bone quality are reduced and that’s going to increase your risk of fracture. The way you find out you have osteoporosis is through what’s called a DEXA scan. That’s dual energy, x-ray absorb geometry. It’s a painless test, like an x-ray, but very low levels of radiation. You lay down on the machine, the machine does this scan, and it’s going to tell you your bone mineral density, which is the actual mineral content of your bone. That generates the score.
That score is called a T score. The T score is telling you how much your bone mass differs from the bone mass of an average healthy 30-year-old adult. If you have a score of plus one or minus one or zero, that’s what they’re going to consider normal and healthy. If you have a score of negative 1 to negative 2.5, that’s considered osteopenia, which is considered low bone mass, also a precursor to osteoporosis. If you have negative 2.5 or lower, so negative 2.6, negative 2.7 so on and so forth, that’s considered osteoporosis. The greater that negative number becomes, the more severe the osteoporosis.
Most women, most people are going to be getting these scans done later in life, their fifties, their sixties, their seventies, as a check in the box, or maybe it’s a fracture or something like that that they have and then they go get a DEXA scan. In my opinion, that’s too late. We want to get these things earlier on in life. We have some objective, near-term indicators from which we can monitor future changes. If you’re listening to this, and you’re in your thirties or your forties, or even your fifties, or sixties, and you haven’t had one yet, I would go get one. Just to get a baseline so you understand where you’re at at this point and what changes are going to take place in the future.
Ari: I want you to scare people a little bit. What I mean by that is, most people won’t take action to go do something like that to go to their doctor and say, Hey, I want a bone density scan and I’m willing to go maybe subject myself to the scary-sounding x-ray radiation stuff in order to get this data.
Kevin: There’s very low levels for that, but [unintelligible].
Ari: What I mean is that most people won’t take action unless there is some need to, or a scary enough thing like let’s say cancer people will maybe go get some screenings for cancer because cancer is super scary. I don’t want that. Tell me about why people should be scared of osteopenia, osteoporosis and why they should really be concerned with it. What kinds of things result from this if you do have low bone mineral density?
Kevin: Let’s go through the stats of this. Approximately 10 million Americans have osteoporosis. Over 44 million have low bone density. One in two women and up to one in four men are going to break a bone in their lifetime due to osteoporosis. For women, the incidence is greater than that, of heart attack stroke, and breast cancer combined. That’s huge, right? Six months after a hip fracture, you got only 15% of patients can walk across a room unaided. Every year, we’ve got nearly 300,000 hip fracture patients and one-quarter of them end up in a nursing home and half of them never regain previous function.
Again, that’s huge. These are alarming statistics. This is not something… The challenging thing with osteoporosis is it’s a silent condition and almost forgotten, even if people do realize it because it’s not really affecting your day-to-day life, you could still feel fine and have low bone density. The way you’re going to know that it’s really an issue for you is once you have that fracture.
I can tell you after working with thousands of people and we work with people that have had anywhere from no fractures to 5 to 10 or more fractures, the people that have already had fractures, they will tell you it’s much better to be on the side of prevention, than reaction. I would a hundred percent reinforce that. Those are the stats around it and it’s pretty alarming. I will also say too, this is not something that is trending down. It’s an increase.
Ari: This hip fracture thing, I’ve always heard stories since I was young of people who are 80 years old, 75 years old, who fall and they break a hip, and then they just never recover from it. That scenario is pretty much always due. Maybe that’s too strong of wording, but most often due to osteopenia or osteoporosis creating that susceptibility to fracturing that hip in such a severe way. Is that accurate to say?
Kevin: I would say that that’s usually going to be the cause. Especially, even if somebody is standing and they fall over it, you shouldn’t fracture your hip just from standing and falling over. That’s going to be an indicator of reduced bone density and reduced bone quality.
An important thing here too is we were just talking about bone density and bone density scans. When you get those scans, though, they’re only going to tell you part of the picture, so bone density is part of the picture. The other part of the picture is bone quality, and bone density and bone quality combined to create bone strength. A lot of times people get these DEXA scans done you may be told you have osteoporosis, by bone density, but you don’t have the other part of the picture. Bone quality is how that bone is organized, the structural integrity, the microarchitecture of that bone.
That’s a really, really important part of the puzzle too so there is a software called TBS, Trabecular Bone Score, that is an add-on to DEXA, not all locations, have it not all physicians will try to interpret this. You can ask and you can request it and see if there’s one in your area. When you go get the DEXA scan, and you get the TBS at the same time, you can leave with a more whole picture of what your actual bone strength is. There’s also another tool called it’s more prevalent in Europe right now. It’s kind of slower to adopt here in the US, but it’s called Echolight, REMS Ecolight Radiofrequency Echographic Multi Spectrometry technology. It’s like an ultrasound technology.
Ari: Can you say that 10 times fast?
Kevin: I was going to go down that path. Basically, this REMS technology, it’s an ultrasound, and it’s going to look at both your bone density, your bone quality, and it’s going to calculate five-year fragility score, basically, which is going to tell you risk of osteoporotic fracture. There are tools that can help but even if you find that you have low bone density, it’s important to actually start doing things to make progress there.
The root causes of bone density loss
Ari: With that in mind, let’s talk about how we might address root causes. Let’s go into what are the root causes for this? I’m curious — you’re obviously a very atypical case having this in at 30 years old. I’m curious what your root causes were, and if they are the same, or different from the more common root causes of that middle-aged and older women are especially susceptible to?
Kevin: That’s great. Like, so for me, I’m going to start with me as an example. Yes, I am an atypical situation, most of the time, unless somebody has celiac disease or other GI conditions from a young age, which those can be contributors. If somebody from a young age, but 90% of your bone mass is put on by the time you turn age 18, and the remaining 10%, is put on by the time you turn 30.
If you had at a younger age, you smoked or drank excessively, you lead a sedentary lifestyle, you took certain medications, you had an eating disorder, you didn’t get proper diet, nutrition, from a young age, all of those things can contribute to you not achieving and reaching peak bone mass. That can be part of the picture too.
For me, I had some of those things when I was in the Marine Corps, I partied a little bit hard, I smoked cigarettes for five years, not good decisions actually, those are — if there’s one thing I regret, it was smoking cigarettes, I would never do that again. Then I also had digestive issues, and I was staying up late and I wasn’t getting proper sleep, and stressed out all the time. Having celiac disease was probably the primary contributor for me because when you resolve that, you can actually have an improvement and be able to digest your food and absorb your nutrients.
Now, for most people, a lot of people don’t know this, but there’s multiple types of osteoporosis. You’ve got primary osteoporosis, that’s related typically to a decrease in estrogen and postmenopausal women. Estrogen has a protective effect on bone, when estrogen levels decrease as they do during menopause, that’s going to cause an increase in the activity level cells that break down bone.
Then there’s a whole ‘nother cause, and that’s what I fell into, which was secondary osteoporosis. That’s where this occurs as a result of behaviors, conditions, disorders, diseases and medications. Most people unexpectedly diagnosed, ’30s, ’40s, ’50s, they have or had a secondary cause. Just because you’re a postmenopausal woman does not mean we should just say, “Oh, it’s just hormones, it’s a natural part of aging.” Move on with the medication and not address root cause issues because I’ve seen many, many times where there are still root cause issues that have to be addressed.
Ari: Is there a trend and prevalence of this in terms of the last 30, 50 years and if there is what are the biggest explanatory factors for that?
Kevin: I would definitely say, this is not something that’s going down. It’s increasing, we’ve got more cases of osteopenia, osteoporosis, fractures that’s on the rise. Obviously, hormones play a massive role and if people are not taking the steps they need especially before or right around menopause, including even considering bioidentical hormone replacement therapy, then you could potentially have an issue there.
Then also, when it comes to the other contributing factors to bone loss and osteoporosis, if you have those things and you’re not addressing them, then that’s going to be something that you need to do. I can just walk through some of the more common things that can be contributing to bone loss and osteoporosis, which…
How medication affects bone health
Ari: Yes, please let’s talk about some of these key root causes.
Kevin: Yes. One of the first ones would be medications. If you’ve got glucocorticoid medications, a lot of people take these medications. They’re steroid medications designed to suppress inflammation, they mimic natural steroid hormones in the body, they’re going to be used to treat conditions like asthma-like autoimmune disease, rheumatoid arthritis. Two of the more common drug names, a lot of people will probably know or prednisone and cortisone. Bone loss is a common side effect of those medications and that happens for a few reasons.
The first one is that those medications, they’re going to reduce the GI absorption of calcium. They’re going to increase urinary excretion of calcium, that causes a deficit. Then we have the glucocorticoids are directly acting on osteoclasts, the bone breakdown cells, to increase their lifespan. What happens there is that ends up reducing your bone density. Also, selective serotonin reuptake inhibitors, typically used as antidepressants. There was a review of 19 studies on the effects of SSRIs that indicate they have a negative effect on bone mineral density and increase the risk of fracture.
Ari: Oh, you know that. That’s interesting.
Kevin: Yes, that’s super, super important and then this is a big one, antacids. These are drugs that reduce the production of or increase the suppression of stomach acid. These are your proton pump inhibitors, your H2 receptor antagonists drugs that would be omeprazole, Nexium, Prevacid, ranitidine, Zantac, Tums can even fall into this category. A lot of people that have or think they have too much stomach acid, actually have too little stomach acid. When they take these, they ended up suppressing what little stomach acid they do have.
The reason that’s a problem is because you need stomach acid to properly break down and extract nutrients from your food, like amino acids are the building blocks of protein, your bones are 50% protein by volume, they need amino acids, calcium, magnesium, iron, B 12, if you’ve got low stomach acid, you’re going to be starving of those nutrients basically. That’s going to obviously increase issues with having enough calcium, it’s going to increase the risk of osteoporosis. Those are some of the bigger ones.
Then digestive issues. I mentioned celiac disease, that’s an autoimmune condition where the consumption of gluten damages these tiny little nutrient absorption centers and your small intestine called villi. These are responsible for absorbing the nutrients from the food you eat. When you eat gluten, and you have celiac disease, that’s going to blunt those villi to the point where they can’t actually do their job. When they can’t do their job they’re not going to be absorbing your calcium, your vitamin D, your phosphorus, and your bones.
Your body still needs those nutrients on a daily basis to execute its daily functions. If you’re not taking them in and you’re not absorbing them, where’s it going go? It’s going to go to the bones, your greatest mineral reserves, and it’s going to pull those, and that’s going to be contributed bone loss and osteoporosis. Those are some of the big ones. I mean, there are many, many contributors, but those are a couple of really big ones.
Environmental toxicants that affect bone density
Ari: Few more specific questions. Are you aware of any significant environmental toxicants that are linked with this?
Kevin: Yes, I think one of the biggest ones that we’re facing, I wouldn’t even say I can go to environmental in just a sec, but I would say one of the biggest ones is that people are consuming on a daily basis in many cases is sugar. If people didn’t know that sugar was an issue before, I’m going to give you one more reason as to why it’s probably not a good thing for your bone health.
Number one is sugar damages bone by triggering an inflammatory response so it’s going to lower your vitamin D levels. It’s going to deplete your bone healthy minerals like calcium, magnesium, chromium and copper, it’s going to inhibit that intestinal absorption of calcium. It’s going to block the absorption of vitamin C and is key for maintaining a healthy skeleton. Most of your audiences probably already are aware that if you’re eating crackers and cookies and cakes and pizzas and pastas and crackers and all that stuff, that’s not going to be the best thing to support your bone health.
That’s probably one of the main things and then also chemicals. Glyphosate is a big one. It’s a broad-spectrum systemic herbicide, crop desiccant, it’s sprayed on and around certain foods that’s associated with an increased risk of cancer, but it’s also a key [unintelligible 00:20:40] of minerals, too. You need those minerals and those nutrients, you need to be able to take those in and absorb those nutrients. That’s another big one.
Then also unfiltered water. If you’re drinking unfiltered tap water, there’s a good chance you’re consuming all those chemicals and pollutants that the environmental working group talks about and says were found in our water. Those volatile organic compounds, heavy metals, pharmaceuticals, endocrine disrupting chemicals, chlorine, fluoride.
Actually, you can go to Ewg.org/tapwater, you type in your zip code, and it’s going to generate a list of all these contaminants that are detected in your tap water, that exceed health guidelines. You can go find that information out now and then what you do to remedy that is you can go find, invest in a filtration system or something like that reverse osmosis with remineralizer or you can find something like a solid block carbon filter like a Berkey or something with fluoride filters. That’s going to filter out the bad stuff, but it’s going to leave in the minerals.
Those are some big ones that I would say too, and then we’ve got BPA and, and phthalates in plastics and water bottles, plastic, food containers, synthetic fragrances, commercial cleaning products. These are all things that a lot of us have, and we can always find healthier, or better alternatives to these things, switch to the essential oils. You can clean with vinegar or castile soap. A lot of different things you could swap out there.
The role of nutrients in bone health
Ari: As far as nutrition, I know you’ve mentioned some aspect of that, but is there anything you can speak to as far as the role of vitamin D and vitamin K in particular modern diets in particular, commonly deficient in vitamin K. Most of the population is deficient in vitamin D, which is largely result of sun deficiency, but also some aspect is nutritional as well. What’s the role of those two things in this picture?
Kevin: Absolutely. Vitamin D plays such a major role in not just bone health, our health in general. It’s one of the most important nutrients for overall health wellbeing bone health. It’s not just the vitamin. It acts as this powerful hormone in our bodies. It induces the transcription of more than 50 genes. It’s going to increase the intestinal absorption of calcium.
It’s promoting higher bone mineral density. It’s lowering that fracture risk. It’s helping us improve our muscle strength and decrease the risk for falls. There’s just so many benefits that come with vitamin D. Super important.
Like you said, a lot of people aren’t getting enough of it because of the lack of sun exposure for one and even if people do get sun exposure, maybe they’re not getting that midday sunlight with UVB radiation, or maybe they’re lathering up in sunscreen and they’re not actually getting that exposure to their skin. They may be outside, but they’re not actually getting that.
You need to make sure from dietary sources perspective, you can get vitamin D sun is going to be your best source of it, but you can get vitamin D from fatty fish. Salmon, herring, sardines, anchovies, oysters have some, egg yolks, mushrooms have D2. In terms of supplementation, that can also be helpful. With supplementation, with vitamin D, this is not a supplement that you just start taking blindly. You need to check your levels beforehand. Then as you start to take vitamin D you need to monitor that every three to six months and see where your level’s at, because you can get to a point where you have too much vitamin D.
If you are going and getting your 25 hydroxy vitamin D lab test, and you’re looking at that, the range on that, if you’re in the US, 30 to 100 ng/mL. that’s a massively wide range. If you’re at a hundred or higher, that’s too much, and it can actually contribute to bone loss if you’re above that. Then if you’re on the lower side, if you’re around the thirties and lower, that’s also going to contribute to bone loss. We need to bump that up, get that higher than 40-50, somewhere around there. Some people’s needs may be higher than that. In that 40 to 80 range is going to be really important for most people.
Then vitamin K also. A lot of people hear of vitamin K, but a lot of people don’t understand there are different types of vitamin K. There’s K1 and there’s K2. K1 can be converted to K2, but not efficiently. K2 is what’s most important for bone health. Vitamin K2 has a lot of different forms, but the major ones we hear about mostly our MK4 and MK7. MK4 has a really short half-life, stays in your blood four to eight hours, something like that. It may require larger doses that are spread throughout the day. MK7 has a longer half life and that stays in the blood or in the body two to three days.
The reason why K2 is so important is it’s going to aid in bone mineralization and formation by activating something called osteocalcin. What this is doing is it’s ensuring that calcium is deposited in our bone and not our soft tissues, like the arteries and the kidneys. Super important.
Where can you get these from your diet? Dietary source is a K1. Those are your dark green veggies, asparagus, your kale, your broccoli. K2 MK4, that would be things like beef liver, grass-fed beef, butter, dark meat chicken, pasteured egg yolks. Those are all great sources of MK4. Then MK7, K2 MK7, hard cheeses, fermented foods, sauerkraut, kimchi, nato, and bacterial fermentation in our guts.
You can also supplement. Actually, in Japan, there were some studies were showing that 45 milligrams of vitamin MK4 is actually used as a treatment for osteoporosis. You can supplement with MK7, MK4. Those can be helpful additions to your plan, too.
How to asses bone quality
Ari: Excellent, you mentioned earlier that there’s these two aspects of assessing your skeletal health bone, mineral density, and what was the other, the name, bone quality.
Kevin: Yes, bone quality.
Ari: As far as my understanding of physiology and I’m certainly far from a bone expert, but we have osteoblasts, we have osteoclasts. Bone deposition, bone formation, and bone destruction. What are the key determinants of bone quality though? What is actually determining if we are laying down bone in a high quality versus low quality way?
Kevin: I would say if you are some of the things you have to be incorporating into your plan, exercise is going to play a major role in that. In the quality of bone, that’s formed the stress that you’re putting on your bones, that healthy stress exercise plays a massive role in that, but at the same time, you have to have the minerals, the nutrients, and all those inputs to help form that structure.
It’s a collagen protein matrix structure upon which those minerals will form, but you also have the have to have the stimulus. What happens with bone is you have these cells that are called osteocytes too. The osteocytes they’re mechanical signalers that say, “Hey, we’ve got stress that’s being put on the bones,” or, “Hey, we’re getting these tiny little cracks or fractures in the bone.” That’s natural for everybody. Not just people with osteopenia, osteoporosis as you and I are going about our daily lives, exercising intensely and things like that, we’re going to start to get these little tiny micro-cracks and things like that.
These cells, these osteocytes say, Hey, we’ve got these little micro-cracks that need to be repaired. Then what happens is the osteoclast come in, the bone, resorption cells come in and they scoop out those tiny little cracks. Then we have these bone-forming cells that follow right in behind it and fill it in with stronger, healthier bone. It’s a coupled process and that is why it’s so important to be active because you have to have that stimulus to build stronger, healthier, better quality bones.
Ari: It sounds like we should also add to the discussion of root causes, sedentary lifestyles being a big contributor of this issue as well.
Kevin: Absolutely. I can even talk about too, mitochondrial function is super important when it comes to bone health. Mitochondria function is actually, it’s essential for maintaining your osteoblasts, which are bone-building cells, your osteoclasts, which are bone-breakdown cells, and the myocytes in the muscle. What happens is when we have mitochondrial dysfunction, that’s going to impair osteogenesis. That’s the formation of bone we were just talking about. It’s going to increase osteoclast activity and accelerate bone loss.
Part of the reason for this is, when you have compromised energy metabolism and oxidative stress, that’s going to contribute to age-related stem cell dysfunction in that bone. Mitophagy is also key in keeping the cell healthy. It’s going to promote turnover mitochondria and it prevents that accumulation of dysfunctional mitochondria. That, in turn, is going to play a role in the proliferation, the differentiation, and the function of those bone-forming and bone-breakdown cells.
We really need to be focused on how we can support musculoskeletal health. There’s plenty of research that suggests some of those things we were just talking about, anti-inflammatory diet with plenty of protein, super important, exercise, proper supplementation, vitamin D is important, omega-3 fatty acids, even probiotics can have a positive effect on muscle strength, bone density, and bone quality too.
Does protein consumption harm bone health?
Ari: Excellent. There is a myth that’s been around for…well, I shouldn’t say a myth. There’s an idea that’s been around for probably at least three or four decades that consumption of protein and animal protein, in particular, acidifies the body, and that this leeches calcium from the bones. Are you aware of research that has tested that and what does that research say?
Kevin: Great question, because I’ve heard this many times too. Protein is essential for bone health. When bone is being broken down, it’s not like that bone is being — we’re going in and we’re selectively plucking out calcium from that bone. We’re actually tearing down that whole structure, which includes the protein. Protein is so important, you cannot rebuild or much less maintain if you do not have adequate protein.
The absolute minimum amount that you would want to be including in your plan, and I mean bare minimum, 0.545 grams of protein per pound of body weight. If you weigh 100 pounds, 55 grams is the absolute minimum. What’s unfortunate is, I see this a lot, especially with people that are following, this is not a dig or anything on that dietary approach on vegan and vegetarian, but I see a lot of times, people are falling short. Like really short. They’re not getting those nutrients and those amino acids that they need. We need to be really, really intentional about how we get there…
Ari: In many cases, they become actually fearful of consuming too much protein. There’s ideas that consuming protein or animal protein might boost mTOR and IGF-1 and increase your risk of cancer, or is acidifying your body and causing your bones to leach calcium. These ideas have been circulating for many years. Some people are actually falling short on protein consumption due to fear of consuming protein.
Kevin: There was a researcher at Tufts Nutrition Research Center on Aging in Boston. They did a study and they noticed that a high calcium intake did in fact lead to increased bone gain if the patient’s intake of protein was high. This was Bess Dawson-Hughes, she had previously published the results of a calcium and vitamin D supplementation trial that produced a better than 50% reduction in fracture risk in healthy Bostonians.
What she realized is that the people that had the highest protein intakes, so about one and a half times the RDA, bone gain was dramatic in that group of people. That’s 0.8 grams per kilogram of body weight. In the other group, it was zero in the more than usual and usually adequate protein intake, so those lesser-amount groups. You have to have enough protein, but you also have to have the other nutrients that are going to be there too, because just enough protein is not going to be the only thing you need there.
Calcium and how it relates to bone health
Ari: With that in mind, let’s talk about calcium consumption and dairy, specifically. This is another controversial area where… since you and I were little kids, we saw commercials on TV saying how consumption of dairy is so important for bone health. Yet, if you are in some of the vegan and vegetarian communities, you might encounter people who are saying consumption of dairy was actually linked with decreased bone density and things like that, and there are some studies that have shown things like that. I’m curious what your interpretation of the body of evidence on that topic is, as far as dairy consumption and bone health.
Kevin: I’m not a proponent of “drink a bunch of milk,” I’ll start with that. I’m not a proponent of “drink a bunch of milk,” but I will start with dairy is a rich source of calcium. That’s a fact. A little over 30% of the calcium in dairy is absorbed. If dairy is part of somebody’s plan and dietary approach, cultured and fermented dairy is the kind of dairy you want to be incorporating.
That’s your kefirs and your yogurts and things like that, because you’re not just getting those bioavailable nutrients, and it’s more than just calcium at that point, but you’re also getting beneficial bacteria, beneficial yeast too. Whey protein, if somebody can tolerate it, if you can tolerate that as part of your plan, that could be a helpful addition. If you’re somebody that has an autoimmune disease or you’re trying to improve some other health condition, you may test that and realize it’s not going to be the right thing for you in that moment.
Let’s even just shift away from dairy for a second and talk about where else can we get calcium from that could actually be helpful for us. We already know a little over 30% of calcium in dairy is absorbed, edible bones are probably very similar to that. That’s your salmon, your sardines, your mackerel. You can go get canned fish, and when I say “canned,” nobody wants to eat out of a can, I can tell you those bones that are in there, they’re going to be really soft, almost melt-in-your-mouth.
I know that doesn’t sound appetizing, fish bones melting in your mouth, but they’re not going to poke you. What’s great about wild sockeye salmon bones, sardine, mackerel is those bones don’t just contain calcium, they contain all the other nutrients and factors and things like that that your bones need in the right proportions. How perfect is that? It’s nature’s perfect food.
Then we’ve got the addition of protein that’s coming from the fish, and then we have omega-3s, the dampeners of inflammation. That’s an awesome one right there. Then we have 40% to 60% of the calcium in most cruciferous vegetables is absorbed, which is great. That’s your broccoli, your kale, your bok choy, arugula. Gosh, arugula is one of my absolute favorite leafy greens. It is a great source of bioavailable calcium.
I don’t like plastic clam shells that are in the stores, but if you’re looking at one of those, and you sauté that down into a small portion, that’s got about 200 milligrams of bioavailable calcium in it. It’s one of probably the last remaining bitter foods in most of our diets, which is going to be great for your liver health, for bile production, and for your digestive system too. I absolutely love arugula. If you can incorporate that one, go for it. The other thing I like about…
Ari: It’s also one of the richest foods in nitrates, which allows for nitric oxide, which is critical for circulation and microcirculation. I’ve been doing a deep dive on that lately.
Kevin: That’s great.
Ari: Microcirculation, I think, is critical for so many issues, and I am certain that it’s critical for bone health as well. Interestingly, I will say that one of my go-to meals that I prepare for myself when my wife is not making much more elaborate and delicious meals for me, is I take a big handful of arugula, just pre-washed arugula. I take a big handful, throw it on a plate, put some sardines on it, and put some high-quality dressing on it. Maybe throw some leftover potatoes or something like that on there, sweet potatoes. Sardines and arugula, for me, is a meal I have probably every other day.
Kevin: Oh, that’s a staple. Same here, staple for me. Sometimes, I’ll use that Primal Kitchen dressing, that could be a great one. It’s easy, too.
Ari: Hey, stop copying me.
Kevin: It’s an easy one. What I realized is you don’t have to be perfect at this. As long as it’s sustainable, and you can make it work for you… you and I are sitting here just talking about how we both eat the same food almost every other day and we have never talked about this before.
Ari: And it’s easy.
Kevin: It’s nourishing, so it’s great. Those are going back to this, I’m not drink a bunch of milk fan. They’re great sources of calcium out there. If you’re going to incorporate dairy culture mented, and it doesn’t have to be cows, milk, sheep, goat, camel. There are other great sources that have less inflammatory proteins and even better nutritional profiles in some cases too.
Ari: Right now I’m in San Diego. There’s a company here that started selling some raw milk products at the local health food store and they have a raw goat milk kifer that I’m in love with. I used to many years ago I used to go to goat farmers in the area and just buy goat milk from them because it wasn’t even legal to sell raw goat milk but now, fortunately, laws have changed and so you can get raw goat, milk products and raw goat milk kifer and it’s awesome and it’s delicious.
Kevin: I actually got camel milk for our kids recently just to try it out and see it. They didn’t really know the difference, so that was good.
Ari: I would like to get camel and milk to the company I’ve seen selling it’s ridiculously expensive for very small quantities.
Kevin: It’s very pricey, yes.
Ari: I better be doing a lot of good stuff in my body for those prices.
Kevin: I know.
How you can optimize your bone health
Ari: [laughs] What else did I want to ask you? There was one more question I had on something related to that. Maybe I’ll come back to it. Let’s talk about the bone healthy plan looks like as far as what do we need to be doing on a daily basis or a weekly basis in order to maintain optimal bone health, take us through the list and some of your top strategies and maybe throw in a little hack or two somewhere in there.
Kevin: If we were to zoom out and look at a stronger bones plan, what does that look like? This is the stuff I walked through in depth and at length, but I’ll synthesize it down here. The first step you have to identify and address root cause issues of bone loss. If there are things that are damaging your bones or contributing to bone loss, you have to know what those things are actually when you go get that bone density scan… Remember if you haven’t gotten it, go get it. Then once you get it, that bone density scan is not telling you right now, if you are still actively losing bone. How do you find that out? You go get a test called a serum CTX or a CT low peptide test.
It’s a blood test and that test looks at the activity level of cells that are breaking down bone. If that activity level is really high, that can be an indicator of active bone loss and a root cause issue that needs to be addressed. There’s also the NT low peptide and urine NTX test. You’d get the second urine of the day for that. Those are two of the bone resorption tests that you would look at, but you also want to look at formation too. There’s a test called the P1NP, procollagen type 1, internal pro peptide’s most sensitive marker for bone formation and you always want to balance the two of those things and get them at the same time.
That gives you a great picture at least initially of what’s going on inside your bones at this point in time. Start there, then you have to make sure you’re getting the right nutrients to support stronger, healthier bones through diet, through digestion, through absorption. You have to make sure that you’re taking in the right nutrients and the right amounts that you’re actually absorbing those nutrients and those nutrients are making it to the cell level. All three of those things have to line up.
Unfortunately, what I see even when people are eating healthy and they’re doing the supplementation stuff, they might not be hitting layer one. It’s hard for the rest of those things to align downstream. If you notice things in your own digestive health that are off small intestinal, bacterial overgrowth candida, low stomach acid, or maybe you feel like you’ve got too much stomach acid and some of those other indicators, then you need to do a little bit more evaluation there to get to the root because of what’s going on and address those things.
Then we need to focus on building. You need to build strength, the body strength, the mind strength, the bone, and you need to do that in a way that prevents fracture and injury. Building strength, the body exercise plays a massive role in your bone health. You need two different types of stimuli for your bones. You need muscle pulling on bone and you need impact the most effective interventions they’re going to use one or both in combination. What happens is you’ve got this mechanical signal.
That’s sending a chemical signal. That’s telling those bones to become stronger. A lot of times most people are told, Hey go do some weight bearing exercise. I can tell you not going to be enough. It’s great for your daily health. I would say still incorporate that into your plan, but do not count that as your only form of exercise, especially if your goal is to improve your bone strength it could maintain, it could help you maintain your bone strength, but it’s not going to help you build really especially if there’s still something underlying.
Do incorporate weight, bearing exercise by weight bearing anything that your muscles and your bones are working against gravity to keep you upright. Anything that’s on your feet. That’s placing that stress on the bones. That’s going to be good thing. Running, jogging, hiking, gardening, playing tennis, soccer with the kids or grandkids whatever those are all weight-bearing.
Then also keep in mind what are the non-weight bearing things that you’re doing and are those making up the majority of the activities that you’re doing. Cycling, kayaking, swimming, are those the only things that you’re doing for exercise, because those are non-weight-bearing exercises and that’s not going to place the stress on the bones that we need. It’s not to say that just because those things are not placing the stress on the bones doesn’t mean we shouldn’t ever do those. If you enjoy riding your bike and it makes you happy and it reduces your stress, ride your bike. If you enjoy kayaking, I freaking love it, go do it. Swimming, all that stuff, great, but don’t count it as the only thing.
You have to incorporate the next thing I’m going to talk about, which is muscle and strengthening exercise. You have to do it at an intensity. The studies that show the greatest effects from that 5 to 10 rep range that you have to do it at that an intensity that’s actually going to have the desired effect that you want. You could use heavy resistance bands. You could use free weights. You could use barbells and things and how to use those things and the major compound movements, the squats, the deadlifts, the overhead presses, those movements. Those are movements that are really going to be helpful.
Now, just from this conversation if you already know how to go to those exercises, please do not go to YouTube, watch one video and go start cranking out five to 10 reps of dead lifts. Please don’t do that, probably not going to be the best thing for you. [unintelligible 00:48:07] get someone to be your buddy [unintelligible 00:48:09], evaluate your movement patterns. Then once you do that you’ll be off to the races there.
Then the other thing is you need to sleep well. That’s the time for your muscles and your bones and all these things to repair. It is pretty well documented. If you have poorer sleep, it will reduce your bone quality. That’s one of the biggest things that you can do is start getting some better sleep.
Ari: Beautiful. Last question, I actually remember the one that I want two more questions. I remember the one I wanted to ask you before. Are you aware of any research around stem cell activity and bone health? Is there a link between doing things which are stimulating the release, the proliferation of stem cells and maintaining bone health?
Kevin: I actually just did an interview on this recently with someone where we talked about stem cells and bone health and while there aren’t any human studies, yet there were some promising animal studies that showed there may be some benefit there. I think the more research is going to have to come out on that and obviously just from this conversation, I can’t make a statement that’s going to be an effective intervention for that but at least from a clinical perspective too, I think it could be helpful, but I we don’t know yet. That’s probably the safest way to answer that question.
Ari: The last question I have for you is, are you aware of any more advanced technologies, things like red light therapy things like post electromagnetic fields or anything along those lines that has been shown to be effective in helping bone mineral density?
Kevin: Yes. PMF, Dr. Pollack, he’s one of the leading people in that whole PE [inaudible 00:50:11] vibration plates. A lot of times people come to me and they ask me about these different modalities, vibration plates, like the power plate, or Marodyne or something like that, or PMF mat, those things can be helpful and they can be a compliment, but a lot of times people start with those things.
They come to me and they say, I got this single supplement, or I got this vibration plate. I’m like, great. Do you know if we have addressed your root causes? We’re still having diarrhea every day, or we’re not sleeping at all at night. I can tell you that, the investment you would make in those things is not going to do what it’s intending to do, until you get the other pieces in place.
Ari: Beautiful. This has been awesome, Kevin, I’ve really appreciated this. I think you’ve given a lot of value here, and thank you so much for sharing your wisdom with my audience.
Kevin: Happy to.
Ari: Where can people follow your work or get in touch with you to work with you one on one? I don’t know if you offer that as a service, but let us know where people can can reach you.
Kevin: Yes, for sure. You can always find me over at bonecoach.com. We’re on all the major social channels, YouTube, Instagram, Facebook, Tik Tok, all that stuff @bonecoach. What I’m going to do for you and your audience, Ari, is I’ll give your audience access to my free Stronger Bones Masterclass, maybe we can link this in the show notes or something…
Ari: Yes, absolutely. We’ll put it at theenergyblueprint.com/bonecoach.
Kevin: Awesome. What that’s going to have in it, is it’s going to walk through in more depth that three step process that I talked about, to start building stronger bones, addressing your bone loss, getting on the path to improvement. Beyond that, we’ve got coaching programs, we have a highly credentialed team of experts, got about 14 people on our team that work with people, specifically, if they’ve got issues with osteopenia and osteoporosis and need to improve, we can help you get there. We’ve helped a lot of people at this point. That’s about it.
Ari: Awesome. Thank you so much, Kevin, and thank you for the gift to my audience. I appreciate that, very kind of you.
Kevin: Yes, absolutely.
Ari: Yes, awesome. I look forward to the next conversation.
Kevin: Sounds good, Ari.
Show Notes
Why Kevin got into working with women on improving their bone health (01:07)
What is osteoporosis and osteopenia (04:35)
The root causes of bone density loss (12:08)
How medication affect bone health (16:12)
Environmental toxicants that affect bone density (19:33)
The role of nutrients in bone health (22:38)
How to asses bone quality (27:43)
Does protein consumption harm bone health? (31:35)
Calcium and how it relates to bone health (35:00)
How you can optimize your bone health (42:00)
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