Kim (00:01.679)
Hi, Kevin, welcome. Thank you so much for joining me on the podcast. We were just talking offline about how obsessed I've become about bone health and you have been in this space for quite a while and have your own kind of pain to purpose story. So I would love to start out with you explaining what brought you to the world of bone health and now being the bone coach, Kevin.
Kevin Ellis (Bone Coach) (00:24.443)
Yeah, well first, thanks for having me, Kim. This is an important topic and I don't think it gets discussed and talked about enough. And I often think that our bones are just this forgotten organ that, you know, really doesn't get much attention until later in life. And it's kind of a tragedy because we can do so many good things so early on that could add an extra 10, 20, 30 years of good quality to the end of our life. Because we don't just want to live longer and be in a wheelchair. We want to live longer and be active and be up and...
you know, be able to do all the things that we love long into the future. So that's really behind why I do what I do. And my whole journey is definitely you wouldn't you wouldn't think about a younger male who would be typically interested in bone health. Mine started because of my own osteoporosis diagnosis right around 30 years old. And for me, it was shocking at the time because prior to that, I was in the Marine Corps, I always identified as somebody who was an athlete or tough or who could endure. And
I had all these different health issues after I got out of the Marine Corps, high stress, poor sleep, chronic digestive issues, was diagnosed with celiac disease. Celiac disease for those who don't know, it's an autoimmune condition where when you ingest gluten, it damages the villi in your small intestine, these tiny little nutrient absorption centers that are responsible for absorbing nutrients from the food you eat. it damages them and it blunts them to where they can't do their job.
Your body still needs these nutrients every single day to execute its daily function. So muscle contractions nerve impulses that require calcium and other nutrients and If you're not taking them in and you can't absorb them I couldn't absorb them your body is going to go to the bones and pull from there So mine we're pulling from my bones and it's not just like selectively plucking out calcium
it's actually tearing down the entire protein matrix structure to release those minerals into circulation. it's, it led to bone loss for me and a really shocking diagnosis. And the unfortunate thing was I had gone to a lot of different doctors to help me try to figure things out. went the conventional path and I didn't make much progress. I had people tell me, you you're, you're normal or healthy and it just, it wasn't matching up. And it's, I know that's frustrating for so many people. I was in the same position and
Kevin Ellis (Bone Coach) (02:41.669)
the person of all people to ask me, hey, you have celiac disease or you have gut health issues. Have you ever had a bone density scan before? Like kudos to that PA. It was a physician's assistant who said that because none of the other doctors I saw at the time asked that. if you're listening to this and you got chronic digestive issues or you got celiac disease or ulcerative colitis or Crohn's or any of that, go ask your physician. Actually, I'll talk about who else should get, you know, scans and stuff soon, but
you need to be talking to your physicians about that and get those tests early. And that's kind how it started. And then it transitioned from me getting the right plan in place, making progress, making improvement, doing it mostly for I have young kids or at least I had a young daughter son on the way and I lost my dad when I was about two months old. So I know the pain of growing up without a person who you want to be there.
And it is incredibly painful. is actually the greatest pain of my life. And I didn't want to put my kids in that position. So I had a very strong impetus to make improvements and change. And I went this path and you know, I turned it into what is now the biggest passion of my life, which is helping people build bone strength, prevent fracture and injury. And we've got about 250,000 people in our community to this day, a team of 43 people now.
lots of credentialed experts that are functional medicine practitioners and exercise physiologists and you know, really smart people that know how to help stronger bones. So that's kind of where we're at now.
Kim (04:18.968)
Wow.
Kim (04:22.723)
Wow. Well, thank you for your work and for being here and sharing your story and everything that you've learned along the way. So I guess, like, just to start out, there's so many things out of that, just one little introductory story that I want to cover, but just to start with the basics, what is, why is bone health important? And when people think of bones, well, we don't think of bones. were talking about that. It's again, it's inside of us. It's kind of like the pelvic floor. We don't see it. We don't necessarily think about it until there's a problem.
So why is bone health important? And then I wanna talk about the three main categories that we hear talked about, one being osteoporosis, most people hear that term. Some may also be familiar with the term osteopenia and then osteoarthritis.
Kevin Ellis (Bone Coach) (05:07.953)
Yeah, so let's go with, let's start with osteoporosis. It literally means porous bone. It's a condition characterized by either not enough bone formation, excessive bone loss, or it's a combination of the two of those things. And an osteoporosis, both your bone density and your bone quality are reduced. That's going to increase your risk of fracture. Fractures are what's going to put your future in question, right? So all the bucket list places you want to be, all the activities you love doing.
it's going to put all those things in question. So it is important if you get this diagnosis, the way you get a diagnosis is you go get a bone density scan, painless test, kind of like an x-ray, very low levels of radiation. You lay down on a machine, it does the scan, it tells you the actual, your bone density, your mineral content of your bone, then it generates a score. If that score is plus one or minus one or somewhere in between there, that's considered normal and healthy. If it's minus one to minus 2.5,
that's considered osteopenia, which is like a precursor to osteoporosis. If it's minus 2.5 or lower, so minus 2.6, minus 2.7, so on and so forth, that's considered osteoporosis. The greater the negative number becomes, the more severe the osteoporosis. Now, what's important to note is that when you get this bone density scan, you oftentimes don't have the full picture. And when we talk about bone density, that's only part of the picture.
There's also something called bone quality. So bone density is the actual mineral content of the bone. Bone quality is the structural integrity of that bone, the micro architecture, how the bone is organized. Those two things combine to create bone strength. So a lot of times when you get that scan initially, you only have part of the picture. And I've seen people, we've had over 10,000 people come through our stronger bones programs at this point. So I've seen people that have
bone density in the negative threes that have never fractured. I've seen people that are in the negative ones with osteopenia, technically by Dexa, that have fractured many times. Bone quality is playing a big role in that. So in order to get the bone quality part of the picture, that's where you would use a technology like REMS is another technology that can do bone density, bone quality. You can also, there's an add-on software to Dexa. You got to call the facility ahead of time.
Kevin Ellis (Bone Coach) (07:32.113)
You gotta ask them, but it's called TBS, trabecular bone score. So those two things can help you get a picture of your bone density and your bone quality. So now you've got that. Now you've got a more comprehensive picture. And then the other piece that you usually don't have is, especially if you only have one scan, is you don't know if you're actively losing bone right now, present day. So that's a really important part of this whole thing.
Because what's normally gonna happen when you get told you have osteopenia or osteoporosis is that you're just gonna get calcium, vitamin D, go for a walk, take this bone drug, we'll see you in two years for your next bone density scan. That's the prescription for 95 % of people in 15 minutes. You, as the educated, empowered patient, advocate for your own health, you need to be able to say, look, I'm not saying no, I'm just saying not yet.
Can you help me get a little more information? And what you did is you opened up a conversation versus just putting a wall between you and that physician. And that's when you can open up and say, what I'd like to do is can we get some bone turnover markers run also? Now, bone turnover markers give you that other piece of the picture, which are, are you actively losing bone right now, present day? So if you get this bone turnover marker, it's it's a blood test.
It's called the serum CTX CT lo peptide test. there are different places you can go to get this, your doctor, your, your general practitioner. They may not be, if they're not familiar with the interpretation of a test, they're not going to order it because it creates a liability, right? Or they might refer you out to somebody. They might refer you out to an endocrinologist or rheumatologist. That person may or may not order that test for you also, because it may just slow things down or they may just kind of shut you down.
So you can go, there are other services, there's osteo IQ as a service. You can go to get tests for active bone loss and bone building. and especially if you can't make progress with your physicians, but, that is a really important test because if it's, if it's off or elevated or not where it needs to be, that can be an indicator of active bone loss. And then what we say is what's causing that bone loss and what do we need to do to address it? So this is why.
Kevin Ellis (Bone Coach) (09:55.599)
When people get told they have osteopenia or osteoporosis, you just need to get more objective information before you start jumping into a treatment.
Kim (10:05.262)
Yeah, I did a DEXA scan. was a body comp imaging place in Vancouver. It looks at your whole, your muscle, like all the kind of the fat free mass, everything. so I wanted to do this and I did the DEXA because I was also approaching menopause at the time. And I'd never heard of REMS and it wasn't until probably two months ago, I was speaking at a conference and one of the people in the trade show had a REMS.
and was telling me all about this. And so I have since booked in, I have a, it's ultrasound and that will be in January that I do that. if I'm hearing correctly, then it may be beneficial for somebody to rather than rely on, even though people are talking about the REMS being superior, I still feel like maybe that's beneficial to have both plus the blood. Would you agree with that?
Kevin Ellis (Bone Coach) (11:01.381)
Yeah, REMS scores are typically going to show better than DEXA scores, right? So show an improved score, not always, but most of the time. But the problem I think is, the good thing is REMS, it started in Europe, it was more prevalent there, it's making headway in the US, it's probably going to be in more locations just as time continues on, which is great. More access for patients is going to be great. But if you don't have one near you,
You can either go to one, find one that's close to you and then go to it or start with the bone density scan, right? You can still get that piece of information. You can still get a bone density with a TBS score and get that part of the picture too. So that you don't have to feel like you're out of luck and some data is better than no data too. And then yes, I would say always get the bone turnover markers, always.
at least need a foundation from which to monitor future changes. you if you get one you want to get the other one at the same time. So if you get the CTX, if you get the active bone loss test, then what you want to do is you want to get this the other side of the picture. You want to get the P1NP. P1NP is pro collagen type 1 N terminal pro peptide. That is an active bone building test. So are we actively losing bone? Are we actively building bone?
is the ratio between the two of those things improving. Now this is important. And I think one of the flaws in the conventional model of monitoring just bone density every one, one and a half, two years, is you're looking at a lagging indicator of success. You have all these people that are given a prescription or given just a list of foods of dairy and take calcium and vitamin D, walk out the door and we'll see in two years.
and hope and pray that the things you're doing are the right things. That's not a good strategy. We need objective data. Are we moving the needle in the near term? And if not, how can we make corrections and improvements, look at the data again and see if we're bringing that CTX down. We're actually bringing the bone formation up. We're improving the ratio between the two of those things. So the bone turnover markers are really leading indicators that you're moving in the right direction. And I think this is something that
Kevin Ellis (Bone Coach) (13:24.709)
You know, more people need to focus on. And look, your doctor is not, if you can get your doctor to order the bone turnover markers, they'll probably order them once a year, maybe. Right? So if you can get that, But you may need to do it every three months or six months or 12 months. So if somebody comes to us, you're actively losing bone right now. There's a lot of root cause issues contributing to it. You need to be doing that every three months or so until we start seeing improvements in those.
then you can drop it to six to 12 months. Or if you're just starting bioidentical hormone replacement therapy, or you started a medication, you got to have a baseline first, do it three months in. Is it actually working? Is that bioidentical hormone replacement therapy, is it actually bringing that CTX down? Are you seeing a bump in bone formation? And again, those are leading indicators that are going to make sure you hit that target two years down the road.
Kim (14:18.905)
Yeah, yeah, that's so important. You, you talked about root causes. And so for you, you had a root cause of celiac, and not not absorbing the nutrients needed to build your bones. What are some of the other root causes for bone loss or poor bone health?
Kevin Ellis (Bone Coach) (14:39.109)
Yeah, there is primary osteoporosis. So that is typically related to a decrease in estrogen in postmenopause women. Estrogen has a protective effect on bone. When those levels decrease, as they do during menopause, that causes an increase in the activity level of cells that break down bone. But there is secondary osteoporosis too. And this is where it occurs as a result of behaviors, disorders, conditions, diseases, medications.
So celiac disease of course falls into a secondary cause of osteoporosis, but there are many, many others. Medications that people take, one of the most important ones, prednisone. If you have taken it in the past or you're taking it now, just be aware that medication will cause and contribute to bone loss. There are multiple reasons for it, but the big ones are it's going to reduce your GI absorption of calcium. It's going to increase the urinary excretion of calcium.
and it's going to directly act on the cells that break down bone to increase their lifespan. So you just be aware that if you're on that medication, you need to be doing other things to protect your bones. And if you can avoid that altogether, that's great. Some other medication, antihistamines, PPIs, proton pump inhibitors. Now I've seen people be on these medications, these PPIs for decades and 20, 30 years.
And you what these do is they they either reduce the production of or increase the suppression of stomach acid and You need stomach acid to properly break down and extract nutrients from your food like amino acids The building blocks of protein your bones are 50 % protein by volume. So you need amino acids to rebuild that foundational structure calcium magnesium iron b12 all these nutrients are really important for your health and for your bones and
And if you don't have good stomach acid production, then your body, your bones are going to be starved of those nutrients. And most people take PPIs when they actually have too little stomach acid. It's counterintuitive. And so before you take that or consider taking it, just know that it will have a negative impact on your bone health long-term. can wean yourself off of them. and in many situations you probably want to work with a practitioner.
Kevin Ellis (Bone Coach) (17:04.823)
help you do that and help boost those stomach acid levels again. that's another big one. On the on just the health condition side. So we talked about gut health a little bit, any of the conditions that contribute to nutrient problems with nutrient absorption, they will affect your bones. So celiac disease, I mentioned that IBD, ulcerative colitis, Crohn's. Or if you are somebody who for long periods of time, so think
you know, six months, 12 months, decades. I've had people come to us after decades of chronic digestive distress, like bloating, belching, burping, gas, constipation, diarrhea, IBS, loose stools, right? If that happens for long periods of time, nutrient absorption could be an issue that you're facing. And what we would want to do is do some kind of gut health testing, figure out what's going on there, and then address those underlying issues. So
That's another big one. Autoimmune conditions can be contributors to through through inflammation. Yeah, there are a whole host of other ones. Also, also, I would say it's important to know contributing factors right now. That's that's probably most important. But also think about and listen to this. If you're paying attention and you're like, I have kids and grandkids to just know that 90 % of your bone mass by the time you turn age 18.
and the remaining 10 % fills in by the time you turn 30. So if when you were younger, you had poor diet and nutrition, you were eating a lot of sugary foods and sugary soft drinks and candies and not getting vitamins D, K, C, magnesium, calcium. If you led a sedentary lifestyle, you weren't playing sports or doing gymnastics or moving your body and your bones in these short, sharp, dynamic movements creating
that the stress and stimulus for good quality micro architecture from a young age, right? If that stimulus is not there, that quality is gonna be affected. So if you've got kids and grandkids and you're listening to this right now, how do we get them off the tablets and get them up and be active, get them outside? And I know that conversation can be really hard to have with your kids. I have that conversation. I've had it and we're good.
Kevin Ellis (Bone Coach) (19:31.639)
you're doing them a favor by adding an extra 10, 20, 30 years to the end of their life that's better quality when you do that. So it's out of love, but you got to do it. And eating disorders, if you had anorexia, bulimia, if you smoked or drank excessively, all of those things can prevent us from achieving peak bone mass. So oftentimes osteoporosis, the result you see is a combination of things that happened before you reached peak bone mass.
and also things that are happening right now that need to be addressed.
Kim (20:04.018)
Okay, we're going to come back to the gut. when I was, I recently took a certification for osteoporosis fitness. I I used to teach osteoporosis or osteo fit as it was called many years ago and wanted to get recertified because so many people in my community are struggling with bone health challenges. And in that certification, they were talking about diet and some of the things you've mentioned, they did mention gut health. But one thing they said was to
maybe not so much protein, which part of me was struggling with that because as you just said, 50 % of our bone is protein. And if we not consuming, we already are not consuming enough protein. And so I would think that could be another maybe secondary root cause of bone loss. Would you agree with that?
Kevin Ellis (Bone Coach) (20:57.809)
I would say that advice, similar to the advice that somebody gets when they get this diagnosis of don't lift anything heavy. Right? I would say that advice of don't eat protein because it causes bone losses. That's negligent advice. have to have, you have to have protein. You have to have protein for your bones. We talked about 50 % protein by volume. You also need protein for your muscles too.
Kim (21:06.991)
Yeah.
Kevin Ellis (Bone Coach) (21:26.981)
And there is a tight connection between muscle and bone. When muscle pulls on bone, have a, that mechanical signal is sending a chemical signal to tell the bones to become stronger. You need good strong muscles and bones. What do you have to have for your muscles? You got to have protein. So some tips that I give people around this would be, number one, if you, if you suspect that you're falling short, and I would say most people are falling short.
Cause you have to be intentional about it. Most people are busy. They forget to eat a couple of meals or, you know, they, they prioritize something that's not protein first. So I would say get essential amino acids. Those can be great additions to your plan. you know, if you are adding them in before a workout, if you're adding them after a workout or at any point throughout the day, you know, I typically I'll sip on a little bit of creatine and essential amino acids and electrolytes throughout the day.
And with a little bit of Redmond's real salt, so that's exactly what's in here right now, right? Just a little bit of creatine a little bit of amino acids and You know some electrolytes of sea salt but or Redmond salt but the the protein component is important and then in those meals in Each of your meals you want to prioritize that protein first or at least just make sure that it's there So if you can get at least 30 grams in a meal
That's fantastic. Some people are like, I can't eat three meals in a day. That's fine. Maybe you have two regular meals and you have a smoothie or something, right? Where you put a little bit of collagen in there. You put a little, whatever other kind of protein you like, whether it's whey and you actually tolerate that. If you don't, don't incorporate it. But if you do great, cause whey can be great for muscle and also for bone. If you don't tolerate that, you could do a beef protein isolate.
You can get grass-fed beef protein isolate. That's a complete protein. And then you can add in a little bit of collagen or something like that. those are just some tips on how do you get a little bit more protein. would say those are great starting points.
Kim (23:38.515)
Yeah. So you've talked, I had written this down earlier to you college in, and creatine. So those are all the, mean, loads and loads of research on creatine in general. Of course I'm biased now to kind of perimenopause post menopause as, the population. That's where I am myself, but also many people in my community. And now more and more research about the benefits for post menopausal women with creatine as well. So
Can you talk a little bit about creatine for the bone? And then you've also mentioned collagen, and this is also something that I have been using for several years now because it's for bone, it's for ligaments, it's for skin, it's for all the things. I just feel like there is research to support the benefit for this as well. So is there benefit from a bone perspective with collagen? And then if you can talk about creatine.
Kevin Ellis (Bone Coach) (24:32.239)
Yeah, great. So from a a creatine perspective, let's just talk about there's plenty of research out there that shows that creatine is probably one of the it's one of the safest, most well studied supplements that you can incorporate. And I know when people hear creatine, if you haven't heard about it yet, it's you might think of like bodybuilders and, and you might have some hesitation. It's a it's a relatively safe thing to incorporate into your plan. And it's it's great. So
There is a lot of research that suggests that it's great for improving your muscle strength and function, particularly in post-menopause women and older adults. That's going to have an indirect effect on bone through muscle. But then specifically for bone, it could help with the actually promote bone formation. I do think there's more research in the bone area specifically that needs to come out, but
that it may positively influence the bone cell activity. I think creatine can be a great addition. You just heard me say, I personally incorporate it every single day into my plan. I use about five to 10 grams a day. And that's, you know, you got to figure out what's right for your situation though. And then what was the other one? The other one was college college. yes, so collagen is it's a really important protein in your body. Your bones are actually a collagen protein matrix structure.
Kim (25:47.196)
collagen.
Kevin Ellis (Bone Coach) (25:55.301)
with minerals laced in there. So you need to have good healthy collagen levels. What I would say in terms of the collagen that actually shows it has benefits for bone. Most of the time when you see collagen products promoted, you'll see they'll talk about collagen specific benefits for bone. And then if you look at the research down below, they reference specific peptides within that research. The specific peptides that show
that have a randomized control trial for bone would be Fortibone. So Fortibone is a peptide from Jolita and it's incorporated into different collagens out there that you can incorporate. I would say that is one that you can add that actually has research showing benefit for bone to it. And yeah, I mean, you can easily add a scoop of that into a smoothie, right? And combine it with something else too, or you could just dump it in a little bit of water, stir it up.
take it down and that's a good way to.
Kim (26:53.734)
Yeah. But then coming back to the gut really at the end of the day, that has to come first. It has to be, are you absorbing? So getting the blood tests, getting, you know, are you absorbing the test that you had mentioned? Because we could take all the creatine, all the collagen, eat all the protein, eat a perfect diet. And if we're not absorbing, it's going to be money down the drain and we're not going to be getting the gains that we need.
Kevin Ellis (Bone Coach) (27:21.285)
Yeah, I like in the villi is like roots in our soil, these tiny little nutrient absorption centers. They're like roots in your soil and you need good healthy roots. If your body and your bones are like a plant, you need good healthy roots to pull in those nutrients. So if you have celiac disease, and just a note because I have celiac disease, so just a note for anybody who's like, gluten free is not a thing or you don't take it seriously, for somebody with celiac disease,
If they do consume gluten, even small amounts, it can damage those villi. It's not a choice. It's necessity in that situation. But that could be one thing that needs to be addressed. And for celiac, you just go gluten free. There's no cheating. That's a pretty easy one to address. In terms of some of the other conditions that you have in your soil where the roots are, you may have bad bugs.
So you may have gut infections or parasites or something else that could be preventing those nutrients from being absorbed. They could be using those nutrients to grow and to stay healthy and make you not healthy. So that would be something that you can get a test for. You can do like a GI map test. You could do a Genova diagnostics test and get that objective data to see what's going on inside your gut.
Now, if you try to take one of these functional tests to your conventional MDs, like I did a long time ago, they might laugh at you and they might tell you this has no, you know, no validity whatsoever and kind of laugh you out of the office, but go to your functional practitioners, have them look at and evaluate the results of those tests. And then they'll build a protocol for you and tell you what do you need to do to clean up your gut? You could also have good bugs in the wrong place.
So small intestinal bacterial overgrowth. And in those situations, again, there are different ways of adjusting your diet nutrition plan to address that. And you can get a protocol built to help with that too. But addressing the gut health issues is super important.
Kim (29:30.737)
Yeah, yeah, more. It's all coming back to the gut so many, so many things. It's a you know, gut health has been the trendy word for so many things for several years now. And this is just another confirmation that the guts really important.
Kevin Ellis (Bone Coach) (29:43.823)
Yeah. You know what? You know what I want to point out is there's another really strong connection between gut health and bone health. And I talked about this earlier. A lot of people think about their bones as just these static structures that hold you up right and carry you through life. And they do that. They do a really good job of it. But they're also living tissue. They are endocrine organs. 95 % of the blood cells in your body are produced in the bone marrow. Bone marrow is a soft spongy material that produces those blood cells. So if you need help with
preventing bleeding or clotting, platelets are going to help with that. If you need help with carrying oxygen to the body's tissues, carrying carbon dioxide away from the tissues back to the lungs, red blood cells are going to help with that. If you need help with fighting infections, healing wounds, anything related to the immune system, white blood cells are going to help with that. The cells that break down bone are a form of white blood cell.
So anything that stimulates the immune system is speaking in the same language as the cells that break down bone. Where does 70 % of your immune system reside? In your gut, right? If you have chronic digestive issues, I know I was drilling home the absorption piece, that's an important part. But the other piece is that if you're stimulating that immune system, it's speaking in the same language as the cells that break down bone, and that will contribute to bone loss also. So
That's another reason to get that digestive health dialed in.
Kim (31:11.334)
Yeah, yeah, that's so interesting. So then from an exercise perspective, so with it really, it all know, everybody I talked to in different fields, yes, I'm biased to the pelvic floor, but many people are coming in and I'm trying to find the link for everything to the pelvic floor, of course, but it so gut health comes up, sleep, so sleep, digestion, nutrition, hydration, movement.
These are all fundamentals that need to be in place before we really, I think before, and I know that you do consider this as well, before we're considering things like other interventions, we want to get the basics dialed in first, because just doing that could potentially turn things around and start moving in the right direction. But from a movement piece, when we think, you know,
Some people are told not to lift heavy, but then the advice is to lift heavy to build your bone and that's beneficial. then yoga, people say walking, but walking from everything that I've seen is really not enough of a stimulus. And then there's jumping. And then of course, in my population, nobody wants to lift heavy. Nobody wants to jump because they think it's gonna make their pelvic floor challenges worse. what is the optimal in terms of the type of exercise, the amount of
that type and does diversity with movement and exercise matter?
Kevin Ellis (Bone Coach) (32:37.521)
Yeah, let's break each of those down. So let's start with what most people are told to do, which I just kind of talked about. When you're told, you have something, you have osteopenia, you have osteoporosis, don't lift heavy, do some walking. I will tell you right now, walking, while it's great for your health, it is not enough. It's not enough to, and it makes sense. If you're just out walking, you're only really working your lower half and you're moving pit.
Pit pat in the same direction. There's no like multi-directional diverse stimulus that you're applying to your bones there So it kind of makes sense that it's not going to be the best thing to support bone density again You should still do it But don't just do walking and say I've done my exercise for the day because you've got to do more than that And in terms of the bones you need different types of stimuli for your bones You need muscle pulling on bone like I talked about earlier. You need impact
The most effective interventions use one or both of those things in combination. You also need different types of exercise. So you need weight bearing exercise and that would be where your body and your bones are working against gravity to keep you upright. They are things you're doing on your feet. They're placing good healthy stress on the bones and this would be like you're walking. Walking falls into that category. You're jogging, you're hiking, you're gardening, you're playing pickleball, you're playing with the kids or the grandkids out in the yard.
Or it could be yoga, Pilates, Tai Chi, Shigong, right? All of those are weight-bearing exercise. So as long as you're doing them and you're doing them in a way that has good form, it's not going to lead to injury, it doesn't affect your pelvic health too, then, or it supports good pelvic health, keep doing them, right? But you also have to be aware of what's non-weight-bearing too. And this would be your cycling, but mostly swimming is what I'm referencing here. And
Kim (34:18.885)
you
Kevin Ellis (Bone Coach) (34:32.367)
This is where your body and your bones, they're not working against gravity to keep you upright. They're not, you're not doing these things on your feet. You're not placing good, healthy stress on the bones. And this is the same thing astronauts deal with when they go up into space. You, you're not working against gravity, muscle and bone are very much use it or lose it. So you have to be applying that stimulus. Otherwise you will, you will quickly lose what you've put on in the past and swimming. I'm not saying don't ever swim.
I'm not one of these people that's on extreme ends of anything. I'm like look, if it makes you happy, if it brings you joy, if it reduces your stress, you do it with your family, keep doing it. But don't get in the pool, swim laps five days out of the week and just say, I did my exercise. Because you haven't. You did some, but you haven't done the rest. You haven't done the other part that you need to do. And that's where we need to bring in muscle strengthening and resistance training exercise. So weight bearing, yes.
muscle strengthening and resistance training? Yes, you have to incorporate this. This is one of the most important parts of building muscle and bone strength. So now this is where we're adding in things like barbells, dumbbells, the machines at the gym, if that's where your comfort level is at, or what I really like, variable resistance bands, right? That can be another safe way to apply a really strong stimulus at a good intensity.
that can help support your muscle and your bone in a safe way. Some of the exercises now that are really good for supporting bone that you gotta make sure, especially if you're dealing with issues with your pelvic floor health too, that you're doing them with good form or you're consulting with Kim or the resources that she's put out there about this is squats. Squats are great. Deadlifts, overhead presses.
and some impact box jumps, things like that. Those can be helpful as long as you're doing those things safely, of course. But those bigger movements are can be really beneficial for bone. And I know when people hear that, especially deadlift, deadlift is a scary one, right? When people hear that, especially if they've never done it before. And you know what? I've lifted a lot in my life and deadlifts can be intimidating sometimes if you don't know how to do it. And so what I would encourage you is
Kevin Ellis (Bone Coach) (36:56.121)
When you hear about these exercises, if you're not familiar with them, that's okay. Find somebody who is. Find somebody who knows how to do it in a way that's safe and is actually gonna start you with good form. Look at your body mechanics. Start you with a lower weight. Slowly progress you up to where you need to be to provide the intensity and the stimulus that you need to provide. Because if you can't provide the stimulus safely, you shouldn't provide the stimulus at all.
because all that's going to do is lead to fracture or injury and it's going to set you back a long time. So that's my guidance around exercise for people and again you don't have to do it all at once. don't like people doing that because it will lead to injury. You just got to slowly work your way into there.
Kim (37:43.634)
Yeah. I just lost my train of thought because you said something there about that I really wanted to tackle but I'll come back to it. It'll come back to me in a minute. But one thing that I'm one thing that I did write down that I wanted to cover is if somebody has had a fall and they've fractured a hip or if they have had or need a hip replacement.
sometimes from osteoarthritis. And actually, that's a question I have. Is somebody needing a hip replacement? Is the main reason for osteoarthritis or could it also be an osteoporosis need as well?
Kevin Ellis (Bone Coach) (38:25.569)
it could be, it could be because they've had a fracture too. You know, it could be because they fractured their hip. And ideally, you know, I've seen a spectrum, a wide spectrum of people. I've seen people that have no fractures to 15 or more fractures. And I would tell you anything we could do to be on the side of fracture prevention is, the ideal situation to be in. And specifically with hip fracture, oftentimes people see that as
Kim (38:28.072)
Yeah, yeah.
Kevin Ellis (Bone Coach) (38:51.473)
You know, it can be the beginning of the end which I don't like to be doom and gloom and you know the fear-mongering and any of that stuff because I know it gets done way too much but that is something that you know, we just need to be aware of too is How can we prevent those things from happening? So whether that's doing balance training doing the strengthening exercises And anything else that we need to do to make sure we prevent that from happening. That's ideal situation
Kim (39:16.211)
Yeah. Yeah. I remember what I wanted to ask you from a resistance training perspective. There's, if you're following people about how to get bigger, how to build endurance or certain sets and rep ranges and that type of thing. But generally when, when we hear lift heavy, it's usually we're working in a, in a like four to six rep range with quite heavy weight versus
somebody who's maybe doing 12, 15, 20 repetitions with a lighter weight. Does it matter how heavy? Because what's heavy, like when we say heavy, yes, I just explained that it could be within a rep range or a percentage of a one rep max, but what's heavy to you is not heavy, well, what's heavy is gonna be very heavy for me. But we could have two women, same age, same build, one of them could find 20 pounds light as a feather, the other thing.
20 pounds could be the heaviest thing in the world. So it's all relative. But what's the important part of it? Would it be the length of time, like time under tension that they experienced the load or how often they are under the load? What would be the most important part?
Kevin Ellis (Bone Coach) (40:27.949)
If they're in that five to 10 repetition range is a great range to be in providing that intensity where you actually have, where you're struggling a little bit again with good form. Cause if you lose the form, you shouldn't be doing it, right? That's when you shouldn't be doing that exercise. So that's kind of the intensity you might, you try to be in. Let's say you have, let's say you do have osteoarthritis. Let's say you have had a fracture.
or let's say there's some other condition that prevents you from doing it in that range, feeling good about it, feeling good about the form that you've got in that range. Any stimulus you provide is still gonna be better than no stimulus as long as you're doing it safely. So even if you have some pains, have some injuries, something like that, and you drop to a lighter weight, and you're in that 15 to 20 rep range, but you're still getting a good stimulus provided, but you can't do the five to 10, that's fine.
Do the 15 or 20 if you can. Because some is going to be better than none, for sure.
Kim (41:25.106)
Okay.
Kim (41:30.163)
Right. And even if they're not getting to the point of fatigue, but as long as they're under that load for a period of time.
Kevin Ellis (Bone Coach) (41:36.037)
Yeah, but the best, the ideal is if you can be in that. But if you can't, don't feel defeated there. There's still stuff you can do. And again, the most important thing then would be is let's look at your bone markers, right? After you start on an exercise plan, you start making adjustments in your diet nutrition, is that bone formation coming up? Do we see it coming up? If not, maybe the stimulus needs to be a little bit, maybe we need to...
need to make some adjustments in the stimulus that's being provided too.
Kim (42:06.985)
Yeah, yeah. Okay. I'm trying to think what else I need to so we talked a little bit about supplements and diet. And you listed off a few, but I kind of want to just cover it quickly. Again, many people when they think of bone, and they think of what they need to either supplement with or eat more of its calcium rich foods. So we think of calcium all the time. But I heard you mentioned D three, I heard you mentioned magnesium. So what are the other important
know, minerals, nutrients that we're getting either supplementing or from our food.
Kevin Ellis (Bone Coach) (42:41.179)
Yeah, protein is a really important one. We already touched on that one. Vitamin D again. So the ones that you do hear from your doctor, those are, those are legitimate nutrients that are important for bone because they have studies behind them. Vitamin D calcium. Calcium is the primary mineral constituent of your bones. So you need it right. And you need enough of it. Vitamin D is also important. And I think most of us have heard about vitamin D and its importance in our health and all this stuff. It is important for your bones as well. Now,
The way you find out, I always tell people if you're gonna supplement with vitamin D, first you wanna try to get it from some of the best sources out there, which would be the sun. But in the colder weather months, the sun's rays aren't gonna be strong enough to generate enough vitamin D production. So when you're in those colder weather months, it's probably gonna make sense to supplement. Also, if you have some genetic variants, can also cause you to be somebody who needs a little bit more vitamin D.
You may have issues with conversion or transport or some other issues that are preventing you from really getting the most vitamin D that you need. So that may be another situation where you need to supplement. The good thing is you can test your vitamin D levels with a 25 hydroxy vitamin D test. You can go to your regular physician and get it covered by insurance and get that objective data.
And when you do, you're going to see that that range is about 30 to 100 NGML if you're in the US. And a lot of people end up on that lower part of the range. And if you're right around 30, your doctor may tell you that's normal. Or if you're right under 30, your doctor may tell you that's normal. Most of the people in the functional health space are going to tell you to be in that 50 to 80 range or the 60 to 80 range. So bringing that up, boosting that up can be really helpful. And the way you would do that,
is you can consume foods that have vitamin D in it. You can consume eggs and you can consume sardines and mackerel, but the biggest boost is going to come from intentional supplementation with vitamin D3. And when you do that, you then want to confirm with testing three months or six months, is the supplement that I'm taking actually working? Is it actually boosting the levels up? Again, we don't just want to take things and not know the intended impact.
Kevin Ellis (Bone Coach) (45:03.369)
or not know the impact of those things. So that would be my suggestion around around vitamin D for calcium. Calcium is most people are told, hey, just drink a bunch of milk. And that is horrible advice. It's not that I'm against dairy. I'm not. I but I don't think pasteurized homogenized, you know, dairy and milk is just the way it's not. I am a fan of
cultured and fermented dairy as being part of a plan if someone tolerates it. If you don't tolerate it you don't do well with it, then don't incorporate it into your plan because it's not a health food for you if it creates inflammation in your body. So you can go in these groups and see people talking about, this thing is amazing and does this. But if it doesn't work for you, then you can't incorporate it. But I do like cultured and fermented dairy. So when I say that, mean kefir.
Yogurts those kinds of things can be great because you get the protein you get the calcium you get other nutrients to get probiotics All that can be great If you are dairy free and you're trying to find natural sources of calcium Some of my personal favorites from a an animal based source would be sardines or mackerel I really like those you can go to a company like vital choice. I have no affiliation with them, but they're at least they have
like sardines in a can, a BPA free can, at least at the time of this recording they do, that are no salt added. You know, could get salt added, whatever. And then they've got all the bones inside there that are soft. They're not hard, pokey bones that are gonna hurt your mouth, but they've got all the minerals in the right ratio that your own bones need inside of there. So you can eat a can of sardines.
Kim (46:37.333)
You
Kevin Ellis (Bone Coach) (46:56.985)
or mix them into a little sardine pate or mix them with avocados and pickles and whatever to make it taste good or drizzle it with primal kitchen dressing, whatever you need to do. And that's about 400 milligrams, 300, 400 milligrams of bioavailable calcium. So that's a non-dairy protein omega-3 rich source of calcium. The other one I like that's plant-based would be arugula. Arugula is a leafy green, same cruciferous family of vegetables as broccoli and kale.
It's rich in vitamin C, vitamin K, potassium and bioavailable calcium. A lot of times when people go to the store and they're looking at their greens and they turn over the bag or turn over the package and they see, spinach, spinach is really high in calcium. Well, spinach is also high in something called oxalate. Oxalate is an anti-nutrient that binds up these bone healthy minerals and prevents you from actually taking those in. So in those situations, especially
If you have issues with gut health or if you have issues with kidney stones or chronic joint pain, I would swap that spinach, a high oxalate food. would swap that for arugula too. Right? So now you've got a great bio available source of calcium there and it's easy. It's so easy to incorporate this. Take a handful of arugula, saute it with some extra virgin olive oil and some sea salt or take a handful of arugula and use it a little side salad.
It's just easy to do, right? And the easier things are, I think the better it is to try to incorporate those things. So those are a couple other sources that you can add into your plan. And then the last part about calcium that I'll say is that calcium supplementation is controversial for a lot of people. My guidance is always start with diet and nutrition first, close the gaps with supplementation for calcium specifically, if and when necessary.
500 milligrams a day would be the max that I would suggest people are supplementing with calcium if they need to and Because if you exceed that you're going to be increasing the risk of cardiovascular disease Increasing the risk of kidney stones and you you're not just taking calcium. You shouldn't just take calcium You have to have other minerals nutrients and cofactors along with it. So you vitamin D calcium magnesium
Kevin Ellis (Bone Coach) (49:23.833)
As your vitamin D and calcium intake increases, so too does your need for magnesium. We all know it's important for getting better sleep and for a lot of other things. You have to have it if you're supplemented with calcium. And then vitamin K2, that's the other one that if you are supplementing calcium, you need to be taking K2 because K2 is activating osteocalcin and matrix GLA protein. Osteocalcin and matrix GLA protein are making sure that calcium
goes to the bones to support bone formation and not to the soft tissues like the kidneys and the arteries where you don't want it to be. So, and then the last nutrient that that's a big one, there are a couple others, but I'll just keep it short. Vitamin C, vitamin C is very important for your skeleton. It is key for maintaining and developing a healthy skeleton. your bones, I mentioned there are collagen protein matrix with minerals laced in there.
Vitamin C stimulates pro-collagen and enhances collagen synthesis. if you're figuring out, you can supplement with vitamin C, but you can also get it from natural sources too. Berries are a great source. Get your berries organic if you possibly can. yeah, I would say those are some good important nutrients to incorporate.
Kim (50:44.041)
Yeah. When would medication be indicated? We've talked about a lot of things. Again, we are very much on the let's do make sure all the fundamentals are in place. And then if we need an intervention, here are some other things. So when would medication be required? What are the medications, the most common medications and what are the downfalls or side effects to those medications?
Kevin Ellis (Bone Coach) (51:08.527)
Yeah. And I have a unique perspective on this because I've seen thousands of people with osteoporosis and I've seen people that have no fractures that have 15 or more fractures. I can tell you if somebody is coming and they have 15 or more fractures and they're still fracturing, there's you need to have an immediate intervention. So I can't be anti-medication. Even though I know some people in the natural health space can go really hard on that.
and say, hey, no medication for anybody, know, it's poison and toxic for your body. For most people, there's so much you could do before you get to the medication. But for the person that is having that needs that immediate intervention, sometimes it is necessary. So I will say from a bone coach perspective, we're always focused on people come to us for a natural approach to stronger bones. And that's what we primarily focus on. But we will still teach about the medications.
risks and side effects, short and long term implications of use, important considerations, how do you transition from one to another? When does it make sense? Because really it's just about empowering you to make the best educated decisions, not just for now, but in the long term too. So that's kind of my thoughts around medication, but in general, medication is there are different categories of these medications. They're anti-resorptives, they're anabolic.
Anti-resorptives are designed to slow down the activity level of cells at breakdown bone. And do they do it? Yeah, of course they do. Do they have risks and side effects that come with them? Of course. The two different types of anti-resorptives are bisphosphonates and rank ligand inhibitors. Bisphosphonates would be Fosamax, Re-Glass, Actin, and Elboniva. The safety and efficacy of bisphosphonates is not really well known beyond five years.
As you're taking these medications, you have to understand that as you're doing your daily activities, going about your daily life, doing chores around the house, you actually have, you're starting to get these tiny little micro cracks, micro damage in your bones. That's normal for everybody, right? So as you're working out, as you're playing pickleball, you're getting these tiny little micro cracks, micro fractures. Then what happens is you have cells within the bone that sense that damage. They're called osteocytes. They sense that damage and they send out a signal.
Kevin Ellis (Bone Coach) (53:30.353)
to the other cells in the bone that say, we need to become stronger. And then these other cells called osteoclasts that resorb and break down bone, they pick up that signal and they come in and scoop out that damaged, worn bone. And then right behind it, it's a coupled process. You have these cells called osteoblasts that come fill in stronger, healthier new bone. This is a normal process for bone remodeling. This is supposed to happen throughout our lives, how we get a new skeleton every seven to 10 years.
If you're taking these medications, especially for longer periods of time, these anti-resorptives, you can actually slow down that process too much to where you start to accumulate that old worn damaged weakened bone over time. So even if your bone density score while you're on these medications, especially after multiple years of use, even if it's showing stable or maybe a slight improvement, the quality, we talked about quality, the quality may not be.
So you may see an increase in density, but the quality may not be there. And eventually that can catch up to people too. So that's an important consideration. Rank lagging inhibitor is the other one. That's where Prolia is. A lot of people have heard about Prolia. With Prolia, once you start that medication, you can't just stop cold turkey, right? Because if you go on that medication, you stop cold turkey, it's going to increase your risk of vertebral fractures pretty quickly.
And especially if you have taken it for you do it every six months. So if you've done multiple rounds of prolia, if you've done one round and you're trying to transition off of prolia, and by the way, this is not medical advice for everybody listening. Don't just don't just go jump into this and say, I heard Kevin Ellis say this bone coach say this on the podcast. I'm saying if you were to transition from prolia to a bisphosphonate, if you've only done one round of prolia,
you could get away with using like Fossum X to do that. You have to monitor it with those bone turnover markers. Any transition you're doing, do not just stop cold turkey. Don't do it without the objective data. You have to look at the CTX and the P1MP when you do it, especially the CTX. And then if you've taken three rounds of Prolia or more, you have to use the strongest bisphosinate reclass, the IV infusion. That is the only one that can shut down.
Kevin Ellis (Bone Coach) (55:55.023)
that rebound effect. Again, you would do this under the guidance of a practitioner. I also can help provide guidance around that, but certainly not in this format. Not in this format. Not one too many. But in terms of that is another important consideration. And then again, you look at your bone turnover markers and that's going to help be your guide. So that's the anti-resorptive side. The other side is the anabolic.
Kim (56:04.947)
Not on the podcast,
Kevin Ellis (Bone Coach) (56:23.309)
Anabolic medications. These are the drugs that designed to build bone build better quality bone build it faster Do they do that? Of course they do are there risks and side effects and timelines for use there absolutely are so you've got Forteo Timlos Avenity and These medications you just have to know that once you start taking them you can only take them for a certain period of time and Then after you're done taking them
And I see people, I talk to people a lot. They're like, yeah, I was on Forteo, I just stopped it. And they don't go on to a, you have to go on to an anti-resortive immediately after it, just to not lose the bone you just gained. Some people go on Forteo or Tim Loser or Vinity, they do it, they get a boost in bone quality, which was the intended effect that they're looking for. And then they don't go on an anti-resortive, because they don't want to take another medication. What happens is when you take that anabolic medication,
It's not just speeding up the cells that build bone, it's speeding up the process. It's actually increasing the cells that break down bone too. So if you just stop and you don't follow it with a drug to slow down that activity level cells that breaks down bone, then you can lose that bone too. So just important considerations. People don't get this in their 15 minute conversations with their doctors.
Kim (57:42.739)
Yeah, yeah, yeah. Okay, you have shared an incredible wealth of information. I have two final things. First of all, how are your bones doing now?
Kevin Ellis (Bone Coach) (57:52.849)
Great, I don't have osteoporosis anymore, which is great.
Kim (57:55.345)
Awesome, awesome, okay. And for people to learn more about you and find out more about your community and potentially join you, where can we find you?
Kevin Ellis (Bone Coach) (58:04.921)
You can always find me at bonecoach.com and that is probably the best source. We've got the Stronger Bones programs, resources, recipes for how to make your sardines taste better, all that kind of stuff. And then you can always find me on the podcast, which Kim was just on my podcast recently too, the Bone Coach podcast. And I'm on all the social channels too at Bone Coach or Bone Coach Kevin, but bonecoach.com probably the best place.
Kim (58:26.996)
Awesome.
Yeah, and we'll have all of that in the show notes. Thank you so much, Kevin. This was super informative. I really appreciate your time and I know that my audience will really benefit. Thank you.
Kevin Ellis (Bone Coach) (58:38.265)
Awesome, thanks Kim. See you everybody.
