In this episode, I am speaking with Margie Bissinger who is a physical therapist, integrative health coach, author, and happiness trainer. She has more than 25 years of experience helping people with osteoporosis and osteopenia improve their bone health through an integrative comprehensive approach.
Table of Contents
In this podcast, Margie and I discuss:
- Why paying attention to bone health is critical for quality of life
- The root causes of osteoporosis and osteopenia
- The surprising impact your mood has on bone health
- The best and worst foods for bone health
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Ari: In this podcast, I am speaking with Margie Bissinger who is a physical therapist, integrative health coach, author, and happiness trainer, and we are talking all about bone health, how to improve your bone health. She has over 25 years of experience helping people with osteoporosis and osteopenia improve their bone health through an integrative comprehensive approach. She’s the creator of the Happy Bones, Happy Life online program as well as the host of the podcast by the same name.
She’s a wonderful expert in this area, a wealth of knowledge, and this is an interesting conversation given that she also has expertise around happiness, which is something we also talk about in this conversation and an area I’m always interested in because I think what could be more important to study for us all than happiness. Happiness and health are at the top of my list certainly. Enjoy this conversation with the wonderful, brilliant, bone expert, Margie Bissinger. Okay. Welcome to the show, Margie.
Margie: Oh, well, thank you so much. I’m so glad to be here.
Why you should pay attention to your bone density
Ari: We are going to be talking all about bones. You are an expert in bone health. Now, this is not the sexiest of health topics. This is not one of the things that people really wake up in the morning and get out of bed thinking, “Man, I really need to make sure I have healthy bones,” but it’s one of those things that once you don’t have healthy bones and you’ve got osteopenia or osteoporosis, all of a sudden it becomes a big concern. Why don’t you tell people why they should be concerned with having healthy bones before they get a diagnosis of having poor bone density?
Margie: No, it’s such a good question because we’re so concerned about other things, heart disease, and we take care of so many other issues we prevent, but nobody really thinks about their bones until they’re older and they either get a diagnosis of osteoporosis or osteopenia or they fall and have a fracture and break a bone. The problem is it’s really common. In the United States, one in two women and one in four men over the age of 50 will have a fracture due to osteoporosis in their lifetime. That’s huge.
In other countries, it’s better worldwide. It’s one in three and one in five, but still, that’s a huge number. It’s very prevalent. The problem is the consequences of these fractures are devastating. If someone has a hip fracture, 24%, actually, it’s over that now, will die within a year after that hip fracture due to complications and then a huge percent will also either they’re just never going to be independent or completely destroys, really changes the quality of your life.
The good news is that there’s so much that can be done to prevent this, so nobody has to be one of the statistics. It starts in childhood. I mean it really starts– We have our peak bone by age 18 in women or the most bone we’re going to get, 85% to 90% of our bone by age 18 in women and 20 in men. This starts way back, but all through life there are things we can do and the things you do for your bones help the rest of your life as well. It’s not something separate.
Ari: Are there statistics on the rates of osteoporosis and osteopenia from, let’s say 50 or 70 years ago compared to what they are now and if so, what do those statistics look like?
Margie: Yes, that’s an interesting question. They really don’t have those because they didn’t start, well, the evaluations that they do now. Here’s the thing, they didn’t have the medications. People weren’t really paying that much attention when they didn’t have drugs to treat it. Unfortunately, in conventional medicine, it’s really sad because you will get a diagnosis of osteoporosis and they’ll say vitamin D. They do work on vitamin D, calcium, and they’ll say exercise.
They’re not specific, but typically, if you have a certain number and all that number means on the bone density, they look at your bone density compared to a 30-year-old and how many standard deviations away. It’s just really a number. It only talks about density, not quality. Anyway, then they’ll put you on a medication without looking at root causes without seeing what’s really going on. There’s so many other things that can be done. That’s the exciting part.
Ari: Okay. I think what I was trying to get out with that question and it’s a shame we don’t have good statistics, but I’m trying to understand the prevalence of this condition over the last few decades. Is there any good data that we have that can speak to that? Is this a condition that’s been relatively constant throughout the human species? Do we have evidence that this exists in hunter-gatherer peoples? From the remains of archaeological digs or from studying modern hunter-gatherers, or is this something that is uniquely in modernized Westernized humans?
Margie: No, that’s such a good question. Certainly, when they look at cultures that are hunter-gatherers or different societies, they are at lower risk, or people who are active throughout life and hunter-gatherers would be that way. That’s very interesting in terms of have they actually looked at their skeleton in detail and say that it’s gotten worse.
I mean it is more of an epidemic now, but people are also living a lot longer, so they’re really seeing older age. I do think it did exist, but when people were more active, the diet was so different back, there wasn’t all the processed foods. I think the level of activity, as well as the nutrition, and people didn’t have all the gut issues and all the root causes of osteoporosis. They haven’t really done the longitudinal or any of those studies like that, but certainly, in those cultures, there was less osteoporosis and they found that those activities increase bone density and there is a difference.
The most common root causes of osteoporosis and osteopenia
Ari: Okay. What are some of the key root causes or maybe not some but maybe take me through a good comprehensive list of the root causes of osteopenia and osteoporosis?
Margie: It can start from childhood, and that’s an interesting point because when someone gets a number, is it that they’re actively losing bone? Because inflammation is a root cause. When there’s anything that’s causing inflammation in the body, whether it’s dysbiosis with the gut, whether it’s autoimmune issues, it can also affect the bones. Just like it can affect different body parts, the bones can be affected. Any type of inflammatory process can be a root cause of osteoporosis.
However, it’s important when people get diagnosed, are you actively losing bone or were you a child that didn’t exercise, you didn’t have a good diet, or you had eating disorders? It can be that you just never developed that much bone growing up and so it’s not that you’re actively losing, it’s just you don’t have as much.
It will matter what it is, but in terms of anything with inflammation, anything with the gut, people who have issues whether they’re– any type of thing going on, Crohn’s or any of those issues, irritable bowel, all of those things where there is inflammation, they may not be absorbing their nutrients, and the bones need nutrients. If they’re not getting the micronutrients, you could be losing– You’re just not having the material for strong healthy bones. Any type of gut issue like that.
They’ve even found gut bacteria. There’s a correlation between bone density and the diversity of the microbiome. They’re finding such a relationship with the gut and the bone connection. That’s a big issue. In terms of, again, you either didn’t build bone because you weren’t active, you didn’t have a good diet, or you had inflammation or different medication. Steroids. Steroids significantly reduce bone. A lot of people whether they’re on inhalers or whether they’re on–
Ari: You’re talking about corticosteroids-
Margie: Yes. Corticosteroids.
Ari: -as opposed to what most people think of when they hear the word steroids which is more like bodybuilding, anabolic-androgenic steroids.
Margie: Yes. Corticosteroids. A lot of people are on that whether they’re their inhalers or for different conditions throughout life will certainly reduce bone density. As well as one of the biggest ones is the proton-pump inhibitors. So many people have acid reflux and heartburn and people are on this for a long period of time.
It’s a huge risk factor because it reduces stomach acid and we need that stomach acid to break down the proteins and the nutrients for the bone. There’s a big correlation with people who’ve been on proton-pump inhibitors, any of those, the Nexium, the Prilosec, any of those that are reducing stomach acid and osteoporosis as well as even- people aren’t told- even if they are on medication such as antidepressants which are so prevalent today, that can also affect bone density and bone quality. Medications, anti-seizure medication, thyroid, too much thyroid hormone, hyperthyroidism, that can cause problems with osteoporosis.
There’s the gut inflammation then there’s also inflammation if you have a sensitivity, let’s say, to gluten. Celiac disease is known as a big risk factor for osteoporosis, but just gluten sensitivity or weak sensitivity also. I see this all the time where people go off gluten and not only does their bone density improve, but then their arthritis improves and so many of the other conditions.
I’m trying to think what else I miss. Also hormones, for women, a lot of times they’ll lose bone. That’s common after menopause. That’s where it accelerates bone loss. A lot of times if people are working with bioidenticals or different things that can reduce or prevent some of the bone loss or just stress. Stress is the body’s own cortisol. It increases your body’s own inflammation. The cortisol has been shown to reduce the activity of the bone-building cells. How we react to stress is a very big issue, and I see this all the time. It’s all the factors. It’s multifactorial. You need to really look at everything and just being a couch potato.
The bones respond to the forces placed upon it. People who are inactive, that puts them at much higher risk for osteoporosis.
Ari: You said in passing there, you gave the example of someone who didn’t build a lot of bone density growing up as a child. Can you explain that more in depth? What would be the reasons for why they wouldn’t build enough bone density?
Margie: Okay, so there’s a couple. Activity is a big thing and it scares me with our kids today who many of them are just more sedentary or they’re working on the computer and they’re just not getting out. Because the way that bones builds and gets strong is through forces placed upon them. What that is in terms of jumping, forces through the bones against gravity. Being on the jungle gym, jumping and doing all those activities that we did, that kids do in just playing is giving forces that say, “Hey, we need bone here.”
Because they’ve done studies showing here when people are on bedrest or they’re not exercising, they lose bone. On bedrest you can lose almost 1% of your bone per week. For kids, there’s a huge difference in activity levels. They’ve shown tennis players, their one arm has much higher bone density, gymnasts have much higher bone density than other people.
We need that, we need those forces as we’re growing really to develop normal bone. That’s what we want. It’s the one thing, the exercise and the activity. Unfortunately, there are kids who just don’t do that. Then the second thing is the diet. You need the nutrients. We need calcium, we need magnesium, we need all the, from the rainbow. We need those bone-building nutrients as well as protein, good quality protein and what blocks the absorption of many of those nutrients is sugar and the junk food. I think depending on the diet, if you’re not getting the nutrients, you’re just not having the building blocks for good healthy bones as you get older.
Ari: If you were going to say that there’s one dominant factor in explaining the epidemic of bone density issues, what would you say is the single most important factor? Would it be nutrition or would it be what you were just talking about, these forces acting on the bones?
Margie: I have to say it’s both. I really can’t say it’s one versus the other because you can improve bone density through doing both. Exercise, as a physical therapist, I’ve been working with this for over 25 years and there are people that don’t change anything. I’d like them to change everything and just increase their exercise and they can improve their bone density. You can certainly lose bone density if you’re not exercising. I have to say, it’s a combination. I think both can really be very, very, it can be very negative and both can have effects.
The key thing is you have to get to the underlying cause. If you have inflammation from some process going on, let’s just say gluten or celiac, you have to deal with that because you can still be losing bone and then, there’s even other issues like parathyroid tumors that can happen that. One thing I would say, I’m sorry, I can’t say one if there was just one to do because– and the same thing even with stress. I just like to do a combination of everything because you really need that for a good comprehensive program. You really need the mind, body, spirit and the exercise, nutrition as well as reducing stress.
She connection between bone health and mental health
Ari: You’re a certified happiness trainer in addition to being a bone health expert and a physical therapist. How would you explain the tie-in between our mental states and our happiness and bone health? Is there a significant tie-in, is there evidence that speaks to this? Is there maybe evidence around depression increasing the propensity for osteopenia and or osteoporosis?
If so, do you think it’s mediated more by the mind-body connection in the sense of being unhappy leads to increased cortisol, which is, as you said earlier, decreasing these bone fibroblasts and bone production? Or is it mediated maybe more by the fact that depressed people are less likely to be physically active or what other dimensions of maybe the happiness bone connection have you explored?
Margie: Well, first of all, in the research, there is a connection between people who are satisfied with their life and happier have increased bone density. They’ve made a correlation with that. In terms of the research, in terms of stress, they have shown that there’s actually been studies showing that increased cortisol has reduced bone density, also even social stress has reduced bone density. There have been studies in humans as well as animals showing this correlation with the cortisol and reducing the activity of the osteoblasts. There is the research.
What I’ve seen in my experience is, I’ve started– Oh gosh, this is back almost over 35 years ago as a physical therapist, I had gone through a bad situation and my patients, I was working with chronic pain and they were telling me, “You’re so happy.” I thought, gosh, if they only knew what I’d gone through, they wouldn’t say that. It hit me how happiness was an inside job and it wasn’t based on your external circumstances.
I just started teaching, I said, “What the heck? They’re so unhappy. They were just like the most miserable people. What helped me, and I just couldn’t get over how chronic pain got better faster, it was just amazing how back pain, neck pain, TMJ things got better so much quicker than traditional physical therapy. It’s been part of what I’ve done for as I said, over 35 years, I’ve been part of everything.
I think it’s a combination. I think yes, there’s the scientific with the cortisol and when you’re happier, you have different hormones going on in your body as well and the reduced stress. I also do think sure, when you’re feeling happier, you’re much more likely to be involved in an exercise program. You’re much more likely to be aware of what you’re eating and eating food that’s better for your body as well as just doing all the things that are going to help build bone.
I think it’s a combination of both. I have seen just, again, from teaching this for so many years that this piece of it, to me, it’s foundational. It’s not in lieu of, but once you get this piece down while you’re doing other things, who doesn’t want to be happier? A lot of times people think it’s selfish to be happy, to work on your own happiness. It’s just the opposite because it’s a ripple effect. When you’re happy, your family’s happier and then they bring it out to the world. The world right now can use as much happiness [chuckles] as we possibly can have.
There is a correlation and it’s fun for people to work on as well because everything gets better. I always say osteoporosis is an opportunity. It’s an opportunity to look at your life and see what’s missing. You get this diagnosis, you might feel fine, and all of a sudden you’re panic stricken. “Oh my gosh, I’m not going to be able to enjoy my grandchildren or go hiking or do anything because I’m going to fall and break my– it’s just scary. Instead, if you look at it, “Okay, let me look at my body, what’s going on?” It’s a message. “What’s causing my bones to break down?”
You figure out what’s going on and you take those steps, people get stronger when they get very strong and that’s very empowering and they look back and it really can be a blessing in disguise.
Ari: I’m curious, I almost can’t help myself because it’s so unusual to talk to somebody who has formal training in the topic of happiness. I would love if we could maybe take a brief detour and explore that.
The paradigm of human happiness
Ari: This is kind of a weird thing in my opinion because it’s like what could be more important for humans to study than happiness? Yet we rarely study happiness, and the field of happiness studies, in the context of human history, has only recently even become a thing where it’s possible now to get degrees, take college courses, and get degrees in that field in positive psychology and in specifically in happiness studies now. There’s a weird thing going on there. For decades we’ve put people into calculus courses but have never given them a course on how to be happy.
This seems very backwards to me. It seems like we’ve got our priorities very mixed up if we’re forcing everybody to take advanced maths courses using very bizarre calculations that unless they have a few very specific careers, they will never see those equations again the rest of their life and neglecting to study something that is the core of having a good life. Human health, human happiness are I think in my opinion, certainly the top three or five most important fields that we could possibly study. Having said that, you have this formal background in happiness studies, what have been some of your biggest insights? I’m curious maybe on a big picture level, what your paradigm of human happiness looks like.
Margie: Oh, so my paradigm of human happiness is that you wake up, you’re excited about the day. You’re looking forward to the day, and you fill your day with things that make you feel expanded, make you feel joyful, and when life isn’t easy. Everybody has their ups and downs, and when you have your downs, you can ride the waves, you have that resilience. The thing about happiness, a lot of people are turned off because they think what happiness isn’t. A lot of people think is, oh, you’re walking around in this fake smile across your face all day, that’s not it at all.
What it is, is a deep sense of peace and well-being regardless of your circumstances. I like to put another piece to it also, it’s to live your life in color because so often people are just sort of, “How are you doing?” “I’m getting by,” but we’re not meant to get by, we’re meant to thrive. The interesting thing is they’ve actually done research on what’s called the happiness set point, and everybody has this happiness set point. It’s like the thermostat, everybody’s at certain level and not everybody’s the same, but what they found is that– and what makes that up. Again, this was studied 40– what is interesting is most people think it’s circumstances, that only makes 10%. 50% is genetic.
As you and I both know now with epigenetics, we can affect the expression of our genes. We can even affect that, but 40% are your habits. You have the ability to really increase your happiness set point and that’s what’s so exciting. There’s just so many components to it, again, there’s really– like when I teach. I teach seven different areas of the set point being the foundation, your thoughts.
Many of us have negative thoughts. What can you do about that? Are you living from the heart? A lot of people in terms of forgiveness and gratitude, who do you surround yourself with? Are you living with purpose? Do you plug into spirit or connect to something greater than you are? There’s many different relationships there. There’s many different pieces to the puzzle, but it’s so exciting because there’s so much that can be done and this is where I’ve seen real miracles throughout my life. Again, as you said, we focus on so many things but what’s really important in our life, you want to enjoy, you want to have joy in your life.
There’s no reason to just get by, and so I agree with you. I think more people are becoming aware and realizing there is more– that why not or that they can– I think people don’t realise that they can actually improve this and that they really– there are the concrete steps you can take so that– part of it is helping improving your health. If you’re not exercising and eating sugar all day, that will affect your happiness as well.
The #1 food that harms your bones
Ari: Got it. That was excellent, very, very insightful. I love your brief very high level summary of human happiness there. Thank you for indulging me, let’s loop back into bone health now. Let’s talk about nutrients. Nutrition and maybe some specific foods and specific nutrients that are uniquely beneficial for bone health, or you could also maybe speak to the opposite direction, uniquely harmful to bone health.
Margie: One of the things uniquely harmful is sugar. Sugar just reduces the absorption of magnesium, of calcium and it’s just an anti-nutrient. Definitely, so you want to get rid of sugar. For so many people, and I see because I have people get tested, I see so many people with issues with inflammatory foods but gluten for some reason. I just see that when people have an issue with gluten, it a lot of times it affects the inflammation and they’re not absorbing the nutrients and they tend to have osteoporosis or osteopenia.
I see that as a very inflammatory food for many people. In terms of what’s been very interesting in the research and I don’t think people know about this, something so important is getting enough protein. Years ago they felt, oh, these high protein diets or too much protein is going to cause calcium to be leached from the bone. It’s just the opposite, the research now shows we need enough protein and we need more than the RDA, the recommended dietary allowance, what they say.
They’ve done research on this and the people that have increased on the studies bone density, they have higher levels. One formula, there’s a couple you can use but you can just take your body weight divide by 0.5, 0.5. That was one that they used in some of the research studies. It’s more than the RDA and a lot of times people aren’t getting the protein especially as they get older, so just very important to make sure you get good quality.
I’m big into organic grass fed and I’m wild, and if it’s a protein powder, have it organic and whether it’s vegetarian or whether it’s not, but the key is the quality and getting enough protein, that’s found to be very, very important. Besides that, the one that everybody worries about and the big thing everybody is so concerned about is calcium. The problem I’ve found is that people are getting too much calcium because their whole life, they’re like drink milk, do this, do that. Plus then the doctor says, “Oh, okay, take a calcium supplement.”
More is not better, and so in the United States, they recommend anyone over 50 gets 1,200 milligrams. In other countries it’s less, and so what happens is people are getting some in their diet, they’re taking more. Now, let’s say they take 1,200 milligrams as a supplement, they’re getting too much. There have been some research not conclusive, but showing that this extra calcium isn’t good. It goes places we don’t want as the arteries or kidney stones, and so we don’t want too much.
Why eating more calcium may not treat osteoporosis
Ari: Is that truly a function of too high of calcium intake or is it more a function of calcium intake in an imbalanced way relative to some of the fat soluble vitamin D and K and A and other minerals like magnesium and zinc and things like that? If you’re just taking calcium supplements in a way that’s not in harmony with those other nutrients like would be common in the context of getting calcium from your diet, but if you’re taking in a supplementary way as isolated calcium, is that the main issue or do you really feel like it’s just too much calcium overall?
Margie: No, I completely agree with you, but that’s never been studied. That’s my exact feeling, exactly what you said. That’s such a very good point because most doctors will tell people take calcium, and they do check your vitamin D level. Most of the doctors will look at vitamin D and depending on what it is, have you increase your vitamin D. However, what they don’t put in is that vitamin K2. Vitamin K2 takes that calcium and makes sure it goes into the bones and sweeps it out of the soft tissue. I think that’s something that’s really missing, now you can get K2 in some food.
There’s a Japanese food called natto and people in those parts of Japan where they had natto they have significantly reduced incidents of osteoporosis and fractures. It’s pretty slimy, it’s not that tasty. Most people can’t get enough from their food, so it’s a supplement that I recommend pretty much for almost everybody. The magnesium is very important that you have the whole orchestra so that you can absorb the calcium but still you don’t want high doses of calcium, there’s no reason to people and again, we don’t know because they don’t know the research.
There were just studies that had showed some cardiac issues and other things when people were taking too many calcium supplements, like high dose calcium supplements. Again, it’s not a hundred percent conclusive. Even the Bone Health and Osteoporosis Foundation says get it from your food and only, only take a supplement if you’re not getting enough in your food. It’s always food first with calcium, but we need those other nutrients. You need the entire symphony of nutrients but the K2 is one that’s missing and I think it’s absolutely critical.
Ari: What does K2 do? I think for people unfamiliar with this topic, it will be extremely important to understand the role of K2, vitamin K more broadly, but K2 especially and also in light of the fact that many people, particularly in this COVID era, are using high dose vitamin D. What is the role of vitamin D in terms of bone health and what is the role of vitamin K in bone health?
Margie: Okay, well, vitamin D helps with the absorption of calcium just to make it simple. It’s a complex situation with vitamin D and your parathyroid but basically it increases calcium’s absorption, so we need the vitamin D. The vitamin K2, there’s two proteins. There’s osteocalcin, it activates, so it activates osteocalcin. What that does, the osteocalcin makes sure the calcium goes into the bone, so that’s part one. Part two is it activates something called GLA matrix. What that does, that protein that takes the calcium, sweeps it out of the soft tissue, places it shouldn’t be so that it’s not– and so together it’s doing just what we don’t want to have.
It’s making sure the calcium gets where it needs to go as well as getting it out of the soft tissue. There’s two types. There’s a MK-4 and an MK-7. There is some controversy with what’s better and I have the summit happening and the doctors give different– lot of people talk about this K2 because it’s so very important but there’s research on the MK-4 showing significant reduction in fractures. That’s very important to focus on. Instead of what’s your bone density, is this reducing fractures? Because that’s what we’re so worried about.
The study of the MK-4 which is you have– MK-4 is a much shorter half-life so it doesn’t last very long in your body. It’s a little harder to take on a regular basis. The studies showed 45 milligrams taken so like three– it has such a short half-life, for it to be in your system, you need to take it like 15 milligrams, three times a day ideally versus the MK-7 has a much longer half life, a few days. It’s much easier to take. The MK-4 has shown the fracture reduction, the MK-7 is shown reduction in bone density and it’s not that it hasn’t shown fracture reduction, they just haven’t done the same studies or used it for the same.
Both are good. My feeling is that a lot of the doctors, some– people recommend both. You can do both as well but they’re both good. The point is you need the K2. Now a lot of people confuse it with K1. K1 you’ll get in your leafy greens and most people if they’re eating a good diet, will get enough K1 but K1 is also involved in blood clotting. Oftentimes if someone’s on Coumadin or if they’re on some type of blood thinner, you really need to talk to your doctor before you increase K1.
K1, they haven’t really found– it’s not the same as K2, but it’s still good and some studies early on showed people who had more lettuce or in different studies who had more K1 didn’t have more bone density, but they had more flexibility. If they fell they didn’t fracture. It’s all important but the K2 is that one that I think is so critical and so many of the experts on the summit make a very big deal that that’s a huge part of their program in terms of people who have been dealing on an integrative approach with osteoporosis.
Dr. Millman, Dr. [unintelligible 00:34:31] they both feel that and they both have been using MK-4. Now Dr. Millman is saying she’s open more to K2, MK-7 as well because they’re doing more research. Anyway, a long answer for it but I think it’s so important and something that for some reason conventional doctors, I don’t know why, because there is research on it will just tell people D, calcium and they’ll say exercise, but they’re not specific in what type of exercise.
Ari: Yes, that’s a very big problem to just say take vitamin D and calcium and do exercise without getting specific. We’re going to get there in a second. I want to touch on nutrients a little bit longer. Let me ask you this. Are there any nutrients of great importance beyond vitamin D and K and calcium?
Margie: Well, magnesium I think is very important. Magnesium also helps get into the bones. In terms of the bone matrix, we talked about protein, but so the calcium is embedded in this bone matrix but what makes that bone matrix, what’s important is the protein, but vitamin C as well so I think vitamin C is an important nutrient. I also think collagen can be helpful for people because whether they get it from bone broth or take collagen, but there’s boron, there’s zinc, there’s biotin, there’s like a whole, folate is important. I think if you’re eating a good diet, I personally have people get a micronutrient panel because I think it’s so– when people want to do everything they can do, I’m a big believer in tests, don’t guess.
I want to see what’s lacking in their diet, what are they not having? All of those things can affect, boron. All of those things can affect the bones but again, the same– in terms of the research, the ones that have been shown are the K2 really and the calcium and the vitamin D. Even the magnesium hasn’t been shown exactly to correlate but we know it’s important. We know it has so many functions. That’s what I like to do. I like to have people get a micronutrient test and so we can see what’s missing in terms of their diet because a lot of times things are.
The best foods for bone health
Ari: Are there any foods that you would consider bone health super foods?
Margie: Yes, so I like the greens. The leafy greens to me are super foods. For example, collards, collards have like 265 milligrams of calcium. They also have magnesium, they’re packed with many nutrients so you’re getting a lot when you’re having the collards. A lot of people, that’s not part of their diet, collard greens but you can use it as a wrap. Just steam it and put it around a turkey burger or bean burger or you can saute it as well but it’s a great wrap in terms of putting all sorts of things in it. I love the leafy greens. I like collards. Bok choy is also one that’s high in calcium.
I think that has like around 150 milligrams. That’s another good one. Kale is also very good. It’s high in calcium as well. They have so many other components with the magnesium and there’s just many things when you take the leafy greens. What is interesting though is that with oxalates like spinach, some people think spinach is a great food for the bones. Well, it’s not because it’s high in oxalates and oxalic acid combines with calcium to make it an indigestible compound.
You’re not going to get the calcium from that, it becomes indigestible and there’s even animal studies now that are showing that with the oxalates it even binds to additional things to reduce the calcium. You have to be careful not to have a diet very high in oxalates and sometimes people can’t have dairy, which for a lot of people, as you know it’s very inflammatory and so they have very high doses of almond milk and different things and that could be high oxalate as well so you have to just be careful.
Ari: Some of the alternative milks have creatinine in them as well. Very inflammatory for the gut as well.
Margie: Exactly and so some other food though, I love sardines. Sardines, and I always like to get the wild kinds from a good source but sardines are great because they’re high in calcium as well as protein. Wild-caught salmon is good as well. There’s lots of things that are good in terms of nutrients or high in calcium, and they’re also beneficial for other reasons as well. I’d say those are some of my top favorites.
Diary consumption for bone health
Ari: Great. You touched on dairy briefly a couple of times so far. What exactly are your thoughts on dairy? Particularly given the obvious relevance to this topic given how much dairy and milk consumption has been advertised for strong bones over many decades and obviously, we have that. Then on the other side we have people in the vegan camp who are saying actually– They’ll say study is saying dairy consumption actually led to weaker bones and that all these studies over here that showed positive outcomes were funded by the dairy industry and are therefore bad science.
Seeing through these different kinds of either financial agendas or dietary dogma-driven takes on things, what is your perception of the scientific evidence on that topic?
Margie: Well, the interesting thing, with dairy I grew up in the milk mustache where everybody, every athlete was showing the milk mustache and you’re right. You must have your milk for strong bones. Well, they found in countries, there’s data that countries that have the most dairy consumption have the greatest incidence of osteoporosis. That certainly is not a panacea and it’s not something that is–
Ari: There could be a very obvious confounding variable there, which is that what those countries are– I would guess would be the United States and probably some other modernized westernized countries that have consumed a lot of dairy milk. Those countries tend to also be the ones that are more sedentary and eating a highly processed food diet and deficient in some of the nutrients that we’re talking about. I would see that as a confounding variable. Are there any interventional studies where they’ve maybe put people in high or low dairy consumption, maybe even women who already have osteoporosis or 60 plus years old and you consume lots of dairy, you consume very little, let’s compare five years from now. Any studies like that?
Margie: Not great studies. Nothing conclusive to that extent. There were some positive effects from dairy in terms of in the past and cheese and things like that and yogurt seemed to have better results. My take on the whole thing is certain people, and I see this a lot, dairy is inflammatory. Again, you can get tested also and see, but people know, so if you’re having full-fledged inflammation, many people have issues with the casein. Many people have issues with the lactose, they’re intolerant. I see this a lot. If it’s causing inflammation, it’s not going to be something that’s going to be helpful for your bones because the inflammation is something that affects–
There’s the osteoblast and the osteoclastic inflammation increases the activity of the osteoclast. The cells that actually break down bone. In that sense, the dairy is something for that person in terms– If it’s inflammatory, which I see a lot, I see that tremendous amount. That would not be good for that person. For some people, sure they can tolerate some dairy, but it has to be good quality. You know as well as I do that the regular dairy that’s not organic has so many hormones in it and there’s so many chemicals and it’s really unfortunate.
If people are having dairy, I always want them to have dairy that is organic, that’s from the pasture, and good quality. There’s not an actual answer in terms of great studies that showed the benefits of dairy outweigh the negative because they are inconclusive and we do need calcium and we know that, but we haven’t found that dairy really is the answer.
I know I’ve talked to a lot of pediatricians and there’s pediatricians I’m doing on my summit coming up and there’s a pediatrician as well and they see that it’s so inflammatory for so many of their kids. In turn they have to find other ways to get the calcium because it’s so important for your bones and not the dairy. Again, most of the people can’t– some can, but I see a huge problem that for many people it causes inflammation, which we don’t want.
Physical movement for osteoporosis
Ari: Okay, before we run out of time, I want to make sure that we get into one of the most important topics, which is movement and physical activity, exercise. I would argue, and I suspect you would agree with me, that even if you had the most perfect diet for bone health, even if you completely eliminated your psychological stress and were the happiest person in the world. If you did not subject your bones to lots of physical stress, physical forces acting on them, creating stress, creating tension and pressure, that you would still have very weak bones.
You need this physical stress present in order for your bones to have the stimulus to remain dense, to build density and to retain their density. Would you agree with that?
Margie: Absolutely. That was very well said. You can just look at the astronauts, they’ve looked at astronauts and that’s a big part of the research that they’ve done at NASA and they found that they lose significant bone because they don’t have the forces, they don’t have gravity, they don’t have the forces placed upon it. As I said with bedrest, people are losing almost 1% of their bone per week in studies. Absolutely, exercise is a huge, huge component.
Ari: This gets into something that is my biggest area of focus and passion right now is this is the subject matter of my next book on hormetic stress. This is one example of it. How subjecting the body to stress not only creates positive adaptations that confer health benefits but is actually necessary, is required for normal healthy expression. Our biology is designed to require certain stressors in adequate amounts consistently in order just to be normal in.
In other words, living in an environment that has a deficit of those kinds of stressors creates abnormal cell and tissue function. This is a great example of it with physical forces acting on the bones. Let’s get specific because we were mentioning how it’s a problem that doctors don’t get specific on this. You tell me specifically what types of exercise are the best for bone density?
Margie: Yes. Because it’s interesting because doctors will say, well walk. Walking has been shown to reduce hip fractures and balance is so important to produce fractures, but it doesn’t actually increase bone density. It’s really not enough. What they found that’s enough is impact. Again, depending on what the level of osteoporosis is you may change this. For people early on or just to prevent strong bones jumping jumping causes more bone to be produced because that’s the force against gravity, so anything where we’re getting impact on the bones. Now that’s one, or resistance training, strength training is amazing.
When we’re contracting a muscle against resistance, it’s like, hey, we need more bone here. They found it’s not the repetitions, it’s the actual force, it’s the weight, so they rather do eight to 10 repetitions that somewhat hard. They have this formula, versus 50 repetitions of something easy. You see that people are lifting two pounds forever, it’s not going to be enough. Just like you said, you need to keep increasing the weight so that it’s not easy. Your body has to work against it and that’s how it gets stronger. Strength training, at least twice a week has been shown in the research to increase bone density at any age. They did a study called the LIFTMOR study where they had people who had osteoporosis.
This was supervised. I wouldn’t suggest people look at those exercises and do it themselves, but they did show all ages increasing bone density people that even had fractures in the past and osteoporosis. The point is, yes, you can, but so resistance training, you have strength training at least twice a week and then weight bearing whether it’s dancing, jogging whether you’re getting the jumping even in people if they jump, they had studies showing jumping a few times just people jumping every day. A little bit of jumping, increased bone density. It’s just important for young people to play, to jump rope, to do things at all ages.
Even young mothers get so busy in their life, they don’t do these things and they’re not getting the forces on their bones and it’s not that hard to start a strength training program at any age and impact. Even high-intensity, different types of impact training’s good, but the research is the strength training as well as the impact and the weight bearings. Those are the two types of exercises that are most important. What I see typically is that people aren’t doing enough weight. They don’t keep increasing the weight.
Ari: Especially women. I was a personal trainer for many, many years.
Margie: Oh, so you know this.
Ari: A lot of time in the gym, a lot of time training women. It is extraordinarily common. I would say probably almost 99 out of 100 women who even– First of all, it’s rare for a woman to even approach weight training and start that. It’s becoming more common now than it was 10 or 20 years ago. Even among the women who hear a message like the one that you are giving right now and say, “Oh, well maybe I’ll start strength training,” Then it’s common for them to really not understand what strength training really is.
Also, there’s a common fear among women, I don’t want to get too bulky. Let me put those fears to rest because I can assure you it’s quite difficult to put on muscle mass. If it was a problem that lots of people were waking up with too much muscle mass from doing a little bit of weight training and going, “Oh my gosh, I have too much muscle mass. This is a real problem.” I would’ve run into this problem a long time ago because I’ve been weight training for 25 years.
In the absence of steroids, it takes a lot of work to put on muscle mass. It’s very difficult. It’s a very slow process. Apart from the rare, extraordinarily genetically gifted person who might put it on easier than the norm. Women in general definitely do not put on muscle mass easy. You do not get bulky by accident without busting your butt for years lifting heavy weights. I just want to emphasize this to your point to hopefully let women who are dealing with low bone density listening to this podcast know, lifting weights is extremely important and don’t be afraid of pushing into heavier loads, challenging yourself to actually lift some weights that are relatively heavy for you.
Don’t injure yourself. Obviously, don’t push beyond your capacity. Be slow and smart and systematic about how you begin and progress. The idea is not to forever be lifting the five-pound pink dumbbells on day one. Then a year from now, if I see you in the gym after a year’s worth of workouts, if you’re still lifting the five-pound pink dumbbells, you’re doing something terribly wrong. You’re wasting your time?
Margie: I just want to say one thing, two things actually. I couldn’t agree with you more. Absolutely, you’re right on the mark with that and it is scary. Two things. Number one, it’s so empowering strength training. You’ve seen this, it’s amazing when you increase your strength. I have 85-year-olds helping me move things because they’ve been doing it. It’s such a win-win situation.
Anyone that does have low bone density or osteoporosis, there is one precaution you need to take. They’ve done studies showing that rounding and forward bending increases the risk of fractures. Because right on the front of the vertebrae, on the front of the spine is where fractures occur. You don’t want to do any exercises that cause rounding. Not that you can’t do everything, you just do it with modifications.
You maintain the inward curve and you can do pilate, you can do yoga, you can do everything just without doing the rounding. You’re bending from the hips and knees, not the waist. There’s all sorts of things. My recommendation is to see a physical therapist. If you’re scared you get the diagnosis, it’s covered. At least in the United States, it’s covered by insurance. Just ask your doctor to get a physical therapy consult for someone who works with osteoporosis and they’ll just make sure, because you want to do things safely, that your posture is good, that you’re doing everything. They’ll get you started, so you don’t have the fear.
Then you can do just what you said. You can do the strength training and the lifting, it’s so powerful and so effective in increasing bone density. You’ll be older and you’ll just be so active and you’ll be so happy that you did this. [laughs]
Ari: Wonderful. Margie, you’re a wealth of information. Thank you so much for coming on the podcast. Are there any final thoughts you want to leave people with?
Margie: I just want to leave you like what I said that not to be scared to look at it as an opportunity because whatever affects your bones, affects everything else. I also wanted to– can I tell them about the summit?
Natural Approaches to Osteoporosis and Bone Health summit
Ari: Please, yes. Tell them about the summit you have coming up.
Margie: Yes. I’m really excited because as you see, I’m so passionate about this, but last year I did a summit called Natural Approaches to Osteoporosis and Bone Health. Around 60,000 people came and so many lives were changed. What I did, I have physical therapists showing exercises. Actually, Dr. Sherri Betz shows how to do strength training. I actually have them demonstrating balance, different things. Anyway, so I have therapists, I have the doctors who work with osteoporosis and all the different root causes. There’s so many different areas.
In terms of nutrition, I actually have people showing how to make bone-healthy meals. It goes on and on, but there’s just a ton of information, practical information that you can put into your life for even prevention. I highly recommend it. When you sign up, you immediately get two classes. I did one on showing balance exercises because that’s so important as we get old. Anyway, there’s tremendous amount of information and every day I teach happiness habits. You’ll get a little happier by going. Also, I do a habit a day, very quick. Just something you can put into your day to get started.
Ari: Beautiful. Margie, thank you so much for the work you’re doing. Thank you for coming on the podcast. We’ll put a link for people to sign up at your summit at theenergyblueprint.com/margie, M-A-R-G-I-E, so theenergyblueprint.com/margie. Thank you so much. I look forward to our next conversation, either on a podcast or perhaps in person at another health–
(00:53) Guest intro
(02:06) Why you should pay attention to your bone density
(07:26) The most common root causes of osteoporosis and osteopenia
(16:00) The connection between bone health and mental health
(20:55) The paradigm of human happiness
(25:41) The #1 food that harms your bones
(28:10) Why eating more calcium Is bad advice
(31:35) Vitamin K2
(35:55) Magnesium benefits
(37:57) The best foods for bone health
(40:30) Diary consumption for bone health
(45:05) Physical movement for osteoporosis
(54:50) Natural Approaches to Osteoporosis and Bone Health summit
Join Margie’s summit here