Groundbreaking Science on Bone Health (Your Genes Are Not Your Fate) | Belinda Beck

Defy gravity and rebuild your bones at any age with Dr. Belinda Beck's pioneering high-intensity resistance training protocols. In this groundbreaking conversation, the Professor of Exercise Science shatters myths around weightlifting for women and reveals how targeted loading can stimulate new bone growth - even for those with osteopenia or osteoporosis. Prepare to have your assumptions shattered and unlock a life without fear of fractures. You can find Belinda at: Website https://onero.academy/ | LinkedIn https://www.linkedin.com/in/belinda-beck-97862561/ | Episode Transcript https://www.goodlifeproject.com/podcast/osteoporosis-resistance-training-bone-density-belinda-beck If you LOVED this episode, you’ll also love the conversations we had with Dr. Adeel Khan https://episodes.fm/647826736/episode/NjY0ZGZjZGI2NzdkZjAwMDEyOTRlMWZk about cutting-edge treatments like stem cells and gene therapy to heal the body. Check out our offerings & partners: Join My New Writing Project: Awake at the Wheel https://jonathanfields.substack.com/aboutVisit Our Sponsor Page For Great Resources & Discount Codes https://www.goodlifeproject.com/sponsors/ Hosted on Acast. See acast.com/privacy https://acast.com/privacy for more information.

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• 0:00Jonathan Fields?

  So I am at an age where, for the first time, I'm starting to think about the health of my bones. We tend to lose density and strength as we age, although some people might argue I'm actually getting more dense as I age. And the effects on our bones can be pretty brutal, from pain and fractures to serious limitations. You hear words like osteoporosis or osteopenia and wonder, what exactly is that? And what does science say we can do to keep the bone we have and potentially even slow down or reverse any loss that we might be experiencing, no matter how old you are? There is just so much misinformation and mythology in this area. So I wanted to talk to somebody who's not only a leading

• 0:42Jonathan Fields?

  voice, but also a primary researcher who is changing what we once believed was possible. My guest today is Dr. Belinda Beck, professor of exercise science at Griffith University and director of the Bone Clinic in Australia. With over two decades of research, her pioneering work has revealed some really powerful new insights to stimulating new bone growth through targeted high-intensity resistance training, even for people who had for years been written off as beyond being able to be helped. You're about to hear the remarkable stories of Dr. Beck's study participants, who despite osteopenia and osteoporosis diagnoses,

• 1:22Jonathan Fields?

  and being later in life, achieved astonishing increases in bone density and skeletal resistance. They'll pretty much shatter every myth you've heard about women and weightlifting. In this mind-blowing conversation, you will discover a groundbreaking approach that defies conventional wisdom and unlocks your body's innate ability to fortify this foundational structure from within. So imagine unleashing a life without fear of fractures, moving with confidence, embracing activities you love. That is the transformation that Dr. Beck's evidence-based exercise protocols have delivered for countless individuals now worldwide. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project.

• 2:10Speaker 01

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• 2:43Jonathan Fields?

  Good Life Project is sponsored by Stihl. So I am not in the studio today. I'm actually out on the trail in the Rockies at about 6,000 feet above sea level in Boulder. The leaves are exploding with color and it's just stunning out. And yes, I'm wearing my favorite Stihl hat. And just last night, I was wearing one of my favorite Stihl jackets, which, if you know me, is not unusual. I wear the hat almost every day and my Stihl jackets pretty much live on me all fall and winter. There's even a Stihl shop back in town practically in my backyard. Here is why I love them. Stihl is designed and tested in Jackson Hole at the base of the Tetons by locals who ski and bike and hike and climb and fish there pretty much every day. They have been at it since 2011, so they know warmth and they also know style.

• 3:28Jonathan Fields?

  Everything I have from them, it works great, it holds up in every condition, and also looks awesome. And their hometown down is 800 Phil Down, but it feels more like just your favorite hoodie than a puffy. And ski season is almost here, so gear up now the way that the locals do. Go to stihl.com/goodlife for 20% off your order. That's S-T-I-O dot com slash good life. Stihl.com/goodlife. Stihl, designed and tested in Jackson Hole. Good Life Project is supported by Ernesto rugs. So a small confession, our front porch has been the most neglected corner of our home since we moved in. It's the first thing anyone steps onto and it's been kind of greeting people with a sad

• 4:08Jonathan Fields?

  too small mat. Ernesta sent me their samples and now they're making us a rug. And the cool thing is for $10, you get five oversized 12 by 12 samples. So you see the colors at real scale in your own space before you even get it. So we lived with all five colors for a few days and cool morning light and golden afternoon light. And we're sure to be roused in the sky, but Caldwell just kind of kept quietly winning. The thing you're certain about isn't always the thing that fits. And because Ernesta rugs are custom size, cut to the ins, the one we ordered is made to our exact six and a half feet by nine feet space, not close enough. Visit ernesta.com and order five samples for only $10 and you'll

• 4:49Jonathan Fields?

  get $50 toward any rug of your choice. That's E R N E S T A dot com. Before we really dive into some of the details and nitty gritty, I'm also curious, just on a personal level, you chose this area as something to devote your professional life to, to really deepen into the research. What drew you to it? Was there something specific? Or was this sort of like just something you stumbled upon?

• 5:12Speaker 02

  I think most people who really get down in the weeds in a subject, there is a connection. And for me, I was a runner and a hockey player and I used to suffer from medial tibial stress syndrome, what everybody used to call shin splints.

• 5:26Jonathan Fields?

  Shin splints, right.

• 5:27Speaker 02

  So my master's project was an anatomical study of the things that attach to the leg there because everybody thought it was, you know, it was a muscle problem. And it just became very obvious, very quickly to me that this is a bone problem, not a muscle problem. And so my PhD, I wanted to know what it was that was signaling the bone to adapt because that, that was sort of the mystery at the time. And so I did an animal project to do that because you, you really can't do that in humans. Then I really discovered that I can't do animal research because it entails ki- killing animals and I don't want to do that for my entire life. My postdoc was learning clinical trials at Stanford and they were all about osteoporosis then rather than bone stress injuries.

• 6:11Speaker 02

  So I have continued studying bone stress injuries throughout my career, but you cannot get funding for it unless you go to the army and and it was very obvious that osteoporosis was a much, much bigger problem to the population, the world population at large. So I sort of went in that direction because it seemed like a more meaningful place to go, but it did allow me to keep my hand in because I'm an exercise physiologist at heart and I really do think that exercise is medicine. So it just seemed like the logical way to go. Bone stress injuries are from people doing too much too soon. Osteoporosis is probably not enough ever.

• 6:49Jonathan Fields?

  Yeah, that's such an interesting sort of contradiction or contrast. As you're describing what I grew up calling shin splints, I grew up when I was a kid, I was a competitive gymnast and trained year round until I was about twenty years old. And I kind of lived with this pain in the front of my shins perpetually, you know, we were just sprinting down hardwood floors and like landing and it was also a very different role. We trained differently, you know, like back when when I was doing this, but and I was always told it was a soft tissue issue, you know, like this has nothing to do with the bone. And it was just like you just learn to live with it and you're walking around in pain.

• 7:22Speaker 02

  Yeah. The thing that I suppose the hook that really got me in was when I started, and this is as a PhD student, learning what an incredible tissue bone is. I mean, if we thought about all the structural materials that engineers use, if they could find a self-healing concrete, that would just transform engineering. But we've got one and it doesn't heal with a scar, it heals with fabulous new tissue and can be even stronger than it was. So. It's wonderful stuff and we can't trick it either. We like to think that we can by

• 8:02Speaker 02

  giving people meds, bone medications that will lay down more bone and they work for that, but it will put that bone anywhere. Whereas exercise gives the bone a signal where the bone is bending the most because of that load and the bone adapts to avoid injury in that site. So it's this site-specific, really targeted, effective response. It's, yeah, it's fabulous.

• 8:31Jonathan Fields?

  I want to dive a lot more into that, but before we get there, I want to understand bone a little bit better, you know, because people we listen to this like, okay, I know that I have this thing inside of me called the skeleton. I have heard, and a lot of our listeners, certainly in the middle of years of their lives, a lot of them are women who are pre-menopause, peri-menopause, menopause, post-menopause, and a lot of them also probably have kids. So they're thinking about the full spectrum of that. When we think about bone, I think a lot of us, we kind of look at it as, okay, we have the skeleton side of us. It's this hard structural stuff that allows us to like be upright and muscles and soft tissue, you know, can work against it, but kind of look at it as this thing where it's sort of like, it's this inert thing. It's not, I think a lot of folks don't

• 9:15Jonathan Fields?

  look at bone as being alive. So take me into like, what are we actually talking about when we're talking about bone?

• 9:21Speaker 02

  Well, nothing could be further from the truth. It is very much alive. It is full of cells, bone cells, which are called osteocytes. They're all throughout the bone. They, they live in tiny little caves of their own. The very cool thing is that they're not in isolation. There are channels between those little caves where the bone cells reach out and actually hold hands, if you like. So there's this massive system network of communication of all of these cells in bone. And not only that, there is a huge blood supply in bone. So that's why if you break a major bone, you you are in danger of bleeding to death unless you, you know, like unless you stop that.

• 10:03Speaker 02

  So very much alive and very much able to adapt to stimuli because of that blood and that cellular network.

• 10:13Jonathan Fields?

  So we, when we injure bone, probably everybody, if you get to a certain part of your life, you've done something to a bone in your body, whether it's a bruise or a fracture or a break, I've certainly had my fair share. When bone heals itself, what is it actually doing?

• 10:30Speaker 02

  Well, it has, not to get too much into the detail and send everyone asleep, it it just, it has a cleanup crew that comes in first and sort of gets rid of all the mess. There are a bunch of chemicals that float around and pull other cells in to help do that. And then sometimes creates a little bit of a cartilaginous matrix and the cells can go into that then and convert that into bone. And sometimes it just bone cells come along and actually lay new bone straight on to the fracture. But the, so there are two kinds of cells, osteoclasts, which are the bone resorbers, and osteoblasts, which are the bone builders.

• 11:13Speaker 02

  The osteoclasts will come along if there's a microcrack, so not a complete break, but a microcrack. They can detect there's a crack there because it probably has disrupted that network of cells I was telling you about. So the osteoclasts will munch along that that crack and then the osteoblasts come along behind it and lay down perfectly new bone. So just just a little rep, and you wouldn't even know that the crack was there once it's done.

• 11:38Jonathan Fields?

  So that's why I've had moments in my past where I've done something, I felt pain in a particular joint. Couple of months later, I've gone back and I'll get an X-ray and and I would hear from the doctor, well, you had a fracture. And it's basically healed itself.

• 11:55Speaker 02

  If you had a fracture in the middle of a long bone, like and broke it completely. So that's a fairly drastic kind of a thing. Back in the day, before orthopedic surgeons, people still fused bones. And if you get them roughly in alignment, the bone will fuse back together. If you get them perfectly in alignment, you'll just get a little bit of a callus around the outside. And over time, that callus will resorb and then it'll look like nothing's happened. If you are unlucky enough to have a fracture, you know, right out in the bush and just stuck out there for for months. And maybe the bones don't align properly, maybe they're elapsed slightly. They can still fuse in that position. Unfortunately, that means you've probably lost a bit of length of that bone.

• 12:39Speaker 02

  They'll still fuse there and over time they'll remodel a little bit, but you're almost certainly going to retain some of that defect. Cause that's pretty full on. But what was probably obvious about your previous fracture is that the callus was still evident. So the thickening around it was still evident, but over time, as I say, even the callus normally will resolve.

• 13:00Jonathan Fields?

  So we have these osteoblasts that lay down new bone osteoclast kind of go as you described munch it up. And as you're describing that, I'm also remembering years ago, I remember reading about this procedure. That was, I guess, initially developed for kids who had a limb, generally a leg that was substantially shorter than the other. Where they would literally go in, take the large bones in the leg, cut them, effectively screw an exoskeleton on them. And then every day ratchet them apart a millimeter a day, and then the bone would fill in. So I guess what you're describing is, I guess, especially when you're a kid, this is probably much more efficient. That those osteoblasts would just create new bone effectively, allowing you to lengthen it.

• 13:43Speaker 02

  How cool is that, hey? That's exactly right. I mean, it's, and you have to be pretty careful with your lengthening timing and so on. So that there's enough proximity for the signals to be getting through. And because there are some cases where bone doesn't heal because the ends are too far apart and they can't sense each other. And you, you get a non-union fracture and that requires a bit of stimulation. But bone lengthening procedures are amazing in in childhood because then you don't go through life with one leg longer than the other. Or or which is going to mess with your back and. All sorts of things, yeah.

• 14:19Jonathan Fields?

  Then I remember more recently, reading an article about how people were now doing this for cosmetic reasons, fully grown adults, you know, 30s, 40s, 50s, and they just wanted to be taller. I remember the article describing this brutal experience of almost being bedridden for six months. And then when they finally stepped on it, it was a question about whether at that age, whether the regeneration of bone would be effective enough so that it could actually have the stability and the structure to carry their weight.

• 14:50Speaker 02

  Yeah, there's so much problematic with what you were just describing.

• 14:55Jonathan Fields?

  Where do we start, right?

• 14:56Speaker 02

  One, that we're a society that values height so much that you feel the need to put yourself through that major surgery. But there's all sorts of reasons why people might do that. I'm not judging. I tend to think your body is a bit of a temple and what you've got is pretty amazing and don't mess with it. I don't even have pierced ears. I just think, leave it alone. It's great. But for some people who do that, I think I would just bring to their attention the fact that if you are on bedrest, and you would have to be non-weight bearing, if you were, if this was a lower extremity procedure for a long time. And then what's happening is you're essentially atrophying everything

• 15:41Speaker 02

  else that needs to be weight bearing. So what you're mentioning is, can your body actually hold you up once that's happened? Well, yeah, it can. As I say, bone's amazing, has this ability to adapt, but it will take a long time. And if you do the procedure quite late, you may never get back to what you originally had.

• 16:04Jonathan Fields?

  And we'll be right back after a word from our sponsors. Good Life Project is sponsored by Talkiiatry. So you know that moment when you finally say, okay, I need some help? That takes courage and then you start calling psychiatrists and here we're not taking new patients or our next opening is months away. Talkiiatry exists to change that. Unlike therapy only platforms, Talkiiatry is psychiatry. It's a 100% online practice where a medical provider can diagnose conditions like anxiety, ADHD, depression and more, and prescribe medication when it's appropriate. All 800 plus clinicians are in-network with major insurers, take a short assessment, get matched and have your first visit in days, not months.

• 16:48Jonathan Fields?

  More than 300,000 patients have already found care through Talkiiatry. So head to talkiatry.com/goodlife to complete the short assessment and get matched with an in-network psychiatrist in just a few minutes. That's T-A-L-K-I-A-T-R-Y.com/goodlife to get matched in minutes. Talkiiatry.com/goodlife. Good Life Project is sponsored by Quince. So these days I tend to want fewer things made well. That's how I'm thinking about gifts this year and it's why Quince is on my list. So Quince makes elevated everyday essentials from premium materials like Mongolian cashmere, organic cotton and stretch denim at 50 to 80% less than similar brands. Cashmere sweaters that start at just $50, they work directly with ethical factories

• 17:33Jonathan Fields?

  and cut out the middlemen. Our executive producer Lindsay actually just ordered their organic cotton denim chore jacket in indigo blue, her verdict, dreamy and soft. She also grabbed Quince's bees oil wood conditioner. It's made in the USA from beeswax and mineral oil. It's food safe and it's lovely on cutting boards and bowls. And I actually just got the yummiest button down from Quince, which is great as the weather gets cooler. So give the gift of quality this holiday season. Download the Quince app for app exclusive offers or go to quince.com. Get free shipping on your order and 365 day returns. Now available in Canada and the UK too. And when Quince asks where you heard about us, let them know it was Good Life Project. It's the best way to support the show.

• 18:17Jonathan Fields?

  Good Life Project is supported by Kachava. So I used to think being salty was reserved for bad moods and pretzels. But lately, I have come to realize that a little salty edge actually makes life, and especially dessert, way more interesting. Any pastry chef will tell you that a pinch of salt isn't there to ruin the party. It's there to make the sweet parts just really shine, which is exactly what Kachava pulled off with their new salted caramel. First sip, I actually laughed. It's that good, rich caramel, a little salty edge, and none of the sugary drawbacks. And it's still the Kachava that I count on. Two scoops for complete nutrition with plant-based protein, fiber, greens, and so much more. No artificial flavors, colors, or sweeteners, no fillers, no nonsense.

• 19:01Jonathan Fields?

  Which if you're feeling a little salty yourself is kind of the point. Embrace your salty side. Go to kachava.com and use the code GOODLIFE for 15% off your order. That's Kachava, K-A-C-H-A-V-A dot com, code GOODLIFE. Let's talk a little bit about bones and life cycle. And I want to eventually get to the, what you brought up earlier, which is this notion of osteoporosis and the various different stages of that, too. But let's start a little bit earlier in life because our bones don't stay the same. We're not born with bones in a particular way, and then they just kind of stay that way through life. So walk me through a bit, maybe starting out in childhood. You know, like what, tell me, what are we looking at with the bone structure there?

• 19:45Jonathan Fields?

  And then maybe we could sort of progress through the major life cycles and how that impacts bone.

• 19:52Speaker 02

  So starting right back, you know, in utero, we have our full skeleton in terms of the shape and all the little bits and pieces. This should blow your mind. It blows mine every time I think about it. When we are eight weeks old in utero, the full skeleton is there in this tiny little bean, but it's cartilage. It has to be because you need to be able to grow and develop a little human inside another human. So it's a way to grow that skeleton quite quickly.

• 20:26Speaker 02

  Shouldn't be calling it a skeleton because it's not until it's fully ossified. But that process of ossification begins in utero. All the major bones begin to have ossification centres in them because to be born as a little blob of cartilage would not be evolutionarily successful. So we have the bones of our skull are largely formed to protect the brain, you know, the the ribs are protecting the lungs and so on. But if you were to X ray a baby's hand or a foot, it would look like there was no bones in there because they're still all cartilage until that begins to ossify. By the time a baby is one years old and they're starting to walk, then there's a lot of bone in most of the weight bearing parts of the body. So

• 21:11Speaker 02

  the reason why we don't ossify instantly is because if we did, we would be that size forever. Long bones have ossification in the middle of the bone and then to an ossification at either end so that they're allowed able to have a growth plate at either end and the bone can continue to grow. And when we're considered to have stopped growing, that's when your growth plates have also fused over. And there's no cartilage there anymore. The bone is the length that it's going to be. So that happens at very different times for people. It is an individual thing. The gro- major growth spurts are when kids are very young, sort of between toddlerhood and the next stage of childhood and puberty.

• 21:53Speaker 02

  Now puberty, there's a massive influx of growth hormones and so on and and all of the sex hormones that change everything, those of us who've had teenagers. And women tend to, you know, have that growth spurt and then they tend to stop growing roughly around about eighteen. Can be a little earlier or younger uh or later. And men tend to to take a little longer to finish growing, could be roughly about twenty five when they actually stop growing. But again, the variation is enormous in that respect.

• 22:28Speaker 02

  But what we do know is that you almost certainly will have all the bone you're ever going to have by age thirty. And in fact, you probably have ninety nine percent of any, all the bone you're ever going to have by age twenty. So most of that, I, I guess the take home is if you're trying to build your bone bank, the window is childhood. And from what I can tell from the work that has been published, the most important window is puberty, keeping active and doing the right kinds of exercise.

• 23:02Jonathan Fields?

  I'm actually gonna jump in because I just wanna ask about that sort of like eighteen to twenty five year window, or like the point where we quote peak. Totally understand that in the context of the bones aren't going to get longer. Does that also apply to the bone mass, the density of the bone? Like, does that also basically peak in that same window?

• 23:21Speaker 02

  It does for, as a general rule, for most people. But whether it does depends on the person. So genes are largely determining what that peak bone mass is going to be when you stop growing and so on. Certainly, the amount of exercise and your diet is going to be important in, in optimizing your peak bone mass, but genes are really the major determinant there. What happens next over the rest of your life is going to be very much determined by your lifestyle. And that's when that sort of stuff kicks in. So yes, is the answer to the question. That's pretty much it for, we measure bone by bone mineral density typically on, on a

• 24:06Speaker 02

  DEXA scan and, and typically that's the maximum BMD you'll ever have. It's maximum length, width and so on. But there are caveats and I, I suspect you're gonna ask me about those, so I'll wait until you do.

• 24:18Jonathan Fields?

  So if, you know, by the age of thirty or so at the latest, let's assume for the moment that we've got what we've got, and granted, we'll talk about, I'm sure, some things where maybe we can actually alter that equation, without doing anything substantial to intervene, what is this sort of the progression of your bone health, your bone density, as you move into the middle years of like thirties, forties, fifties, sixties, and then beyond?

• 24:42Speaker 02

  Yeah, so for most people, if they don't have anything that stops them from being normally mobile, you know, or normal amounts of activity and normal access to food and no major condition, life-threatening condition or something, you will plateau for a while with your bone mineral density, and then you'll begin to lose. So for men, that is a very gradual process, pretty much from any time between thirty and forty, roughly about forty for men, until the end of life. For women, because estrogen is such an important hormone for bone, because, remember, I talked about the bone munching cells, the osteoclasts?

• 25:25Speaker 02

  Osteoclasts are inhibited by estrogen. So when estrogen is withdrawn at menopause, it's a bit like taking your hand away from underneath it, a running tap, and suddenly the osteoclasts start resorbing bone like crazy, and you lose much more rapidly for the next sort of five to eight years through perimenopause as that's removed. Now, that does eventually sort of level out again, and the rate of loss tends to parallel men towards the end of life. But there is a massive loss at menopause, and this probably is one of the major reasons why women are more likely to have very low bone mass at the end of

• 26:09Speaker 02

  life compared to men. But of course, you have to factor in that we don't gain as much bone, at peak bone mass, as men either. So we start lower, and we lose more across life. And that does explain why more women than men are fracturing at end of life.

• 26:24Jonathan Fields?

  If there's this process of, quote, "natural," I don't want to say shedding, but reduction in density, reduction in mass, that just happens year after year after year. And again, as you described, often different between men and women, in no small part based on the change in estrogen during menopause. As this process is unfolding, why does this matter to us? Like, what are the changes that it makes in us, in our abilities, in our risks, that would make us want to say, huh, I wonder if there's something I can do about this?

• 26:55Speaker 02

  For most people, that loss actually doesn't matter. You lose mass, but if you never do something that puts you in a position where you overload your skeleton and you never have a fracture, actually, all you've done is lessen the load in your body and you use less energy to get around. However, most people do get to a point in their life where they have lost so much mass that they are at increased risk of what we call a minimal trauma fracture. So this is a fracture that would occur more likely in somebody with this reduced bone mass. And it's why you would see the, most commonly in the spine, and you see that kyphotic deformity or the curvature of the spine

• 27:39Speaker 02

  when people have fractures in their spine. From little things like lifting up a grandchild or carrying a very big bag of groceries or jolting down a step when you thought you were on the ground, but you forgot there was one step to go. That can actually cause a fracture. And these normally wouldn't cause a fracture in most people. But after the age of probably about 60, there's, we're talking one in two or one in three women, and about one in five men, do have a fracture. This is something that is not insignificant. The risk is quite high. So I suppose the goal is to prevent your skeleton getting to that point,

• 28:24Speaker 02

  you know, preventing the loss across life, which, you know, many people think, used to think you couldn't do, but I tend to think that you can.

• 28:34Jonathan Fields?

  So the risk really then is that will lead to fractures, which may lead to anything from pain to disability to all sorts of limitations, which is, I would imagine for the typical person, to the extent we have control over this, something we'd rather not endure. One of the things that I think a lot of people hear about, well, if you reach an age where you're losing a certain amount of bone mass, that the risk of falls goes up. And then along with the risk of falls is fractures or entire breaks. And often, you know, like the spine and the hip are things that people point to. I'm wondering, like, is there a chicken and egg thing going on here also?

• 29:13Speaker 02

  There is a very tiny percentage of times when that happens. If somebody has a very, very weak hip, that may happen. But 90% of hip fractures are a direct result of a fall. I would say 99% of all wrist fractures are a direct result of a fall. The three main osteoporotic fractures are wrist fracture, typically falling on an outstretched hand. And a wrist fracture isn't a really big deal for most people. It's an inconvenience. It heals over the course of six to eight weeks. You know, you can survive with one other hand. You can move around. It's okay. A spine fracture is probably the most prevalent. It causes considerable pain for most people.

• 29:58Speaker 02

  Not everybody, not everyone even notices when they fracture a spine, but most people do. It causes pain in the actual fracture. But if you have such a bad fracture that you crush the spines to the extent that it squashes the nerves that come out of the spinal cord, then that's going to cause pain that will radiate to other parts of the body and become much more problematic. So severe spine fractures, it's not a place you want to go. And the hip fractures, of course, normally falling to the side and not being able to get your hand out to stop yourself falling directly onto your hip. Either you've been knocked over or you've moved suddenly or for whatever reason.

• 30:40Speaker 02

  So I guess I digress, but the answer to your question is almost certainly the falls happen, not the other way around, fracture then fall.

• 30:48Jonathan Fields?

  So then if you if you fall, whether you trip or whatever the cause may be, if your bones have already lost some mass, then when you fall, like if you had that exact same fall when you were 20 versus when you were 60, where you have a, you know, if you have a meaningful loss in bone mass, I guess in the likelihood of that fall leading to a fracture or break would go up dramatically.

• 31:12Speaker 02

  Dramatically, absolutely.

• 31:15Jonathan Fields?

  So talk to me about words like osteoporosis and osteopenia. What are these and how do we know if we quote have it?

• 31:23Speaker 02

  So osteopenia is a description of low bone mass and osteoporosis is very low bone mass. Now, to diagnose them, you would normally have a DEXA or a bone density scan. DEXA stands for dual energy X-ray absorptiometry. It is a very large sort of X-ray machine that you lie on. It has very low dose radiation, so they're very safe, relatively inexpensive. And if your doctor was had some idea that that you may, you had a family history or whatever reason, they would send you for a scan. And normally a hip and spine, because as I mentioned, those are the two places that

• 32:08Speaker 02

  are most likely to fracture or if they do fracture, cause the most trouble. When determining whether you have osteopenia or osteoporosis, your score, your bone mineral density score is compared with the scores of a big database full of people who are like you. So in my case, a white woman. Your T score is your score compared to a young, or mine would be a young white woman. Not somebody the same age. Your Z score is compared to somebody the same age, but the T score is how osteoporosis is diagnosed.

• 32:47Speaker 02

  If your value, your BMD value is more than two and a half standard deviations away from the score of somebody your sex and race at age roughly twenty, you're considered to have osteoporosis. If your T score, if you, sorry, if your score is between minus one and minus two point five, then it's osteopenia. So they're really just terms on the same scale and they were, these cutoffs were created essentially so that doctors knew when you are most at risk for fracture and when they should be do, um, prescribing therapy.

• 33:29Jonathan Fields?

  If I have it correctly, then this is a very low radiation um test. Often, and it's generally comparing to two different standards. One is sort of like you as a twenty year old. And then also you probably like in, versus a population who's similar age to you. So it would be possible then to look at the comparison to the twenty year old number. And that come back and say, well, like you clearly have osteoporosis. But then compared to other people, your same gender, your same age, your same ethnicity, you might actually be a lot closer to what the typical person is.

• 34:04Speaker 02

  That's right. Because of the fact that everybody loses across life, your Z score, which is the comparison of your score to the average of you at your age, will be much closer. The reason that it's compared to baseline is because that at any stage during life, if your score is two and a half standard deviations below that young normal score, you are at increased risk of fracture. That's what the big epidemiological studies say.

• 34:31Jonathan Fields?

  How accurate is DEXA? Um, I've always been curious about that.

• 34:36Speaker 02

  Oh, the million dollar question.

• 34:39Speaker 02

  On a population scale, it's great. It's a really great screening tool. It gives us a very good snapshot of where we are. Can you get different scores on DEXA from one day to the next? Sure. Will they be in the ballpark of where you you probably are? Yes. So there is error. There definitely is measurement error. Typically, in a bone lab like mine, we do reliability studies where we test a new DEXA and and scan people. We put them on the machine, we scan them, get them off, reposition them, scan them again, and that's considered to be our reliability number. And so when we do an intervention trial, we can see whether the effect of whatever

• 35:20Speaker 02

  we've tested is greater or lesser than that error that we measured in our reliability study. Of course, not all the clinics are doing that, but the assumption is they're pretty close. There are all sorts of things to remember when you're having a DEXA in series. So oftentimes, it's recommended, particularly for women, to have a bone density scan at the time of menopause so that you can see where you started and so you can see how much you lose or hopefully don't. And you need to make sure that your follow up DEXAs are on the same DEXA because you can't compare numbers that come from different machines.

• 36:00Speaker 02

  There are some machines that do have calibration standards, the same model, same type, the same brand of machine, and they calibrate for all of them. That's not quite so bad, but if you had a scan, for example, on a Hologic machine and then went and had one on a Luna, you could not directly compare those two scans.

• 36:17Jonathan Fields?

  That's so interesting. So then you could effectively, your doctor could order a DEXA scan. You could go get a scan. You might choose one place or another place. They might have a different machine. And based on the fact that it was a different machine, you would potentially get a different score back.

• 36:33Speaker 02

  Correct. It's very frustrating for those of us who do research, but like I say, they're a good broad brush, pretty reliable and valid. The thing about DEXA is that it is. Highly related to your risk of fracture. So and it's it's easy to interpret the results, you know, on the plot. Very easy to understand and doctors are used to it. So it's it's a pretty good tool. It's definitely not perfect, but it's the best we have at the moment. There are various tools coming out, but for now it's the best we have.

• 37:07Jonathan Fields?

  I don't know if you I'm sure you're you're tracking this, if not involved in it. But it seems like A I is becoming really involved in a lot of imaging processes. And I'm wondering if they're sort of like in a near future where A I actually becomes involved in the testing of bone mass and in some way makes it either like more accurate or more consistent.

• 37:28Speaker 02

  Yeah, that's definitely is already happening. It's not my area, so I can't really speak too much to the the specifics of it. There are other forms of detecting osteoporosis because most people don't even think about it. You know, you wouldn't, you don't think about your bones until you have a fracture. Some people are being screened for other conditions where perhaps you have a chest X ray. And in that case, there are some A I programs that are being used to also examine the density of the bone and.

• 37:59Jonathan Fields?

  It feels like we're on the cusp of just some really interesting stuff.

• 38:03Speaker 02

  Yeah.

• 38:03Jonathan Fields?

  I feel like there are also some myths floating around and maybe the biggest one that bridges the gap a little bit is that referencing what we talked about earlier, this idea that we have what we have up until, you know, late twenties around thirty ish and then from that point forward, it's just going to get less and less dense. Your bone density is going to diminish over time, year after year after year. And there's nothing you can do about it. It's just the way it is. It's the natural process. Just accept it. You don't buy that.

• 38:32Speaker 02

  Oh, it's not true. So, I mean, it's it's absolutely not true. We we've shown that over and over. Bone is way ahead of us. It's you can absolutely do something about it.

• 38:44Jonathan Fields?

  What about weight loss and bone density? Is there a relationship that you're aware of between losing weight and losing bone density?

• 38:53Speaker 02

  There absolutely is. And this is so frustrating for people who are doing something good for their body by shedding excess weight that could be bad for all kinds of metabolic and joint reasons and so on. Because particularly if you lose a large amount of weight, you are also going to lose lean mass, a muscle. And then the other, some of us who are doing some work to, to see if um if our exercise program can prevent that loss. One study that we were doing was interrupted by COVID, so we don't have the answer yet. But there is certainly plenty of evidence that shows that some exercise can prevent some loss of bone and muscle during weight loss. So it's

• 39:34Speaker 02

  definitely better to do something. But the, in the past, those forms of exercise haven't been enough to stop all of the loss. So I worry about drugs like Ozempic and it's just, that's the name that I always remember, I'm not singling it out. But these are highly effective weight loss drugs and they're almost miracle drugs. For some people, they're really life-saving. But in the process of losing a lot of fat, in that case, also losing bone and muscle. Now, it's easy to put fat back on. It is not that easy to put bone and muscle back on. So people do need to be aware of that.

• 40:09Jonathan Fields?

  Yeah, I mean, it's, it's so interesting, right? Because it's like you're trying to do something that may really affect, you know, different health indicators in a very positive way. And at the same time, what you're doing actually is very effective. Um, it can have this potential other impact. And I know that the same as, as you described, the same is true of muscle. Oftentimes, when somebody loses a meaningful amount of weight, and part of that is lean mass in the form of muscle, and that is the metabolic engine of the body. So it has its own repercussions. So I guess the answer is um that there is a relationship there, that it looks like maybe there is a way to stave off some of this. But the answer is not entirely

• 40:50Jonathan Fields?

  in yet. And can we actually completely maintain what we have while simultaneously losing weight?

• 40:56Speaker 02

  Because we haven't tested, you know, as I'm, I'm sure we can talk about this, bone does have a very, bone needs a very specific form of loading to actually grow. So if you're not doing that during weight loss, you're not going to be able to save your bone. So um, yeah, it's very targeted.

• 41:16Jonathan Fields?

  So let's go there. Let's switch gears a little bit into, okay, so let's say we're at a certain point in life. Maybe we've just gotten a DEXA and we've gotten some numbers back, T score, Z score, and you know, we're kind of like, oh, that's, that's not what I wanted to see. I'm either heading in the direction of osteoporosis, or maybe I'm already in it and really concerned. I've been told by a lot of people traditionally that it is what it is, or maybe there are pharmaceutical interventions, and we'll talk a little bit about that. But you want to do something to reverse this, if it's reversible, or at least stop the progress of it. So much of your work focuses around exercise. But it's not just any form of movement that's really effective. So take me into how you approach this, what actually works and what doesn't work.

• 42:02Speaker 02

  Maybe if we start with what doesn't work, because you know, as an exerciseophile, or somebody who believes that exercise really is the best medicine for, for, for many, many conditions. And the fact that I did start work, start my career in animal research, where it's really obvious that if you load bone, you can, you can grow bone, which is essentially what exercise is. Then finding in the literature, just a dearth of evidence that a regular exercise program can improve bone mass, and particularly in the people who need it most, who already have low bone mass. I was a real head scratcher, until we started drilling down and looking at the kinds of exercise that were, had been tested.

• 42:44Speaker 02

  So from that, it became very clear, walking is insufficient to grow bone. It's very good for your heart and lungs, great for your metabolism, probably really good for your mental health and socially, but it does not grow bone. A lifetime of walking is better than for your bones than not ever having done a lifetime work, walking. But once your bones, in older age, when you've got low bone mass, choosing walking as your intervention is really, I think, wasting an opportunity to do something that might actually work. Same for swimming, same for cycling, same for activities like Pilates, Tai Chi, yoga, anything that is low intensity, and anything that is not weight bearing. You need to be

• 43:29Speaker 02

  on your feet, and you need to load the body with, at a higher intensity. Exercise is very site specific, only the loaded bones are going to adapt. It's not like, go for a run and my skull bones will get thicker. That's not how, how exercise works.

• 43:45Jonathan Fields?

  And we'll be right back after a word from our sponsors.

• 43:50Jonathan Fields?

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• 44:35Jonathan Fields?

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• 45:20Jonathan Fields?

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• 45:45Jonathan Fields?

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• 46:27Jonathan Fields?

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• 46:49Jonathan Fields?

  Here's my question around this. I live in Boulder, Colorado. I live in the mountains, and I hike on a regular basis. And I've wondered, is there a meaningful difference between walking and hiking? And in particular, I will gain sometimes 1,500 feet in elevation on the way up. And I would imagine there isn't a meaningful difference there. But I'm wondering if I then have to come down 1,500 feet in elevation, which in my mind would mean that I'm loading the bone at some sort of, you know, like multiple of my body weight, or like it's more than just, you know, like one time the body weight as I descend. Do you know if that is anyway meaningfully different than just sort of like walking?

• 47:29Speaker 02

  It hasn't been measured empirically. So but I would almost certainly say that that level of intensity of walking is going to be better for your bones than just walking along flat pavement around a city street. I think that is

• 47:47Speaker 02

  Going to be the case, partly because walking uphill makes the muscles contract more, more loading on bones than just walking at a, at a relaxed pace. But also, I suspect when you're walking, sometimes you're on trails where you have to jump down a ledge or, so you're getting little impacts here and there around the place and, and slightly unusual kinds of, of movements. Bone loves that, to be surprised. And also, you're almost certainly carrying a pack on your back, so you've added to your load already. And if that's quite heavy, if you're camping at the time and you've got quite a bit of gear, then absolutely, that is a different form of walking.

• 48:26Speaker 02

  The only time I've ever seen a, a research study show that there is an effect of walking on bone is when, I believe, a weighted vest was, was worn and the walking was very rapid. So it's the same concept, put an extra load on the body and the muscles would, forces on the bones are probably greater as they're trying to move you more quickly.

• 48:50Jonathan Fields?

  Okay, so tell me what does work then?

• 48:52Speaker 02

  Heavy loads and impact. And um, we came to this conclusion because even looking at regular gym programs, which are beautifully designed to work all the muscle groups in the body. If you're doing sort of low, uh, high numbers at, at relatively low loads, that is not going to grow bone. It may help to maintain bone. So remembering that across life, we've got this trajectory of downward movement. Doing a regular gym program is almost certainly slowing that loss. But if you want to gain bone, you have to load it more than you um ordinarily would.

• 49:31Jonathan Fields?

  There was a, a season where the trend was, do three sets of like thirty reps of each of these things in a gym. And it was just lighter weight over and over and over and over and over. And often too fatigue. And maybe there are, there may, I'm sure there are other like health and fitness and wellbeing benefits of that. But what you're saying is, that's not really going to get you there when we're talking about um bone.

• 49:52Speaker 02

  Not for bone. However, as you mentioned before, falls are important. And, and we're trying to stop people from falling. There are some people who either can't or won't lift heavy, they're just, it's just not something that they are willing to do, in which case, that loading to fatigue isn't such a bad idea because there are different, um, multiple ways to get to the same end when it comes to improving muscle strength. And there's certainly a school of thought that thinks, yes, heavy loads done a small number of times, it's probably what we all assume is the most effective way to increase muscle strength. But actually, if you load at a

• 50:33Speaker 02

  lower weight to failure, to, so you cannot lift it one more time, there's evidence to show that that also increases muscle strength. Now, I am a very busy person, and there are many, many people like me, who want to get in and do their exercise quickly and get out. I know which one of those protocols is going to suit me because exercising to fatigue takes much, much longer.

• 50:57Jonathan Fields?

  When you talk about heavy loading then, I guess, where, you know, what I, what my brain hears is heavier weight, like, and oftentimes substantially heavier weight. When is this and when is it not safe for somebody, especially for somebody who maybe is further into their life, maybe already has a DEXA or some sort of diagnosis that shows there is some level of osteopenia or even osteoporosis. It seems like there's this dance that you would have to do. On the one hand, you need to lift heavy to effectively either preserve or even rebuild bone. But is there a simultaneous risk of doing that when you already have some bone degradation?

• 51:37Speaker 02

  Absolutely. And that's the reason when I was scratching my head and, and started working in this area, thinking, why are people doing these low intensity exercise interventions for people with osteoporosis when we kind of know that that's not what bone adapts to? Well, it's because everyone's scared of hurting people, and I was too. So, we never want to put somebody at risk. You don't want to cause the fracture you're trying to prevent because then that's, that person's had a fracture. And having one fracture increases the risk of having another by four times. So. Have to be very careful. And I would say the very first rule of loading heavy for osteoporosis is supervision.

• 52:20Speaker 02

  Just because you might have done quite a bit of exercise in your life, doesn't mean you don't need to be supervised on on heavy lifting if you have very weak bones. Your technique is everything and you can't see your technique properly even by looking in a mirror. In fact, sometimes when you're lifting by looking in the mirror, you're messing with your technique. Unfortunately, the way to have an effective exercise program for osteoporosis is to have somebody who is qualified supervise you and take you through that program. Because they will know by looking at your lifting technique, whether you are over and underloaded and at what amount they should be progressing you.

• 53:04Speaker 02

  You know, I often get asked, so how do I know what's heavy enough? Well, somebody who's expert will know that and they can help you.

• 53:12Jonathan Fields?

  And I guess, you know, part of this also is that you don't walk into a gym the first day and say, I want to lift hefty. Or I want to lift heavy if you've been largely sedentary, you know.

• 53:22Speaker 02

  You're not.

• 53:23Jonathan Fields?

  I think this brings us nicely also to the study that you did, Lift More Study. Walk me through this because, you know, it sounds like it's a population where it's basically the population we're talking about now where there is a concern. And the outcomes were stunning.

• 53:37Speaker 02

  Yeah, so this, there were two things that hadn't been done. I mean, there had been a couple of studies that had examined the osteoporotic population, but not very many because normally in these exercise trials, people were too scared. So they were screening people with osteoporosis out. Now, that's the other thing. If your bones are already quite strong and you load them, the bone goes, I I'm strong enough. I don't need to adapt. So that's the other reason it looked like it wasn't working. What you need to do is recruit people who actually need the exercise. So in Lift More, we recruited people who had low to very low bone mass and some of them had prevalent fractures already. So this would be somebody with a T score of minus one and as low as it went.

• 54:22Speaker 02

  I think the lowest we had was minus four and we were terrified, but we we took her anyway. The other thing is nobody had tested these very high loads before.

• 54:33Speaker 02

  So we didn't know how conservative we had to be. So we just started very conservative. Um. We taught technique to begin with, very, very light loads, taught the uh the movement patterns and then just gradually added the loads. Now, curiously, it was the study participants who were frustrated with us that we were going way too slow. They could do way more than we thought they could. And we had originally planned for a one month sort of lead in period. And after a while, it was just, come on, I'm so bored. So after two weeks of teaching them technique, we then started loading them up and away they

• 55:13Speaker 02

  went. Getting them to be able to lift as heavy as they could in what we call the eighty five percent one repetition max. So eighty five percent of what they can lift maximally once. And that, you know, that process, we we were very nervous about it. But at the end of it, we had a group of women who had gained considerable bone at the spine, uh bone mineral density from DEXA. At the hip, they had gained a little bit. It was statistically significant from the control group, mainly because the control group lost BMD at the hip. We were scratching our head a little bit because we couldn't understand why they

• 55:55Speaker 02

  weren't growing a lot of bone at the hip, until we used some software I have in my lab that allows us to do a three D analysis of the hip. And it showed us that actually the bone of your thigh, where it connects to your pelvis, that's what's, it's what people call the hip, but actually the hip is the joint. It's the femur we're looking at. That bone doesn't adapt by becoming more dense. It adapts by changing its shape and getting thicker. And that three D hip software, thankfully, because I was just tearing my hair out thinking, how can this not be working? Actually, it turns out almost thirty percent greater increase in thickness at the femoral neck.

• 56:36Jonathan Fields?

  Oh, wow.

• 56:37Speaker 02

  In our intervention group. And that's right where the fractures happen, at the femoral neck. So this was a big aha moment for us. Number one, we were growing bone at the spine. And number two, we were showing that we were actually changing the structure of the of the proximal femur in such a way that it was becoming stronger and more resistant to the kinds of loads that we put on the bone during everyday activities.

• 57:03Jonathan Fields?

  So if I remember correctly, this study, it was women who were postmenopausal and sort of like clearly past any symptomology or past menopause, as you described, many of them already, I guess, to qualify for the study, they had to have some level of loss of bone mass or bone density. What was the duration of, how long, how many months did you measure?

• 57:23Speaker 02

  Normally, when you do bone research, interventions are run for a year because bone is so slow to adapt. In our case, this was a PhD student study and we have to get them out the door.

• 57:35Jonathan Fields?

  Right, time is of the essence, yeah.

• 57:37Speaker 02

  We brought it down to eight months because I knew that if there was something to be seen, we would be able to detect it in eight months. So the intervention was eight months long. Turns out it was sufficient to be able to detect a change. When we measure these days at the clinic, we do allow a full year in between our testing. So, yeah, twice a week for eight months.

• 57:59Jonathan Fields?

  What they were doing also, it wasn't some sort of crazy complex or complicated. From what I remember, this is, these were very fundamental movements. I mean, they were, they were dynamic movements that involved the whole body, but these are like the basic things that you see somebody do in a gym. There was nothing fancy or complicated about it.

• 58:17Speaker 02

  No, well, we wanted, I mean, feasibility for me, whenever I'm doing research, testing something just for the sake of testing it, it doesn't make a lot of sense. Research is expensive and you've only got a certain amount of time to do it. So test something that is feasible, acceptable, people will actually do. I wanted it to be brief, so these were only thirty minute sessions. And I wanted it to hit everything that, you know, in the body that needed to be hit. I don't normally talk about the actual exercises publicly because people do silly things when they hear me say that.

• 58:54Jonathan Fields?

  They run out to a gym.

• 58:55Speaker 02

  They run out and do it. And what I'm trying to emphasize is that it really does need to be supervised. But what I can say is these were complex compound movements that are pretty straightforward. Plus, we added in some impact. And the transfer of those compound movements to everyday activities, like getting down and up out of a chair and in and out of a car, onto the toilet, reaching above the head to pull something out of a cupboard. The movements that we did in this study translate directly to everyday activity. Carrying a heavy ba- um, basket of laundry, those sorts of things. The participants in the study reacted so positively because they just felt like they

• 59:40Speaker 02

  got their life back. And to a point, they, you know, we, we came for our bones, but we stayed because we just feel so much better and stronger. And, you know, I don't have to ask my husband to undo this particular thing because I can do it myself now. And that's just music to my ears.

• 59:58Jonathan Fields?

  And there is this mythology that I've heard also that, that, you know, quote, women shouldn't lift and women shouldn't lift heavy. And you're basically saying, no, we have research that says, I mean, that was never true. It was probably dogma from a male dominated gym scene. Um, and in fact, it can be done in an intelligent, in a way that is guided with a professional who really knows what they're doing so that they can monitor and make sure that your form is really good. It can be stunningly effective at not only building muscle and an effective lifestyle oriented movement, um, but also potentially rebuilding bone mass. I want to shift gears a little bit to talk about nutrition. And there are two things that tend to pop up. I've heard two different opinions on this lately.

• 1:00:40Jonathan Fields?

  You know, for a long time, I feel like if you were diagnosed with osteoporosis and you went to, uh, somebody to get advice and you asked, well, what should I take? Without getting to pharmaceutical interventions, often calcium was the thing that was offered. And, and not as a kid, but like as, you know, somebody in their forties, fifties, sixties. And now I've heard conflicting research that shows that actually calcium is not the thing that you should be taking at all. What's your lens on this?

• 1:01:06Speaker 02

  Yeah, this is quite a polarised area in the research. And I'm not a nutritionist, but I certainly, I spend a lot of time reading and listening to people talking about this. One school of thought is you should always get your calcium intake to a certain level. If you have osteoporosis, that's thirteen hundred milligrams a day. Another school of thought is you don't need to worry about it. Just eat a healthy diet and you'll be fine. And you should never, ever supplement. I think I fall somewhere in the middle. I certainly am a food-first person when it comes to nutrition. If you can avoid supplements, you should.

• 1:01:46Speaker 02

  We didn't evolve taking great big boluses of one nutrient at a certain time every day. If you do that with calcium, you're most likely, if you take, for example, a thousand-milligram tablet of calcium, you'll get a big splurge of calcium in your, in your system, most of which will be excreted. Some of it will actually lay down on the inside of your arteries. And if they're your coronary arteries, that's not a good thing. So that's where some of the pushback has come against calcium supplements. Because if you have too much in your system, there is a slight signal that you may be increasing your risk of heart attack. Now, there are ways around that.

• 1:02:28Speaker 02

  Because if somebody is, is really not getting enough calcium. We use calcium in many systems of our body, so we can't not have it in our blood. If you're not eating it, where do you go? You go to the calcium bank. What's the calcium bank? That's your bones. So you do need to have enough that you're either replacing what you've previously withdrawn from the bank for, for some of these processes, or that it's available circulating for you to use. I just use as a rough rule of thumb for adults about a thousand milligrams a day and try to get it through a very absorbable form. Now, the most absorbable form is dairy. There is no getting away from that. There is a very anti-dairy culture online.

• 1:03:13Speaker 02

  My reading suggests that there are not negative um health outcomes from eating dairy. Not any evidence that I can see convincing evidence. There's does seem to be very positive things that come from having dairy in some form or other. Some people are lactose intolerant. You can still have, those people typically can still have yogurt and hard cheese where the lactose is broken down. Some people have an actual allergy, a dairy allergy, and and there are ways of getting around that. You know, eating, getting your calcium from other sources. But basically, if you can, try and get about a thousand milligrams a day through your diet, something that's bioavailable. Your dietitian will be able to tell you that.

• 1:03:57Speaker 02

  There are definite subtleties. You can't just go and look in a a book and find out how much calcium is in a substance. Because, for example, in spinach, there's an element that prevents the absorption. You have to cook your spinach to be able to get calcium without the negative effects. So a dietitian is is probably the best person to see. So the answer is, a long answer to a short question. You need a certain amount of calcium to keep your calcium bank full and not be depleting it. Best source is food. Make sure you you speak to a dietitian to get the most bioavailable. If nothing's working, you cannot get it in your diet.

• 1:04:41Speaker 02

  Take a calcium tablet that is also very absorbable, like calcium citrate, and have little bits throughout the day. Don't have a great big tablet. You know, maybe two hundred milligrams at a time and spread it throughout the day. Otherwise, you're putting your heart at risk or you're peeing it out.

• 1:05:01Jonathan Fields?

  And as you said, talk to a nutritionist who can work with you individually and really like understand who you are and what your needs are. It's hard to have the calcium conversation with all, so at least touching on vitamin D, which again, I feel like has become almost equally polarized in terms of like warring factions. And you're like, should you have it? Should you not? Should you supplement? Should you not? Should you just, you know, get 20 minutes of sun in the morning? What's your take on this in the context of bone health?

• 1:05:28Speaker 02

  Yeah, well, you're quite right. You can't talk about calcium without vitamin D because if you, if you're eating calcium, you won't be able to absorb it without vitamin D. So you do need to have that. Now, there's just massive differences of opinion as to how much vitamin D you need and how much you need in your bloodstream to be sufficient. But again, I try to take a very practical evolutionary approach in that I, how would we have got vitamin D in the past? Exposing our skin to a bit of sun is probably the most practical way to do it because food sources of vitamin D are things that we have probably been discouraged of eating that much of.

• 1:06:12Speaker 02

  You know, red meat and butter and there is some in salmon, mushrooms are high in vitamin D, but there's not a lot. There are some people who may need a vitamin D supplement, people who for whatever reason, perhaps culturally they cover up and they don't see any sun or they're in a nursing home and they don't get outside. Those people probably do need a supplement. Whether or not you should be tested for vitamin D is also highly controversial because a vitamin D test from one day to the next can be vastly different. And so a lot of doctors are moving away from testing. They're just advising on how to make sure you have enough. Now, I live in Queensland in Australia.

• 1:06:55Speaker 02

  We have the highest rate of skin cancer in the world, I think, because we are white people living in a black person's country. And our skin, if we get too much sun, does develop skin cancer. This has made us very sun averse. We have a slip, slop, slap campaign here. Slip on a shirt, slop on sunscreen and slap on a hat. So we keep the sun off us to the extent that many people in Australia are vitamin D deficient. And that has repercussions, not just for bone, but for many things. So I've taken again, an approach that I think is sensible, getting some sun on my skin. At a time where the sun is not at its most strong.

• 1:07:39Speaker 02

  Never ever getting even close to being sunburned. So in Australian summer, you probably only need about 10 minutes of 10 o'clock in the morning. And that is not only good for vitamin D, but sunlight itself is good for us. There are all sorts of other things that benefit from sunlight, not just the vitamin D. So I think that's a healthy approach and should be enough. People with very dark skin need a little longer in the sun than people with very fair skin.

• 1:08:07Jonathan Fields?

  If we move on to the last category here, and it's something that you referenced earlier, which is medication pharmaceutical interventions. What's the state of that right now? Are there effective medications to help either prevent bone loss or even rebuild bone loss? And, and even if so, are they safe? Are there, you know, like, are there side effects that actually are, or without way of taking them? What's your take on this?

• 1:08:32Speaker 02

  The bone medications is also slightly fraught. I would say that there are certainly a slew of bone meds that will grow bone. And many people need them, should be on them. If they have very low bone mass, that is one way of increasing your bone bank and reducing your risk of fracture. The caveat is that they don't work for everybody. And the side effects can be quite negative for some people. Most people would be aware, if they do even the smallest amount of online Google doctoring, that the potential for osteonecrosis of the jaw and atypical femoral fracture is increased with bone drugs.

• 1:09:17Speaker 02

  Because many of the drugs, most of the drugs act to clamp the osteoclast, the ones that chomp through bone.

• 1:09:25Speaker 02

  Now, one of the roles of that chomping through bone is replacing microdamage, as we've talked about. So if you clamp down on those osteoclasts too much, some of the roles that they perform are also inhibited. Now, for someone who has jaw surgery, remember I was talking about what happens when you're healing a fracture. The first thing is the cleanup crew comes in, including osteoclasts. And if you stop them doing that cleanup, it actually stops the repair of the surgery, the surgical site. So typically, I believe, endocrinologists or GPs, whoever's in charge of the patient,

• 1:10:07Speaker 02

  recommends that you stop your meds a little bit before you have your surgery and have the surgery allowed to recover and then go back on. There are some people who think that you don't need to do that. Some people who think that the incidence of ONJ or atypical femoral fracture is so low that it's worth staying on because the risk of fracture is so much higher. And there is some evidence to show for every one person that has osteopenic process of a jaw. You know, there are multiple people prevented for having fractures. So there are just many different ways of looking at it. And I think really the answer is you have to have that conversation with your doctor.

• 1:10:53Speaker 02

  How at risk are you of fracture? And the higher risk you are, the more likely it is you do need to go on meds. Before you go on, maybe see your dentist. Check all of your teeth. Is it likely you're going to need to have oral surgery? Get that done before you go on the meds. Atypical femoral fracture is exactly as it says. It's a fracture that occurs lower on the femur, the thigh bone, than a typical hip fracture occurs. And nobody really knows why it occurs, exactly where it occurs. But it seems to be because the osteoclasts are not chewing up the little microcracks in the bone and replacing and repairing it. And those little microcracks.

• 1:11:35Speaker 02

  Cracks sort of all eventually coalesce, form a complete fracture and the femur breaks. Because those little cracks are quite often painful. Doctors will say you need to be aware, if you have any upper thigh pain, aching pain. Uh, you need to be aware of that and tell me and we'll do an X ray. And we'll certainly stop the, the drug and allow that to heal. Some drugs are, are more prone to that than others. It's a very fraught issue and I think there, it's a conversation for your doctor.

• 1:12:10Jonathan Fields?

  I would imagine on a similar vein, not really, I guess you consider pharmaceutical intervention or not, but hormone replacement therapy, as you were sharing earlier in our conversation, like one of the main differences between the bone density outcomes between men and women later in life is that once estrogen goes dramatically lower, these osteoclasts basically get let loose. That if you then start on hormone replacement therapy that increases that estrogen. It sounds like you would have similar issues to what we're talking about with certain pharma substances.

• 1:12:42Speaker 02

  The funny thing is with hormone therapy, they call it menopausal hormone therapy these, instead of HRT, they call it MHT these days. As far as I'm aware, it is not associated with the same problems. The same O N J and A F F. I don't know that for certain, but it's, that is my suspicion it's not. Now, that hormone therapy, while you're going through menopause and in the years immediately after it, it can be safely started then, and it is a very effective bone protecting agent and, and many people are on it. What happened with that, right back at the turn of the century,

• 1:13:23Speaker 02

  there was a study called the Women's Health Initiative, it was run in the U S, a very big cohort study. And, and it was discovered that the people in, um, who were taking hormone therapy were at increased risk of certain things, thromboses and embolisms, a couple of other things. What it was good for was bone and I believe bowel cancer. I think those were, it was protective there. So everybody dropped it like a hot rock and it it just, everyone went off hormone therapy and it is slowly coming back into the clinical milieu and and is being used again because people realised they threw out the baby with the bath water. This is

• 1:14:07Speaker 02

  something that probably the the negative uh side effects happen for if you start it in many years after menopause. You you can't start somebody on hormone therapy when they're seventy. It has to be in the years around menopause. Also, you don't want somebody who has a history, even a family history of breast cancer. They they tend to avoid that. But for some people, it's it's very helpful. Whether or not I would go on it, that's a personal decision, you know. People have different levels of acceptance of medication.

• 1:14:42Jonathan Fields?

  It sounds like of everything that we've talked about, whether it's hormone replacement, some sort of pharmaceutical substance, whether it's different aspects of nutrition or calcium or vitamin D, you get people on different sides. The one thing that it sounds like is has kind of become crystal clear now is that loading your your frame by some form, whether it's classical weightlifting, but basically resistance training in some way, shape or form. Would it be safe to say pretty much everyone who's even mildly informed now agrees this works and it's pretty accessible to almost anyone as long as it's done in a healthy, thoughtful, progressive, well-guided way?

• 1:15:25Speaker 02

  Okay, two things. Declaring my conflict of interest here, obviously, because we run the bone clinic and we run our exercise programme as Oniro and and we are licensing people all over the world with with Oniro and they're and they're running it very successfully. So this is because it does work and it is a targeted programme that actually works. So not any resistance training is going to grow bone, but any resistance training is going to be better than nothing. So if you can't find an Oniro provider, I I would absolutely still be saying, you know, a resistance training programme is going to be good for you. If you are at risk of of- Vastu product fracture, you still need to get some supervision.

• 1:16:05Speaker 02

  As to the other point, nobody would argue this. Oh, man, I can tell you many, many very uninformed people will still argue this and and it's because it's mainly in the primary care level. It's because GPs are so busy. They cannot keep across all the evidence that comes out for new therapies. And they don't get any training in exercise therapy and medical school. So it's not something that they have a really good understanding of. So I understand it. But what I would love is for, rather than to be negative about it and say it won't, it won't work, it won't be helpful.

• 1:16:46Speaker 02

  Is to maybe do a bit of just the briefest look, look at some, some guidelines. And and you'll see that the evidence is there and you're doing your patients a real disservice if you don't mention it to them. And particularly if you tell somebody with a T score of, say, minus three. Oh, Mrs. Smith, just go for a walk. That's actually worse than not telling them about an effective exercise intervention because not only will it not work, but you're putting that person, if they haven't been active, at risk of falling. They will go for a walk and maybe trip over a tree root or the neighbor's dog will run out and they'll fall. And they'll have a fracture. So it's not a no harm recommendation.

• 1:17:32Speaker 02

  Walking is a fantastic exercise, but for some people, it actually increases their risk of fracture.

• 1:17:38Jonathan Fields?

  It also, whatever time they're allocating to the walking, that could have been time that is allocated to a type of exercise that actually potentially would help them, especially if they have a limited amount of time in their day. So it's actually stopping them. Because it's saying, I have a half an hour to do whatever it is I'm going to do. I'll do the walking rather than saying, I'm going to do this other thing, which would potentially be much more effective. So as you described, you have your clinic where you do um work with individuals. It's in Australia. You have been training and licensing professionals, I guess, pretty much around the world for a chunk of time now. We'll link to all this stuff in the show notes here so people can find out, like, do I actually have somebody qualified near me? Even at that pace, I'm just curious, if we zoom the lens out with like you and the

• 1:18:23Jonathan Fields?

  work that you're so passionate about, it seems like the universe of people who need this type of help is so vastly larger than the world of people who are now sort of like equipped and skilled to help them. How do you dance with that?

• 1:18:38Speaker 02

  I'm an academic, first, and I'm a scientist first and foremost. So you are quite right. This is a job that is too big for me. I'm because I did open the bone clinic so that the work that we do at the university in my research lab could be tested in the real world. And it truly is a translational research facility. Every single person who comes is a research participant and we track them. We've been open for 10 years now. So we have some beautiful data. What I need is another one of me and I'm just in the process of employing another one of me so that I can get back into my lab, do what I'm, I

• 1:19:19Speaker 02

  love to do and, and this person can help to disseminate the license a little more. It's very helpful when people like you take an interest and really delve into the detail of this. So people understand why it's so important to do it. I did another podcast recently that really raised the profile in the US. So that's what helped to get a lot of people licensed over there. And I'm getting probably 10 emails a day from people around the world. Not everybody is eligible. You do need to have clinical training so that you can look after people. But the demand is huge and we're just chipping away at it.

• 1:20:01Jonathan Fields?

  One step at a time, one day at a time. Feels like a good place for us to come full circle in this conversation as well. So I always wrap with the same question in this container of Good Life Project. If I offer up the phrase to live a good life, what comes up?

• 1:20:14Speaker 02

  Ah, to live a good life, you would want to be able to do all the things that you wanted to do. And that means being physically and mentally able to do that. You need to have the time, space and capacity to do the things that you love. That's what I think is living a good life.

• 1:20:35Jonathan Fields?

  Hmm. Thank you.

• 1:20:38Jonathan Fields?

  Hey, if you loved this episode, say that you'll also love the conversation we had with Dr. Adeel Khan about cutting-edge treatments like stem cells and gene therapy to heal the body. You can find a link to that episode in the show notes. This episode of Good Life Project was produced by executive producers Lindsay Fox and me, Jonathan Fields. Editing help by Alejandro Ramirez and Troy Young. Christopher Carter crafted our theme music. And of course, if you haven't already done so, please go ahead and follow Good Life Project in your favorite listening app or on YouTube too. If you found this conversation interesting or valuable and inspiring, chances are you did because you're still listening here. Do me a personal favor, a seven-second favor, share it with just one person. I mean, if you want to share it with more, that's awesome too, but just

• 1:21:22Jonathan Fields?

  one person even, then invite them to talk with you about what you've both discovered, to reconnect and explore ideas that really matter, because that's how we all come alive together. Until next time, I'm Jonathan Fields, signing off for Good Life Project. Today's episode is sponsored by NerdWallet Wealth Partners. Making more money doesn't come with instructions. Nobody hands you a manual that says, "Congrats on the raise, here's what that does to your taxes." That's where NerdWallet Wealth Partners comes in. They're a financial advisory firm built for high earners in their 30s and 40s. The first thing they do with every client is create a financial plan. It's basically a roadmap

• 1:22:05Jonathan Fields?

  from where you are today to where you want to be. When you decide you want to retire five years earlier or spring for the bigger house, they'll run all the numbers on what's possible. And they meet with their clients regularly because they know that at this phase of life, things change quickly. Think of NerdWallet Wealth Partners as the manual for high earners that you never got, plus someone who's actually read it. Find out more at nerdwalletwealthpartners.com/good. NerdWallet Wealth Partners LLC is an SEC-registered investment advisor. Registration as an investment advisor does not imply a certain level of skill or training, nor does it constitute an endorsement by any securities regulator. Please see nerdwalletwealthpartners.com for disclosures and important information.

• 1:22:47Speaker 01

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• 1:23:48Speaker 03

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