Kim (00:01.916)
Hi, Debbie, welcome. guess you had reached out to me because of I think my skeleton pants online and then crazy small world, we ended up getting connected via the Mindshare community when we were at the conference and now here we are. I've been listening to your podcast, you reached out and asked me to come on yours and we're talking all about bone health. I'm really excited for this call. I've been, as I was saying to you offline, I've been really...
diving back into bone health. was an osteo fit instructor way back in the day when I first started as a personal trainer almost 30 years ago. And obviously a lot has changed in the meantime, but so many people in my community are dealing with bone health issues. And so I'm trying to get up to speed and you are an expert and I'm really excited for the conversation that we have today. So can you tell us a bit about what brought you down? It wasn't necessarily the best experience you had that brought you to the world of bone health, but tell us a little bit about your story.
Debi Robinson (00:56.174)
Yeah, they say my mess is my success and it's so true. And so what happened to me, I was so active. 10 is five days a week, spinning four days a week, had three young kids. I was a dynamo and I was really into yoga. I had a very strong practice and I had just got certified to teach. This was in 2010. I was 44, just got certified to teach. And in a yoga class, my favorite yoga teacher pushed me and tore my hip.
I didn't know at the time that's what it was, but I felt a pop. Like my whole entire mind went to my hip when that adjustment took place. And then when I was on the tennis court, I was very unstable. My body wouldn't stick anymore. So I, five years later, I mean, I tried to live with that injury and my whole life started slowing down, stopped playing tennis, stopped spinning, stopped being so active, very nervous, and also had to pay attention to my bones. I feel like I was thinking about my hip all the time, wondering what's going on in my hip. used to visualize.
Does it look like honeycomb? It was so weird. Like you don't think about your bones in your 40s. You just don't because why? And then I had an MRI and it showed that I had a torn labrum. And so I had a surgery to try to repair it and that physician took off what I believe to be too much bone and four months later my hip joint collapsed. I was 50 years old. So I had a complete collapsed hip joint and when I went back to see him for the follow-up at six months, he said, if you came in today with this x-ray,
would recommend a hip replacement. And I was 50 years old. I'm like, what? Now at this point, I wasn't really moving anymore. Tennis hadn't played in like five years probably. No spinning, no yoga classes because all the classes were a fast paced vinyasa flow and I couldn't do it. I gained weight at this point, maybe 20, 30 pounds. And...
I was thinking about what do I do next, thinking potentially hip replacement is something. But when you're 50 years old to make a decision to cut the top of your leg bone off to do a replacement part, what if it doesn't work? What if I need another one 10 years later? Just the whole fear of that.
Debi Robinson (03:03.04)
And then I did, and then I had my hip replacement. And at that point, so much atrophy had gained 40 pounds. I weighed the same when I went in to get my hip replacement that I weighed for all three of my children's birth. The check-in to the hospital to give birth, that weight is what I weighed when I gave in to give the birth to the new body that we all got with.
Kim (03:24.82)
Wow.
Debi Robinson (03:27.66)
Yeah, it was crazy. it just came to a place that I would never ever have done at 50, 51 years old. And it just made this whole aspect of bone health become so front and center to me because I know how important they are.
Kim (03:42.313)
Wow, I can appreciate, I'm 53 but I can appreciate now having a decision like that to make how challenging that would be. That's a big decision. And you think of hip replacements of people in 70s, 80s, know, further down the path but to make it at that age is scary, I can imagine. Yeah.
Debi Robinson (04:03.406)
Yeah, and what if it doesn't work? And that's the thing, Kim, when people are diagnosed with osteoporosis or osteopenia, the hip is the most deadly fracture. mean, 50 % of the people don't survive a hip fracture. 25 die from it, 25 die within a year, and are not independent within that year. And that's scary. So the hip is such an important thing. that for it's, yeah, it's so scary. I mean, it's just, what do I do?
Kim (04:29.416)
Yeah, yeah. Yeah, the stats, I was just recently doing a refresher for for bone health, for osteoporosis and fitness and the statistics are staggering. You just shared some of the more common ones. It's shocking, actually. And then there's the differentiation between osteoporosis and osteopenia.
So if you can tell us what the difference is there, and also this is something that I heard you talk about on your podcast, I've heard a few other different bone health people talk about as well, is removing the it's not reversible, but also we need to be careful with, we can't just blanket statements say reversible for osteoporosis. So if you can clarify that, the difference between the two and what language can we do, because there is hope for people, just because you've been diagnosed with osteoporosis, that does not mean the end of the world.
Debi Robinson (05:20.482)
Well, I would like to say that osteoporosis is reversible. Bone loss is reversible and I will say that. I will scream that from the rooftops. And there was a point where a few years ago I was put in my place saying you can't say it. Well, I interviewed doctors and I asked them, is osteoporosis reversible? Yes, it is. Yes, it is. Yes, it is. I see it all the time. I asked Dr. Mark Hyman at a book, TV show that was taped and I asked him, said, Dr. Hyman,
is osteoporosis reversible? And he said to me, yes it is. And I said, wait, can I say Dr. Mark Hyman said osteoporosis is reversible? He said, yes, I see it happening all the time. So I am going to say, yes, it's reversible. Now, the difference is this.
They measure us on a DEXA scan at the age of 30 or mid-30s when our bones were the strongest. And how far away you go from that is what puts you into those different categories. So the criteria, osteoporosis, which is a disease, it's the disease of bone loss, is when you're negative 2.5 standard deviations away from you at 30. So that's how far away you've gone.
the stage before that 2.4, negative 2.4 and below is osteopenia. So there's a line and even that in and of itself is a whole thing that was determined by a group in 1992 in Rome. They decided, okay, the fractures are happening. Here's the disease osteoporosis. We're gonna choose this number negative 2.5. And then they said, but what do we call the people below that?
And they came up with this term osteopenia. And it just so happened that this company had a medication. And now they had this ability to diagnose 50 % of the women over age 50 with these words, osteoporosis osteopenia. So really, there's like a whole bigger issue to this on how we came around with these names.
Kim (07:18.708)
Right, interesting. Yeah, okay. So osteoporosis is the disease of bone loss and what would osteopenia be?
Debi Robinson (07:30.354)
It's bone loss greater, it's bone loss before you get to osteoporosis. So it is bone loss from you at 30. And you know, Kim, I don't know about you, but I do not look outside like I did when I was 30. So why would I think my bones should be that?
Kim (07:46.474)
Yeah, yeah, interesting. Okay, so I love that story. I love the fact that you are saying it is reversible. think that that's something that historically we haven't and I still think a lot of people say that that it's not reversible. You talk, so when I was listening to your podcast, you talk a lot about yoga and that sort of your main form of exercise. And when you think of, when I look at least for research and the education I'm doing with regards to movement for osteoporosis, it's,
resistance training, it's loading the joints, so bones. And one thing that I love that you talk about so much is posture. I am a huge posture geek, loading through the joints. Can you talk about that first? And then I wanna explore a little bit deeper into the movement piece. So why is posture so important from a bone health perspective?
Debi Robinson (08:37.174)
Okay, but before we get to that just the reason why osteoporosis is reversible is because it's a metabolic inflammatory disease. It's a lifestyle-based disease like type-D diabetes type 2 obesity and heart disease and we know that we can change those with lifestyle shifts Which is why I will raise that awareness that we can also change this other metabolic inflammatory disease called osteoporosis. So there's that
Kim (09:00.052)
Awesome.
Debi Robinson (09:00.844)
Why is posture so important? Because half of all the fractures are in the spine. They're in the front or the anterior portion of the spine. They are from thoracic 8, 9, 10, 11, 12, lumbar 1 and 2. That is where almost all of them are. And they happen from poor posture. we do everything we do is anterior. Everything is forward. And the average head is about 10 pounds. So when you have this 10 pound object forward, you're then going to have the next part of your spine. That's the cervical spine.
You're next going to have the thoracic which is attached to your ribs. So if the head goes forward, the rest of the spine is following. And when you're in that forward position and you put that front pressure, that anterior pressure on the spine, that contributes to too much pressure and that can lead to a fracture. And the vertebra of the spine is actually mostly trabecular bone. So it's more, it's not the outside hard cortical bone like the hip joint is, it's the softer bone. So to have that much pressure on the
of the spine can lead over time to anterior compression-wide fractures.
Kim (10:06.513)
Is that a reason why people get shorter with their age as well?
Debi Robinson (10:10.2)
So I say that the height loss is not necessarily degeneration. know, just, again, I don't look like I did at 30, so why would I think my insides are? So you have a spine bone and a disc, a bone, a disc, a bone, a disc. The discs, if you look at them, are not that big. So yes, there is degeneration in the tissues inside. Really, I think height loss is mostly postural because we're not stacked up the way we should be.
to test to see how good your posture is to stand next to the wall and to try to get the center of the head, the shoulder blades, and the sacrum and then the backs of the hands and the wrists and the arms to touch the wall. And you'll start to notice, maybe I do have more rounding in my body. And if you do notice that you're not posturely aligned, then how can you be that height you were when you were 18?
Kim (11:02.902)
And what do you mean by stacked? Like when you say posturely stacked, what do you mean by that?
Debi Robinson (11:09.76)
Okay, the way that we create, so posturally stacked, meaning that the bones are right on top of each other. If our bones were to stay on top of each other perfectly, if the joints were to stay exactly as they should, vertebra, vertebra, vertebra, if this would happen, there would be no or minimal degeneration in our joints. However, we do not live like that. We have little malalignments or little adjustments, usually postural, you know, our head is forward, cooking, gardening, reading, texting.
computing, all of that. So if we're off alignment and you're forward, now you need to lay down more tissue in the front part so our bones dissolve the calcium they're storing in order to lay down osteophytes and bone spurs. Bone spurs are your bones dissolving the calcium and calcium is nature's band-aid. So calcium comes to the rescue. So now you have more padding over here. Now if you have not the
upright stacked joints, you're gonna, you there's arthritis and breakdown, but also if they were stacked, then you get the perfect osteogenic loading to come from above all the way down to keep your bones as strong as you need them to be for the rest of your life.
Kim (12:26.075)
Yeah, I've heard that term used more often is the osteogenic load. It's not so much that there's a magic exercise, but something that stimulates that osteogenic load. And if we are in more appropriate postures experiencing that load, that would be even more favorable. Was that accurate to say?
Debi Robinson (12:44.588)
Yeah, and this is the whole premises behind weight-bearing exercise is an orthopedic surgeon, Wolf, in the early, I believe, 1900s did tests on birds legs. And they're so tiny and skinny. And so they would put forces of pressure and the lines at which they applied the forces they looked at, they were more dense. So we know that the loads at which you apply pressure on the bones will cause the bones to lay down more tissue or build more in those lines of force.
Kim (13:14.217)
Interesting. So now bring that into yoga. I heard your interview with Dr. Fishman and his 12 yoga poses and hit all the research and everything that he's been doing for years and years and you've trained with him. What what how does yoga influence bones? Because again, we think of yoga as stretching. We don't think of it as being resistance training. We don't think of it as being impact, which is historically what people think is what we need for building bones.
Debi Robinson (13:43.5)
Yeah, so interesting. Well, first of all, yoga is for the mind, Ayurveda is for the body. So yoga is really to manage the mind or to manage human suffering. on a bigger sense, traditionally, what is this practice? And the physical part, the postures that are in yoga, is so that you can be in a, they're called postures. You could be in the right posture to sit in meditation for a few hours to manage your mind. So that is traditionally where this all came from. The aspect of osteogenic loading,
comes to yoga is this. If you're in a posture, I call them postures not poses, because poses we come into it and we think here I am I'm in warrior two. No, continue to find warrior two. Push down your shoulders, lengthen your arms, slide your shoulder blades towards each other, activate your posture when you're in the posture.
So for example, if you're doing some of those lower body exercises and you're in Warrior II and you have your femur bone, which typically is right underneath your hip joint managing your weight, now you've taken that leg of yours out to the side and bent your knee. You've taken this bone that has to manage your pelvis, your rib cage, your head and everything above in a whole different range of motion. That hip joint in that hip capsule and the position of the femur bone inside the hip capsule
is now being applied pressure from a different angle. So to me, honestly, Kim, there is nothing better than yoga for osteoporosis and bone health because we can apply force at many different angles within the joints, especially the hip, the pelvis, the spine, and we keep that range of motion or that, I call it dancing joints, dancing ankles, because the more range of motion you have, the more flexibility. If you do slip, trip, stumble, or fall,
pull on your bones in a way that you normally don't, you have more play in there, less likely to get a stress fracture.
Kim (15:43.86)
Yeah. And people often will avoid postures from yoga because they aren't supposed to twist. They're not supposed to bend. And so how do you help people navigate around the restrictions that has historically been placed on them because they've now been diagnosed with osteoporosis? You know, I'm not supposed to do X exercise.
Debi Robinson (16:08.844)
Well, they are, those are right, they're right. It's just that we're not understanding what that means. You are not supposed to forward flex your spine when you have osteoporosis because the front of your spine is where the fractures happen. 50 % of the fractures are in the front of the spine. 53 % of the people that have a hip fracture had a previous spinal wedge fracture. So it is true that you should not bend your spine.
forward folding should take place in the hip joint. And when you flex forward in your hip, that is okay to do. So forward folding in the right place is okay to do. You're not gonna be doing the typical vinyasa practice. And honestly, over in our 50s and beyond,
Flowing through joints quickly is really not recommended. I mean, it's not recommended traditionally in India. I study with my teachers in India and I'm a yoga therapist. don't know. So a yoga therapist is really fast. 1,000 hours of training beyond yoga teacher and we're trained clinically. We're trained by PT, chiropractic and doctors to understand medical conditions so that we can modify the practice accordingly. So I go to India and study that there as well. The thing is is that you
can bend and you should bend because you're gardening, you're going to the toilet, hopefully at least a bowel movement every day, and all the other things, right? So you are bending, you have to bend in your hip and you have to learn how to do that. So that becomes a big thing. The twisting, it's end range of motion or if you're not in an aligned, properly aligned spine and you're putting too much anterior pressure and then you are cranking into a twist and now putting
pressure and twisting pressure, that's not okay. But what is okay is to be aligned.
Debi Robinson (18:02.03)
80 % of rotation takes place where the low spine meets the middle spine, that thoracolumbar joint. So with that alignment and really trying to get rotation in the thoracic where the ribs are attached. And the reason for that is that the muscles that go through the spine, the multifidi muscles, they're attached to different places on the bones. So when we rotate, we're creating force from so many different locations to create those lines of force to get stronger, stronger, stronger, stronger.
Kim (18:32.222)
And it's the pull that's influencing the bones when you're in sort of a, when you're in yoga posture. It's not the impact. The resistance is coming from the pull of the posture. Is that accurate to say that?
Debi Robinson (18:45.814)
Yeah, there's compressive and tensile pressure. So you're either pushing the bones into themselves, like if you're doing a triangle posture, your front straight leg is actually pushing deep into the hip capsule, creating that pressure in the acetabulum, in the pelvis, and in the femur neck. So you're getting that. You're pulling on the pelvis because the adductors are lengthened, your hamstrings are lengthened, so you're pulling on the bones with the tendons where they attach to the, pulling on the bones with the tendons
of the muscles and then you're pushing. So you get both compressive and tensile and even loading down into postures or moving into a posture, the whole time in that joint as you're moving you're creating resistance, tension and pressure.
Kim (19:30.922)
Yeah, that whole tensegrity philosophy is very much what you're talking about. So you're heavily invested in the yoga camp. Would you say, like, do you do no resistance training? Do you do no impact training? You solely do yoga?
Debi Robinson (19:51.246)
So in terms of impact training, I think about my training and what I've learned and the population I work with. So I mostly, I mean, I teach live classes, five a week. I teach for a hospital. My students are 60 plus. These are not people that are out currently jogging and doing that. So when I think of that, I think more of jogging and stuff. And so I think that kind of in the joints, I think as we age, we have to be careful with that. The other type of work
I know heel drops, they're saying heel drops are creating that piezoelectric stimulation of the body. You know, when we're in the heels, we're in the bones. When we're in the balls of the foot, we're in the soft tissue. And so I would say that I do think that doing resistance training is amazing. Going to a gym, I don't think it's a good idea to do it with someone that doesn't know what they're doing. And that, because safety to me is critical.
Kim (20:48.758)
Mm.
Debi Robinson (20:49.95)
If there is a person, and I don't mean some young 20 year old or 30 year old, unless they've gone through extensive training on osteoporosis and osteopenia, I think you have to be really careful who you follow, who you trust, to make sure that you are in a posturally aligned position, that you are doing the right amount of weight, whatever that is, and being appropriate. So I really think it's important to work with someone that knows what they're doing.
This is why I'm here Kim, because somebody pushed me into this place, right? So safety is like so tippy top for me when it comes to strong, safe bone building stimulation.
Kim (21:32.524)
Yeah, yeah. It's interesting. I was recently in Mexico and the place we were staying had a yoga class every morning that we went to. here in, I live in Canada, you're in the United States. So North America wise, there's definitely been, I have, I can't remember the last time I was in a class where the instructor came and touched you. So that used to happen a long time ago. I don't see it happening anymore for various reasons. And in Mexico, they were all
They were touching and pushing and doing all the things. And there's an element of it that I like. I like when somebody can come and assist. But with what happened to you, there was more force applied than what would be considered appropriate. And there's a one-on-one interaction that is happening in a group that there's no consideration for who that person is on the mat and their history and everything that's happening. I was feeling like I kind of missed
the touch that used to happen in yoga class. But I also was reminded that I think yoga is the in fin says yoga is a feeling, not a pose. And at the end of the day, there isn't we don't need to be pushed somewhere because it's wherever we are at that moment is our posture or our pose. And as you say, we want to then experience more outlets. Here we are in warrior to we've reached the pose.
Now let's feel more into the pose and let's do it on our own rather than having somebody come and push us there.
Debi Robinson (23:08.61)
Yeah, and you know, it's so interesting because honestly that person was my favorite teacher. That posture in that moment that my hip joint, my labrum tore, I was the deepest I'd ever been in Baddha Konasana. So I was, know, soles of the feet together and then forward flex. My legs were touching the ground and my nose touched the ground. And in one moment, I was so grateful to be led to that place.
What I've come to realize though is that we need to find within our own body because we don't have an x-ray to tell us that you have this range of motion in that hip joint or in that knee joint or in that shoulder joint. And so we need to find within our own bodies. And then as we age, we have dehydrated tissue, might have scar tissue, we might have issues with mineralization that's or something could be happening. We don't know that. And so that's why that feeling
and being in control of your journey, where are you going? And then also you develop this interoception and this internal intelligence on what is appropriate for you. We take that away if we do the other stuff.
Kim (24:19.213)
Yeah, interesting. So you talked about mineralization and I want to go down the nutrition path here because that's also something that's super important. And of course, most people think calcium, I need to consume a lot of calcium and then I will have healthy bones. And it's a much deeper conversation than that. So what is it from a know gut health plays a big role. So high level starting what nutritionally
would be most important for us to do for our bone health. And then I want you to dive a little bit deeper into the gut health component in particular.
Debi Robinson (24:49.838)
Okay, so top of the funnel is we need the four musketeers. So the four musketeers are, calcium is number one, 99 % of the calcium is stored in our bones, so we need that. We need vitamin D because it helps it get absorbed. We need magnesium because it puts it into a solution so that vitamin K can take it to the bones. So those are like the four musketeers. You need to make sure that you get most of it in your food because the quality of supplements matters. know, some calcium supplements
are made out of ground up rocks. So you have to be careful, yeah, some of the less expensive, lower quality. So you have to make sure that you have really good quality supplements. So I think getting it from the food is the best source and to look at labels, if you're eating foods with labels, and to do it that way. So that's that. The big thing is though, is that the food or the supplements needs to get from the mouth to the bones. And what's in between mouth and bones is the gut.
So you have to go through the stomach and make sure you're optimizing digestion. And as we age, digestion diminishes. We lose hydrochloric acid, which is the main stomach acid. And then also if we're not doing our digestive habits, like we're not sitting and eating or we're drinking too much liquid with our food, or we're stressed out watching the news, then we're not in a digestive state. So we have to make sure that we are supporting digestion. The next place
where all the absorption takes place is the small intestines. That's where 80 to 90 % of absorption takes place. So we need to make sure we don't have a leaky gut. We have the right form of food coming out of the stomach. It has to be digested well. Then we have to the right pH. So now your gallbladder will secrete bile to break down the fats, vitamin D, vitamin K, and others. And the pancreas will secrete the enzymes to digest further. And then you need the beneficial bone building.
bacteria to be optimized. They make food for the good gut microbes. make vitamins. Vitamin K is one of the vitamins they make. So we need this whole entire system to be optimized. the bigger thing of all, well, that's a big thing, but the big thing is that this is an inflammatory disease. We're going to eventually call osteoporosis an inflammatory disease and realize that it is reversible in conventional medicine terminology. And when we understand that so much,
Debi Robinson (27:19.644)
inflammatory triggers take place in the gut and so the reduction of the root causes a bone loss is when we focus on gut health.
Kim (27:29.565)
Okay, so what are the root causes of bone loss?
Debi Robinson (27:33.198)
So seven main root causes inflammation. One, stress. And that can be stress of what your body's managing or stress of mental-emotional. Hormone imbalances, mineral imbalances, acidity, toxicity, and sedentary, have a sedentary lifestyle or not the right amount of force in the right way that you need.
Kim (27:57.252)
Yeah, okay, so root causes. I've become quite bullish on root cause in pretty much everything. So I love that you're talking about that. So optimize gut health. when gut health has become a, a lot of people talk about gut health and we hear gut health, gut health. What do we, what does that mean? How do we optimize our gut health? You talked about hydrochloric acid. So does that mean that we should be consuming hydrochloric acid or people say,
apple cider vinegar or bitters or something before you're eating but how do we know if we have poor gut health? How can we optimize gut health so that we can have better bone health?
Debi Robinson (28:39.022)
Poor gut health symptoms would be constipation or diarrhea. So if you're not, if your system is not optimal, that you would know according to constipation or diarrhea. You should have a bowel movement every day and you should have a bowel movement typically first thing in the morning without the assistance of caffeine. So that would, once you get into a really nice internal balance state, your circadian rhythm is optimized, your body would eliminate and the whole night it would have been processing toxins and
the morning would be the time to get rid of that. So a daily bowel movement is one of the things to look for. Gas, bloating, GERD, acid reflux, those would all be symptoms that something's not optimal in your digestive tract. And then skin irritations, any kind of red skin, itchy skin, acne would be a sign that your detoxification channels are not optimized and the liver is a part of that whole digestive system. So those would be some of the symptoms. And then let's say the biggest symptom could be
osteoporosis because then you know things are really not going great. So that would be what to look for from a symptomology perspective. Then to bring into some support. Now hydrochloric acid is the main acid of the stomach but I wouldn't take that as a support for digestion. I would use digestive enzymes, amylase, protease, lipase.
because hydrochloric acid, if you did have a bacterial overgrowth called H. pylori in your stomach, if we use hydrochloric acid, we get H. pylori to burrow and hide in the stomach lining. And that can be linked later down the road to ulcers and it impedes digestion. So I wouldn't recommend that. And there's some natural things to do.
Having, if apple cider vinegar works for you, 30 minutes to 40 an hour before a meal, you could try apple cider vinegar in water. You could try salt in water. Those are things that are gonna potentially hydrate your system and prepare. Being in a relaxed state, not drinking liquid with your meals is another digestive support. And then of course, making sure you're eating good foods, not processed foods, not franken.
Debi Robinson (30:53.45)
foods, not things that are hard for your body to figure out what it is.
Kim (30:59.674)
Yeah, yeah, I love that terminology, franken foods. I want to talk about medications from two perspectives. So one medications that people may be taking for some other health condition that could negatively influence the bones. And then medications that somebody may have been put on because they have been diagnosed with bone loss. And the more that I'm learning about that, the short
the reasons for the short period of time that you should be on it because of the negative impacts of that. So I want to kind of bring, want to highlight some of the things people may not know about some of the bone health medications. But let's start first with other medications that could potentially be contributing to bone mineral loss.
Debi Robinson (31:48.782)
Well, one of the biggest ones is cancer and cancer meds. And if you do have cancer and you need take medications, you have to, right? You have to at that moment. that exists and then it becomes, okay, now learn all the lifestyle practices to support your bones once you've gone through your cancer treatment.
The other one is glucocorticoids, so any kind of steroid treatment. And that could be you have joints or body parts that are not happy and you keep getting those cortisone injections or take steroids. Well, let's get to the why you have the issue in the first place instead of using the band-aid, which is the medication.
You know, heal yourself naturally so that you don't have to take that. But if you did, that could be a contributor. And another really big one are all the digestive medications, the protein pump inhibitors, the PPIs that women with GERD and acid reflux have been taking for years. Those lead to osteoporosis. So those are some of the medications that potentially could have contributed to osteoporosis later down the road.
So that's that, that's that piece. Now the thing about medications, it's the only tool in the toolbox in the conventional way that we approach bone loss, or we approach osteoporosis or osteopenia.
And I think big pharma and big insurance plays a big role in this because that machine, the DEXA, that tells us we have this condition started in the 90s, this company had this pill, and this company had this machine, and then all these women could be diagnosed. So let's start at the start line where we kind of got ourselves into this situation with this machine that could be wrong up to 70 % of the time, with a company with a pill, bisphosphonates, Fosamax, and then with a machine that could
Debi Robinson (33:39.022)
tell us we needed it. So let's even start with how we even got started. Now those pills deal with the what, which is that disease called osteoporosis that that machine said you have or that you have osteopenia. That's the what.
And so we give whatever medication of choice, the band-aid on the what. Now we can't use these pills for very long. Really, why Kim? Because eventually they damage your liver and kidneys or you have adverse effects somewhere else. Or they might actually cause a fracture in your femur bone and atypical femur fracture. Or wait a minute, they might break down your jawbone osteonecrosis of the jaw so your teeth fall out. So, uh-oh, we can't take those for too long.
We have a new medication now we have this bone building medication to deal with this what part we still don't didn't do anything about the why Why are your bones breaking down? We didn't do anything in there. We just said wait a minute Let's focus on this thing and then that if you go off of that in two years Well, you just built up this you artificially built up this bone with this pill for two years Now you better take this one that'll stop bone loss for two years so that you could keep what you just built up oops, but wait now you have to
Anyway, it's not going to be on these things for the rest of your life. There's negative consequences from taking these pills. And the biggest thing for me is it's disempowering and it makes you think you are not in control of your body and bones, which is a bunch of baloney, because you are.
Kim (35:08.176)
Yeah, I love that. You mentioned in terms of your list of seven, hormone balance. And of course, post menopause is we lose a significant amount of bone in those first five, 10 years post menopause. That's where we will face the biggest bone losses post menopause. what role, like when you talk about hormones, what can we do in our fertile years to prepare ourselves for this?
we're facing this bone loss when we're postmenopause and then also once we are reaching and in our postmenopause years what can we be doing from a hormone perspective?
Debi Robinson (35:46.444)
Yeah, because hormones play such a critical role. Testosterone and estrogen are so linked.
to the strength and the density and the quality of our bones. And so, and post menopause, we lose up to 20 % of our bones because of that. So what do we do before that? Well, perimenopause can be years before you get to menopause. So whatever you're gonna do to optimize your hormones before you go through menopause, and those are lifestyle factors. That's stress management and optimizing sleep and making sure you have the right diet and making sure that your body is
imbalance. So you are having that daily bowel movement. So all those lifestyle components of how to optimize your internal biochemistry.
and before you get to menopause matters. And so that's that piece there, but you also have to do all that weight bearing stuff. So make sure you are doing your workout, doing your yoga, doing whatever it is you do so that you can maximize what you come into menopause with. So the lifestyle for supporting hormones is really the same on both sides. I are there supplements? Sure, there are supplements that can support. Maca has been shown to support. There are certain herbs that are precursors
to bones or certain blends that have different bone herbs that you could take. But really before you do all that, I would say to really work on those lifestyle pieces, optimizing sleep and managing stress and doing the weight bearing, going into menopause.
Debi Robinson (37:18.262)
And then in menopause, you're really doing those same things as well. You just have to, I don't want to say work harder, but you have to focus a little deeper maybe. But it's on both ends. So you have to optimize your gut because the gut is when the outside world, all the food you see that you're making, that you're buying, that's the outside of you, right? That's the, ooh, there's that for my bones and that for my bones. gonna eat this for my bones and this for my bones. So what you're gonna be bringing in to build your bones,
stuff, that's the outside world. The inside world is when it crosses that mucosal barrier. So this is where we have to have that optimal gut health aspect so that we make those choices.
Kim (38:02.872)
Do you, like evidence-wise or even opinion-wise, where do you stand with regards to hormone therapy and estrogen?
Debi Robinson (38:10.926)
Okay, so I think it's the number one thing to do. I think BHRT, bioidentical hormone replacement, and the big thing about that in, I believe, 2003 was Women's Health Initiative. And that study, when they came out with those results and said that hormones cause heart attacks, stroke, and cancer, everyone was pulled off of their hormones that was on hormones. And what happened in the next few years? Fractures. Women started breaking their hips and having fractures.
Yet, what were they going to do? Because that Women's Health Initiative said hormones are terrible.
Let's fast forward 20 years later, 2023, we realized, uh-oh, that study wasn't correct. It wasn't peer reviewed. We use synthetic progesterone and we used oral estrogen, which is not the way estrogen is metabolized. Uh-oh. And so now what is the number one course of action with functional medicine physicians and people who provide hormones is BHRT, bioidentical hormone replacement.
therapy, which is the hormones that are natural for our body. So I am a huge proponent and studies show women over 65 can benefit, women that have had previous cancer can benefit. You have to go to a practitioner that prescribes and that is current and knowledgeable about this.
Kim (39:35.219)
Yeah. And there was one interesting statistic and I need you to help me clarify it. The risk of fracture is greater than three types of cancer combined. And that was breast, uterine and ovarian cancer. Which that was, know, and when you bring up the women's health initiative and that's what created so much fear. I'm going to get breast cancer. I'm going to die by taking hormone therapy. And yet now we look at the risk of fracture is greater than three of the major cancers.
Debi Robinson (39:47.115)
ovarian.
Kim (40:05.418)
And you gave the statistics at the beginning of the call of how many people once they have that fracture end up dying or not able to be they can't function on their own independently after that. And then they die. Yeah.
Debi Robinson (40:19.734)
and then they die. What about this one? One in two. It means you or me, right? One in two women over age 50 will fracture a bone in her life due to osteoporosis. It's the number one disease of menopause.
Kim (40:29.308)
Yeah. Yeah. Yeah. Shocking.
Yeah. Yeah. Okay. Love it. You kind of were touching a little bit on supplements. There's one and I'll try to be generic on this. There is an algae supplement that a lot of people talk about and I've heard a few different people in the bone health community talking about the benefits of algae from a supplement perspective for bone health.
Can you talk a little bit on potentially any research or evidence or is that something that we should be looking into?
Debi Robinson (41:07.086)
So I will say that initially when the companies that use that product in their product had strontium as a part of it, and they were using the studies to say that they were proving an increase in bone density on a DEXA scan. So they were using research of improved DEXA scores. And that is because strontium that was in the initial formulations,
will give a better DEXA scan score. Not that you have better quality bones though. It's because strontium is a heavier mineral than calcium and it will actually displace calcium. And strontium is not actually part of the metabolism of bones, the physiology of bones. So I do not recommend strontium. Now, I know that some of those companies have taken strontium out because there's a little bit more negative publicity, yet they still use in the marketing that they have an improved DEXA scan score.
I'm not sure if they're saying that's if you have strontium in there because women are choosing to get the supplement without strontium in terms of the formulation of calcium coming from Algae or not the way that I like to look at everything because we only know what we know and we really honestly know very little no matter how much kind of research we're doing very very hard to hold this 70 trillion cell being held everything constant except for this one
Kim (42:26.162)
Mm-hmm.
Debi Robinson (42:33.476)
variable. This is the algae. What is it doing in your body? So how often would you be eating algae or would I be eating algae in our lives? I mean,
Kim (42:42.92)
Not often.
Debi Robinson (42:45.102)
or this other supplement that's in Japan that comes out of these fermented soybeans, this vitamin K. What about the rest of the world and how would we have access to fermented soybeans in Japan? And should the whole world be eating this one thing that's in this one part of the world for bone health when we have eight and a half billion people that have bones? You know, I just, really look at everything like that.
Kim (43:01.407)
Mm-hmm. Mm-hmm.
Mm-hmm.
Yeah. Before we wrap up one thing I want to talk about quickly, you've mentioned the DEXA scan a few times and some limitations and false positives. And so what would be like, are there other ways to look at the integrity of your bone? And there's also, it's the outside layer of the bone there's, but we also need to consider what's on the inside. And so does a DEXA consider sort of the flexibility?
of our bones as opposed to just the hard surface.
Debi Robinson (43:39.008)
No, so the dex is an x-ray and it looks at everything. It looks at your fat, your soft tissue and your bones. It's a light source that's coming down and on the bottom it captures that light and whatever light is captured, that's what gives the bone density. Well, the smaller petite women are always going to have osteoporosis and actually severe osteoporosis. It's why a lot of the orthopedic surgeons that I work with and interview, it's why they got into this because they have tiny wives and their tiny wives
who they know are very strong, any doctor would tell them, you have severe osteoporosis, here's the pill. So the DEXA scan is a 40-year-old technology that was from the 90s, very, very old and outdated. You cannot look at children's bones with a DEXA scan. So the five foot two and below ladies, the petite ladies, really are in the child size category. So they're not gonna have accurate readings. It matters who does it, who's the technician, what was the body position.
they put you in? What were you wearing? Did you have an underwire bra that maybe got in the way of it? Is your spine aligned properly? Because when they look at density, they have to look at both sides equally. And wherever the technician puts the boxes when they're looking at your L1, 2, 3, and 4 for your spine, or your femur neck or your femur bone,
wherever they place the area to look at matters. And so who's the technician? How did they do it? Did they position you correctly? Did they say the right height, weight, age, or ethnicity? And so all of these things go into it. There's a lot of variability. Sometimes it can be wrong up to 70 % of the time. So to be honest, at this point, I don't even...
rely on them very much anymore. I don't, I take them with a grain of salt. And that's what I tell women. you know, because it is a mental, emotional diagnosis, because you get the, the, you know what scared out of you, it's really important that we understand that because if you are scared still and you're not moving, you're going to lose more bone. So we really have to pay attention to that. The better technology is an ultrasound and the ultrasound actually looks at the inside of what you were talking about.
Debi Robinson (45:54.628)
X-ray looks at the outside, the cortical bone, which that has nothing to do with the fracture. What matters is what's inside. And so the newer technology is called REMS, radio echographic, R-E-M, don't know, musculoskeletal spectotomy or something, REMS, or ECHOLITE is the parent company. So that's the terms that women might hear. And so that's the better way, because that actually looks at what's inside, which is going to give you the quality and the true fracture risk.
And so that is the the now and the other thing there's all these pop-ups now because it's a moneymaker for a lot of companies so you have some of these bone centers have the machines now and chiropractic offices and the people that do these are not trained to Interpret them yet as of the time of the taping of this podcast They're not as trained as the orthopedic surgeons or the doctors because it is
a medical screening device as is a DEXA scan. So it needs to be they need to be interpreted by a medical professional or someone who has that level. And so the one caveat here is that these machine these scores are being done right away you get an printout so the AI printout right away of fracture risk and of T score, Z score, density and all of that. And so that's happening right now but what's not happening is the women are not getting that deeper interpretation in the way they need to.
So that's something I'm doing now. I'm working with an orthopedic surgeon and we're doing master classes on this for women to learn, well, wait a minute, what does this mean? It is the best technology, the REMS.
Kim (47:34.015)
Mm, cool.
Okay, and then, so you can still get a T score. You still get the same information, but it's just more accurate. That's it.
Debi Robinson (47:45.41)
You get a T score, you get a Z score, you get a fracture risk, you get all that, it's more accurate. It's the bone quality versus the bone density, because bone density is not an indicator of fracture risk, bone quality is.
Kim (47:48.713)
Got it. Cool.
Kim (47:53.31)
Yeah.
Kim (47:57.363)
Yeah, I love it. Okay, so where can people find you, find out more, follow along, listen to your podcast and get more informed about their bones?
Debi Robinson (48:07.758)
So my podcast Stronger Bones Lifestyle, my website debirobbinson.com, debirobbinson.com, Instagram debirobbinsonwellness, and yeah, that's where you can find me.
Kim (48:20.615)
Awesome. Yeah, I'll share all of those in the notes too. Thank you. This was fascinating. I learned a ton and I know that my listeners will really benefit from all of your information. Thank you for your work.
Debi Robinson (48:31.138)
Thanks, Kim. Thanks for having me.
