Kim Vopni (00:01.191)
Dr. Newstead, welcome to Between Two Lips. Thank you for joining me. We are going to be talking all about bones and bone fractures and bone health today. If you can take a second just to let us know who you are, what you do, what got you into this realm, and and tell us about your book too. I recently finished reading that and I'd loved listeners to know about it.
Dr. John Neustadt (00:22.254)
First, thank you for having me on your podcast. I always you love the opportunity to share what I've learned because this has been as much a journey of my own discovery and changing how I look at this issue and how I've worked with with patients as I've gone along and learned more because twenty years ago in clinical practice when I was working with patients, I was doing exactly what I was taught. I was a young doc, you know, fresh into my own private practice and I had some patients.
With osteoporosis, and I was working in an integrative fashion with them, you know, diet, lifestyle, supplements, and their bone density was going up, so I was happy. But the real wake-up call for me came with my mother-in-law. She had osteoporosis and was taking phosamax, and her bone density was going up. So her physician was happy, and so was she, and and I was too. We all thought she was protected. Then she tripped on a rug in her house and fractured her hip. And I thought something's
Wrong with this picture. So I started diving into the research and trying to understand this situation better. And what I learned absolutely shocked me. Even back then, the research was clear that a bone density test predicts less than half of people with osteoporosis who will fracture. And a couple years after that, a a study was published showing that for women with osteoporosis, a bone density test only predicts 44% of them who will fracture, and only 21%.
Percent of men. And despite that, at the time, but even now, 20 years later, that number on the test, that bone density test number, is almost exclusively what the conversation revolves around with a doctor and what they track to believe they're being successful, and what patients track to believe that they're protected and their bone strength is actually improving. And so I've worked really hard over the
Years to understand not just what will improve a number on a test, but what will help people maintain bone strength, what will reduce fractures, because it's breaking a bone that's the most dangerous thing about osteoporosis. It's not the number on a test. If you're a woman with osteoporosis and you fracture a hip, there's up to a 36% chance that you're going to be dead within a year. And those who survive, over half of them never regain their prefactors.
Dr. John Neustadt (02:51.864)
fracture, a pain free level of mobility to enjoy all the things that they used to, and a significant percentage of them continue to need ongoing care just with basic activities that we all take for granted, like bathing ourselves, going to the bathroom alone, dressing ourselves, brushing our teeth, you know, things of that nature. And in fact, it is such a devastating condition that globally osteoporosis is second only to cardio.
Cardiovascular disease as a global health crisis. Every 30 seconds, someone somewhere in the world is breaking a bone because of osteoporosis. And a woman's risk of an osteoporosis fracture is equal to her combined risk of breast, uterine, and ovarian cancer. And so I'm really passionate and focused on trying to move the needle on the dip this debate and this clinical focus away from just.
Numbers on a test to focusing on doing everything we can to reduce somebody's risk of breaking a bone. And that is why I named my book Fracture Proof Your Bones. And now in the second edition, Fracture Proof Your Bones, expanding an updated edition. I walk people through questions to ask their physicians to make sure they're getting the best possible recommendations. What are hidden causes of bone loss that most doctors
doctors aren't even aware of that many doctors are causing unknowingly and then I walk people through s how to create holistic bone health programs that make sense for them.
Kim Vopni (04:33.136)
Mm-hmm. Yeah. Well, you've been busy. and there and you'll still continue to be busy. I I just as a sidebar, my observation in today's world with the GLPs, at least the early ones like Ozempic, I think there's gonna be a bit of a I think there's gonna be a lot of people with the muscle wasting and what have you and bone health challenges as a result. And I know that newer renditions are potentially addressing some of that, but I feel like this is gonna be an ongoing
epidemic as you say. Before we go into the what we can do, when you we're talking about the testing, right now most will probably have heard of the DEXA. And I know most countries don't s even use that until I heard yesterday one country was 75. In Canada here we're 65. And so where when should people
Or should they use the test? Should they use ADEXA? Should they use there's also the REMs now coming on to the scene? So how given the stats you just shared about testing, what is your recommendation on timing if we should do it at all? And what do we take away in terms of the information from those tests?
Dr. John Neustadt (05:47.414)
I do think getting testing is important because it gives information. It's perhaps not as predictive as many people thought, but it is one piece.
We did want to see those test numbers improve. The bone density test, the DEXA scan or DEXA test, that extra
Kim Vopni (06:10.182)
Sorry, John. There's some there was feedback and your your voice sounded your voice left. Can you keep talking for a second? yeah, there now it's all clear again. That's weird. I don't know what happened. okay, so carry on. So the you were leaving you were talking about the DEXA.
Dr. John Neustadt (06:21.038)
Sure. I can not sure what happened.
Kim Vopni (06:33.655)
just start where you had said you do believe in testing.
Dr. John Neustadt (06:38.028)
I do believe you know testing is important because it provides information people need to understand there's a problem because most of the time people don't even know there's an issue with their bones because this condition doesn't have any symptoms for most people. In fact, the first sign that somebody has a problem oftentimes is that they break a bone. And the challenge is is that a bone density test or any test is just not as predictive as most
People think, but it is one piece of a much larger puzzle. Now, the DEXA test, the dual X-ray absorptiometry test, that X-ray is the gold standard when it comes to osteoporosis screening and tracking. And that is one that most you know insurance companies will cover. It's one of the most accessible tests, and despite its limitations, I do think people should get tested with a bone density test. Now there's REMs, and I'll talk about that.
That in a moment. But with respect to when somebody should get tested, there are different recommendations out there. There's the U.S. Preventative Services Task Force recommendation there that recommends that you know postmenopausal women should not get tested until they're 65. They don't recommend testing for men. If you're postmenopausal and under 65 and you have a risk factor, then you should.
Get tested, and that's that subtle point if you have a risk factor is important because frankly, most people probably do, but clinicians aren't really paying that much attention to these screening guidelines. So I think a much easier way to look at it is anyone who breaks a bone at 50 years old or older should get screened with a bone density test. And that is the recommendation of the Bone Health and Osteoporosis Friend Foundation, which I happen to agree with. And for full disclosure, I am on their corporate.
advisory roundtable. And also if people are on certain medications that are known to destroy bones, and there is a long and growing list of those. You mentioned GLP1s, currently there's no evidence that those damage bone directly, but I do share your concern that with people consuming less food, not that currently people are consuming, you know, you know, primarily healthy food. Many people are consuming poor food
Dr. John Neustadt (09:07.628)
quality food. In fact, about 70% of the 60% of the calories in the US diet currently is from ultra-processed foods. But with GLP1s, my concern is it's going to create nutritional deficiencies that can then lead to osteoporosis. But other medications directly and indirectly do cause osteoporosis and fractures. Antidepressants like anything that raises serotonin, acid blocking medication, prednisone, aromatase inhibitors. I mean there's just a long list. People should get
Tested and there are guidelines for some of those medications for testing. And overall, clinicians are not ordering those tests per the guidelines to get screening and follow-up done. And so educating ourselves about asking and advocating for those tests is important. And I would add that my personal preference is any woman at 50, even if she doesn't break a bone, I do want to get a b a baseline bone density test because if she hasn't started
overtly with perimenopausal symptoms, she will likely soon. And so I want to get that baseline because during menopause and for the 10 years after is the when the fastest rate of bone loss occurs.
Kim Vopni (10:22.992)
Yeah. Yeah, I I I I a thousand percent agree with everything that you're saying and I think this should happen much earlier. And it's it's the conventional model of waiting until there's a problem and then we'll try to fix it and then why why are we waiting? And let's intervene early, especially when it can be so detrimental and and life-threatening. The DEXA is one you talked about, and then the REMs is fairly new. Not everybody knows that and it has an additional reading or measurement.
So can you tell us about that and do you think there's value in doing both tests?
Dr. John Neustadt (10:56.684)
Those are great questions. For me, REMs, the jury's still out for me on REMS. I think it does have some some value as a replacement for a bone density test. I'm not convinced that it it will end up doing that. The REMs was approved in 2018 by the FDA and it can provide a a T-score equivalent. The T-score is the one of the two results or values that are reported on a bone density test. It's the T-score.
score. So a BREMS test can give a T-score equivalent, meaning it can convert its results into a T-score so clinicians can readily understand it because that bone density, you know, the DEXA score is the is the gold standard in what
But the Rams test is ultrasound technology. So one of the benefits is it doesn't expose people to x-rays, although the exposure of an x-ray from a bow density test is less than somebody gets in a cross country flight. So it's it's really not a lot.
But for people with a history of cancer who really don't want that exposure or very concerned about that, that might be very that might be a good choice. It also can be done in offices, in doctors' offices, and in health fairs, and so that makes it more accessible to many people. I'm not convinced yet that it has been sufficiently validated as a technology.
So there's what they report is what's called, they use a fragility score. And that fragility score compares the ultrasound waves, what's called the scatter, how well they pass through the bone, to a database of healthy bone of people in different age groups and tenure agreements, twenty to thirty, thirty to forty, all the way up to, I think,
Dr. John Neustadt (12:53.248)
And that fragility score, one study showed that the lower the fragility score, the lower the risk of a fracture. And so the both the REMS tests might be better at predicting who doesn't fracture than predicting who does fracture. The challenge with that is there's only there are a couple. One is there's only been one validation study done. So I'd like to see more data before computing is accurate.
The second is that there have been a couple of studies that have been published since then where they played with the variables in the machine to test its sensitivity and to test its algorithms because the the manufacturer of machine has not made its algorithms and how they compute the results public, it's private.
So nobody can evaluate their technology under the hood, so to speak, to understand how it's arriving at its conclusion. And they only changed two things. They only changed the BMI and the age. And what they found is just changing the age accounted for about 95% of the results.
Meaning that we know that as people get older, their fracture risk increases. Just changing the age in the machine, the inputs on the machine, changed, accounted for 95% approximately of the change in the score or the results of the of the test, meaning that there it is uncertain, according to those researchers, whether the REMS test is actually testing bone quality at all or whether it's doing something else.
For me, I just want to see more data and I'd like to see it validated. I think that's important to to have that information. But that said, I think one of the most important things about any test is raising awareness, getting people to understand that there's a problem so that they can take action, so that they can be more proactive and begin to do things to change the trajectory of their health and improve their health.
Dr. John Neustadt (15:01.65)
One other thing that I would say about a REMS test that is an important point is we know from the one validation study that that was published using a fragility score that lower the score, the lower the risk of a fracture is about you know I think about less than thirty-seven. What we don't know
Is that if you have a a fragility score that's higher, and then you do things and that fragility score decreases, is it also decreasing your risk for fractures? And why is that important? It's important because but we we don't see that with a bone density test.
Because a bone density test, when somebody is taking an osteoporosis medication, those medications improve the bone density test results, but the improvement in the number on the test is not a good indicator that somebody's fracture risk is decreasing. And that's not, my opinion, the position statement of the American Academy of Clinical Endocrinology. So just because the number on the test is changing doesn't mean the fracture risk is also changing.
Kim Vopni (16:12.218)
Yeah. Yeah. Interesting. with regards to you talked about there are things that maybe doctors are they're not evaluating for, they're not necessarily considering, they're not aware of all the things that could potentially be interfering with or negatively influencing somebody's bone health. What would some of those things be? You mentioned medications. What are some of the other things and maybe even elaborate on more on what other medications are?
Dr. John Neustadt (16:39.032)
For me, medications are the are the biggest red flag and the most common problem that exists. Doctors are
Kim Vopni (16:49.415)
Yeah.
Dr. John Neustadt (16:50.19)
Destroying bone. The most commonly prescribed medications do that. The SSRIs, you know, anything that artificially increases serotonin activates osteoclasts. Those osteoclasts are one of two metabolically active cells in the bone. The osteoclasts break down old, worn-out bone and the osteoblasts build up new healthy bone in a process called bone remodeling, which we need. We need that healthy balance throughout life. In fact, about every 10 years.
when there is healthy bone remodeling, you have all new bone, complete bone turnover. And osteoporosis or bone loss is essentially a condition of imbalance where the destructive forces are with there's receptors
Kim Vopni (17:44.113)
Yeah.
Dr. John Neustadt (17:44.771)
bone destruction to the point where one study concluded that for every nineteen women taking one of those medications, we'd expect one of them to fracture.
Kim Vopni (17:54.961)
Wow.
Dr. John Neustadt (17:55.913)
Acid blocking medications also increase the risk for fractures. The first FDA warning letter for that was went out in 2008. So this is not new information. And yet and yet it's available over the counter. People are taking them for years and doctors don't even realize that it's a problem. aromatase inhibitors for estrogen receptor cancers, they they reduce the the production of estrogen in the body.
Kim Vopni (18:07.536)
Wow, that's crazy.
Kim Vopni (18:37.658)
Wow.
Dr. John Neustadt (18:40.056)
Prednisome, glucocorticoids, powerful anti inflammatories used for autoimmune diseases. About one to two percent of the general population is in that, but when you look at postmenopausal women, it goes up to about five percent. And that's the greatest risk for for osteoporosis and fractures in that age group. And yet they're taking a drug that powerfully destroys bone and and creates fractures. And not only that, the glucocorticoids also destroy muscle fibers. So you
Create imbalance, less steady on their feet, which increases their risk for falls. And so that's also should be addressed if possible. And the medications are such a problem because doctors don't know about it. And there's a study that was published that looked at the medications women were taking three months before they ended up in the hospital with osteoporosis and a fracture and a hip fracture, and then what they left the hospital taking.
percent of the women when they entered the hospital with the fracture were taking a drug that destroyed bone, caused osteoporosis, increased fracture risk, and increased fall risk. When they left the hospital, there was no decrease in that. If they were switched from one medication, they were put on a different medication that essentially did the same, created the same problems. And so it's re imperative that people evaluate the medications they're they're taking and discuss that with the doctor. There's a whole chapter just on that.
Kim Vopni (19:54.438)
Wow.
Dr. John Neustadt (20:09.996)
In my book. The other thing that I would say that's a that's a a hidden danger is what people are eating, ultra-processed foods. To me, those are environmental toxins. They're not real food in any sense of the word. And there's one study now that's come out, and there's an association between you know the more ultra-processed food someone's eat someone eats, the greater the risk for bone loss and osteoporosis. And it's not just for bone loss, it's across the
the board, breast cancer, dementia, obesity, diabetes, you name it. There's just nothing good that comes out of eating those. And so again, it's a dose, what's called the dose response type of situation, meaning the more someone eats, the the worse the outcomes.
Kim Vopni (20:46.642)
Yeah.
Kim Vopni (20:56.978)
Mm.
Kim Vopni (21:25.242)
Yeah. Yeah. You talked earlier when we were referring to GLPs, the you're consuming less food and therefore less you're you'll become mit most likely some sort of nutrient deficiencies will show up. And when you're talking about the ultra processed foods, that's also a similar mechanism with less nutrient density. What are the most when we talk about bone health, what are the nutrients that we're most worried about and what do we need to look at?
ensuring we have in our diet if we happen to be taking a GLP one, for instance.
Dr. John Neustadt (21:59.023)
Th that's a great question. And the way that I think about diet and the way the epidemiological research tends to express this issue where they've seen the most the best benefits is not by looking at any one nutrient, but looking at overall dietary patterns. And the Mediterranean dietary pattern is associated with a twenty percent reduction in osteoporosis risk and about a twenty percent reduction in hip fracture.
Kim Vopni (22:20.945)
Wow.
Kim Vopni (22:25.799)
Wow.
Dr. John Neustadt (22:27.554)
And so that's the type of dietary pattern that I teach and that I advocate and help people transition into beginning to eat that way. And in doing so, there is, you know, I that's that basically is a plant-forward whole foods diet. And what's often missing in the recommendations or the analysis in the research is how much protein somebody should consume within that. I really have them just track two things: the amount of fiber, total fiber they're getting a day, because that is
Going to be from whole foods, from plants, fruits, and vegetables. The fiber is important because it helps modulate blood sugar. It also helps create a healthier gut microbiome, but it's also where that fiber is found. Looking at those whole fruits and vegetables, we also have the vitamins, the minerals, the other plant nutrients that our biochemistry needs to thrive and that our bones need to stay healthy and to improve.
their health, like magnesium, copper, zinc, and and many more. With protein, you know, there's this interesting high protein, you know, keto craze, paleo craze. And despite that, what I find repeatedly when I'm working with people and talking to them, if they seem to be doing everything right, but their bone density is still not improving, inevitably dig a little deeper, they're not getting enough protein.
Kim Vopni (23:53.372)
Mm-hmm.
Kim Vopni (23:57.234)
Mm-hmm.
Dr. John Neustadt (23:57.781)
The amount of protein somebody can consume can account for two to three percent of bone mineral density. Just that alone. bone is a complex tissue like all tissues. It's made up of different things, not just minerals. But there are a hundred and eighty eighty to two hundred proteins in bone, in addition to bone collagen, which is the main structural protein in bone. It is highly protein dependent. So I recommend people calculate based on their body weight. if
Kim Vopni (24:42.322)
Mm-hmm.
Dr. John Neustadt (24:57.124)
pound of body weight per day, those sorts or tube, those sorts of recommendations to me are excessive. I tried that just as an experiment and what I found is I was so full that I didn't have room to eat all the the fiber in the plants. and the research just doesn't show those benefits that it does with that protein calculation amount that I mentioned.
Kim Vopni (25:19.088)
Yeah. Yeah, it's yeah, that debate I there's a little meme that goes around that especially midlife women are having more peer pressure to eat protein than they did to use drugs when they were a teenager. And and I would I would say that I I take part in that too. But so c so you mentioned collagen as part of being the structure of the bone, protein being part of what's necessary for that. And then of course people's minds go to a collagen supplementation.
And there's many different types of collagen on the market, and there's some that are skin and hair and nails. And then there is fortabone, which is supposed to be helpful for bone. And research has has supposedly shown that that can be helpful. Where do you stand on the collagen? Is it beneficial to consume for our bones, for our joints? or is it still we just focus on food?
Dr. John Neustadt (26:10.818)
like to talk about s supplemental collagen, dietary supplements in the way that I talk about all supplements. I believe that they should be used as, you know, the US FDA I'm in the United States as the US FDA intended. That is a supplement to a healthy diet. Diet
Kim Vopni (26:26.362)
Right. Yeah.
Dr. John Neustadt (26:28.832)
It wants to supplement with with collagen, that's okay. I don't have a problem with that, but our bodies can produce collagen when we give it the raw materials to do that. Looking at the clinical trials, I evaluate the clinical trials for dietary supplements through a very narrow lens. I want to see, first and foremost, has it been shown in studies to maintain bone strength?
And the most sensitive indicator for bone strength is if somebody breaks a bone. So did they look at fractures as the outcome in the clinical trials? That's the highest level and the best level of evidence, in my opinion. After that, then I get into testing. You know, does it improve that bone density test result? Sure, we want to see that go up, but if that's the only data that they have, to me, it doesn't necessarily translate into maintaining bone strength. We see that over and over with different different studies. Just because
Because it may affect bone density doesn't mean that it maintains bone strength. Collagen, hydrolyzed generic collagen, has clinical trials on it showing that it can support and promote healthy bone density, where the bone density improved in the clinical trial volunteers. And I'm talking about specifically, you know, types one and three collagen, that's bovine derived collagen, and also for skin creating a less
visible lines and wrinkles, improving skin hydration. You know, those are things that have been found in clinical trials with that type of hydrolyzed collagen. Florida bone is a proprietary product of amino acids that they put together and they have clinical trials on it showing that it does improve bone density. So I'm not opposed to to that either strategy, you know, either one. But if someone were to say that that
what I'm going to do instead of eating healthy, I think that that is a mistake.
Kim Vopni (28:29.52)
Yeah, yeah, fair. The on the topic of supplementation still, there's several that are out there, and you've brought up a great point, which I hadn't even considered is are they looking at reduced fracture risk as opposed to just improvements or maintaining or not losing bone density? and there is an ingredient in some called strontium, which I've heard you talk about on a few different podcasts. Can you highlight your what strontium is and
why it is something that we should maybe have some we should have some caution.
Dr. John Neustadt (29:06.638)
And it's in found in diet some dietary supplement formulations. And they're taking the research from strontium as a medication in Europe where it was approved. The form of strontium over there is strontium ranolate. And they're putting strontium as a mineral in dietary supplements in the US as strontium citrate. Strontium ranolate does not exist in the United States. So to be clear, there are zero, there are no clinical trials on strontium citrate.
The research from strontium ranolate and assuming that it's equally, potentially equally as effective. I think that if we're going to do that, we also need to be say, well, it's probably potentially equally as safe. So what do the reasons what does the research show in terms of effectiveness and safety? Well, there are five large clinical trials of strontium ranolate and postmenopausal women with osteoporosis in Europe, because it was a medication there, it's been quite well studied. Four of the five show that
it only reduced vertebral fracture risk. Only one of the five studies showed a significant reduction in hip fracture risk. So for me it's doubtful that it actually reduces hip fractures, which is the most dangerous type of fracture.
The reduction in fractures with strontium randolate on vertebral fractures was about what people get from the oral bisposonates like Fossamax. And the challenge that I have, you know, beyond that, that I don't think is as as helpful as as many people believe, is that it incorporates into the bone and creates false bone density test results. And so the test results that somebody's looking at is artificial.
artificially higher. Well I've seen the recommendation. We know that strontium ranolate increases it by 8 to 12%. So if you just reduce the artificially by 8 to 12%, so if you just reduce your bone density test result by 10%, you'll probably get a more accurate result.
Dr. John Neustadt (31:11.506)
I personally, despite the limitations of the bone density test, I want my results to be that I'm looking at to be as accurate as as possible. In Europe, where it's a medication, the the machines, you know, they can correct for that. In the US they can't. And there are no research studies on strontium citrate, you know, showing that it equally is
Kim Vopni (31:23.782)
Got it.
Kim Vopni (31:32.142)
Eight to twelve percent. Wow.
Dr. John Neustadt (31:33.891)
false increase at falsely elevated. So it does increase bone density, but about eight to twelve percent of that increase is is fake of the strontium ranolate. We don't know what that is with strontium citrate. The assumption is well, you know, it's the strontium that's doing that, not the ranolate portion, and so we're assuming that it's the same. Regardless, I don't want my test results to be inaccurate if possible.
Kim Vopni (31:36.284)
Crazy.
Dr. John Neustadt (32:00.063)
Then I do have a challenge with
Kim Vopni (32:05.296)
With what, sorry?
Dr. John Neustadt (32:06.304)
With the safety.
In Europe, strontium ranolate was taken off the market for a little while, and now anybody taking it has to have a cardiovascular risk assessment because what they found out is that for every one fracture that it was preventing, it was causing a blood clot that can cause a deep vein thrombosis, a blood clot in the lungs called a pulmonary embolism, which those things can cause strokes and heart attacks. So basically for every one fracture that was being prevented.
they were potentially killing somebody.
Kim Vopni (32:41.062)
Wow. That's not what we want. And it's it's interesting, I think of I I can't think off the top of my head, but sometimes you are required to have some sort of a test and they need to assess your liver function ahead of time because of the dye they're using or to make sure you're gonna clear it or and it just it boggles my mind that with what we know about certain medications that or you know, that they wouldn't have more screening for bones earlier in life, but also especially if you're gonna be taking
certain medications or steps, it's it's it's bonkers to me. what can we if you've talked about the Mediterranean diet, plant forward, fiber forward, protein, mentioned a couple of different supplements. We haven't discussed exercise for bone loading. What else can be what what are the the main things we should be doing to
ideally prevent bone loss, but if we have some bone loss, how can we build it back?
Dr. John Neustadt (33:43.917)
Th those are great questions. One of the things that people can do is first of all have an awareness early early on before there's a problem, which I always advocate for. It's it'd be amazing if people did that. Sleep is really important. getting less than six hours of sleep a night on average is associated with faster bone loss and osteoporosis. So making sure that, you know, your sleep is part of a this holistic approach of a basically a wellness approach of more, you know, aligning
our body and our lifestyles and our habits with our circadian rhythms and and what our bodies need to thrive, giving it the environment our that our bodies need, because our bodies do adapt to the environment. That includes the internal environment and the external environment.
So walking, exercise is amazing. It doesn't have to be a pumping iron in a gym lifting weights, although that would be great. When you're talking about walking, 7,000 to 7,500 steps a day is associated with a 50 to 70% reduction in all cause mortality. That's death from everything, including osteoporosis. And so it's not just for me looking at the bone density test and how to improve bone density tests. It's also what do we do to reduce the risk of
Fractures and somebody dying. 95% of fractures occur because somebody falls. So it's also about helping to reduce fall risk. And not everybody wants to pump iron in a gym. If somebody's a couch potato and they've never worked out and have no interest in going to a gym, you know, recommending they do that isn't gonna make much of a dent, isn't gonna improve things much because these are things that people have to do for weeks and months and years and really become part of a lifestyle. What the research shows, however, is that
when somebody starts to move in a direction of doing something healthier in one domain, whether it's diet, exercise, sleep, they tend to start to do other healthy behaviors in other domains of health. So I want people to understand and not be overwhelmed by all of the choices that the most important thing is small changes done consistently can completely change the trajectory of their life.
Dr. John Neustadt (35:59.541)
And their health.
And so it's about doing things over time and building on those successes. And in my book, I walk people through how to create holistic bone health programs that make sense for them and questions to ask their doctors to make sure they're getting the best possible recommendation. But within that, I'm very clear: start somewhere. It doesn't have to be any specific place. Just start doing something. And one of the important things that is left out often with the debate is community support.
Kim Vopni (36:20.178)
Mm-hmm.
Dr. John Neustadt (36:30.512)
Community connection. The research has been clear that when people have a strong social network, and it doesn't have to be tons of friends, you know, the life of the party. What the research shows is the benefits max out of about three people. Meaning you do things with them, people you call, that if somebody does fracture, they recover faster, they recover better. And so that is part of this whole picture as well.
Kim Vopni (36:56.432)
Yeah. Yeah. The the nutrition conversation is when I think of, you know, you're not supposed to have carbonated beverages. there are things we can consume that can deplete the amount of calcium we absorb. Part of that comes to the fiber and the gut health. Are there things that we would want to maybe avoid or eliminate from our diets that could potentially be interfering?
Dr. John Neustadt (37:22.458)
Absolutely. And and I get this question a lot, you know, should I avoid you know, whatever it is. Should I eat more of this one nutrient or should I avoid this one substance when I for my bones? I'm not as concerned about any one specific food as I am about the overall dietary pattern because it's what people are eating throughout the day and weeks and years, not any one particular food. If they're just eating that one food, that's a problem beyond just bones.
So when looking at what people should avoid, there is a or minimize, there is a category that I think definitively people should reduce and get out of their life as much as possible, and that's packaged and ultra processed foods.
Kim Vopni (38:03.386)
Ultra process fuse? Yeah.
Dr. John Neustadt (38:06.882)
Seventy percent of packaged foods in the on in American supermarkets on the shelves are ultra processed foods. And it's not only that these Franken foods, these chemically engineered substances we call food, have nothing in common with what was grown and what they were originally. They're completely transformed.
but also the packaging they come in. Research has shown that the packaging leeches into the food. And so people are also consuming those environmental toxins as well.
Kim Vopni (38:39.6)
Yeah, that's crazy. wrapping this up with a with a bow, what would be so Mediterranean diet, high fiber, high protein, well, adequate protein, consistent small habits, even if it's just one thing you start with and you do consistently. S prioritize your sleep. the exercise we've you know, again, it's what
y somebody's going to do consistently. Is there anything that we've left off that list that we need to be paying attention to?
Dr. John Neustadt (39:11.512)
I I think an important tool in the toolkit. I mean there's some some supplementation some supplements, some nutrients that have been shown to be very helpful at promoting bone health and maintaining bone strength. You know, also in terms of hormone balancing, looking at hormones more holistically with you know, HRT c it can be a phenomenal strategy when it's safe and done effectively at at building bone back up, w make promoting and improving bone density, but also fracture reduction. and also looking for men
At hormones as well, because men's can men can lose bone also, and making sure their testosterone and estradiol are also tested. So there are other things that people can do that I I I go through in great detail in my book. But the biggest things in people's control are diet, exercise, lifestyle, the supplements that they're taking to be educated about those, and the conversations they're having with their clinicians.
Kim Vopni (40:08.08)
Yeah. What I'm taking away from this conversation is I have been in my mind focused on the bone density piece. And you're helping me look at this more of reducing fracture risk. And when I think of my population being many of them are finding out about pelvic health much later in life. Some of them already have a diagnosis of osteoporosis or osteopenia.
Many of them have stopped moving because of their pelvic floor symptoms and they have poor balance. Sometimes if they're waking up at night to be, we know that's a risk factor risk factor for fracture, as is, you know, incontinence and prolapse themselves increase the risk of falling for general and elderly population. And so thinking about even how I'm programming my workouts and adding in things of
Not so much let's just stomp to build the density, but what other things can we be doing to reduce the risk of falling and fracture? And I thank you for your work. Your book is amazing. I recommend it all the time and I look forward to having more people aware of your work, your book and everything else. Where can people find you to learn more?
Dr. John Neustadt (41:18.678)
best place would be going to my website, which is nbihealth.com. NBI stands for Nutritional Biochemistry Incorporated. nbihealth.com.
Kim Vopni (41:28.772)
Amazing. Thank you so much for your wisdom, for your time today. I appreciate you so much.
