Ep. 252 How To Optimize Your Bone Health with Bone Coach Kevin Ellis

Cynthia Thurlow: 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 had the honor of connect with my friend and colleague Kevin Ellis, The Bone Coach. We dove deep into his background and interest in osteoporosis and celiac disease, the role of bone health, as well as osteopenia and osteoporosis. The contributors that impact bone health including lifestyle, drugs and chronic diseases, conventional treatments for osteoporosis, and why they’re problematic. Ways to address osteoporosis in a proactive manner, the role of the gut microbiome and bone health, as well as a study discussing the impact of blood pressure, accelerating bone aging, and the impact of insulin resistance. I hope you will enjoy this podcast as much as I did recording it as so many women in particular are impacted by not only osteopenia but osteoporosis throughout their lifetime.

Kevin, it’s so great to have you on the podcast. I’ve been really looking forward to diving deep into bone health.

Kevin Ellis: Well, I’m excited to be here, so thanks for having me.

Cynthia Thurlow: Yeah, so what got you so interested and passionate about bone physiology and bone coaching?

Kevin Ellis: My own personal health journey, like so many other people that start out in the health space, it’s their own personal health journey. For me, it was being diagnosed with osteoporosis in my early 30s at a really young age. My health journey really started when I was a lot younger. When my mother was five months pregnant with me, my father was told he had cancer. Two months after I was born, he passed away and he was 35 years old at that time. My entire life I grew up feeling like 35 was going to be my finish line. When I got out of the Marine Corps, I started having all these different health issues and I had really high stress, I had poor sleep, I had gut health and digestive issues. I was diagnosed with celiac disease, the autoimmune condition that damages the villi when you eat gluten. I was subsequently told I had osteoporosis.

Here I am, this tough Marine who is thinking in his head like, how could this possibly be? How could I have been so tough and gone through all these things and then come out and have weak bones? At the same time, I had young kids that were going to be on the way and I was just worried that I was going down the same path of my father and I was going to head to an early grave. That was really my impetus for wanting to get into the research and start doing these things so I could benefit myself first. As along the way, I started learning all about bone health, the research, the reading, consulting with different experts, spending a lot of money trying to figure all this stuff out. I realized it’s not the 30-year-old male that’s dealing with this is trying to figure these things out. It’s the woman, usually 50 to 65 plus with osteopenia, with osteoporosis that’s told, “Hey, you have osteoporosis. Here are your options. Take some calcium, take some vitamin D, go for a walk, and here’s your bone drug. We’ll see in one year for your next bone density scan.” That is woefully inadequate and oftentimes just not the right approach for so many people. I realized I could help a lot of people here. So, we developed The Bone Coach. I became a health coach. I built it out a team of credentialed experts, and we developed a program that’s now helped people in over 1500 cities around the world. I’ve been featured in Forbes and a lot of other places, and it’s just exciting to see the people that we were helping and the lives were changing.

Cynthia Thurlow: What an incredible pain-to-purpose story. One that I was saying to you before we started recording. I can’t think of a lot of people talking about bone health, but yet it’s so important. When I was preparing for this interview, it’s interesting, I’m going to just read some statistics. 95% of maximum bone density is by the age of 17. I have teenagers at home, both males, men, it’s 21 years old. 17 years old for women, 21 for males. After 30, our peak bone and muscle mass are in our 20s and 30s. After 30, there’s a gradual decline in natural bone mass reduction. We don’t talk about this, we don’t even worry about it until someone gets a screening DEXA, maybe when they’re 50, maybe when they’re 40, and they have no idea. And so, let’s talk about the impact like what is osteopenia versus osteoporosis? Understanding that osteoporosis is one example impacts 44 million Americans. I mean that’s a staggering amount of people that are walking around with poor bone health.

Kevin Ellis: Yes, so osteoporosis literally means porous bone. It’s a condition that’s characterized by either not enough bone formation, excessive bone loss, or it’s a combination of the two of those things. And in osteoporosis, both your bone density and your bone quality are reduced and that’s going to increase your risk of fracture. Now, the way you find out you have osteoporosis is through what’s called a DEXA scan, that’s dual-energy x-ray absorptiometry, a painless test, kind of like an x-ray, very low levels of radiation. You lay down on the machine, the machine does a scan and it tells your bone mineral density, the actual mineral content of your bone. Then what it does is it generates a score. That score is called a T-score and the T-score is basically telling you how much your bone mass differs from the bone mass of an average healthy 30-year-old adult. If you’ve got a score of 0 or somewhere +1/-1 somewhere there that’s considered normal and healthy.

If you’ve got a -1 to a -2.5 that’s considered osteopenia what most of us call low bone mass. And It’s like a precursor to osteoporosis. If you’ve got a score of -2.5 or lower so -2.6, -2.7 so on and so forth, that’s considered osteoporosis. The greater that negative number becomes, the more severe the osteoporosis. Now, you know this well, most people are not getting these until later on in life till their 50s, 60s. Maybe not even until they’re 65 or older. I recommend people get them a lot younger. Their 30s, their 40s, or something like that. You have at least one objective measurement from which you can monitor future changes so that when you hit menopause or you become postmenopausal and you have some reduction in bone loss, you’re not just surprised because you may not have actually had peak bone mass or reached it in your younger years too.

Cynthia Thurlow: Well, it’s interesting because how many women are on oral contraceptives and as one example oral contraceptives are keeping your sex hormones low, and how many women are on them from their teenage years until maybe they’re 30 years old until they start trying to have a family and they don’t understand they’ve missed out on all these years of healthy bone development. And yet I understand we take oral contraceptives to help with contraception or to “Fix PCOS” or other types of menstrual regularities. As someone who was on oral contraceptives for a chunk of my young adulthood and is osteopenic now, I start reflecting back like what could we have done differently? What could have happened? And the other thing about osteopenia that I find really interesting is it’s really a diagnosis that’s been driven by the pharmaceutical industry because you can’t compare a 30-year-old’s bone to a 50-year-old’s and expect them to be the same it would be unusual.

Can you speak to that? Like, what has been your experience? I think a lot of people here have osteopenia and they automatically they get this diagnosis or I’m going to put that in air quotes, there really isn’t a diagnosis. They get this attachment to their bone health and all of a sudden they’re fearful that that determines for them that they absolutely positively are going to end up developing osteoporosis. It doesn’t have to be the case.

Kevin Ellis: Yeah. So, a couple of things there. Osteopenia, that’s what most people are told they have, but we would refer to it as low bone mass. It’s not a formal diagnosis, but that’s what someone’s going to be told they have. When I’m communicating with people, that’s the language they know. So, that’s the language I’ll use. I’ll tell them, “Hey, it’s low bone mass,” and there’s more to the picture than just your bone density score. The bone density score, I just talked about a T-score, that’s comparing your bone density to the bone mass of a healthy, approximately 30-year-old adult, no matter what your age is. There’s also a Z-score, that’s comparing your bone mass to somebody who is the same age as you also. That’s going to probably be a better score to look at, especially if you’re a younger person.

Then the other part of this is that when you get a bone density scan, it’s only giving you part of the picture. Bone density is the actual mineral content of your bone. Bone quality is the structural integrity of that bone, the microarchitecture, how that bone is organized. Those two things combine to create bone strength. A lot of times you only have part of the picture at the time of diagnosis and diagnosis happens in 15 minutes. You get your bone density scan results back, calcium, vitamin D, go for a walk, here’s your bone medication. There’s more information that you have to have. Another piece of information you have to have, is that a bone density scan, especially if you only have one, it can’t tell you if you’re actively losing bone right now. A single bone density scan won’t tell you that. What can tell you that are what are called bone turnover markers?

One of them is serum CTX or a C-telopeptide test. This test looks at the activity level of cells that are breaking down bone. If that activity level is elevated or even really high, that can be an indicator of active bone loss and a root cause issue that needs to be addressed. There’s also NTX, that’s another one, and then there are bone formation markers too, that you can look at. P1NP is one of them, that’s Procollagen Type 1 N-Terminal Propeptide. That’s the most sensitive marker for bone formation, but these are just some of the things that you can look at. That, again, the single bone density scan is not going to give you that part of the picture.

Cynthia Thurlow: I would imagine that it’s probably a functional or integrative medicine provider that’s going to offer those additional bone turnover tests.

Kevin Ellis: They would probably lead, a functional provider would probably lead with those tests. You’re going to have to ask your general practitioner and the general practitioner, they might not even order them because the physician does not understand how to interpret a test. They’re likely not going to order it for you. They may send you out to an endocrinologist. Bones are an endocrine organ, so they may send you out to an endocrinologist to get that test done. The endocrinologist may or may not order it for you. So that’s part of it?

Cynthia Thurlow: Yeah, absolutely. Some of the more common things that impact bone health, lifestyle pieces, medications, what are some of the more common things that you’re seeing with your clients that are impacting bone in negative ways?

Kevin Ellis: Yeah, they’re actually different types of osteoporosis, and I think it’s really important to distinguish between the two. There’s primary osteoporosis that’s typically related to a decrease in estrogen in postmenopausal women. Estrogen has a protective effect on bone. When estrogen levels decrease, as they do during menopause, that’s going to cause an increase in the activity level of cells that break down bone. But then there’s a whole other cause of osteoporosis and that’s secondary osteoporosis. That’s where osteoporosis is occurring because of behaviors, disorders, diseases, medications, all of those different things. An important note we need to make here is that just because you’re a postmenopausal woman does not mean that as the sole cause of your bone loss. A lot of times I hear physicians sharing with their patients, “Oh, it’s just hormones or this is the natural part of aging, there could be more things that need to be investigated,” and that leads into secondary osteoporosis.

If you’re younger or you’re a male even and you’ve got bone loss and osteoporosis, it could be occurring as a result of those different things. Let’s even talk about let’s unpack some of those, Medications, for example, one of the biggest medications that’s going to contribute to bone loss is glucocorticoids. These are steroid medications designed to suppress inflammation. They mimic natural steroid hormones in your body, and they’re used to treat conditions like rheumatoid arthritis, for one. Asthma is another, and that would be your prednisone and your cortisone. Now, the way these affect your bones is that it’s going to contribute to bone loss, and it’s going to reduce your GI absorption of calcium. It’s going to increase your urinary excretion of calcium. That’s going to create a calcium deficit. The biggest impact comes from these glucocorticoids acting directly on the cells that break down bone to increase their lifespan and that’s going to reduce your bone density.

Another medication, antacids, okay, a lot of times people take antacids. These would be drugs that are designed to reduce the production of or suppress your stomach acid. These would be your proton pump inhibitors, like your omeprazole, your Nexium, your Prevacid or your H2 receptor antagonists drugs like ranitidine or Zantac. I took these for a number of years and I took them because I thought I had too much stomach acid. A lot of times when people think they have too much stomach acid, they oftentimes have too little stomach acid. So when you take these PPIs to suppress that and you’re suppressing what little stomach acid you do have, that’s a problem because you need stomach acid to properly break down and extract nutrients from your food like amino acids. Your bones are 50% protein by volume, they need amino acids, calcium, magnesium, iron, B12. If you don’t have sufficient stomach acid, your bones and your body are going to be starved of these nutrients.

There are a lot of studies that show long-term use of antacids are not going to be good for your bone health. There are quite a few other medications, too. That SSRIs. That’s another one. These are classes of drugs that are typically used as antidepressants. There was a review of 19 studies on the effect of SSRIs on bone that indicate they have a negative effect on bone density and they are going to increase the risk of fracture. There are quite a few other medications I would talk about 2, some of the other diseases and conditions that can contribute to bone loss, anything that’s relating to or affecting the digestive system. We can even just talk about celiac disease as one of them. Now, for me, being diagnosed with celiac disease and malabsorbing nutrients for many many years, that was a secondary cause of my osteoporosis at an early age.

If you’re listening to this and you have celiac disease, or maybe you just have digestive issues, be aware that your bones are likely being affected. If you suspect that you have celiac disease or even if you don’t get tested, rule it out. Make sure that you don’t have celiac disease. If you do have celiac disease, go to your physician. It doesn’t matter if you’re in your late 20s. I’ve worked with people as low as their late 20s. It doesn’t matter if you’re in your late 20s, your 30s, 40s, 50s are higher, go get a bone density scan, request one. Say I have celiac disease. I’m concerned about bone loss. They will order it for you, okay? That way you have an objective measurement.

The other ones, Crohn’s disease, ulcerative colitis, those are some other ones that we have to be aware of can contribute to digestive issues and issues with our bones. I would say also rheumatoid arthritis. I kind of touched on that before, not just because of the glucocorticoid use, but also any of these autoimmune conditions that we have that are maybe creating inflammation in the body. If it’s creating inflammation in the body that’s going to contribute to and fuel bone loss, and it’s not going to be helpful for our bones long term.

Cynthia Thurlow: I think it’s really helpful to have those connections because I know that when I worked in cardiology, we gave PPIs to everyone, and I’m not kidding, everyone in the hospital was put on a PPI. It’s one thing if you’re on it. They’re designed to be used for short term, less than a month, but patients are on them for years. Just thinking about the net impact, I know that statins are also, there’s some association with statins and osteoporosis and how many patients are on statins? Millions? I think it’s really helpful to know that if you’ve got an autoimmune condition, you mentioned celiac, rheumatoid arthritis, Hashimoto’s. We all know that when you have an autoimmune condition, you’ve got a breach in the small intestinal lining and so you’re leaking proteins into the bloodstream. You are making yourself much more susceptible to developing autoimmune conditions, which is self on self your body is attacking itself in different degrees.

Now, another things that I thought were really interesting when I was preparing for today is the use of lifestyle things. Like alcohol, and in particular, tobacco use can also impact bone health in negative ways. Now, we probably don’t see as much tobacco use as we did 20, 30 years ago, but certainly alcohol for a lot of people, we’re maybe three years into this pandemic. I know most people I talk to are consuming more alcohol, not less, but just being cognizant of the fact that can have a negative net impact on not only inflammation in the body, but also can impact your bone health. The other thing that was interesting, I know we had shared an article, I had shared an article earlier this week from American Heart Association, and it was making the connection between hypertension or high blood pressure can accelerate bone loss.

The thing for me is that the reading I did was really talking about the interrelationship between insulin resistance, which we know is that basis for high blood pressure driving the issue related to bone health. Have you had a lot of clients that you’ve seen this in as well?

Kevin Ellis: Yes, there are a couple of things there that I wouldn’t touch on. The first one is I was talking about peak bone mass before you and I had both touched on that, is that when you’re growing up, 90% of your bone mass is going to be put on by the time you turn age 18. By the time you turn 30, the remaining 10% approximately will fill in. If when you were younger, you had a poor diet and nutrition, so you weren’t getting enough calcium or vitamin D or other important nutrients at a young age, or you take a note of sugar, drank a lot of sodas, and sugary soft drinks, or you led a sedentary lifestyle. You weren’t doing gymnastics or playing sports or doing resistance training. You weren’t doing those things, or you smoked or drank excessively, and you continued that on. Or you’re still continuing that today, or you had an eating disorder, or you took certain medications.

All of those things can affect you even reaching and attaining peak bone mass. Remember, it may not just be the things you’re doing today. It could have been the things that you were doing when you were younger. A lot of times it’s a combination of both. A lot of times it’s things you did when you were younger. Things that do need to be addressed today. The other part of this is I touched on sugar there too, but reducing your sugar intake. I’m sure you’ve already driven this home and every health podcast and person drives this one home. I’m going to give it one more for bone health, you need to reduce your sugar intake for bone health. Sugar damages bone by triggering an inflammatory response. It lowers your vitamin D levels. It depletes your bone healthy minerals like your calcium, your magnesium, your chromium, your copper.

You just have to understand that’s not going to be a helpful thing. The other thing is that blocks the absorption of vitamin C and vitamin C, I’ll talk about this too in a little bit, it’s key for developing and maintaining a healthy skeleton. So really, really important. If you’ve got high blood sugar also, that can damage your bone, well, partially by damaging the kidneys, which is going to make it harder for you to absorb calcium. Then also you’ll start to get AGEs. This is going to be really important to understand because you can actually have these age-deformed proteins can actually replace healthy collagen protein in your bones. That’s going to lead to weaker bones over time. Just a lot of really important things there when it comes to lifestyle factors that can be impacting your bone health.

Cynthia Thurlow: Well, and I think a lot of people just assume bone is bone. They don’t think about the fact that the net impact of the types of foods they’re consuming and the bulk of the population right now we know is not metabolically healthy. A lot of people eat a lot of hyper palatable highly processed foods. The message we’re kind of bringing home and there are things we can change that can impact bone health in positive ways. Now let’s talk about the kind of conventional allopathic approach to osteoporosis, osteopenia. It’s really, really interesting that I was practicing as an NP for a long time before we started seeing the development of some of these drugs that were designed to help women, predominantly women, but there are some men as well, predominantly women, that have osteoporosis that have a lot of side effects. If you’re taking things like Zometa, Boniva, Actonel, Fosamax. They are not without side effects, but I’d love for your touch on this.

Kevin Ellis: Yeah. I always liken the use of medications to that old economic adage, there’s no such thing as a free lunch. There’s a risk associated with everything. There’s short and long-term side effects and implications of use of all of these things. When it comes to bone medications or bone drugs, it’s not like taking an aspirin. These have a dramatic effect on bone physiology and short and long-term implications of use. There are two different categories of these medications. There are antiresorptives and there are anabolics. Antiresorptives, these are drugs that are designed to slow down the activity level of cells that break down bone. This would be your bisphosphonates like Fosamax, like Boniva, like Reclast those kinds of drugs, and then it could also be your RANK ligand inhibitors, like Prolia, for example. Those are all antiresorptives. Now, for bisphosphonates specifically, the safety and efficacy are not really well known beyond five years.

As you and I are going about our daily lives, doing our daily activities, working out, exercising, doing things around the house, all those things, we’re getting these little micro-cracks and damage in our bones, that’s normal. It happens with everybody. And then what happens is you have cells within the bone called osteocytes and they sense that damage, they’re like orchestrators of the bone remodeling process. They sense that damage and they send out a signal. That signal goes to these other bone cells. One of them is called an osteoclast. The osteoclasts come in and they scoop out that damaged bone and then it’s a coupled process. Behind it comes the osteoblast that fill in stronger, healthier bone. What happens is though, you can actually slow down the activity level of cells that break down or that clear out that damaged bone. You can slow that down too much to where over time you start to accumulate that old, worn, damaged, weakened bone.

That’s why even if you’re taking some of those medications, your bone density may show higher in some situations, but it might not actually be stronger bone. So, really important to note there, and then with anabolic medications, these are the other ones. A lot of times anabolic medication I can’t always be, “I am pro, do everything you possibly can naturally before considering medication as an option. That’s kind of my approach and I would say 90% of the people I work with, they’re trying to do everything they possibly can naturally and that’s how we support them. At the same time, I have seen situations where medication has been necessary and life-saving. That’s kind of the little caveat I have to put in there. Anabolics are medications that are usually proposed to people that have already fractured or they’ve had low trauma fractures or really poor-quality bone.

And they need an intervention very quickly. The anabolic is designed to build bone, build better quality bone and build it faster and they do that as long as you’ve addressed the root cause issues and things like that, they can do that. The drugs would be Forteo, Evenity, and Tymlos. But with these drugs, you have to understand you can only use them for a certain period of time. There’s a time limit on their use and then this is the big one. You have to follow that drug with another drug with antiresorptive just to not lose the bone you just gained. So, many people don’t get this level of education about these medications in that 15-minute conversation when they’re diagnosed, and they just jump right into it without understanding that you may be committing to a medication not just for a short period of time, for a couple of years or maybe even the rest of your lifetime.

Cynthia Thurlow: I think that’s really important that as clinicians and we’re talking to patients, that we give them the full understanding of the implications of taking that medication. As you stated, there are times when it’s appropriate for people to be on medications, but understanding it’s not just that drug, it will then lead to another drug. One really interesting statistic that I found is for those that are taking biphosphates, the longer you take them, the greater the risk for mandibular necrosis. This is actual damage to the bone in your jaw and atypical femoral fractures, which I saw a lot of this in the ER, as well as atrial fibrillation, which is a heart arrhythmia, which I saw a lot of, and then an eye issue called uveitis. Just really interesting, like, as I was diving down this rabbit hole to get prepared for today, I was like, there’re long-standing issues. It’s not just the bone. You can also impact heart arrhythmias, eye issues. You can get these relatively seemingly benign atypical femoral fractures. You’re building bone, but it’s not per se, healthy bone.

Kevin Ellis: Especially, I’ve had a lot of people that talk about, “I tried the medication even one time and they just had this full body reaction, just basically rejected it or it really triggered or accelerated different digestive issues that they had.” Usually, I would always encourage people and again, consult with your physician, but I would always encourage people to pause when you’re in that room and you get told, “Hey, I have osteopenia or I have osteoporosis, pause and gather more objective information before you just jump right into that decision.”

Cynthia Thurlow: Absolutely, one thing that I’m starting to find and see is now that hormone therapies are not as vilified as they were 20 years ago after Women’s Health Initiative came out, I’m starting to see more providers prescribing estrogen and testosterone therapies to help with bone health. Are you seeing that in your clinical practice as well?

Kevin Ellis: Yeah, and we always– hormones are such an important part of this picture, and there are preventative things that people can do before they go through menopause, but there are also things that can be done after. I always tell people, and we’ve got people on our team that help with hormones and things like that. I don’t personally or specifically deal with the creation of the plan for hormones for people, but it’s an important part. Bioidentical hormone replacement therapy can be an important part of that plan. Estrogen, testosterone, progesterone, all of which are important. Then you just work with somebody to figure out what’s the right amount and the right dosing for you.

Cynthia Thurlow: Absolutely. It goes without saying, a lot of the conversations that we have on this podcast is just providing good information. If you are osteoporotic or osteopenic starting that conversation with your healthcare provider earlier rather than later, so you can be proactive. Now, it’s interesting, I was reading in the American Journal of Clinical Nutrition that calcium does not reduce fracture risk in postmenopausal women and may actually increase hip fractures. Has that been consistent with what you have been reading as well?

Kevin Ellis: Calcium is going to be important. It has to be taken or consumed with other nutrients and cofactors. If we look at just calcium or just vitamin D by themselves, and maybe we’re supplementing for 500 milligrams or more or something a day, if you don’t have these other nutrients and cofactors, that’s going to increase cardiovascular disease risk, it’s going to increase risk of kidney stones and all those different things. I’m always encouraging people, start with your diet and nutrition first. How can we get you to the point? You need to actually kind of count this out, at least initially count it out, see where you’re at from at least your most important nutrients, so we could talk about what some of those other nutrients are in a minute. Get to the point where you are sufficient in some of these nutrients and then where you can’t close the gaps or you’re having a really challenging time, especially if you’re on an autoimmune protocol or you’re on a restrictive initial dietary approach that maybe is limiting certain nutrients, that’s when we’re going to bring in supplementation to close those gaps if and when necessary.

Some of the other nutrients. Calcium is obviously one of the nutrients. Yes, it is the primary mineral constituent in your bones. So, it is important, but we have to have these other nutrients and vitamins and minerals too. So, what are those other nutrients? Vitamin D is really important. Most people already know vitamin D and calcium for bone health. Vitamin D is increasing the intestinal absorption of calcium. It’s reducing the urinary excretion of calcium. It’s going to promote higher bone mineral density, it’s going to slow bone loss and have a lot of other positive health impacts for us. Before you actually go supplementing with vitamin D, you need to get a test run to see what your vitamin D levels are at. A 25-hydroxy vitamin D test, get that run, see where your levels are at. For most people in the US that range is really wide. It’s 30 to 100 ng/mL. If you’re on the very low range of that, or you’re on the upper end of that, you’re going to be told that’s normal, and that’s not normal to be up at 100 or more ng/mL, you can actually get to the point where you’re taking too much vitamin D and that can contribute to bone loss too. If you’re on that lower end of the spectrum and you’re in the 30s or you’re lower, that’s also going to be something that has to be addressed. Most of people are going to recommend right around 50 to 80 ng/mL somewhere around there. It’s going to vary based on your situation, but that’s a good target point. As you start supplementing with vitamin D, you want to check your levels every three to six months to see where you’re at, to see the effectiveness of the supplement that you’re taking, but also to see where your levels are at if you’re getting too high or if you need to make adjustments.

Maybe you’re supplementing a certain amount and it’s having zero impact and you need to make adjustments there, too. That’s for vitamin D, another nutrient that’s really important, vitamin K, K1, K2. K1 can be converted to K2, but it’s not going to happen efficiently. K2 is what’s most important for your bone health. K2 is going to aid in bone mineralization. It activates what’s called osteocalcin and matrix Gla protein. What that’s going to do is it’s going to ensure that the calcium is not going to your soft tissues like your arteries and your kidneys, but that it’s going to be directed to your bones where it needs to be. Some of the dietary sources for that. If we’re talking about K1, these would be your dark green veggies, your asparagus, your kale, your broccoli, your chard, all that kind of stuff.

If you’re talking about K2, there’re different forms of K2. There’s MK4 and that would be found in like beef liver, your grass-fed ghee and butter, your dark meat chicken, your pastured egg yolks. Those are sources of MK4 and in MK7 would be your hard cheeses, your fermented foods, sauerkraut, natto, and this is really interesting, bacterial fermentation in our guts, your gut can actually produce nutrients for your health. That’s amazing, we have that within us and it’s amazing that it can do that.

Cynthia Thurlow: Do you have any research? Are you talking at all about melatonin? I did a melatonin podcast a few months ago and so it was down the rabbit hole about melatonin. From what I was reading, it actually helps with bone turnover and promotes osteoblasts. 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 use. 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?

Kevin Ellis: We would always encourage somebody to start. What progress can we make before incorporating or adding that in. It could be a helpful part of somebody’s plan because most people, melatonin hormone is produced. It’s this tiny gland in the 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 play an important role in terms of helping regulate our circadian rhythm. It’s improving bone remodeling by suppressing bone loss, by promoting bone formation. It actually upregulates the gene expression of proteins and markers for a bone formation like alkaline, phosphatase, bone morphogenetic protein, osteocalcin, osteoprotegerin, those are all things that are being upregulated and promoted for bone formation with melatonin.

And then it’s eliminating free radicals. 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, they’re basically toxic byproducts of oxygen metabolism that can cause significant damage to cells and tissues through oxidative stress. Melatonin is actually an antioxidant that can help with that. It can absolutely be a helpful part of that.

Cynthia Thurlow: Yeah, it’s really interesting. Melatonin is one of these 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?

Kevin Ellis: 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, 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 an important part of our health. That fight or flight response, it’s 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 need it most, like your muscles and 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. But when we’re chronically activating this and flooding our bodies with cortisol that’s when we’re going to run into problems. 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. 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 osteoblast to form bone. These are the cells that build bones, so it’s reducing their ability to do their job.

We kind of touched on this with glucocorticoids earlier when we’re talking about prednisone. High glucocorticoids are their natural steroid hormones. That’s what cortisol is. That’s going to kill osteocytes. Osteocytes are the orchestrators of the bone remodeling process. It’s going to contribute to and fuel bone loss if you’ve got chronic long-term stress.

Cynthia Thurlow: Yeah, this is a habitual topic that I discuss in almost every podcast because there’s this unfortunate predilection for people to assume that stress is entirely benign. I remind people acute stress is part of our day-to-day lives. It’s chronic stress that can impact us negatively. I think a lot of people don’t think about bone as its own organ and it really is. So, there’re systemic effects, localized effects from stress. Now, one area that I’m really excited to talk to you about, and I know we are emailing back and forth, is talking about how our bones and our gut health are interrelated. We’ve kind of touched on this, but 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 Sjögren’s, I mean, so many people are impacted by their gut microbiome not being optimized and understanding there’s this complex interrelationship with bone health as well.

Kevin Ellis: 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 down even further. It makes its way to your small intestine, what I call your soil. If you imagine your body and your bones as being like plants, in order to grow you need the right nutrients in the right conditions. So, many people focus so much on the nutrients, the salads, the smoothies or supplements, that they’re not considering that soil. 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. 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.

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 would absorb those nutrients and then they shuttle them to where they’re needed inside the body. If you have damage to those roots or those villi, you’re going to have a really hard time being able to absorb those nutrients. Again, with celiac disease specifically, this is probably the easiest one to tie to it. You will actually start to get blunting of those villi to where they can’t do their job. A lot of those nutrients that you’re taking in, they’re not going to be absorbed. Your body still needs those nutrients to execute its daily functions. If it’s not taking them in from your diet and nutrition and you’re not able to absorb them, where is 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. 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. Those are some of the biggest, biggest things that we need to address.

Cynthia Thurlow: 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, chronic stress can debilitate, it 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 OsteoStrong?

Kevin Ellis: So, OsteoStrong, they use a concept called osteogenic loading, which is basically loading a bone to induce structural adaptation to get it to become stronger basically. 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 body weight 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 would be a compliment, but not a replacement to a full exercise plan. 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. You have to zoom out and look at the full picture. In terms of whether somebody should or should not incorporate it, 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 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.

Cynthia Thurlow: I think that’s very reasonable. And we had Dr. Barrie Tan on in the fall and I was delightfully surprised to learn about tocotrienols and annatto and bone health. Is this something that you are using with your clients right now or your clinicians are using it with their clients? It’s something that really, I found I was humbly, very humbly interested, invested in learning more about the role of annatto and bone health.

Kevin Ellis: Very trying, yeah, he’s done so much research in tocotrienols and vitamin E. He’s been doing this over three decades. He is like the leading person in this Ph.D. in chemistry and biochemistry. What he talks about is the gamma and delta tocotrienols are the best forms. 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 help improve bone formation, it’s reducing bone resorption or breakdown, helping improve 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, especially in the work he’s already done.

Cynthia Thurlow: 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 tocotrienol or annatto as a bridge therapy, if you will until they’re more comfortable. A couple of people ask about diatomaceous earth that somehow has some bone-supportive aspects that I was not aware of, but I said I would ask you nonetheless.

Kevin Ellis: That’s not something I particularly recommend. 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 horsetail extract. When I first heard horsetail, I actually thought I was like, “Do they really put a horse’s tail in this, but it’s not actually a horse’s tail. It’s something different than that.” Those are some sources of silica and then cucumbers, for example, that’s another source of silica. There are ways and there’s silica in a variety of different plant foods that we’re eating also. It’s not like you just have to go take the spoon of diatomaceous earth and this chalky substance and take it down or mix it into your water and gosh, I don’t want to misspeak here, but I’m not sure if taking lots of diatomaceous earth can potentially have issues with kidneys or cause kidney damage long term, have you read that?

Cynthia Thurlow: I think you can get a lot of heavy metal exposure. That’s actually why I don’t personally recommend or use it. 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’re multiple interventions that we can utilize that are very effective. To kind of wrap things up, what are your top three recommendations for bone health? Like, if someone’s listening and maybe they’re not even aware what their DEXA scan is, but they’re perimenopausal, menopausal, or if there’s a male listening that’s in andropause and yes, men do go through andropause and are at risk.

You know 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 genetic susceptibility. 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? So, just blanket recommendations.

Kevin Ellis: 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 who, maybe if it’s not interest 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. Go get an active bone loss test, a serum 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. There’re also plenty of functional medicine practitioners out there that can help with that in figuring out the root cause of issue. The other part of this is make sure your nutrition and your stress and your sleep are dialed in. In terms of stress, we just talked about this, 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, it 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 nonnegotiable 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, I couldn’t live without this at this point? So, cultivate a healthy meditation practice. Sleep, you have to sleep. It is pretty well documented. If you’ve got poor sleep, it’s going to reduce your bone quality. Make sure you’re getting seven, eight, nine hours a night if you possibly can. I know it’s not always possible for everybody, but try to at least get seven. The other part of this is a 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 in 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 into your plan, you still need to get calcium and other nutrients and those bones can be a really helpful source for that. And 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. Try to incorporate that and do a salad, sauté it as maybe a side dish or something like that that could be good. And 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. 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. You need two different types of stimuli to build your bone strength. You need muscle pulling on bone and you need impact. The most effective interventions are going to use one or both of those things in combination. A lot of times people are just told to go do some weight-bearing exercise. Go do some walking. Well, I can tell you walking is not going to be enough to build bone. It may help you maintain may be on the lower portion of your body, but it’s not going to help you build bone strength.

So, yes, absolutely walk. Just be aware that’s not going to be enough. Also be aware that if you’re only incorporating nonweight-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. This could be done with dumbbells or barbells or resistance bands or things like that. 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.

Cynthia Thurlow: Well, this has been fantastic. I have learned so much. I know listeners will as well. Let them know how they can connect with you, how they can work with you. I know that there’s a book coming at some point in the future, I’m going to manifest that happening for you, but let people know how to connect with you on social media and your website.

Kevin Ellis: You can always find me on bonecoach.com and always on Instagram and Facebook and YouTube and things like that. But what I’d like to do for your audience and if it’s okay with you, Cynthia is maybe we can, in the show notes, leave my free Stronger Bones Masterclass for them. It’s got a free Bone Healthy Recipes guide that comes with it too and it’s going to walk them through step by step, everything that they need to be doing to start getting on the path to improvement and stronger bones. They could share this episode also with somebody that has osteopenia or osteoporosis that needs to hear this information. I would say the best starting point is the link in the show notes that Cynthia if you don’t mind.

Cynthia Thurlow: Happy to share it. I actually listened to it and watched it the other night.

Kevin Ellis: Awesome. Well, that’s where you can find me. We’ve got programs that help people build stronger bones, that have helped a lot of people at this point. We’ve got a thriving community of over 100,000 people at this point, too.

Cynthia Thurlow: That’s awesome. Thank you again, my friend.

Kevin Ellis: Thanks.

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Cynthia Thurlow: If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.