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Top Tips For Stronger Bones with Dr. John Neustadt - E107
43 Plays11 days ago
For every 19 women taking common antidepressant medications like SSRIs for just one to five years, one will break a bone.
Bone fractures and osteoporosis don’t just steal your peace of mind - they strike when you least expect it and can derail years of careful health choices. Most people think a bone density test will protect them, but it only tells part of the story, missing the real risk lurking underneath.
This episode untangles all the confusion between bone density and bone strength, spells out what truly predicts fractures, and zeroes in on the hidden lifestyle factors, overlooked risks, and research-backed habits that can genuinely strengthen your bones at any age. Get ready for a reality check on conventional wisdom, straight from someone who’s spent decades digging into what actually works for lifelong bone health.
Dr. John Neustadt, ND, is a Bastyr University graduate and #1 Amazon best-selling author of Fracture-Proof Your Bones, now in its expanded 2nd edition. Recognized internationally as an expert in integrative and functional medicine with a deep focus on osteoporosis and fracture prevention, and as one of the top ten cited authors in the world for his work, Dr. Neustadt has published 100+ medical articles, was editor of the textbook Laboratory Evaluations for Integrative and Functional Medicine, and is on the Corporate Advisory Roundtable for the Bone Health & Osteoporosis Foundation. He received multiple US FDA Orphan Drug Designations for the potential treatment of rare diseases using natural products, and is Founder and President of Nutritional Biochemistry, Inc. (NBI) and NBI Pharmaceuticals.
“The best indicator of bone strength is not a test at all. It's whether you fall and break a bone.” - John Neustadt
In this episode you will learn:
- Why bone density and bone strength are not the same, and what really matters for bone health.
- Why standard bone tests often miss hidden risks for fractures, and how to assess bone strength in daily life.
- Key habits and simple steps to build stronger bones at every age, from kids to older adults.
- Foods, movement, and protein targets that best support lifelong bone health.
- Which common meds, like SSRIs, can harm bone health and what to do if you take them.
- The science behind top supplements for bone health, and why some work better than others.
Resources
- Connect with Dr. Neustadt on Instagram: https://www.instagram.com/johnneustadt/
- Buy his book, ‘Fracture Proof Your Bones’: https://www.amazon.com/stores/author/B0B6LXBLDC
- Shop his supplements, NBI: https://nbihealth.com/
This podcast was produced by the team at Zapods Podcast Agency:
https://www.zapods.com
Find the products, practices, and routines discussed on the Alively website:
https://alively.com
Recommended
Transcript
Medications and Bone Health
00:00:00
Speaker
The most commonly prescribed medications damage bone and cause osteoporosis and fractures. Antidepressants, anything that elevates serotonin like Prozac, Lexapro, SSRI is that category of antidepressant medications. We now know that for every 19 women taking it for one to five years, we'll expect one to break a bone.
00:00:21
Speaker
This is the Home of Healthspan podcast, where we profile health and wellness role models, sharing their stories and the tools, practices, and routines they use to live a lively life.
00:00:35
Speaker
Welcome back to the Home of Health Spam podcast, Dr. Neustadt. It is a pleasure to have you on the show today. Thank you for joining us. Thank you for having me. Appreciate it.
Host's Personal Connection to Bone Health
00:00:43
Speaker
Now, I am really curious. This is a topic I admittedly do not know much about. I'm trying to learn more about it as a father of a 10-year-old girl and as a son of a 70-year-old mom.
00:00:56
Speaker
I think it touches on both ends of the range. But before we get into your work and everything you're doing, how would you describe yourself? I would describe myself as I am a lively explorer of knowledge and information. I love learning and I find myself getting incredibly bored if I stop learning.
00:01:17
Speaker
That is of the three macronutrients for a happy, healthy, long life, according to Arthur Brooks on the latest podcast with Rhonda Patrick. That is one of the three and out of the Harvard happiness study. you know One of those was that curiosity, that lifelong learning. So that that serves you well, I would imagine.
00:01:38
Speaker
And I understand that curiosity, I'm sure is many faceted, but I see behind you a book around bone health. And so this is what I'm excited to dive in with you on.
00:01:52
Speaker
Can you tell us how did you end up in this specifically? Like, what was it that drew you in to looking at this? ah Suffering and the need to help.
00:02:04
Speaker
20 years ago when I was just starting out in clinical practice, if someone had had someone had told me that I'd be sitting here talking to you as an expert in bone health, I would scratch my head and have no idea what they were talking about.
00:02:18
Speaker
I was working with patients, some of them had osteoporosis and bone loss, and I was helping them with an integrative approaches, nutrition, lifestyle, supplements, exercise, and just as I was taught to do.
00:02:31
Speaker
And I think that's common as we get out of school, we start seeing patients in clinical practice. You know, we typically are just doing what we learned. And their bone density was going up. So I was happy and they were happy. My mother-in-law had osteoporosis and I was working with her, giving her some suggestions, not as my official patient, but giving her some integrative suggestions like I do.
00:02:53
Speaker
And she had her medical doctor who had her on Fosamax. And so she was taking Fosamax and her bone density was going up. She was happy. Her physician was happy. And I was happy.
00:03:05
Speaker
And then she tripped on a rug in her house and broke her hip. And I thought, something's wrong with this picture. So I dove into the research trying to understand this condition
Challenges in Predicting Fractures
00:03:18
Speaker
better. And what I learned was absolutely shocking that a bone density test only predicts 44% of women with osteoporosis who will fracture and only 21% of men.
00:03:35
Speaker
ah worse than a coin flip for both and much, much worse for men. Correct. And we've known since the 1990s in the research that it's less it predicts less than half of people overall who will fracture.
00:03:46
Speaker
and And that to me was absolutely incredible to learn because clinically, and even still today, 20 years later, it's that number on the test that ah almost exclusively dominates the conversation in clinical encounters and in patient conversations with their doctor, how to improve that bone density test result. But you get your DEXA scan and you track on that, yeah?
Holistic Treatment for Bone Health
00:04:12
Speaker
Correct. Instead of treating the patient sitting in front of them, because the evidence is clear, through a holistic ah integrative approach, bone health can improve, bone density can improve, and fracture risk decreases.
00:04:27
Speaker
It's not ambiguous. It's not controversial. It's just not taught to clinicians. And clinicians, unfortunately, most of the time don't have enough evidence time with patients to really dive into these more nuanced conversations and they lack the training to do so as well.
00:04:47
Speaker
and And you have this distinction, as I understand it, between bone density and bone strength.
Bone Density vs. Bone Strength
00:04:52
Speaker
Correct. What, what is the difference there? Cause I think we conflate them as, you know muggles that we think they're one in the same. So what is the difference there?
00:05:02
Speaker
And i used to do that I used to do that too. I thought they were similar. But just looking at the bone density test results and how well they predict fractures, you can tell that that is really not the best indicator for bone strength.
00:05:15
Speaker
In fact, you know every medical organization that that has looked at the data have correctly concluded that fracture risk depends on factors largely other than bone density. So in the research, as people, if they go and start reading, there is a distinction that's made between Bone quantity, that's the amount of minerals in the bone or the bone density, and the bone quality, and that's the strength of the bone. And they really are determined by different factors. They they are interconnected, but definitely unique different factors. The bone the bone strength is made up of the extracellular components of the bone, the extra not the minerals, the the components of the bone that are not minerals. So bone is a tissue.
00:06:00
Speaker
Like all tissues has different things in it. So the mineral component gives you the density, but then there are a lot of proteins in bone. There are 180 to 200 proteins in bone in addition to bone collagen. It's highly protein dependent. And it's that collagen that gives bone its ultimate strength.
00:06:17
Speaker
and flexibility. So healthy collagen is strand for strand stronger than steel. And when when it is healthy in bone, it it gives the scaffolding on which the minerals can bind.
00:06:30
Speaker
And it also provides some flexibility to the bone so that when somebody falls, that impact can be dispersed over a larger volume of bone. The bone can deform a little bit. It's not brittle. It can absorb and disperse that force without breaking.
00:06:45
Speaker
Yeah. I mean, I guess if you think of ah a tree or a stick, having some give gives it like a palm tree, right? you're Having more give with the strong wind is what keeps it from snapping. And it sounds like a little bit of that give is helpful in the bone.
00:07:00
Speaker
Exactly. Could we dive into ah kind of two different things? One, how do you measure bone strength? Because I think most people...
00:07:12
Speaker
If they think about it, think about bone density, getting a DEXA scan, you get your number back and like that's what you're working around. So one, how we measure, but then two, what can you actively do about it? So it is what it is today, but it doesn't necessarily have to be that tomorrow if we do X, Y, and Z. But if we could start with just how you measure that.
00:07:32
Speaker
That's a great question. Unfortunately, there is no test that is you know widely accepted as the gold standard for measuring bone strength. The best indicator of bone strength is not a test at all. It's whether you fall and break a bone.
00:07:48
Speaker
That's unfortunately the state of the research right now. In terms of testing and what people can do, you know there is an emerging imaging technology called REMS, which is a type of ultrasound, and they provide a fragility score.
00:08:03
Speaker
And if the fragility score is less than, I believe it's 32%, In women and men, about 95% or so of those patients did not fracture. So it's more predictive in that study.
00:08:16
Speaker
You want a lower score, not a higher score. Yeah, exactly. So that's the fragility score. The lower the score, the less fragile. How correlated is that to your bone density?
00:08:27
Speaker
Well, they can get a bone density equivalent out of that, and it is approved to to make that bone density equivalent calculation. The challenge is is that technology is relatively new.
00:08:39
Speaker
It was just brought under the market, an FDA approved in 2018. It's not covered by insurance, and there's only one validation study on it. And we don't currently know if you actually improve your fragility score. Are you also reducing your fracture risk? And so there's just a lot of things that I think, for me, it's it's promising.
00:09:00
Speaker
It's no better than a bone density test at predicting who will fracture, but it may be better at predicting who won't fracture. But for me, I'd like to see a little more research on it.
00:09:12
Speaker
So that's, that's really the only way to today. Okay. So then i guess there's a separate thing, which was the second, regardless of what the score is, we probably all would want
Diet and Exercise for Bone Strength
00:09:22
Speaker
stronger bones. It doesn't seem like there's a downside to it. So what are the things that we can do to get those stronger bones?
00:09:29
Speaker
That's a great question. I mean, everybody knows about exercise and diet and making sure you're eating enough protein is really important. Like I said, 180 to 200 proteins in bone. i recommend people get their amount of protein based on their body weight per day.
00:09:44
Speaker
So if they take their body weight in pounds and multiply it by 0.6, that'll give you the number of grams minimum of protein per day somebody should consume. And the amount of protein can account for about two to 4% of bone mineral density, just that alone.
00:09:58
Speaker
Just on that, the 0.6 per pound, I guess maybe we might want to clarify because there are a lot of overweight people probably per lean mass pound or ideal weight pound.
00:10:11
Speaker
Well, the research didn't didn't didn't um really parse out the data like that. Okay. So they didn't do, the research didn't show based on lean body weight or or or not. Okay. So...
00:10:24
Speaker
Or just be worried if you're carrying an extra 200 pounds or 150 pounds, that that'd be a very high target to hit. It seems like for protein consumption. Absolutely. Absolutely. But if if, you know, it's a matter of, of, you know, I think at that, at that weight, if you've got some health goals and health challenges, hopefully you're working with a doctor who can help you navigate that or a healthcare care provider.
00:10:45
Speaker
who can create you know solutions specifically tailored to your your needs. And and if if you have people are having a hard time getting that amount of protein through diet, you know that's where supplements come in and can be very helpful to to bridge that gap.
00:10:58
Speaker
yeah Look, muscle weighs more than than fat. And so if people are losing weight and they're exercising, they're doing resistance exercise, you know they may be slimming down, but that scale may not be moving. I'm not a big fan of of scales per se. I'm a big fan of how is your belt fitting.
00:11:15
Speaker
Body composition. Exactly. So you know that is one way. And the Mediterranean dietary pattern has been associated with the 20% reduction in osteoporosis and hip fracture rate. risk And so i advocate for that, a plant-forward whole foods diet. And I recommend people focus on the number of grams of of total fiber they're getting a day, targeted about 30 grams because that has the vitamins, minerals, and other plant nutrients your body needs to to thrive.
00:11:41
Speaker
Resistance exercise or really any movement. So I think that there's ah an important distinction that should be made here between what can we do to make our bones stronger? There are many things that that have been shown to do that.
00:11:53
Speaker
ah including some supplements help to maintain bone strength. But I think for me, when I'm looking at the research and through the lens that I've sort of learned to evaluate all of this under, I ask the question, what has been shown to reduce fractures?
00:12:07
Speaker
Because like I mentioned before, that's the ultimate indicator of bone strength. So if you're looking at the the data on, you know for example, resistance exercise, you've got the lift more study showing that bone density increases and also fracture risk goes down.
00:12:26
Speaker
But we also know that just walking 7,000 to 7,500 steps a day is associated with a 50% to 70% reduction in all-cause mortality. So I like to meet people where they're at and just say, look, if you don't want to go into a gym right now, that's not where you're at at this point in your life. Okay, there are many things that that people can do.
00:12:45
Speaker
One of the important things in terms of reducing fractures is gait and mobility. So somebody's gait and mobility is is the most consistently predictive variable when it comes to whether or not they're going to fracture in the future.
Preventing Falls with Mobility and Balance
00:13:00
Speaker
And that is important because that stability, that balance helps prevent people from falling. 95% of fractures occur because somebody falls.
00:13:12
Speaker
So making sure you've got the right diet, making sure you're exercising, making sure that you're helping to build muscle and build stability, balance, and strength are really important for this whole equation.
00:13:24
Speaker
That was one of the three things, JJ Virgin, who had had on before, yeah you talk about the four movement, you you have strength, you have cardio, and then the third is that balance. And so at the end of a workout, when you when you are more fatigued, when you would be more likely to fall, that's when she would do a lot of balancing exercises to train your body when tired to to work on that balance.
00:13:47
Speaker
Because that is critical. And I believe now with the iPhone, Apple Health, it it has a kind of gate indicator to try to keep an eye on, ooh, something seems a little off, um to try to help you with that.
00:13:59
Speaker
Yeah. And I think people can also look at, you know, do their own self-assessments. And there's an, in my book, there's a whole testing chapter. It's this, the book that is behind me here is the new version. It's the expanded and update, updated edition, the second edition of my book. And in there is a ah chapter all on testing, but it's not just about the technology that you and I have already alluded to. It's what can people do themselves, do self-assessments, the functional testing that people can can do to understand their risk. And so being conscious of their gait is, is one of them. The other thing is just the one legged stand.
00:14:36
Speaker
o Research is clear that they did a study of of people 51 to 55 years old, and they had them stand on one leg for 10 seconds and 95% them could do that.
00:14:48
Speaker
By the time they were 71 years old, less than half could do it. And those who could not had an over 80% increased risk of of dying.
00:14:59
Speaker
So I think that that there are certain things that people can do just to become aware. of where they could improve and start moving in that direction and and and track their own progress. I mean, part of the the goal of this book, because this condition is so undertreated and mistreated, like I mentioned, most doctors don't understand and can't yeah have the conversations about the holistic approaches and what the research shows and help tailor customized solutions.
00:15:27
Speaker
Chapter by chapter, the book goes through and helps people identify what their what their risks are, hidden risks like medications that are damaging bone that they may not be aware about that they're taking, diet, lifestyle exercise, supplementation, and more to help them create a holistic bone health program that makes sense for them and that they can track their progress and they can work with their doctors if they want on doing that.
00:15:53
Speaker
And there's a chapter also in the medication so people can take questions to their doctor to ask the questions to ensure that they're getting the best possible recommendations for their health and can make informed decisions.
00:16:05
Speaker
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00:16:19
Speaker
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00:16:34
Speaker
There are a bunch of things I want to dive in. Before I do, we both have referenced visually your book. But for those just listening, I do want to say it's Fracture Proof Your Bones by Dr. Neustadt. Fracture Proof Your Bones, expanded and updated edition. Thank you for that.
00:16:49
Speaker
Yeah. And so there's, it sounds like there are a couple of buckets. There's the things to do, and then there are things not to do. So if we think about exercise, because I've also heard bone health is actually a juvenile issue.
00:17:05
Speaker
We build our own strength when we're younger. And so I want to touch on different ages of like, hey, if we have kids before they're 15, what are the things we should look at? If we're after 15, what should we look at? If we're after 50, what should we look at? Because they may be different at each of those stages.
00:17:22
Speaker
Just personally, what kind of hit me was looking at Again, this was on bone density, so not necessarily strength, but four different types of exercise. So cyclists had average bone density.
00:17:35
Speaker
Runners had above average, right? you're You're putting the impact, especially if you were a jumper or something, you had the impact. And then as a swimmer, as someone who just got out of the pool, ah we had below average.
00:17:46
Speaker
Right. Because you're spending more time weightless. And so you're putting probably less tension if six hours a day, you're weightless versus somebody who's having to deal with gravity. We were actually putting less on our bones. So if we started with the things not to do, because you mentioned some medications, other things, what are the things that would be detracting from our bone strength and bone density that we could or should stop doing or taking?
00:18:11
Speaker
Well, love that you brought up the children and bone health as they age. And I was going to circle back to that because you mentioned you have a 10-year-old daughter, you have an elderly parent, and sometimes osteoporosis is mentioned as a pediatric condition with geriatric consequences because peak bone mass and peak bone density occur in our twenty s And then the old you know belief was that it's all a downhill you know street, one-way street from there where we lose you know half a percent or a percent of bone density every year. And they're just you know people just should accept it. And we now know that's just not true.
00:18:50
Speaker
Bone is a living tissue. And like all living tissues, we're able to change its health and it can improve bone density and improve bone strength. And that's very clear evidence. in the research. In fact, you know, look, osteoporosis fundamentally, very simply is a condition of imbalance, where the destructive forces are winning.
00:19:10
Speaker
And so we want to identify what those are and remove those and help the body rebalance to help create more bone. In children, you know, one of the biggest things that we see in, especially girls are eating disorders.
Impact of Female Athlete Triad
00:19:25
Speaker
and what's called the female athlete triad. So that's really something to be be careful of and and and watch in in young ah young people, because especially girls, because that is causes osteoporosis and increases fracture risk.
00:19:41
Speaker
Wait, sorry, can we go back to that athlete triad? Yeah, what what does that mean? Sorry. So it's disordered eating. ah It is amenorrhea, meaning they've lost their period because their body fat has has gone down.
00:19:58
Speaker
And it is excessive exercise. Okay. Okay. I just didn't know what the triad was. Thank you for sharing. And I'm sorry. It's, ah I'm sorry. It's osteoporosis, disordered eating, uh, and amenorrhea, not the, not the exercise. So they're already athletes, female athlete triad. Okay. So they've stopped, they've stopped getting their period because their estrogen has dropped too low because they've lost body fat.
00:20:19
Speaker
They are, have disordered eating. They're not eating healthy and they have osteoporosis. That's the definite. That's the triad. Those are the three things in the triad. And I do think it,
00:20:30
Speaker
This isn't necessarily specific to this, but I was speaking to someone else recently. Being a top level athlete is not always the most healthy thing for you, especially in the long run.
00:20:42
Speaker
Right. And so there are tradeoffs at times of saying, hey, look, if I want to be the best in the world at this thing, if I want to be that you are sacrificing other things.
00:20:53
Speaker
And so it's just knowing that going in. um There are el lead athletes at the professional level. Obviously, they have nutritionists and professional trainers and support staff. But there are ways to get to that level and to perform in that level that are safer and healthier.
00:21:12
Speaker
No question. No question. I just think like the super endurance stuff, our bodies, I was 25 kilometers and stuff like that. I don't know if that's good for long-term health. It it was just, you were doing some sacrifice. there There's some benefits, but it may have gone to extremes.
00:21:30
Speaker
And so as a parent, You may want to discourage your kids from doing stuff like that. You say, look, I know you want to do this. i didn't know where it's driving, but maybe think of longevity. Like you look at someone like LeBron who spends eight hours plus a day on recovery, right? Because he really wants longevity, not just this peak at a a short period. And so there are trade-offs there, I think.
00:21:56
Speaker
I love that you said recovery because that's one thing that I do think that is missing. The coaches don't talk to to to athletes, especially teen athletes enough that recovery is part of training.
00:22:08
Speaker
And it's not just separate. It is part of training. I have ah a teen, teenage daughter who is an elite athlete. And we've gone through a lot of these conversations with her. And look, it's it's challenging with with children because i can tell somebody all the knowledge that I have and share with them.
00:22:26
Speaker
But ultimately, I can't force them to change their behavior. yeah And so it's about, I think, meeting people where they're at and accepting that this may just be a stage or a phase in a child's life and continuing to encourage them to eat healthier and maybe talk to coaches, that sort of thing. But if it comes down and it's truly a medical issue, like there is anorexia nervosa or bulimia, you know that can be dangerous. A medical intervention should be What's the most deadly? Yeah.
00:22:55
Speaker
mean, it's the same most deadly mental disorder. Yeah. But then when you get into, know, as people get older, ah they're more likely than to be starting on medications. And 80% osteoporosis cases are in postmenopausal women. However, I think that there's a huge, a huge number of patients out there walking around with low bone density that don't know it at younger ages because they're not getting screened. And and I say that because the most commonly prescribed medications damage bone and cause osteoporosis and fractures.
00:23:27
Speaker
Antidepressants. ah as anything that that elevates serotonin like Prozac, Lexapro, SSRI is that category of of antidepressant medications. We now know that for every 19 women taking it for one to five years, we'll expect one to break a bone.
00:23:43
Speaker
I just want to stop there on the SSRIs because one of the things you can do for your bone density and health is exercise. We know that's going to help. We also know, I believe there's some great studies that exercise has a better...
00:23:58
Speaker
impact on mental health than SSRIs. When they're running against each other, exercise has a bigger positive impact. So you get a twofer just instead of spending the money or whatever on the SSRI, go exercise more. Now, certainly work with a professional, but you're you're getting both of those benefits if you get out and move your body more.
00:24:18
Speaker
and And that's absolutely true. And exercise is crucial. There's a large cohort of patients out there, however, who are, have diagnoses and are prescribed antidepressants because essentially the doctor isn't quite sure what else to do.
00:24:35
Speaker
So chronic fatigue and fibromyalgia, for example. Other conditions, people with autoimmune diseases. I mean, there's just a long list of of why these are being prescribed. and And people just don't, doctors don't even know that side effect.
00:24:49
Speaker
And in fact, a study was done that showed, looked at people who entered the hospital with a fracture, a hip fracture, which is the most dangerous type of fracture. And it looked at the medications they were taking three months prior to breaking their bone and ending up in the hospital. What they found is 75% of them were taking a medication that damaged bone, caused osteoporosis, or increased their fall risk.
00:25:11
Speaker
When they exited the hospital, there was no change. Where a doctor may have identified a medication like prednisone, which is commonly understood to damage bone, maybe reduce the dose or change them to a different medication.
00:25:24
Speaker
They simply put them on another medication for something different. Maybe they added an antidepressant so that overall there was no net benefit. People left. hospital but the with about the same number of medications overall that damaged bone and increased their risk for falls and fractures and osteoporosis as they were taking when they entered the hospital. There was no no improvement in risk.
00:25:46
Speaker
What role, if any, can or should HRT play in this?
Hormone Replacement Therapy Benefits
00:25:50
Speaker
I'm a big fan of HRT. So there's great research on hormone replacement therapy for for women and for men.
00:25:57
Speaker
And that's in ah the in my book and the testing chapter. I talk about the the role of those hormones and the medications chapter as well. And with HRT for women, estradiol and taking HRT has been shown to be associated with about a 40% reduction in in fracture risk in women.
00:26:16
Speaker
And for men, I think one of the challenges is is they can have low testosterone and it's not getting tested. I think men in gen every man in general at 50 years old should get their testosterone tested.
00:26:28
Speaker
Likewise, you know back to the one-legged stand, I think clinicians at 50 years old, every patient that comes in should have a one-legged stand test. It literally takes 10 seconds. So I think that those those are easy things people can do, test the testosterone, see where you're at. But one of the things that's often missing in testing with men is they're not testing also the estradiol.
00:26:47
Speaker
So estradiol in men, like in women, is is what is primarily responsible for for ah bone strength. and estradiol there are some i was just talking to somebody recently deals with a lot of athletes and trainers and he's seen cases where testosterone is being prescribed and they're then prescribing an aromatase inhibitor with the belief that that that decreases estradiol production that you want to drop the estrogen amended to zero and i think that's really dangerous we need some estrogen yeah like just like women need some testosterone okay that's uh they want to do that um
00:27:23
Speaker
I guess a couple of things. Yes. At 50, I, I personally would suggest, especially for women start 20, maybe 30. Uh, so you have a baseline, what's normal for you, because what you see at 50, it may have gone off the rails at 35 or 40, but getting ah baseline when you're younger and healthier to be able to track those hormonal changes over time, i think it'd be certainly helpful What's your thought on that? Because when you come in at 50, you get the score. you're like, well, I don't know. Is this good for me or bad? Because if if you're still high energy, you're you're not noticing a different libido or anything.
00:28:01
Speaker
So and unless a woman is symptomatic in her 20s, I don't recommend that. um Because, you know, the question is, at what phase, stage of her cycle you going to be testing? And is that really relevant to when when she's 50? I mean, when when when I would say maybe if you want to be a little more um aggressive with the testing, maybe start at 45. I mean, a lot of women are entering perimenopause at 50, 52 years old, but hormones start to decline you know before that, before symptoms appear.
00:28:28
Speaker
And so if, you know, 50 to me, just looking at the research seemed like a good cutoff, but I can also see a justification for going a little bit lower. Definitely not. I don't see any reason to test in the 20s unless there's some medical issue that that is being challenged, infertility, PCOS, something that we're concerned about.
00:28:45
Speaker
Well, that's more what I was thinking. That kind of PCOS, that whole world, less around menopause and more so that you would know. And I understand what the cycle, it's hard to tell. But if you could be consistent where in the cycle you're testing to just be able to tell is something off or different, whether it's my diet's changed my sleep pattern changed, something that there's something different going on in my body than when I knew I was healthy.
00:29:10
Speaker
And so that this is where I like personally more preventative health measures to start so that you get a better sense when things are off down, what's off that you can kind of dial in on.
00:29:25
Speaker
I mean, it's an interesting approach. It's not the approach that I would, I would be taking, but I respect people have different, uh, different approaches. The balance test too, I mean, like a lot of these, right, you're testing, there are things you can do actively. So I heard there was an 80 something year old scientist on Huberman that she, she knowing that we just always brush her teeth standing on one leg and then kind of carried it over. Now, every time she's in a conversation, she just got used to, if she's just standing there, she just stands on one leg to practice it.
00:29:52
Speaker
Right. Cause she said, Hey, I know is going to be a danger in the future. So Knowing that's an important thing and it degrades with age, there are certain things like this we can just bake into our day-to-day that are basically zero cost.
00:30:05
Speaker
It's just like, hey, I'm going to be standing here brushing my teeth anyway. Why not do the lower teeth while I'm on my left foot and the upper teeth when I'm on my right foot? And i got that practice in. Yeah, i love that. And I talk about that in the exercise chapter in my book, and I go through practical things people can do. And one of the things that's important ah to understand that I don't think many people do is that, you know, things you do throughout your day are cumulative. They all count.
00:30:30
Speaker
So you don't have to necessarily, you know, carve out an hour during your day to go for a long walk. You know the steps you take are all cumulative throughout the day. Similarly, just simple things when you're doing housework and house cleaning.
00:30:42
Speaker
There was a study that looked at, at, The hotel cleaners. Hotel cleaners, exactly. And they counseled some of them and told them what they were doing was exercise and they didn't counsel the others the same way at all.
00:30:53
Speaker
And what they found out at the end of the study, those who just believed it was exercise were healthier. They had healthier outcomes in terms of fitness than those who didn't. So mindset for all of this is is cannot be underestimated. in fact, it even comes into play with the risk of falling.
00:31:11
Speaker
So the fear of falling itself in the elderly is associated with a about 400% increase in the risk of falling compared to people who don't have the fear of falling.
00:31:23
Speaker
Wow. Okay. That's yeah that. It makes sense right on the mindset side, but I had never realized that. Okay. So and there may be physiological reasons why, and and anatomical reasons why people do have the fear of falling, but also similarly, there may be a mindset issue of why people aren't really focusing And being conscious and present in their daily life where they where they go around and and saying, oh, this can I can make this fun. I can make house cleaning more of a game and see if I can do it with my vacuum with my opposite non-dominant arm and see how that feels for a while. Or when I bend over to get the empty, the lower rack and the dishwasher instead of just bending at the waist, let me let me do a squat.
00:32:04
Speaker
and keep my back you know straight and and stand up and and just do different things and make games of it. Those are all mindset issues. Yeah, I do really like that, kind of how you did the book with the exercises and the things you can do. it It shifts that locus of control. hey This isn't, we peaked at 20 and then it's just trying to slow down the degradation over time. We can and should be taking these steps and here are the things that we can do to regain that agency for not just bone density, but bone health, bone strength, art and which is
00:32:42
Speaker
I forget the exact stats, but I mean, there's very little more dangerous to an elderly individual than breaking a hip, right? Like it's within x number of months on average, you're you're dead.
00:32:55
Speaker
So if you're a woman with osteoporosis and you fracture a hip, there's up to a 36% chance that you're going to die within a year. Now, the the the range of that changes. it's you know But oftentimes, it's you know sometimes 20% is stated, but it goes all the way up to 36% chance. And if you're a man fracture a hip, your risk is even greater than the average risk for women for dying. And if you have certain conditions, it's even higher.
00:33:21
Speaker
A woman with breast cancer who ends up in the hospital with a broken bone has an 83% increase likelihood that she's going to die compared to a woman with breast cancer who doesn't fracture.
00:33:34
Speaker
And the list goes on and on. ah It is incredibly dangerous. And if you survive, though... a fracture with osteoporosis, then it also it oftentimes is the cause of long-term pain and disability. And you talk about health span, it's it's really a main driver as people get older of not being as healthy and vibrant and able to enjoy the life that they want to be living.
00:34:00
Speaker
Yeah. You mentioned a couple times as well, there's supplements we could be taking as well that are beneficial. So we we said there's some medications that are detrimental, but there are other things, right?
00:34:11
Speaker
Healthy diet, both macro and micronutrients to get the right minerals and and build the proteins. There's the exercise to to put that tension on our bones. But what what about the supplement side? What are the we could or should be taking?
00:34:25
Speaker
you know Supplements are interesting. So i just want to preface this part of the conversation with the the important note that supplements have not are not approved by the FDA to diagnose, treat, or prevent any
Supplements for Bone Health
00:34:36
Speaker
disease. They're supplements to healthy diets. So we're talking about bone health. We've mentioned osteoporosis. There are no nutrients that are FDA approved for osteoporosis. Where nutrients come in for me, is exactly how the FDA intended them to be used as a supplement to a healthy diet. Diet and lifestyle are always first.
00:34:54
Speaker
And then when look at the research on nutrients, I look at through a very specific lens of what nutrients have been shown in clinical trials to not just improve bone density. Yes, we do I do want to see that number on the test stabilize or ideally improve.
00:35:10
Speaker
But more importantly, which nutrients have been shown in clinical trials to maintain bone strength? Now, as I mentioned before, the most sensitive indicator of strong bones is that somebody fractures.
00:35:21
Speaker
And so nutrients Nutrients have been shown in clinical trials to maintain strong bones as indicated by fewer fractures in those clinical trial volunteers. So there's calcium and vitamin D. Those have been shown to reduce fractures about 18 to 23%.
00:35:37
Speaker
But not everybody needs the same amount of calcium. If you're getting it all from diet, 1,200 milligrams as a woman, 1,000 milligrams as a man, you don't need extra diet dietary supplement calcium.
00:35:48
Speaker
The average American woman consumes about 800 milligrams of calcium in her diet. So getting a dietary supplement of 400 milligrams, it may be appropriate and definitely in that safe supplemental calcium or total calcium range.
00:36:01
Speaker
And then vitamin D, I do believe people should get their vitamin D tested. The maximum fracture reduction is associated with a vitamin D level of 30 to 44 nanograms per milliliter on testing.
00:36:13
Speaker
I want to get to at least that and taking about 2000 international units or of vitamin D3 day can get most people into that range. Now for immune health and other benefits, you know a lot of people, myself included, want it higher, but specifically for bone support, that's the range on blood testing you want.
00:36:30
Speaker
How high? I mean, are you looking 50 plus or what's your target? I like it around 70, 60, 70. Yeah. no But not for bones. I mean, well, it's incremental. Right. Right. It's diminishing returns. I guess you're saying for bone, like that's the 80, 20 is that 30 to 40 range for bones.
00:36:45
Speaker
Correct. Correct. 30 to 44. And then, and then there's a vitamin K2 specifically though, there are different forms of vitamin K2 available on the market. The most common one dietary supplements is MK seven.
00:37:00
Speaker
ah People have probably heard about It's marketed as because it has a ah longer half-life and it changes a ah laboratory marker called undercarboxylated osteocalcinoma. That's all true, but none of that is has to do with people's health necessarily. Those are things in a lab, just like a bone density test is a is a is a number on a test.
00:37:19
Speaker
How well does that actually translate into benefits in people? And what the research shows with the MK7 is it doesn't stop bone loss and it does not improve bone density.
00:37:30
Speaker
Every clinical trial that's been done has been shown that only at best it slows down how fast somebody loses bone. And there's one clinical trial with high-dose MK7 that showed that, I think it was 320 micrograms per day, that showed that the women who taking the MK7 lost bone at the hip faster than those who did not.
00:37:49
Speaker
And there are no fracture outcomes data on MK7 at all. So for that reason, i don't I prefer another form of vitamin K2 called MK4.
MK4 vs. MK7 for Bone Health
00:38:00
Speaker
MK4 has been shown repeatedly, study after study.
00:38:06
Speaker
There are dozens of clinical trials on it to not only stabilize bone density, but promote healthy bone density, improve bone density in these clinical trials.
00:38:16
Speaker
But most importantly, to maintain bone strength as indicated in studies with women with postmenopausal osteoporosis to reduce their fracture risk by more than 70%.
00:38:29
Speaker
It's been so well studied that it's been approved by the Ministry of Health in Japan for bone health since the 1990s, I believe it was 1995. Okay.
00:38:38
Speaker
okay And the data to me is just you know indisputable of of the benefits of that nutrient in terms of powerfully promoting and pushing the bone health and bone physiology in the direction we want it to to go.
00:38:52
Speaker
It's remembering the results we're looking for, right? It's not the score on the test. It's the score in life. That's the important part. The score in life. I love that. And like I looked at this data. This is, you know, as I mentioned, it's been it's been available in Japan since the 1990s. And so when I was looking at all the we're doing research 20 years ago, starting out on this, I learned of this this research and nothing existed on the market that had the clinical trial doses of the MK4 in it that I needed for my patients.
00:39:19
Speaker
So I created a company, Nutritional Biochemistry Incorporated, or MBI, to provide this solution. I needed products with doses of nutrients shown in clinical trials to work that I needed it for my patients, and they didn't exist.
00:39:32
Speaker
And so i've got I do have a line of bone support dietary supplements to help patients. And because of the strength of that research, um you know I'm convinced and people see the results on repeat testing.
00:39:46
Speaker
That's amazing. Yeah. And Dr. Nusa, I feel like we could go two or three times as long and we would still just scratch the surface. So I'm so grateful that you've documented all of this and the updated ah new edition of your book, which everyone can get for those who want to learn more, whether it's on the supplements, on the book, on you and your work, where can they find you? Where should they contact you?
00:40:09
Speaker
The best place is my website, nbihealth.com, NBI for Nutritional Biochemistry Incorporated, nbihealth.com. Fantastic. Well, Dr. Nooset, thank you for all your work and for your time today.
00:40:24
Speaker
i know I have plenty of people in my life, including myself, that will be a beneficiary of this knowledge. So thank you for coming here to share. Thank you. I loved it. it was a great conversation.
00:40:35
Speaker
Thank you for joining us on today's episode of the Home of Healthspan podcast. And remember, you can always find the products, practices, and routines mentioned by today's guests, as well as many other healthspan role models on Alively.com.
00:40:48
Speaker
Enjoy a lively day.