Ep. 571 Stop Losing Bone After 40 – The Most Effective Way to Reverse Osteoporosis & Build Strength with Dr. Nick Trubee

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. Today I have the honor of connecting with Dr. Nick Truby. He's an exercise physiologist and certified strength and conditioning specialist with over 17 years of experience. He's also a former university professor, now coaches clients online with a focus on osteoporosis prevention and reversal through resistance, training, and impact training. Today we spoke about why bone and muscle loss accelerates after 40. Misconceptions that walking or light activity alone is enough to build bone, specific risk factors for bone loss, and as Nick describes it, it is a spectrum. The reframe that he finds around osteopenia and osteoporosis, misconceptions about exercise as well as progressive overload and what exactly it is, the frequency of strength training to build strength, how to avoid injuries while training, the importance of both intensity and zone two, the role of nutrition in particular protein intake for improving strength and bone health, meal timing, weighted belts, this and weights, why grip strength is a proxy of overall strength, the impact of vibration plates and infrared sauna, and last but not least, why mindset and delayed gratification are so important as it pertains to bone and muscle health. This is one of these truly invaluable conversations, one I'm sure you will listen to more than once. Nick, such a pleasure to have you on the podcast. I love your work, and I know it'll be invaluable to my everyday wellness community. Thank you, Cynthia, for having me. Appreciate it. Before we were recording, we were talking about a lot of the confusion that is around messaging for women about how they need to go about setting up training, and maybe we can kind of start the conversation around what is happening to bone and muscle as we are navigating that perimenopause to menopause transition, because that's a good starting point before we talk about what we can do to address those changes proactively. Absolutely. I think it's a question that we should all ask right away is what is actually occurring internally? It's kind of funny because when you don't really notice it, because the changes actually are occurring many times a decade before you start noticing them. That's just kind of when you've been hiking on this plateau, and then all of a sudden there's the cliff, and we feel that cliff. But in the background, if we're really not intentional about how we're setting up our training, how we're actually physically training in the moment, in challenging ourselves with x, y, and z types of modalities, which we can talk about, changes to muscle and bone are occurring usually negatively if we're not in tune with resistance training or impact training and different forms of exercise. But as a gradual, our body always works toward being efficient. That's just kind of us as humans, our physiology is always working to be as efficient as possible. How can I burn the least amount of calories while I'm sitting here? Or how can I maintain the least amount of muscle mass because muscle is energetically expensive. It uses a lot of energy, uses sitting there. So your body is kind of always fighting against you in that sense. But if you flip that on its head and you kind of, you take charge of that, no matter how old you are, young or old, it usually trends in the right direction. But it really just comes down to applying certain stressors very consistently from a week to week basis. And for women, women, he kind of hit their peak bone mass in their mid-20s. And I think one of the things, even as a clinician myself, I didn't fully appreciate because I was so tucked away in another specialty area was that if you miss out on the opportunities to build really healthy bone in your teens and 20s, what that can kind of set you up for as you are aging. And I'm thinking about people that maybe had relative energy deficiency, maybe they were doing a lot of training. Maybe it's a mom who was spent several years breastfeeding. We know breastfeeding can be hard on bone mass. Maybe it's someone who has been underweight their entire life. And then you couple that with kind of genetic susceptibility to osteopenia. And so when you're working with your clients, how do you identify people that you think are at greater risk for acceleration and bone loss, as opposed to the average? And I know there's even genetic and racial differences between bone mass, but who are the people that you're most concerned about? Sure. Yeah. Most of my clients, believe it or not, are kind of the undersized individuals where they've been pretty petite their whole life, or maybe they've gone through a large weight loss. Now they're at a very small body mass in general. But it's interesting because the more I dive into it, the more people I engage with. There's a large spectrum where I've got some people who have zero experience with any kind of exercise, and they may have been fed well through adolescence and adulthood, or they could be on the exact opposite end of that and been over-exercised and underfed kind of in that cardiovascular, you know, like you mentioned before, cardiobunny or very competitive running or cycling or whatever their kind of modality was, you know, growing up through high school and in college. They both kind of end up in a very similar place where they were developed in loss bone over time, or they never developed, and now they're already at a deficiency to begin with. And both of those realistically kind of have a merge point, and that really comes down to how can I first work on improving their overall body strength? Because most of them are undermuscled and, you know, for a lack of a better term, weak, you know, which, you know, if you can face a head on it makes it a little bit easier to understand. But, you know, that's really the first stage because you can't really have much of an impact on stimulating bone if we're not at a certain level. And most of that time it takes a certain level of strength before you can either load yourself, you know, effectively enough for this bone to see a stimulus for change, or you're strong enough to handle higher intensity movements like an impact training kind of session. So both of those places, regardless of where they were undermuscled, underboned, or the, you know, the exact opposite of that, they both kind of end up in the same place, and that's really, that's find an approachable way to increase body strength, and then we can kind of figure out the best directive from there. Well, and I think for a lot of people, they, when they reflect on, you know, like a frail person, they're thinking of their grandparents, or they're thinking of an older individual. And yet when I was in the hospital still seeing patients, I was sometimes shocked. I had patients who were 50 or 45, and they struggled to get off a bedside toilet. And I kept thinking to myself, yeah, this frailty piece is not per se, equated with chronologic age per se, like there can definitely be people who have just become very sedentary. And, you know, they get this acceleration of muscle loss, and it really feeds this frailty piece. And to your point, before I can even worry about like addressing bone mass issues, I've got to get people to a point where they're stronger so that they can actually challenge themselves. I think I'm probably paraphrasing a little bit, but I think that, you know, you don't necessarily need to be 85 years old and in a rocking trail and have already lost quite a bit of muscle mass, there are much younger people that are experiencing this degree of frailty. And that could be exacerbated by a multiplicity of issues, but certainly the aging process like the sarcopenic obesity that we see so prevalently. And it's interesting, I was having a conversation, my 18 year old is doing an experiment with a continuous glucose monitor. And he's fascinated, he's very muscular, so he's fascinated with how quickly his glucose excursion and improvement, like if he eats a bowl of pasta and a pound of meat, he literally gets a 20 milligram per deciliter increase on a CGM and then it comes down immediately. And I said, you have so much muscle on your body that you have this massive glucose sink. So helping him understand, like if you were the average 55 year old and didn't have a lot of muscle mass, I mean, your blood sugar would probably stay elevated for far longer and probably would, it would take longer to come back down to helping younger people even understand the value of putting on muscle, maintaining muscle throughout our lifetime so that we're not behind the curve. As you astutely mentioned, sometimes you have some patients and clients that come to you that are in that circumstance. Absolutely. And a lot of times it's almost a restructuring and redefining when people think of osteoporosis or osteopenia. I think we all have that vision of our frail grandmother in her 80s that has sadly ended up in that position. But realistically, I've got women in their 30s that are severely osteoporotic already and from the outside, they look very fit and they fit on that very far end of the spectrum. I mentioned about over-exercise, chronically over-exercise, and under-fed for a long time. But realistically, most are 45 to 65 and they look like they're really well put together women. And they've just kind of over time not prioritized maintaining or gaining any kind of strength through improving their muscle tissue or quality in general. And we know all the benefits of how metabolically active muscle is, like you mentioned for after meals and just being a huge sink and receptacle for glucose, which I think is we have to have that. But the beauty of focusing on strength, and I think this is a great message for anybody listening, is when you look at bone and specific, it's very polarizing in that it takes your attention and it grabs it because you're nervous of what does my T-score mean physically. And the way it's spoken to from a medical standpoint, it's typically very negative. People live very fearful of their bodies as soon as they hear that diagnosis and I can't blame them. And then when they dive into, well, how long does it take for me to see changes in bone? And it's even more discouraging because most of the time bone turnover at best, we start to see changes at four months, not even really measurable. And then maybe eight months of consistent intentional, drag down really hard work, right? We can maybe see some measurable changes in bone if you're able to get a scan eight months after you just had one, which that's not going to happen either. Right. So we're talking a year before you actually have physical evidence of what you just did mattered. That's really hard for someone to grab on to and use psychologically. If you're just thinking day in and day out, grind of exercise sometimes. So the strength is a great entry point because we can see changes in strength in two weeks, right? If we're really tactical about exercises we're doing, meeting the needs of where we see deficiencies, people can get highly motivated just within two weeks of seeing strength changes. And I think that's amazing. And then you just build that and you build the rapport off of look at your body is improving. I think your bone can do the same thing. We just need more time. So it's kind of a patient scheme, but that's the beauty of you can sneak that conversation of muscle is a good thing. We're not going to look like I think you've maybe envisioned in your mind of what putting on muscle might mean, right? It is another avenue of getting training and resistance training and impact training more approachable and into their routine. Are you feeling off at night waking up more tired than when you went to bed? It's not just stress. Sometimes it's our bodies navigating the hormonal changes that occur in the perimenopause to menopause transition. And years ago I used to lie awake worrying, tossing and turning only to wake up feeling super exhausted and poor sleep made everything else from focus to mood and digestion even harder the next day. Ever since I started using by optimizers, magnesium breakthrough to my nightly routine, I feel more settled and ready for rest. For me, it helps provide relaxation and calm at bedtime without any groggyness the next morning. And what I love is that it's a blend of seven forms of magnesium designed to support relaxation and overall sleep quality. And unlike other supplements, it uses multiple forms of magnesium to support your body more broadly. 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And when mitochondrial function declines, it can show up as lower energy, slower recovery, reduced 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 urolithin 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 perimenopause and menopause is important to you, might appear is 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. Well, and I think it's helpful to know that you can see gains in muscle strength fairly quickly versus even if you are getting a repeat dexa scan. And that's, you know, when you're talking about that scoring, that's what you're speaking to. And really, you're not getting that every month that might be done once a year. You know, the standard screening modalities here in the United States still speak to 65 years old unless you have some type of a comorbidity, which I think is ridiculous. Everyone listening should start getting dexes in their 30s. Absolutely. They're inexpensive. There's no reason in the world that your insurance should not cover them if they're coded properly, have a conversation with your prescriber. But I think for a lot of people that are very quantitative focused, they're probably like, but I want to know what's going on with my bones. Knowing that you're building strength is one proxy to saying, if I'm building strength and I'm building load on those bones over time, then we can make assumptions that over time, I'm going to be improving that as well. Why are things like, and I'm going to poke the bear, why are things like walking, which is not a bad thing, or just doing bar class or Pilates? Why are these things not enough to actually build bone? Like maybe explaining what it is mechanistically that's important about strength training or explosive movement that's going to be the differentiator for building bone, as opposed to other forms of physical activity, which are still beneficial, but they're not like bone building. Absolutely. I think we have to poke the bear because it just rings a little bit more awareness to our energy that we're expending in the time we're providing in our schedules, which most of us don't have. We need to be really laser focused on what's going to make a difference. Now, you can really look at any kind of exercise and think of, you're asking yourself, is this going to be enough to see changes in bone and or just general strength? It really has to be something that you can, what's called progressively overload, where you can change either the plane of action that you're working in, or you can change the velocity of your movement. You can change the overall amount of work that you're doing from session to session. You can increase resistance, or there's a handful of ways that you can progressively do more work over time. Walking is a challenging one because anything cyclical in nature, our body sees that as a really easy way to, like I mentioned before, become more efficient. It's seeing, oh, I see this step, it just happens over and over again. Over time, you essentially burn less calories in general, doing the same amount of distance covered because you've gotten so efficient in metabolically having the energy reserved for that activity. I'm not going to say that nobody's ever reversed, not reversed osteoporosis or osteopenia by walking, but it's going to be a very, very, very small number because that stressor might be seen as progressively overloaded compared to what they're doing now, but very quickly you accommodate to it. It's normally not enough for the bone to see any kind of stimulus to change. So that's very similar to a bar class or Pilates. I love those two forms of exercise. I recommend them a lot for a lot of people because it really does build coordination, balance, stability, ability to breathe and engage deep core muscles, glute muscles, understand hip flexion extension, all those things that are valuable from a resistance training standpoint. Again, most of those are body weight or applying a certain amount of resistance that really isn't taxing the bone. So great forms of exercise, probably helping us more cardiovascularly or neuromuscularly, not really helping us from a bone or overall strength standpoint. Well, I think that neuromuscular connection, at least for me as I get older, I feel like, and I love solid core for this purpose, making you have to figure out where your body is in time and space. So this kind of proprio reception, especially when you've got your core engaged and maybe you've got your working on like your inner thigh muscles or you're just being conscientious about what you're doing when you're kind of put yourself in a position where you're safely doing these exercises. I'm not suggesting you do something that's going to harm you, but when I'm in those classes, it just reminds me of the need for flexibility and the need for being on an unstable surface because usually you're on a reformer and you're kind of sliding back and forth. In fact, I try to get my husband to go with me and he curses. It's like the only thing analytically that I'm better at than my husband, which says a lot because he's very athletic, but for him, he always says it's like an hour of torture or 50 minutes of torture for him. And I said, well, it just goes to show you like you need to be doing these kinds of activities because it's not your natural inclination. And I think everyone listening probably has things they naturally are inclined to do. And then there are others that require a bit more, dare I say, effort to have to save themselves. Okay, I'm going to lift weights two days a week. It's not my favorite thing to do, but I know it's really important for me to do it. Now, in terms of training frequency, what is the sweet spot? What does the research suggest? How frequently if we're trying to build strength, what is the frequency with which we need to be able to commit to strength training? Absolutely, it's a great question. When you dive into the research, you first have to start with what is your experience? Are you a brand new person of this type of training? That usually means you're likely going to start with less overall work and less overall frequency just because it's a total different load on connective tissue, soft tissue, bone, obviously, and just the movement patterns. So, you know, if you're a newer beginner or coming back into resistance training from a long hiatus, two days a week is a great number to shoot for. And it still gives you somewhere around three days in between training sessions if your week works that way. And you can still compile enough work if you're kind of structuring it in a full body approach to really see noticeable changes. In strength or even increasing the muscle mass. Now, you know, if we look at, if we apply that same stressor, our body kind of works to the point where we need a greater amount of either overall work or frequency to start seeing more and more improvement until there's that walled vision returns. So, realistically, when you have maybe six months or more of a compiled resume of I've been really consistent for two days per week, hitting all my main muscle groups, really starting to see improvements, then shifting to maybe three times per week is a great number to shoot for. And that's based on the research that's typically enough to see a large enough amount of work on a weekly basis to tax our physiology in the way we're hoping to see changes in. So, two to three is kind of the sweet spot based off what I've seen in my practice and what the research is also reporting. Yeah, because sometimes I'll see on social media women will talk about their training regimen, and this is not a criticism I'm just observing as I typically do. And they'll say, oh, I'm doing four or five days a week. And I think about, you know, they might very well be splitting it up so that they're not doing a really intense session five days a week for more than an hour in intensity. But more often than not, I will also then hear, you know, with the frequency, if I'm training with greater intensity and greater frequency, I'm more likely to injure myself. Where is the kind of sweet spot with training? Like how do we determine where the sweet spot where we're pushing ourselves, we're having this progressive overload, but we're not putting ourselves at risk. And I know that there's a lot of factors. I'm asking you a question that's infinitely challenging because there's so many things like, did you sleep the night before? Where are you on your cycle? You know, are you feeling your body? You know, are you super stressed out? I mean, all those things will probably increase the likelihood that you have the potentiality of injuring yourself. But how do we determine where that degree of intensity is? Because quite transparently, I think some of us are able to do a better job pushing ourselves physically than others. And that's again, observational based on what, you know, thousands of patients have shared with me. And just depending on, you know, what's going on in your personal life, you might have a day where you're like, I don't feel like going to the gym and it's going to be a slog to get through, you know, 45 minutes of a workout and you're going to go home and you're going to feel infinitely better after the fact. But how do we determine how much we can push ourselves or where is that point at which we don't want to injure ourselves also? I love that question. I'm glad you you asked it and brought it up because I think it impacts 99 plus percent of us just in general. And I've done a pretty deep dive into this and there's obviously there's a, you know, 10 or more that I can think of right now, physiological measurements that we can track. That just gets really messy and obviously it's kind of fun if you're kind of data driven and numbers oriented. I kind of look at it from a different perspective of tapping into the psychological more. I think that has a greater impact because there's real time you have to slow down and physically take stock in how your body is reacting to what you're asking of it. And I think if you build that into your workout structure, it becomes really fun. It's almost like a, it's a fun way to reward yourself in that you get immediate satisfaction or an immediate reward based off of something very easy. I think our body craves that sometimes. It's like, for me, I love to mow the grass because it's like hour, I put a little bit of work in, I get an amazing result, my brain is happy. I'm a simple guy. So if you apply that to the workout world, it's a little bit different. So for me, you can't really judge how your body is going to respond while you're at rest. Because while you're at rest, your body wants to stay at rest. It's going to, that devil on your shoulder is going to say almost every time, you don't want to do that workout. Why would you even think about- Let's binge on networks. Netflix. Yeah, you're going to be, you don't want to move. Why would you even consider moving? That's, that doesn't make any sense. So I kind of build in with all of my routines and how I structure all of my client workouts and all the group workouts I lead, anything that I do. I start with something that's so simple that your brain releases its stronghold on your body and says, okay, I'll let you do that. Right? This, it's, you're not going to trick me or whatever. So most of the time for me, most of the time for me, it's like you find something more therapeutic that requires little energy. It's like, maybe I do some film rolling. Maybe I might pick my favorite yoga poses that I can connect with. I like the breathing part of it. I like how my hips kind of flow or whatever it is. It can be different for everybody. Find something that's so easy to get your body in movement. And then you kind of say, that felt pretty good. What's the next little bit of, what's the next bread crumb I can go get? Or my brain is still like, you know, thinking I'm doing nothing. It's fun. And then, yeah. So then you kind of build in that next part of your warm up. Maybe it's something a little bit more related to the squat that you're going to do or the shoulder press that you're going to do. Right? But it's still pretty easy. And then your brain just keeps giving up more and more control when you tap more into your body. That's usually when 10, 15 minutes into that kind of progression, you either find the fatigue is real. The sleep you've missed over the week is real. I'm not feeling better after doing these really simple things. And it's like, all right, I did my due diligence, got my body in the movement. It's not responding the way I want it to. Today might actually be the day to just go for a walk or go read a book or whatever. But most of the time, it's you start to rev up and the thermostat starts to dial up in temperature and your body responds well. You're like, all right, now the exercise actually sounds like a good idea at this point. And then you can start to gradually go into your workout and I strategize and organize at the same way where you intentionally start easy with whatever four or five exercises you're going to do. And with each progressive set, you dial up the intensity, whether it's the speed you're doing it or the resistance you're lifting or any metric that you're trying to travel or do that day, you allow your body to see the spectrum of rest, lower intensity all the way up into physically working at whatever level is appropriate for that day. And that lineage your body craves and it's way easier to repeat that pattern compared to go from rest to hardest part of your workout right away. Because your brain, that's all it sees. Yeah, no, I think the irony is this is kind of what my trainer does. Like we start off with like cow and some stretches before we do anything dynamic. And on a lot of different levels, I think people still will self-flagellate, you know, you have a day, you get up, you just don't feel like you have as much energy instead of listening to their body. They're like, Oh, I have to fit this in right now. So now is my time to exercise. So I'm going to make it happen. Even if I don't feel good, I'm going to force myself to go through these exercises. And certainly, that kind of methodology that you just explained, I think for a lot of people can then, you know, maybe five, 10 minutes in, they can be like, Okay, maybe I was just like slow to get moving. Or, you know, I really am not feeling 100% today. And maybe the best thing I could do would be a recovery day. Maybe I just walk outside. Maybe I go take a nap. But, you know, getting attuned to what your body is trying to tell you and paying attention to that. I think this is critically important because how many of us have like forced ourselves through a workout. And I'm not just talking about the days where you just don't feel like working out. You're not as motivated. But maybe it's a day you really genuinely didn't get as enough sleep, or maybe you had a glass of wine the night before, or maybe it's where you are in your cycle, or maybe you're not even cycling anymore. It's just you just didn't sleep well. And there's a lot going on in your personal life. And you'd be better served doing something a little more recovery focused as opposed to like pushing yourself in the gym. Absolutely. And if you kind of follow that strategy, the first five or 10 minutes are very much recovery focused in general. Doing those simple things that just get blood flow back in the hips or upper back or things that just feel good, but don't tax you so much to where you are going to worry about getting injured. And that's a great kind of dichotomy point of, all right, press the pedal a little bit harder, or man, I pressed it and the car did not increase in speed at all. And those days happen. But I think more often than not, you'll see that just progressing slowly, you can flip the script on what you thought you weren't ready for, your body actually responded pretty well too. And that's really fun to see in real time also. Absolutely. And where do we fit in like high intensity interval training or, you know, explosive training, which is important, but again, goes back to like, where are you? Are you a beginner? Are you more experienced? Are you a conditioned athlete? Those are all very different in terms of recommendations, but from like a basic starting point, I think people hear things like, I'm supposed to get on the treadmill and push it hard for four minutes. And people are like, yeah, it's not going to happen. It needs to be like short digestible bursts. And what is the most, because I always think about efficiency, like what is the most efficient way to get that high intensity interval training in without again, hurting yourself? Sure. You know, I think you could even look at just trying to map and get some sense of how much or what's the quantity of stressors that you're, you know, exposed to on a daily basis. If you already have a very stressful situation, adding a very stressful quote unquote, seen as a positive stressor still fits into and, you know, accumulates into what we're body is experiencing a stress. So I don't always right away, prescribe high intensity training because we're just, you know, beating a dead horse at that point. We can build a little bit more value in slowing down and, you know, seeing that spectrum of resistance that we can build and work up to. I think our body appreciates that more on a slower end of the spectrum. And at least our nervous system now understands what slow and heavy and fast and frenetic means. Those two are very different. And that's the beauty of what I love exercise so much is that it is a direct reflection of our everyday lives. And if you kind of use them opposingly, they meet really well in the middle. So don't think that you have to do right away any higher intensity, you know, exercise to start. If we're talking more bone specific, I love impact training and that is kind of high intensity, no training. But when it comes down to impact, you can control it as far as how intense you're going to do. And you can focus more on just the landing opponent. We don't have to even worry about them jumping. The jumping doesn't feel like it's the best thing for us today. We can just focus on what if I step off and land and just work on my mechanics landing. You can build that in and slowly progress to where you really remove injury, you build empowerment and confidence and trust. And then after you build that resume up a little bit more, your body understands how far you can push it. And when it does feel right to push it, everybody's going to be different. But if you don't have any kind of construct for your body to lean on, understand what those, you know, levels of intensity or just work, it's experience them in general, we have nothing to say today's the day. So I'm sure there's many people listening that are reassured to hear that because sometimes when, you know, we have guests and they'll say, okay, you need to do this much strength training and this much high impact training or high intensity and you have a training and this much zone to people are like, where am I supposed to live my life amongst physical activity recommendations? And so it's helpful to know that that can look different for each one of us depending on where we are, depending on how stressed we have. Where does zone two fit into the conversation with your clients and patients? Yeah, I think it's a great strategy for days following resistance training, just that repetitive nature of if you're cycling or walk jogging or whatever kind of modality you choose, you know, increasing blood flow systemically through the body, increasing muscle temperature, all those things are fantastic for recovery from a higher intensive exercise session the day or two before. So I really recommend it and suggest it then. I think it's a fantastic time for your body to experience it. And you know, this is why I never really fit in academia too well. I spent my fair share of a decade teaching and researching, but there's a huge disconnect between what we see in the research and what actually is approachable and feasible for a human being on earth. We used to call that the ivory tower in medicine. It's okay, this is the ivory tower, but that doesn't actually translate into what patients can follow. Yeah, unless they're getting paid to exercise six hours a day, then maybe they can follow all those criteria. Maybe even then it's likely over prescription of exercise as medicine begin with. So you have to find what makes sense. First, sit down and look at what is my actual goal. You know, am I trying to build strength? Am I looking for bone? Am I trying to build cardiovascular improvement? Whatever that is, dial in that goal and make it to where it's approachable in the sense of you are not overly overwhelmed by just stepping foot in that arena. It might feel uncomfortable. You might be doing something that's totally different, but at least you can get up from the couch and step foot and get ready for battle a little bit. Most of the recommendations are so huge and overwhelming that you don't even know where to start. So I look at it as, and this makes sense in my mind, every minute that you're spending exercising is like your savings account for money. And if I'm able to put $5 in one day, great, I didn't lose money. If I can put $500 in the next day, even better, that's gonna, it's kind of compounding over time. But each one of those minutes, each one of those dollars is an investment that is going to grow and they're all worth it. The value is there. It might just be big one day and small the next. For me, that makes it more worthwhile of how I'm spending my time. Well, and I think it's also very realistic, also very validating because, you know, we're not robots. We're human beings and we have some weeks where we might have an easier time getting to the gym or working out another week. We're getting ready to slide sideways into the holidays. What typically happens, at least I know for moms of the world, it was certainly more challenging when my kids were younger and less independent. But you take care of all the decorating, all the cooking, all the wrapping presents and shopping and all the things. And at the end of the day, you're like, I'm too tired to even do anything for myself. And so I think trying to find what is reasonable and feasible knowing that even if you have five minutes of a workout on that day, that's going to be better than pushing yourself through a workout and ending up sick or injured. Where does nutrition play a role when you're talking to your clients about not just building strength, but also building bone mass? Do you have specific recommendations or things you'd like to review with them that you find are particularly helpful, especially if their goal is to build more muscle and become stronger? Absolutely. Not to a surprise to anyone that I work with, but most like I mentioned before, are really undersized. And it's very challenging to eat the recommended amount that we're trying to have. And if you look at it from more of a governmental standard, anyone over 60 or 65, it's physically active and maybe resistance training. The recommendation is 1.3 grams per kilogram of body weight protein. That is, from my perspective, severely underestimated. Most of the time we're talking closer to one gram per pound of ideal body weight. So if a person is 105 pounds and we're trying to get them to be 105 or 110 or 115, you know, the goal might be 115 grams of protein per day. I'm not going to say go from eating 40 grams per day to 115 grams per day because that's never going to happen. It's not realistic. So we usually start with how can I master one meal at a time? Can I get maybe 30 or 35 grams of protein in on this meal that you want to highlight? And you just kind of baby step your way from there. But it is a conversation that happens every day. And most of the time it kind of, it takes a funny turn and people are really interested in the timing of my meals. They get really dialed in on over thinking that they have to eat relative to their exercise time, which there's value and there's importance to that. I always go back to let's try and master the overall need of our body and then we can get nuanced and we can kind of nerd out on, you know, certain timelines. But I think it's the most value is trying to find the balance of can I eat that much food in general? Because it's hard. It becomes a job to start. Can I not obsess about it? Number two, I don't want you to obsess about it. Because it's easy to obsess about it. And, you know, just take the same approach as we do with the exercise strategy is going to kind of baby step my way from one meal to the next to the point to where I'm confident and comfortable getting a certain prescribed amount of overall food calories, but protein even more so. Yeah, I find it interesting that, you know, I certainly was trained during the timeframe where we bastardized fats and fat was bad and saturated fat was bad and eat lots of heart healthy grains and you're probably not eating. I mean, we have a whole generation didn't eat enough protein and now, you know, it's flipping to the opposite of that. Like, you know, eat the right types of fats, eat plenty of, you know, animal based protein and some plant based protein to find some balance. But when I do diet recalls on patients, I'm sometimes shocked to see that women are eating easily a 30 the amount of protein or maybe half the amount of protein they need to be able to because they'll tell me I don't like my body composition. Everything slid sideways after 40 what's going on and I'm like, well, first of all, you're not feeling your body to be able to build muscle. That's number one. And that protein leverage hypothesis, which I'm quite confident you are super familiarized with, especially for women as they're losing estrogen and their follicular stimulating hormones going up. Our protein needs just accelerate. It's, you know, it's not even enough to say you need 100 grams a day. It's like, that's a minimum. Like if you're currently, if you're tracking and you're eating 50, the goal is to get you to 55, then 60 and then slowly ratchet your way up because you can lift all the weight. But if you're not actually giving your body the appropriate macronutrients to be able to build muscle, that becomes hugely problematic. So what I typically see is women under eat protein. If they're eating a lot of ultra processed food, they're of course getting discretionary crappy soils, adulterated fats. And then the other piece of it is I feel like there's still a lot of emphasis on processed carbohydrates. So we've gotten conditioned to eat a lot of like bread and pasta and I'm like, I don't mind if you have a sweet potato or if you have, if you tolerate grains or if you have some berries, but like we have to kind of flip everything that we were taught. And then I'd make the argument that fiber is helpful depending on who my listener is. Sometimes that infuriates people, other people are like, tell me more. But I think this whole nutritional piece is just not discussed enough. And it's kind of like, if you're trying to get stronger, trying to build muscle, trying not to fall, you actually have to eat and you have to eat enough. And that's where the, you mentioned the timing of food can be something that people perseverate over. I totally get it. I always say like, hopefully I've not contributed to that conversation, but as someone who was known for intermittent fasting for a long time, I would say if you can't get your 100 grams of protein into your feeding window, you need to open up your feeding window. But from your perspective, do you think that there's any value in consuming protein pre or post meal? Is there a window in which you think an anabolic window that's particularly important? What are your thoughts there? Because I feel like the messaging has been all over the place for such a long period of time. People don't know what to do. Yeah. If you look at the research, there's a pretty definitive line of understanding what that quote unquote metabolic window looks like. And that really is going to be dictated by either the intensity of the work that you just did or the overall amount, how long of exercise about you did. So if it's hot, more intense, or if you're exercising for a longer duration, that quote unquote window is going to be open for longer. The things happening in the background, cellularly and physiologically, we're using more energy, we're better able to pull in the glucose from our bloodstream, we're better able to ramp up in the background, protein production, all the things that we want to have happen are going to be happening during and after that workout. So that window is, if you're able to, and this is a great conversation that you can have with yourself, it's different for everyone because I've worked with clients that cannot tolerate food right after a workout, it's just not going to happen. Gastrointestinal good things don't happen, and I've had other people that can eat whatever they want after and never ran between. That's like my husband, he can eat anything, doesn't make him feel bad at all. Doesn't matter. Yeah. So you can experiment a little bit with yourself and I think there's some fun and there's some empowerment there. But if you're able to eat relatively soon after a workout, that's always a good window in our time to attempt to eat. Whether that aligns with your circadian eating window and or if you're tracking that as far as intermittent fasting, there's a lot of value in that, I would suggest that you try it. So how long it is, if it's a lower intensity workout, there may be zero window, might be five or 10 minutes. If it's a really intensive workout, it might be 60 to 90 minutes long. So keep that in mind as you're in your brain figuring out how much or if I'm able to eat there after that workout, I think it's worth it. But again, don't take that as president compared to am I getting enough just for my overall daily needs. Yeah, that's helpful. I mean, it's interesting because I feel like for me personally, the most important thing I have to do on days I train. And when I say train with my trainer, like let me be clear, she pushes me harder than I push myself. I have to hydrate. So hydrate and electrolytes are like the most because that impacts how I feel, it impacts how much energy I have, it impacts how sore I am pretty consistently. Like I try to eat at least 20 grams of protein before I work out with her in the morning as opposed to afternoon workouts because I do one of each during the week. And I just come to find I do much better. This was surprising as someone who worked out fasted for years, days that I have had two meals before I work out with her, my performance is always better. I can always lift more weight. I have much more like intensity if she wants to push things. She knows Monday afternoon is my day to push me during my weekdays. If it's a morning, I'm generally like even though if you were to ask me, I'm a morning exerciser, not nearly as much as I can do in the afternoon after two meals. So I try to have like 20 grams of protein before I meet with her. But I'm not one of those people who wants to eat a big meal. Like I couldn't like eat right away and then go exercise. That wouldn't work for me. And I'm sure everyone listening probably has, you know, this is the power of the end of one, a bio individuality. Like each person listening might have a different way of feeling like they're optimized when they're exercising. And it sounds like what you're saying is in alignment with that as well. Yeah, I think you have to take it from that approach because you're never going to fit the recommended mold ever. And I think once you try to, it becomes very frustrating and it's an easy turn off to, you know, turn the other direction. And that's not what we're hoping to have happen. Yeah. So just have the approach of I'm allowed to experiment with some of these recommendations. And at some point, if you give yourself enough patience with that, you're going to find a really structured, doable approachable plan that you're going to see results from. What are your thoughts on weight belts, weighted vest, wrist weights, ankle weights? Do you like these? Do you feel like people go overboard with it? Do you have kind of a general gestalt? And I'm sure like they're very popular right now. So I'm just curious because this is always where the questions come in. Like they want me to ask the researchers, what do you think about X, Y, or Z? Yeah, I know. I just spoke at a Paramount on Pulse conference a couple of weeks ago and they wanted me to talk about this exact. Very timely. Yeah. I was the only man there of I think 110 ladies, which was kind of funny. They wanted me to talk about this. And, you know, really from the research perspective, we're, you know, like I mentioned before, somebody's probably seen improvement on the bone health side of things by wearing a weight vest. It's really difficult to progress those, if we're talking about like, you know, meeting that guideline of progressive overload, you can get some pretty heavy weight vests. None of the ladies in my neighborhood I've seen are carrying much more than 10 or 12 pounds. I was going to say, I only do 10% of my, yeah, I have a 12 pounder, which is like 10% of my body weight. My husband bestowed a 20 pounder on me. And I, well, yes, but I live in a very hilly part of my state and all I did was go up and down the hills on my street and I walked in and I said, this is way too much weight for me. Like I just, I felt like I was shrinking. So then we went to the, you know, 12 pounds and I was like, oh, this is like my happy weight. So it has to be like the right weight for you. Let me be very clear, but like 20 pounds is way too much for me on my frame. Yeah. You have to look at it from a couple of different perspectives, you know, realistically, the weight that you're carrying is more of a metabolic cardiovascular help and or tax compared to really taxing, you know, muscular and or bone. So from that perspective, not really going to be doing much from an osteoporosis, osteopenia perspective. You also have to be, you know, careful. I'm glad you brought it up because if you increase weight to too high a level, you don't have the muscle mass to support extra weight and or your joints and connective tissue have never experienced that. So you're going to see a lot of joint issues with increasing weight too quickly. I've used it and then recommended it a lot when I start talking about when we start taxing lower body exercises, like a step up exercise, or if I can do a pretty relatively upright torso on a squat or a farmer's carry movement, basically the exercises that are limited by your grip strength to progress and challenge the lower body. Right. So I've recommended, Hey, do your goblet squat to the point where your technique is really good. If you want to add resistance, we're putting our weighted vest on, we can progress that movement and do it in a safe way. Weight's very close to my center of mass. It's not going to affect balance. It's directly letting my spine check it off the list again for, you know, for looking at bone. So I look at it as a way to, you know, use as an extra piece of equipment for resistance training when my upper body doesn't have the strength to tax my lower body. 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I say this because I had an injury last year and I now know way more about grip strength than I ever wanted to know. And I finally now have- I'm sure you've talked about it. Yeah, no. I mean, now my right and my left hand, I can do those farmer carries, but I went through a period of time where my right hand just wasn't as strong. And I remember saying, like, this is too important, which is why I wanted you to reaffirm why grip strength is so important as a proxy of overall strength. Yeah, that and so many other comorbidities. It's an easy measurement. But yeah, most of the movements that we are taxing the lower body, we're also taxing grip strength. Farmers carry a goblet squat, step ups, any of those movements. Huge quality. And if you're able to do them from the bone perspective, those are the ones to go for at the same time we're improving grip strength, which is it's kind of a, you know, it's a win-win. Absolutely. Do you have favorite, because, you know, I always ask, guess this, favorite supplements, supplements that you think are helpful for building bone mass or building muscle mass, you know, what are your thoughts on foradotropin, if you're familiar with that, or creatine monohydrate, or any of these other kind of potential ergogenic aids that have gotten very popular. Yeah. I think the first one is, if you're having issue with getting enough protein in general, don't shy away from a protein supplement, you know, supplement in general. I always look at, you know, where's the sourcing coming from? Because some of the off the shelf brands are, you know, the ingredient list is very extensive, not in a good way. So finding a company that you can trust and the ingredient list is very small and they get their sourcing from the right place. That's a good place to start from. Usually that my next kind of recommendation is creatine for a lot of people. It's got a, you know, a ton of, a big limelight, you know, for the past four or five years. And the same goes for that. I think I was just listening to, I think you might have him as a guest coming up. Mike, metabolic Mike is his handle. Yeah. Mike Hutzel, we're friends. And I basically told him, I was like, all right, you said it. I talked so much about creatine and quality. I was like, all right, now I need you to come on the podcast. We need to talk about it. Yeah. He needs to dial, you know, dial him in on that. I love his content, but he had to go down the rabbit hole on looking at where the sourcing and ingredients from. And that was kind of a scary opening. Don't buy cheap creatine. Do not buy cheap creatine and make sure you're getting it from the right place. But it really has no downside. I mean, the side effects are very minimal, very small percentage of people experience them. Most of it's GI based, but from a muscle protective standpoint, a capacity during exercise and workout standpoint are so amazing that it would really be a disservice if you didn't at least try it. Absolutely. And I feel like a lot of the GI effects from creatine are completely obliterated when you use like the high quality stuff like CREAPure, which you have to license. And transparently, I always say to people like, when people say to me, I don't do well with creatine, I always ask them that are using CREAPure and there are plenty of us in the United States that do use that you have to license it. It tends to be a little more expensive. Otherwise, most of the creatine monohydrate is acid washed and it's super cheap and it comes from China. And I don't say this to be disparaging, but, you know, you get what you pay for in most instances. Yeah. And I found that hydration in general too. If you're under hydrated, you may be more likely to experience a GI type of negative experience, but most of the time, if you can dial in hydration with that, then all is well for sure. Are there any other supplements that you like or you're a proponent of, you know, whether it's stuff for sleep, stuff for recovery, are you a fan of like whey protein or things like that? Yeah, I think whey protein, you know, I'm a huge animal product type of, if I'm getting my protein from somewhere, I would start there. But I always kind of recommend, you know, supplement area isn't my, many people know whey more than I do. So I have them find those conversations somewhere else. I kind of will approach things, you know, more physical. I'm a big fan of, you know, sauna or red light therapy, vibration, all those things that have a different way of impacting our nervous system that most of the time is very positive, just from a physical recovery standpoint, but even also from a bones to me, living standpoint. So I always kind of start the conversation there. And then, you know, anything else on the supplement world, there's great people that know whey more than I do. No, and I appreciate that. And you can always speak from your personal experience as an individual, what you like, because you touched on it. So for recovery, you like vibration plates. Do you have like a general kind of schedule that you like for your clients to do that? Do you want to do it in a couple of days a week? Is that something that's just as needed? I say this is someone who has a vibration plate and I'm like, I should use that more often. Sometimes I just forget it's there. I'm like, I need to get on that more often. Yeah, there I mean, really, you get the most benefit from that was from consistency, at least from the data. Like, you know, for example, I have no ties to this company that power plate probably puts out one of the best products on the market. And their research is saying if you're using it five to almost every day of the week, five to seven days per week, and you've done that consistently for a year, at least from their data, they were tracking in their studies, they saw a two to 3% increase in bone mineral density. That's worth it. Which is pretty awesome for a really small time investment. But it comes down to can I do it almost every day? Yeah. So it isn't one of those things you like me. For me, I'm like, oh, I haven't done it in a week, I should probably get on there. But I should now be much more conscientious. So in terms of recovery, you mentioned infrared sauna, do you like things like cold plunging or cryotherapy? I know that it can be tricky around the time in which you lift, you know, there's this anabolic window that you don't want to kind of suppress inflammation that can impact muscle gains. Yeah, you definitely don't want to do it right after a workout. We need those inflammatory responses to happen. I'm not a huge fan. This is just for I don't like to be cold. So I'm just kind of a baby in general. That's why I don't love 30 degree weather. Me either. I also look at it, because I've seen some research, I mean, some research really has great things to say about it. I try and apply it to the people I've worked with and just everyday person walking around. If you know, cold is a very big physical stressor. If you're already living a very stressful life, adding another very stressful, you know, fight or flight response to the nervous system into that whole recipe of things, then you know, you might want to eat might work better. Well, and you know, it's interesting that you say that my 18 year old who is very into weightlifting and mixed martial arts and anything that's intense, because that's his personality. And he was saying to me last night as we were walking the dogs, because we are getting an infrared sauna. And he said, Oh, I think we should get a plunge tank. And I said, why? And he was explaining why. And I said, Well, you're only home until next summer. And then you're going off to college. And I said, I'm sure as heck not getting in it. And he said, tell me why. And I said, well, cold exposure is hermetic. And, you know, I don't need that much hormesis to get the benefits. Like for me personally, I hate being cold. Do I need a little bit of cold? Sure. But I can take off a layer while I'm walking the dogs when it's 30 degrees and I can get a little bit of hormesis. But to your point, I think for each one of us, like the cost benefit we know women sometimes don't respond as favorably to cold exposure. So when I see a lot of women like every single day doing cold plunges, I'm like, I can't imagine. And let me just say that this is not judgmental. It's more observational that when I see that I'm like, if you're doing that and you're not sleeping well, and you're in perimenopause and you're super stressed out and you're low carb and you're intermittent fasting 20 hours a day, and you're overdoing it with exercise that you're just kind of stacking that hormesis like one on top of the other and you may not get as much benefit. It may end up being detrimental. Yeah, I think in that from that standpoint, you're likely going to be from the detrimental arena for sure. And I find it really hard just to and I've even seen some research with that was really fascinating on how you're perceiving the cold while you're cold plunging. If you're running away from it mentally, it has a much higher response compared to you, which I think is impossible, at least from my perspective. Can you relax in it? Yeah. And be truly relaxed that has a totally different hormonal response during and post, which I would think there are very few people that can be fine comfort in being in 36 or 38 degree water. Also, maybe a like a navy like a ranger or Viking or something. Viking. Yep. Someone who just, you know, loves to suffer for sure. I'd love to round out the conversation because one thing that I've been hearing throughout our conversation is the role of mindset. What are your favorite strategies or books or podcasts that kind of address this things that you recommend to your clients or you yourself utilize? Yeah, that's I think that's really the backbone to anything fitness related because fitness is another reason I love fitness is that it's delayed gratification which if you've experienced any kind of by choice hardships and I say that because you have to put yourself in that arena and it's not easy to do. But if you choose to do very difficult things, knowing that the reward is going to come late, the experience becomes that much more gratifying. And I think exercise lives that day in and day out because you're choosing to put yourself through mental and physical difficulty and it's not going to be comfortable. And that's kind of the point and you don't get the reward immediately after. So I've kind of I've played around a lot with that and tooled in my mind for the past couple years on, you know, how can I reward myself in the short term, but also in the long term, just to make it an approachable topic in your mind. And I found that if I remove all of the physical components of the exercise, obviously we want to the physical stuff is awesome. Like we want to look good, we want to feel good, we want to be able to perform or we want to perform. But if we're always tracking that, it's very difficult because it becomes emotional. We're chasing something emotional. If it's emotional, it's up and down all the time. We have no control over that. So I always track, you know, how I feel before, how I feel during, how I feel after for me, that's easily trackable. And if I notice myself feeling better during and after, then that is my immediate gratification. That's me. I just cut the grass. I see the strikes of my lawn, right? Like I was talking about before, I love that kind of stuff. I mean, my dad jokes, it kind of a thing. It's like, you can attach yourself to that. It's not emotional. It's in real time, you know, in that you can attach to and use day in and day out, compared to the physical, which is always going to be different. So you get that sense of being grateful for what your body can accomplish, no matter how big or small, no matter how old you are, how young you are, you can always be grateful for what you just did. I think there's so much value in that that you can't even put a dollar sign on it. And then if you compound those, over time, the, you know, the positive side effect are the physical things that you wanted to have happen. But if you stressed about them, most of the time, they never happen. So if you can just kind of reverse your mindset of being in the moment, being grateful, it's really based on gratitude and just being grateful for what you're able to accomplish and feel that and chase that and repeat it, the physical component takes care of itself. Well, I couldn't think of a better way to end the conversation. Thank you so much for your time today. Please let listeners know how to connect to the outside of the podcast, how to learn more about your work or listen to your podcast as well. Absolutely. Yeah, the easiest place to find me if you're on Instagram is Dr. Nick Truby, DR.Nick Truby. My website is a great place if you want to connect and join my private community, where I do a lot of engaging with the ladies that are in there, most of which are bone health oriented, but a fantastic community to get a lot of support and live action, actionable things to do from the physical standpoint. And then my podcast is called Fitness Lit Breakdown, where I dive into research articles and give applicable things that you can take away from them. Love it. Thank you again for your time today. Thank you so much, Cynthia. If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.