Ep. 556 The Women's Bone Health Masterclass Part 2 | Menopause & Bone Health

Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. This is the second in a series of bone health master classes mash up with Dr. Vonda Wright, Dr. Carolyn Dean, researcher Dr. Barry Tan and bone coach Kevin Ellis. Today we spoke about bone physiology and the impact of menopause. Why training is so important but also fueling our bodies properly. How osteoblasts and osteoclasts actually work and the importance of grip strength along with specific techniques for building and maintaining bone health. Then we dove into nutrients for bone health, especially magnesium, the role of melatonin, the impact of stress, the importance of gut health and the interrelationship with our bones, last but not least osteostrong and supplementation. Again, another invaluable conversation with these bone experts. I know you will probably listen to this more than once. I'd love to shift our focus because of particular interest to my listeners is bone health. Unfortunately, a lot of us don't realize that we're heading into middle age with maybe we're at greater risk due to genetics, maybe we're at greater risk because we're more into bone bearing exercise when we are younger. Let's talk about bone health and the impact of tocautrionols because I think this is of particular interest along with the metabolic disease that we just talked about. Yeah, on the bone health thing, let me quickly disclose what the audience and you and I already know. When we have as we go older, we're able to retain calcium in the bone, which is mostly protein, but have calcium maintained there, would be to take vitamin D and calcium. We all know about that and more recently, we know about vitamin K, particularly manoequinone. You probably read about that and however, the audience may or may not know. The activity to retain bones, strength, a bone, mineralization in the bone is actually MK4 manoequinone 4. Not the popularly proposed MK7, I will get to that, but just make a note as MK4 like that in the bone. Now, in the bone, we have the bone that grow the bone called osteoblasts and then the bone that break down the bone called osteoclasts. We need this because I know it's a little bit sci-fi-ish and a zombie-ish. Every two years, our entire bone system is replaced. So you need to have the growing bone and the breakdown bone. You cannot just have growing bone like that. We are like the hole and you can't do this because our body has to replenish itself. The skin and other plays will be much faster turn-over, but the bone is slower, so you need the balance of this. Now, if you were to be a young boy or a girl going to puberty, you can imagine the osteoblasts will be super high and the osteoclasts will be low. And before puberty, they are equal. Then slow the first 10 years, perhaps slowly like that. And then suddenly the osteoblasts go high when the hormone is surging and the osteoclasts go down. Now, if you try to remember for a woman going to menopause, then the opposite happens because she's closing down on her hormone production, then the osteoblasts come down and osteoclasts goes up. Then if on balance, that is out of kilter and then the bone loss will drop. Men also have this, but it's endogenic. So, meaning that when they are both reached 80 years old, if the men live long enough to be in the 80s, then their bone loss will be comparable. But during the menopause, they say, 50-55, it drops quite suddenly for the reason I just explained. So we designed the study to take advantage of this. So we did, of course, we did not do the study on puberty, girls and boys like that because it just doesn't make sense. And then we would not do a study pre-pubry because there are a lot of question that the professor would ask, why would you give this to like that? And then doing most of their life, maybe from 18 to 35, 40 years old, it's pretty stable, balanced. And then until, so we chose people who are 55 to 65 years old, we did not choose women above 65 because we fear that they may be also parodic. So we didn't want to be at that stage, it's hard to call back. So we is on the osteophenic area. And we measure the amount of bone growing to the bone. So the bone growing osteoblast would be, say, here, but over the three months that we gave to them, the indicator on the bone growing increase. And then on the bone last one, let's say it would drop, the bone loss would be this amount. And then when we gave them the toco, you know, the bone last thing would also drop and the bone growth thing would increase. And there's a ratio, a doctors one, the bone growth against the bone loss. And we saw that to be increased approximately 100%. The reason we measure like that and not actually measure the dexas thing is because if you physically measure the dexas thing, you will need about five, three to five years. And our study cannot be so long, it's going to fail on us because the woman will get this enchanted, they don't want to do the study. If more unfortunately, if they pass away or they move out of town. So there are many things you have to think about when you come to clinical study. So we measure the cytokines, the measurement on what grows and not grow the bone. And that's what we did. Now the other measurement we did, we are very excited about that the scientists and I come, this was done in Texas was that I surmised that women who are going to manopause have high degree of oxidative stress. And the reason I came to that conclusion is the estrogen E2 is actually an antioxidant. I heard very few doctors telling me that I saw the molecule of the feminine estrogen. It actually have a phenol ring and OH group. That's an antioxidant. So when that drop, I said, wow, her systemic ability to protect her body by making the estrogen that drop. But most people only think about that as loss of bone, but also increased oxidative stress because of the estrogen being an antioxidant. So I decided that because it's like the less measure her oxidative stress marker. So we did that specifically because the estrogen dropped and we saw that when it took the Tocotrotino, that oxidative stress is reduced by no less than 100%. This was also published I think in the year 2017 or 2018. So we did that. So after that, the same professor campaign to Mr. Perry, I think that it's very difficult for a long term study to measure the dexasine on women with arsoopenia. Then I said, I asked professor Shen, what do you have in mind? It's a very, I think that when men and women are carrying a lot of weight, they have a sacro arsteopenia, which means that they put on weight and they mask their muscle drop and then the bone loss like that. So I think that we should study people who have obese obesity. Then I said, okay, so the study started two years ago right in the middle of COVID. So it's been delayed a year, but it's still ongoing. Here we have and I'm actually not wanting to say thrilled because it just mean funny. This is the first time we're going to have a biopsies of the obese patient fatty tissue, just where the graph is in front of the abdomen here. And so as you know, the inflammation, thoracidocline is actually on the fat itself. So when we sample it out, now we can decisively look at the cytokine at the fat, not the cytokine subsequent to the fat and in the blood. Not that there is no good, but it's after a lot of time. Even when we study AST and ALT, which is produced in the liver, correct, but we actually measure them in the blood. But of course, we are not simply allowed to cook into the liver. I mean, that's easy to say, and easy to do an animal, but you can't do it in human like that. And that's somebody showed that their hepatitis C or liver cancer, then the doctor would perform something like that. So we don't know the study result because it blinded it again. So probably in a year, we would know that. So that would be, I'm very confident that the Tocotriina will reduce severe inflammation and stress, whether the stress is based on huge amount of fat or huge amount of bone loss or the liver. But on the bone thing, let me segue into something that I believe will be very useful to your audience. I mentioned MK4 manokinone 4. And you will read some study MK7, MK7 is made by bacteria fermentation in the gut. So that if you take a cheese or kimchi or kifur or anything that is done by fermentation, you get this MK4 like MK7. However, and there are many manokinone MK7, 9, 11 and 13, basically the tail is long. So MK7 come from a compound called vitamin K. Let's say you have a ring like this. You have a head. So that is a phyloquinone and a tail. So this and if you, the dark green vegetable, you have this. Nobody asked this question. If you were to be a vegan, you will consume a lot of green leafy vegetable or what I call eating more like a rabbit food. Then they would be consuming a huge amount of phyloquinone. Would they to consume a huge amount of phyloquinone and they were all absorbed. They would clot to death. Because vitamin K is known for clotting to seal the tear. But healthy, vegan and vegan do not clot to death. So the reason is because only a fixed amount of phyloquinone when it get to the gut is absorbed to do exactly what we said. But for the one not, it actually at the gut, it crops it up. See? So the tail is flushed so now the ring goes in. And when the ring goes in, I know I got a terrible example here. The ring is going to look for another tail and then stitch this on like this. That is MK4. It starts with this a phyloquinone and some amount go in for clotting and then it becomes like this MK4 and you know the yellow one that makes MK4 not MK7. The tail that is GG. That is a gunpanko, Jyarnal Jyarnal. And Jyarnal Jyarnal, among many things it does is to make MK4. And then now I've taken the time to explain this. Why is this important to bone health? MK4 help in biochemical pathway for the carboxylation to make protein that is cross lettuce in the bone to trap and keep the calcium in place in the bone. And that is MK4. To this day, if you google MK4, it is a far at 45 mg. It's a pharmaceutical drug in Japan for anti-osteoporosis. So all this to say, I'll say it away now to this here. In the background here, see that is a molecule of GG. That molecule of GG in the plant is used to make Toko. You know, a body doesn't know to do that. And this compound is made in a body since time memorial. We make this like that. We know it a lot. We make this. So I will tell you this. The body, I know of at least three reason why a body makes coq 10. You know, I make GG. A body makes GG to make MK4. And I took the time to explain to you not phyloquinone, but MK4 after a fixed amount going. A body also used GG to make coq 10. In the background, you see the other long molecule. Look at the black and white thing. It's two and a half length of the tail is GG. And people know to take coq 10 because this is good for energy and also good for the muscle. And the last thing is this compound GG that I mentioned to you. It is a critical in the body to make. I'll say very carefully and slowly for skeletal muscle protein synthesis. So therefore of the 40% of the muscle protein our body make as we younger. And of course, we lost much of this as we go older is dependent on GG for the skeletal muscle protein to be made. And so if we lost this as we go older, that so therefore GG is an anti-aging supplement. So therefore when people say that basically older, we don't have enough energy coq 10 because we don't have enough GG. And we take statin drug. Everybody know a lower coq 10. A lower coq 10 because statin drug is on the same pathway that inhibit GG synthesis. So GG is the reason why coq 10 drop. So coq 10 is called ubiquinone. So is ubiquitous? Well, happy to let you know. Probably coq 10 is ubiquitous because GG is ubiquitous. Explain there. And then why do we lose muscle mass because we don't make enough GG just think of your elderly parent. And why do we have osteophenia and osteoprocesses as we go older because we don't have enough GG now. I know I elaborated on women, but this one I must let you know. There are two drugs that affect GG. One is statin. And people take statin drugs because the lower cholesterol everybody know that and the same pathway lower GG. Your doctor does not really care if you take statin drug if you lower coq 10 unless it's a holistic doctor. However, that doctor as well as your holistic doctor do care if when you take statin drug, if you have muscle problem like that, they all everybody care. And the muscle problem is because statin inhibit GG also as inhibit cholesterol, but it inhibits the ability to make skeletal muscle protein. And that's why they have myopathy. That's it. Very simple. So, but if you don't take statin drug, then you have psychophenia. The other one, this one, if I would be a list woman, I'm going to my ears will be propped up. Women at menopause, when they have osteoporosis, the doctor prescribed bisphosphonate. Bisphosphonate is clearly a drug to help in the maintenance of mineralization in the bone. A good thing. You Google after my talk and you Google this phrase, BROMJ, it's simply stand for bisphosphonate related osteo-narcrosis of the jaw. It's a terrible phrase. If I would explain it, it's just kind of like your jaw kind of like fall apart and dies. So, bisphosphonate related osteo-narcrosis of the jaw, this is not a normal dental problem. The dentist discovered this because I asked many dentists, it's a barrier. I have seen this. I have never seen this in a normal person who had bacterial action blah, blah, blah like this. So, this is clearly a drug associated thing. So, the dentists were the first to found this thing out and then they found out systematically it would be 50-something, 50-something, 50-something women and they are taking anti-osuoporosis drug and the answer is very simple. When they take this drug to strengthen the bone in the bone elsewhere, but somehow in the jaw it does exact opposite. So, in the jaw it helps to destroy the gum which is a kind of a soft tissue bone and then the jaw bone where the extraction is particularly when the woman has an extraction and then the wound would not heal and the bone would not seal and then they found out this and then now they found out that bisphosphonate uniquely and surgically inhibit they are still blast off the gum and off the jaw bones GG such that it cannot make enough of the gum and the bone. So, there you have it. So, right now we are trying to find a dental a department that if they take extraction of people to put in a small drop of GG so I have to wait to see this. So, until then if I were to be a person of older age and particularly of a woman and if a person is taking a bisphosphonate drug then minimally they should consider supplementing GG. So, no it's I'm complete my mind is completely blown. One of the things that I read about last night is as it pertains to GG that some Japanese scientists determine that it actually increases testosterone and progesterone which I found fascinating. So, these compounds that you know we may not have been familiarized with prior to this discussion can have a significant impact on our health, our longevity, our metabolic health, our bone health. If you're in perimenopause or menopause and are feeling more fatigued, dizzy, lightheaded, struggling with headaches or noticing your workouts feel harder than they used to, electrolytes may be part of the missing piece. As estrogen declines we lose some of the fluid regulating and vascular protective effects that hormones once provided. That means blood pressure regulation can shift, cortisol can run higher and many women become more sensitive to dehydration, especially if you're strength training, walking more, intermittent fasting or reducing processed foods. That's why I love element. It is my favorite electrolyte formulation and I've exclusively used their products for the past six years. Element contains a science-backed ratio of sodium, potassium and magnesium without sugar, artificial ingredients or unnecessary fillers. It supports hydration at a cellular level, helps reduce muscle cramps, improves energy, as well as recovery, and can even support better stress resilience. This is particularly helpful in midlife when we're prioritizing metabolic health and muscle preservation. I personally use element throughout the day and it's become a staple in my routine as well as my household. If you'd like to try it go to drinkelement.com slash Cynthia to receive a free sample pack with any purchase. Stay hydrated, stay strong, especially in midlife. If you're a woman in midlife or beyond you're probably noticed those changes in energy, strength and recovery just don't feel like they used to. And what's frustrating is that for many women this happens even when you're eating well, lifting weights, prioritizing protein and doing all the right things. You're not lazy, you're not unmotivated and you're not doing anything wrong. A big part of what's changing actually starts inside your cells. As we age or mitochondria, the energy producing structures inside our cells become less efficient and when mitochondrial function declines it can show up as lower energy, slower recovery, reduce muscle strength and feeling less resilient overall. This is a normal part of aging physiology and it's one of the reasons midlife can feel so different. And that's why I've added might appear gummies from timeline nutrition into my daily routine. Might appear as the only clinically proven form of uralith and A, a compound shown in human clinical trials to support mitochondrial renewal. In simple terms it helps your cells do a better job of making energy and when your cells have more energy your body is able to support strength, endurance and recovery as you age. What I appreciate most about might appear is that it's foundational, not flashy. This isn't a stimulant or a quick fix. It's a daily habit that supports how your body actually works at the cellular level and the gummies make it easy. They're just two sugar-free gummies per day. They're vegan and cleanly formulated. They're independently tested and certified for quality and if supporting your energy, muscle health and overall resilience as you move through parimenopause and menopause is important to you might appear as worth considering. You want to go to timelinenutrition.com slash Cynthia and use code Cynthia Thurlow for 20% off your order. Again, that's timeline.com slash Cynthia and use code Cynthia Thurlow for 20% off your might appear gummies. It just magnifies why it's so important. Now when we're talking about bone health, obviously there are things we can do now. But I'm thinking about our younger women, many of whom are appropriately put on oral contraceptives so that they have choices about when they choose to become pregnant. What are some of the risk factors that you're aware of that impact bone health before we go into parimenopause and menopause? Because I think these are important to talk about because these are reasons that may impact many of the listeners. I love that you ask me that because of late. I have you know, we're an Olympic trial time right now. So we're parading out all our young champions who have worked their whole lives to get to where they are. It's a really timely question. But what happens along the way for women, for young women? And also because honestly we in the United States, we've had Title IX for about 52 years. So women have been equalized in sport or trying to get in terms of access for 52 years. Well, female athletes very commonly live in a state of relative calorie deficiency, meaning either they're working so hard all the time and they're underfeeding. They just can't get enough calories in or they are purposely undercalorie because they want to be little like our pinkies were told to be little. Especially if you take care of gymnasts and dancers and runners and right. So what we're having now, and I also have these patients in my clinic, are young women in their 30s coming in with osteoporosis because they never laid down enough bone when they had the opportunity due to relative calorie restriction, overuse, or not athletic calorie restriction, but they just want to be skinny. Right. So it's a real problem. So my poor 17 year old and my 29 year old and all of her friends hear me constantly talking about the fact that are you out there bashing your bones? Are we jumping up and down? Are we doing impact exercise? Are you feeding yourself enough? How much protein have you had such that my 17 year old is very conscious about getting enough protein in which I'm so glad because she was a ballet dancer most of her life, right? And she is teeny tiny. So the osteoporosis is not a disease of old women. It is a disease of people because 2 million men in this country have osteoporosis. Now there's is a little bit characteristically different than women's, but when men fall and break a femur, it is devastating because they're usually older. So to get back on track, bone health is a concern of all women. It should start when they're teenagers. Are you getting off the couch? Are you exercising? Are you eating enough to build a muscle and bone you need for a lifetime? I think it's such an important message. And certainly I think about many women that go without menstrual cycles for years and years and years and don't think of it as being a cautionary tale. I remind women that our menstrual cycle is really another vital sign. And if you're not getting your menstrual cycle, the question is why. And it's interesting even with the rise of social media, I'm seeing 27, 28 year old that are premature ovarian insufficiency. So they're literally positioning themselves to have the magnification of every potential side effect of going into early menopause times 100 because it's not as if they're 57 or 47 or 50, but being that young and that long without those sex hormones is a huge concern. You're talking to your patients about bone health and talking about how we build bone, how we break down bone and the interrelationship of estrogen or estradiol and progesterone. Can we just speak to osteoclasts and osteoblasts because I do think this is interesting how the bone breakdown accelerates within that setting of that loss of estrogen. Yeah. So a little bit of, I mean, bone biology is a multi-step process with multiple cellular processes and stimulates. But if we break it down to basics, we have multiple kinds of bone cells. The two that I want to talk about today is the osteoclast. And I always do this. As if I've got my bone cells on my femur here, right? We have the osteoclast whose job is to go along the bone and when it receives stimulation from the body that, oh, we need some minerals. Oh, I've seen some deficits everywhere in our body. I need some of the things in the storehouse of the bone. The osteoclasts come along, digs out the minerals, leaves a little hole so that those things can go off and work. Coming closely behind is the osteoplast blast. Be for build. It's like, oh, my God, there's a hole in the bone. Let's fill it in. And so these two cells work in tandem. They crawl along the bones. And so throughout our lives, there's a relative balance of breakdown for supplies and rebuilding because our bones replace themselves every 10 years. What happens in menopause as estrogen walks out the door? Estrogen is an osteoclast regulator. It keeps the osteoclast in control. The osteoclast is kind of a crazy, if you want to personalize these cells, a little crazy cell. It's going to go out and go rough shot unless things control it like estrogen. So an estrogen leaves. It's not that the osteoblast stops working. It continues to work and build. It's just that the breakdown outpaces the osteoblast. So instead of working like this, they're working like this. Now this is a gross oversimplification. And sometimes I think bone biologists are going to write me hate mail. But for those of us who deal with the general public, it's a very visual way to see what's dampening the osteoclast. So to answer the question, can you build bone? You continue to build bone, but you break it down more, right? So, and we know this. We know that we can build better bone in the presence of estrogen. We know that we can prevent osteoporosis with the presence of estrogen. It's the one reason the FDA has approved estrogen easily. If you say this person has osteoporosis, it's easy to prescribe, right? But there are other ways to get around bone density problems in midlife. So estrogen is one of them. Lifting weights is another. Everybody always asks me, but what if you already have osteoporosis, can you lift? And the answer is yes. And you can lift heavy. If you're careful, there's a study that has shown, it's called the lift more study, that under supervision in a careful way, you can lift heavy even in the presence of bone deficits. So we need to lift weights. We need to impact our bones. I prefer jumping with a jump rope, running up your stairs. You can also rebound on a trampoline. That's what astronauts do when they come back with bone deficit. NASA has done great work that you can rebound on a trampoline. Weighted vests are all the rage right now. You know, then I get the question, but wait, if I've got osteoporosis in my spine, should I be overloading my thoracic spine with a weighted vest? Well, my suggestion to that is, well, let's put the weighted belt around our waist because it's our lumbar spine and our hips that need to see the extra load. Our shoulders don't need the load. Our hips and our spine need the load. So let's put it there as a weighted belt, for instance. So there are still lots of ways that we can address our bone health even before we get on to the dreaded pharma, a lendronade. And there's a whole list of different drugs that I usually send my patients to an endocrinologist who's really in an expert at that. Before we have to do that, so we're not without hope as estrogen leaves our bone regulation a little bit, Helmell. Yeah, it's so interesting because I joke, well, I don't joke. I'm honest when I say I didn't realize that my peak bone and muscle mass was in my 20s and 30s. Had I known that, there's so much more that I would have done. And perhaps it's the time to pivot and at least touch on muscle health because this podcast community definitely knows the value of why muscle is this endocrin organ. It is metabolic currency. It is so important. How can we measure other than objectively, you know, going if we're at the gym, we're lifting weights and, you know, we're going up on weights. And I definitely want to get to your methodology about how many reps or how long, how many sets? What is the current proxy for determining muscle strength? I know that, you know, I've read that things like grip strength or proxy of overall strength, is that something that you employ? Do you believe that fervently? Is that something that you recommend? You know, I left because my dad used to walk around with one of those little hand grips and we thought it was more of a, you know, one of these things where he was just showing us how strong he was. But when you're working with patients and helping them understand the role of sarcopenia, I would say it's not a matter of if but when, unless you're actively working against it. Well, I do have a grip strength, goniometer, whatever it's called. And I do bring it out at my midlife mastery retreats that it big conferences when I'm speaking to groups because it is a really tangible way. And then it becomes a competition. So I can't get it out of people's hands because they're all going to be like, let me see with this. Oh, and then let me compare if they're within 10% of each other. It is a validated measure for judging overall strength because the truth of the matter is when we lift weights, you know, our biggest muscle groups are below our legs. So I'm not going to make people, you know, do a broad jump or do weighted squats or the wall squats are also a good way to tell. But we evaluated data on grip strength people. It turns a light bulb on it turns on a little competition. And everybody wants to see the needle move, right? So I could use it as a clinical value. It could be another vital sign. There is some data that walking speed, getting up from a chair speed and grip strength predicts surgical outcomes, right? So I think if I were a general surgeon who did massive, I'm an arthroscopist. So my surgeries are generally sports related. But if I had, if I were doing whipples, for instance, our big cardiac surgery might be something I measured to see the physical competency of people coming into the OR, frankly. But how do we measure muscle strength or prowess as it relates to this? Well, we can do proxies like that. What I would rather do is people chart their own progress, right? Everybody's going to start from somewhere. And many times people assign a judgment to that. I mean, sometimes I do. I say put down those manby-pampy pink weights partially to be funny, but partially to help people understand that our body responds to stress. Not all stress is bad. Our body doesn't know that it needs to be stronger, faster, smarter, unless we put the stress on it that it wakes up and says, oh my god, I need to be stronger, faster, smarter. And so when it comes to building muscle, that's why 30 reps of a tiny weight is not going to do anything for us versus fewer reps of heavier weights that we both psychologically neuro-muscularly and within the muscle itself are fatigued, exhausted, for instance. And that's what's going to stimulate building of muscle. It's going to stimulate replication of muscle stem cells, the satellite cells. So that is an indirect way to say we just have to know where we're starting and then monitor every month. A month is about a good, every day is too frequently, but every month you can see real change. Yeah. And so one of the questions that I had was how do we know that we are lifting heavy enough? Yeah. Well, and the question I get is, well, what's heavy? What number should I start with? Everybody's heavy is different. Here's an example from my biceps curls. We want to be lifting heavy enough that we can only do for our big compound lifts, meaning our push and pull with our upper extremities, push and pull with the lower extremities. So for the arms, push is something like a bench press. I'm doing this because I do it with a bar of bench press or a pull like a pull-up. For the lower legs, push pull is squats and dead lifts, right? Those are the giant compound lifts. They involve multiple body parts, four reps, four sets. Now it's an actual range, three to six. But to make it easy for my people, I chose four, four reps, four sets. But it means that the four reps need to be near failure. You can't do eight reps of the weight that you do the four reps. You need to be able to do four knowing that maybe you could get five, but definitely not eight, right? Those compound lifts at that weight, that heavy, are then augmented by the accessory lifts. I'll give you an example. For my bench press, four times four, I accessorize with biceps, triceps, lats, delts, rows, eight reps, four sets. So still eight is more, but it's not three sets of 15. And so for heavy, my biceps, I can biceps curl 15 pounds until tomorrow morning. We could just be doing this all day. That is not going to build more bicep for me. Strength for me. But I can only do 25 pounds three times. The fourth, I'm trying to engage my back, which is bad technique, right? So that is heavy. And that's how everyone should gauge their heavy. And it takes a little bit of experimentation if you've never, ever, ever lifted before or you didn't lift since high school, maybe we have to go back and do functional lifting, body weight lifting, small kettlebells and free weights, which is fine because we're just trying to reeducate our bodies again to even know itself, to get our neuromuscular pathways and to trust ourselves to build the confidence. And you know, there are studies that show with adequate protein, body weight exercise, you can still make good gains. But once you feel comfortable with yourself again, then I direct everyone to lift in the way I've just described. And maybe it demands taking lessons. I mean, who's born knowing how to power lift, not me. So I took lessons. I hired a trainer for a short amount of time, actually not short. I hired a guy just because I liked to work out with him for about six months. But I totally learned how to do this such that I can do it by myself now. And maybe that's what it takes. And I love that you, it's very, very clear that most, if not all of us are probably not lifting heavy enough because we're, you know, going to 10 reps, we're going to 12 reps, maybe we're going to 20, which is great for endurance, but is not going to activate those satellite cells, which are so important. Now, along with strength training, I know that it's also important to incorporate some degree of sprinting or I think sprinting is what you like to do. How do we differentiate about how frequently to do sprint training and or like zone two, which I know has become very popular. It's something I actually enjoy doing. I was doing it this morning on like a four percent incline with a 12 pound weighted vest on the treadmill just because it's hot and humid where I am. Yeah, it's interesting. I can't tell you how many of my patients that were probably north of let's just say retirees. So we'll we'll use that bucket and it's not pejorative, but they would say I don't want to drink more water. I don't want to have to go to the bathroom more frequently. But such an easy thing to do is adding this high quality salt to your water. I'm someone that actually needs to add electrolytes and needs to hydrate and add salt to my food because it makes a world of difference in how I feel. It makes a difference now. I sleep, makes a difference in my energy levels. And it's something that's so simple, so simple. I would love to talk about the relationship between a very important topic for my listeners bone health and magnesium. I don't think enough of us probably understand that 60% of our magnesium's in our bones. And bone health especially as we're navigating parimenopause and amenopause becomes even more important whether someone is on HRT or not helping us understand why bone health and magnesium are so intricately linked. Right. I think what happened with the bone research is someone burned up some bones and the ash of the bones was mostly calcium. And they said, oh, that's what we need if your bones are deteriorating or you know thinning out, you need calcium. And that became the war cry. And that's why we're in a bit of a pin-trade now. I mean, the studies that have New Zealand 10th, well maybe 20 years ago now, there were about six studies and they've realized that women simply who take calcium supplements are at a higher risk for heart disease because they overcame their magnesium source. Now they don't say that. They just, well, I guess calcium is not good for you. And the reason why magnesium is so important, why there's so much in bone, it's because of the soft tissue structure in bones, the soft tissue matrix that's collagen, collagen, alastin, and then magnesium is important for both of those proteins. Vitamin C is also vital for those the collagen production. So you think of vitamin C, you think, oh, you know, we're all getting our vitamin C, but you take a look at any elderly person who's not taking vitamin C and you look at their little wrists and all their bruises lined up and you think, well, you know, what's going on? And you don't get past the thought that, oh, they're just banging themselves, they're old and, you know, but it's scurvy. These people have scurvy. You have to be as dramatic as that. And then in their bones, their bones have lost the vitamin C, lost the collagen. So their bones are shrinking. I mean, I plan not to shrink because I'm going to keep my vitamin C. And seriously, I mean, I'm one of the elderly. I'm 75 in a few days. So I thank you, but it's because, well, it wasn't until, gosh, it wasn't until about 15, 20 years ago that I start realizing about magnesium, right? When I wrote the book, yes, when I published the magnesium miracle. So I've only been magnesium deficient for both 15, 20 years, which caught me up to, you know, building up my bones and my tissues and my everything. So bones, man, we just got it so wrong about telling women that they needed more and more calcium and ignoring the magnesium. So I hope I said that properly because I was dancing around that the soft tissue structure, which is the scaffolding that the bone matrix settles on. And then what happens with the, all the, you know, the bone scans and the bone studies, what are we calling it? Dexam. Yeah, the dexateth. And they're comparing our bones to a 25, 30-year-old bone for one thing. But they're saying that, okay, if you're a certain percentage, you have to take the phoenix amax or one of these terrible drugs that kills your osteo clasps. There's osteoblast that make new bone break. And then the osteoclasts, they arrange the bone properly. They come along and do the fine detail and break down bone that isn't needed and, you know, allow new bone to come. So, you know, these bright pharmac doctors decided, oh, well, we'll just kill the osteo clasps so that there won't be any bone breakdown. So what happened to the bone? It got all healed and it got brittle and it actually got worse for women. There are dent, there's a dental, in a rule that dentists aren't allowed to work on women who've taken these drugs because their jaw bone is so brittle. You can't drill into it. You can't pet a root, you know, well, you can take it out, but you can't put in teeth implants. So that's scary. Oh, absolutely. That's osteomalacia. It's something that I think for anyone that's listening, it's understanding that, you know, those bifostates are designed to make our bone healthier. And I'll put that in air quotes, but they actually contribute to a loss of bone mass, abnormal bone growth, and then skeletal weakness. And that's why, to your point, you know, doing dental surgery on someone that's been on those, you know, boneva, any of those drugs, it's a contraindication. So dentists can't even do surgery. God forbid, you need to have surgery on your jaw. It's just too brittle. So when you're talking about whether it's osteopenia, which technically really is even a diagnosis when they're comparing a 50 year old bone to a 25 year old bone. And that's when our bone is peak bone and muscle mass is when we're younger, but looking at middle aged bone or even older bone, helping them understand that one of the things that contributes to healthy bone is having a properly supported magnesium level in the body. I think that, you know, these are things that are tangible for people. It's, you know, magnesium is important, but it's probably not emphasized enough. Right. Cynthia, one more thing about the last in the soft tissue structure. Magnesium has, I don't know specifically, it has an impact on the production of a last in it, because I used to hear that magnesium made bones more flexible. And it would be through the last in soft tissue matrix. But, you know, I'll just share this with you, not so much sympathy, but here's what happens when you have all your minerals. And, you know, you feel good, you have your collagen a week and a half ago, I slam down, I tripped over someone and slammed onto the firm store that I volunteer with and I help support. Lam down on my elbow, which I'm favoring still. I'm not waving my right hand around and my left knee, but I did not break anything. I should have broken everything so much. But if you have strong bones, you don't break. And every time I fall, like, you know, rollerblading, dislocated my knees, you know, I fell over my handlebars of my bike a few years ago and wrecked my knees for a while. But then you, you know, you get the back, you do your, you know, physical exercise. And that's another thing you have to move. What's it you sent you that said you have to do weight bearing at, you know, as we age. And when I do my two-hour morning walk down along the beach here, I will take my three-pound weight and in one hand and be doing my exercises, you know, switch it over to my other hand and do it the whole way. And so I'm getting my legs and my arms. We just have, I mean, I'm so blessed to be able to walk in nature like that. But I think most people, they could find a way to get out there and, you know, breathe fresh air and smile at people. What I do is I collect smile. So I walk along the path and I smile at someone. And if they're not on their, on their phone, you know, they, for the most part, 99% of the time they smile back. And that is invigorating and then livening if you're smiling. And you have a, you know, you have puffed of attitude. I'm excited to tell you about a foundational health supplement that is backed by some incredible science. This marine super molecule is called AstraZanthin. And it's supported by more than 4,000 scientific papers, 100 human studies, extensive safety handling and NIH validated efficacy in a gold standard longevity model. Extensive research over the past 25 years has shown that AstraZanthin perfectly spans and stabilizes cell membranes, protects lipids, proteins, and DNA from oxidative and inflammatory damage. This promotes cellular health, fights the hallmarks of aging and provides lasting whole body health benefits for your joints, muscles, heart, brain gut, skin and eyes. It also boost healthy energy, endurance and recovery. I'm thrilled to partner with AX3 life and share their bio pure AstraZanthin with you. Compare with ordinary AstraZanthin AX3 has superior bioavailability, purity and environmental sustainability and is better absorbed three times better actually. And it's been shown to be highly effective in the NIH interventions testing program, the world's most rigorous mammalian lifespan study. I'm really impressed with AX3 and I'm super excited to share this particular podcast interview with AX3's co-founder and CEO. AX3 has also generously offered a 20% discount on your very first order when you visit AX3.life and use promo code Cynthia20 at checkout. Again, that's AX3.life and use code Cynthia20 at checkout. My family and I are actually taking AstraZanthin to see if we can drop our LP little A. Stay tuned. If you're in your 40s and 50s and feel like your body suddenly stop responding the way that it used to, you're not imagining it. Bloating, waking, sleep disruptions, food sensitivities and unpredictable energy are incredibly common in perimenopause and menopause. But here's what most people aren't told. Your gut microbiome is changing right alongside your hormones and those changes can influence everything from how you store fat to how well you sleep to how your body processes estrogen. That's exactly why I wrote my new book The Menopause Gut. In this book, I walk you through the science of how the microbiome, metabolism, immune system and hormones are all connected during midlife. But most importantly, I give you practical, realistic strategies you can start using right away without extreme diets or complicated protocols. You'll learn why the same diet that worked in your 30s may not work now, how your gut influences hot flashes mood and weight, the truth about fiber, protein and blood sugar in midlife, and the daily habits that help your body feel safe, stable and resilient again. If you're tired of blaming yourself for changes that are actually biological, this book will help you understand what's really happening and what to do about it. You can pre-order the menopause gut wherever books are sold and when you do, be sure to check out the special pre-order bonuses I put together for you. Again, you can go to www.synthethorlo.com. You'll click on the banner. It'll take you to multiple options for where you can order the menopause gut in pre-sale. Do you have any research? Are you talking at all about melatonin? I did a melatonin podcast a few months ago. It was down the rabbit hole about melatonin. When I was reading it actually helps a bone turnover and promotes osteoblasts. It also, we know it's a master antioxidant in the body, but it also protects bone cells from oxidative stress and inflammation. I typically say if you're over the age of 40, we make less melatonin. If you're under the age of 40, we want to be conservative with melatonin years. I'm talking about middle-aged people and older that melatonin has a lot of benefits and it's not just sleep support. Have you been reading anything or using melatonin in your practice? We would always encourage somebody to start. What progress can we make before incorporating or adding that in? But it could be a helpful part of somebody's plan because most people melatonin as a hormone is produced, it's this tiny gland and lower back part of the brain called the pineal gland that regulates our circadian rhythm and all these other things. Your immune system, sex hormones, even bone health, melatonin is super, super important. In terms of the effect that it's going to have on your bones, it does have an important effect and it does plan an important role. In terms of helping regular circadian rhythm, it's improving bone remodeling by suppressing your bone loss, by promoting bone formation. It actually upregulates the gene expression of proteins and markers for bone formation like alkaline phosphatase, bone morphogenetic protein, osteocalsin, osteoportedron. Those are all things that are being up-regulated and promoted for bone formation with melatonin and then it's eliminating free radicals. And so during the bone breakdown process, these osteoclasts, those cells that break down bone, they're generating these free radicals and free radicals if you're not familiar with them there. They're basically toxic byproducts of oxygen metabolism that can cause significant damage to cells and tissues through oxidative stress. And then melatonin is actually an antioxidant that can help with that. So it can absolutely be a helpful part of that. Yeah, it's really interesting. Melatonin is one of these like grossly underappreciated hormones. I think people just make the association with sleep and it does so much more than that. What about the net impact of stress on bone health? How does it negatively impact our bone health? If you think of the different types of stressors that we're coming in contact with every day, and I know I would say everybody references the lion, right? Thinking about the lion, but it's not always the lion. It's the fear, the worry, the emotionally charged thoughts, the family conflict, the financial challenges, all of those, or this is a big one, keeping up with the perfect lives of the Joneses on social media. All of those things contribute to and drive that stress response. Now, the stress response is something that we need to do. We need to have that. It's important part of our health and that fight or flight response is not a bad thing. But when we're in this fight or flight response for too long, we're sending blood and energy and nutrients and resources away from the areas that are not required for immediate survival. And we're sending them to areas that that need it most like your muscles in your heart. And then we're communicating to our bodies to secrete adrenaline and cortisol. Both of those, they're critical to our survival as a species, right? But when we're chronically activating this and flooding our bodies with cortisol, that's when we're going to run into problems. And in terms of the issues that we can have, we can have increases in blood sugar, weight gain and obesity, leaky gut, cardiovascular disease risk is going to increase hormonal imbalances. And then also it's going to decrease your immune system, impact other hormone levels. So your thyroid function is usually downregulated during stressful conditions. And then it's going to affect your mood, your brain health and your sleep quality. In terms of your bone health specifically, bone specific impacts of chronic long-term stress and high cortisol, it's reducing progesterone production and progesterone is really, really important for your bone health. It's reducing the ability of the osteoblasts to form bone. These are the cells that build bone. So it's reducing their ability to do their job. And then we kind of touched on this with glucocorticoids earlier when we were talking about prednisone, but high glucocorticoids are their natural steroid hormones. That's what cortisol is. That's going to kill osteocytes. And osteocytes are those orchestrators of the bone remodeling process. So it's going to contribute to infuel bone loss if you've got chronic long-term stress. Yeah, this is a habitual topic that I discuss in almost every podcast because there's this unfortunate predelction for people to assume that stress is entirely benign. And I remind people acute stress is part of our day-to-day lives. It's chronic stress that can impact us negatively. And I think a lot of people don't think about bone as its own organ and it really is. So there's systemic effects, localized effects from stress. Now one area that I'm really excited to talk to you about, I know we were emailing back and forth, is talking about how our bones and our gut health are interrelated. We've kind of touched on this. I think that diving a little deeper into the gut microbiome and the involvement of cytokines and how this impacts bone health is of particular interest because we have so many listeners that have autoimmune issues. I mean, Hashimoto's, you mentioned you personally have had celiac, but so many people have got rheumatoid arthritis. They've got sojourners. I mean so many people are impacted by, you know, their gut microbiome not being optimized and understanding there's this complex interrelationship with bone health as well. Yeah, there is a major connection between gut health and bone health. As you're taking in food and you're starting to break that down in your mouth and then it heads to your stomach to be turned in that acidic mix to break it down even further. And then it makes this way to your small intestine, what I call your soil. Right? So if you imagine your body and your bones as being like plants in order to grow, you need the right nutrients and the right conditions, right? So many people's focus so much on the nutrients, the salads, those smoothies of supplements that they're not considering that soil. And so when it gets to the soil, that's where nutrients are broken down to their final form where they're going to be absorbed by us, the plants. But if you have small intestinal bacterial overgrowth, so good bugs, but maybe in the wrong place, if you have gut infections, if you have an issue like celiac disease or one of the other conditions like IBD, ulcerative colitis or Crohn's, those can all affect your ability to absorb nutrients. And inside our small intestine, we have these things called villi, which are like roots in our soil. They're these tiny little hair-like projections that are responsible for absorbing the nutrients from the food you eat. They absorb those nutrients and then they shuttle them to where they're needed inside the body. If you have damaged to those roots or those villi, you're going to have a really hard time being able to absorb those nutrients. And again, with celiac disease specifically, this is probably the easiest one to tie to it, is you will actually start to get blunting of those villi to where they can't do their job. And a lot of those nutrients that you're taking in, they're not going to be absorbed. And your body still needs those nutrients to execute its daily functions. So if it's not taking them in from your diet and nutrition and you're not able to absorb them, where's it going to come from? It's going to go to the largest reserve of nutrients or minerals that you have, which are your bones, and that's where it's going to pull from. So gut health is going to be a major, major issue there that we have to address. And then again, I think I mentioned gut infections, stomach acid, production is a huge part of this. Yeah, those are some of the biggest, biggest things that we need to address. Yeah, it's really important for people to understand that it's not a one-size-fits-all, but understanding that as we're getting older, if we're not taking medications to suppress stomach acid, by the age of 40, we're making less of it. We understand that over time, you know, chronic stress can debilitate, can weaken these structures in the digestive system. And understanding that over time, a lot of lifestyle choices can further exacerbate these changes. Now, I got quite a bit of questions for you. Thoughts on osteostring. So osteostring is, they use a concept called osteogenic loading, which is basically loading a bone to induce structural adaptation to get it to become stronger, basically. And I think the way they have it set up is they've got different machines inside a gym. And it's not like a traditional gym. It's you walk in, you've got four machines, you move around, you exert 4.2 times your bodyweight on these machines. And that's working to stimulate that bone to become stronger. Takes 10 minutes every week. I would always say for people that that would be a compliment, but not a replacement to a full exercise plan, right? Because a lot of times people come to me and they're like, hey, I got this vibration plate or I'm doing this osteogenic loading thing or I've got this new nutrient or vitamin or pill that I'm taking. That's great. Some of those can be really, really helpful additions, but they're not going to be a full plan. Because if you zoom out and look at every single thing that has to be done, the osteogenic loading is not going to address a nutrient deficiency or it's not going to address digestive issues or it's not going to address a parathyroid tumor. None of those things are going to be addressed by a vibration plate either or by a single pill. So you have to zoom out and look at the full picture. But in terms of whether somebody should or should not incorporate, I think it could be a compliment to a plan. Maybe an asterisk I would put there would be if you're somebody that has already, if you already have poor quality bone and you're fracturing multiple times or what you don't want to go do is then load that, put a maximum load on bones that you're already fracturing that are already poor quality, you would not want to do that. So just keep those things in mind as you go and you approach some of these different technologies that are out there. I think that's very reasonable. And we had Dr. Barry Tan on in the fall. And I was delightfully surprised to learn about Toka trionols and anato and bone health. Is this something that you are using with your clients right now or your clinicians are using with their clients? It's something that really I found I was humbly, very humbly interested invested in learning more about the role of anato and bone health. Very trend. Yeah, he's done so much research and Toka trionols and vitamin E. He's been doing this over three decades. I mean, he is like the leading person on this PhD in chemistry and biochemistry. What he talks about is the gamma and delta Toka trionols are the best forms. And in terms of bone health, there are quite a few studies, especially in animals that have been done that are showing that not only does it improve or helps improve bone formation, it's reducing bone resorption or breakdown, it's helping improve the bone strength and reducing oxidative stress. All of those things are helping the overall picture. Will it be beneficial to have more studies in people to see the long term effects of this? Absolutely. But I think it's really promising to see that with the work, especially in the work he's already done. Yeah, it's definitely compelling because I think there are still a lot of women in particular that are fearful of taking hormones, but they're willing to take a Toka trionol or anato as a kind of bridge therapy, if you will, until they're more comfortable. A couple of people ask about dichotomous earth. It's somehow that has some bone supportive aspects that I was not aware of, but I said I would ask you nonetheless. It's not something I'd particularly recommend. Then in terms of I think a lot of times people ask about silica content and things like that too. Silica is important for your bone health. Bamboo is a source of it. They're a horse tail extract. When I first heard horse tail, I actually thought I was like, do they really put horses tail in this, but it's not actually a horse's tail. It's something different than that. Those are some sources of silica. Then cucumbers, for example, that's another source of silica. They're ways. They're silicon a variety of different plant foods that we're eating also. It's not like you just have to go take the spoon of dichotomous earth and chalky substance and take it down or mix it into your water. Gosh, I don't want to misspeak here, but I'm not sure if taking lots of dichotomous earth can actually potentially have issues with kidneys or cause kidney damage long term. Have you read that? Get a lot of heavy metal exposure. That's actually why I don't personally recommend or use it, but because I was asked multiple times, I was like, maybe there's something I'm unaware of, and I did do a little bit of research, but didn't see anything that was compelling. I agree with you that some of the components of some of these binders do have benefits, but I think it has to be taken in the context of everything else. There's a lot of different reasons we develop bone issues, and there's multiple interventions that we can utilize that are very effective. To wrap things up, what are your top three recommendations for bone health? If someone's listening and maybe they're not even aware what their dexascana is, but they're perimenopausal, menopausal, or if there's a male listening that's in Andropras, and yes, Menduc, or through Andropas, and are at risk. We talked about some of the risk factors. They are at risk. One thing we didn't talk about, let me just interject this quickly. There's a genetics susceptibility. So if you're a thin Caucasian or Asian female, you can be at risk. Obviously, we mentioned the smoking, alcohol use, but just understanding, if you haven't yet done the testing, but you want to do some things that are beneficial for bone health, what would be your top three suggestions? It just blanket recommendations. Number one is if you don't have a bone density scan, go get one, get your objective data. If you've got a daughter or somebody else to, maybe if it's not even just for you, or a son that has digestive issues or something like that, go get a bone density scan, find out where you're at. Then go get an active bone loss test, a Serm CTX or something like that to see if it's elevated, to see if maybe there's a root cause issue that needs to be addressed. Explore that root cause issue. Figure out what the root cause issue is. We help people with that, but there's also plenty of functional medicine practitioners that can help with that and figuring out the root cause issue. Then the other part of this is make sure you're nutrition and your stress and your sleep are dialed in. In terms of stress, we just talked about this, that if you've got high stress all the time, ongoing, you're a warrior, incorporate some healthy meditation practice. I know for me, being a marine, I took me a full year just to get to the point where I felt like I knew how to meditate properly. Now, it is a non-negotiable daily practice for me. In the past, I would actually laugh about it, that I thought meditation was kind of laughable. Now, I'm like, how could I couldn't live without this at this point? Cultivate a healthy meditation practice. Sleep, you have to sleep. It is a pretty well documented. If you've got poor sleep, it's going to reduce your bone quality. Make sure you're getting 7, 8, 9 hours a night if you possibly can. I know that's not always possible for everybody, but try to at least get 7. Then the other part of this is nutrition. Anti-inflammatory diet, some of my favorite foods to incorporate would be sardines and mackerel with the bones in. Absolutely love them. The reason I like the bones in is because they've got protein. They've got all the minerals and the right ratios that nature put them in that you need for your own bones. If you're on an anti-inflammatory diet and you've had to remove dairy or something like that or you're not incorporating that in your plan, you still need to get calcium and other nutrients and those bones can be a really helpful source for that. Then omega-3 fatty acids are also in those fish and those are like dampeners of inflammation. So I really like those. Arugula. Arugula is another one of my favorites. I love Arugula for quite a few reasons. So try to incorporate that into a salad, saute it as maybe a side dish or something like that. That could be good. Then vitamin C rich foods make sure you're incorporating those because as I talked about before, that's really, really helpful for developing and maintaining a healthy skeleton. So that's from the nutrition perspective. Then the last part of this, you need to exercise. You can be taking all the supplements you want. You can be eating all the mackerel, the sardines, the arugula, the vitamin C rich foods, the berries, all that stuff. You could do all that and not build bone or be able to build bone strength because you didn't provide any stimulus to help. So you need two different types of stimuli to build your bone strength. You need muscle pulling on bone and you need impact. And the most effective interventions are going to use one or both of those things in combination. So a lot of times people are just told, go do some weight bearing exercise, go do some walking. Like I tell you, walking is not going to be enough to build bone. It may help you maintain maybe on the lower portion of your body, but it's not going to help you build bone strength. So yes, absolutely walk, but just be aware that it's not going to be enough. And then also be aware that if you're only incorporating non-weight bearing exercise, which would be your swimming or your cycling as your only forms of exercise, that also has to be addressed. You have to have the other form of exercise, which is resistance training. This has to be a part of it. And this could be done with dumbbells or barbells or resistance bands or things like that. And you can get to a point where you're providing enough of an intensity and a stimulus in a safe way that is going to get you to a point where you're actually building bone strength. Those would probably be some of the biggest pieces that I would say you need to touch on.