HPN 38: Holistic Approach To Building Bone Density and Lifestyle Medicine Part 3: A Fresh Perspective on Physical Movement and Nature Immersion

October 6, 2023

Welcome to episode 38 of Holistic Performance Nutrition (HPN) featuring Tawnee Gibson, MS, CSCS, CISSN, and Julie McCloskey, a certified holistic nutrition coach and personal trainer, who you can find over at wildandwell.fit. On this episode:

 

Allison L. asks:

Building Bone Density (for a Masters Female Athlete)

First, a huge thanks for all the podcasts over the years. I have listened so much whenever I have a question I can hear you and Lucho discussing it in my head.  

But here’s a new one for HPN:  

I am a 60 year old female marathon runner who recently had a DEXA scan showing 

SPINE RESULTS: T score at L1-L2 is -2.0 with bone density of 0.920 g/cm2. L3 and L4 excluded from diagnostic analysis because degenerative change artifactually elevates measured density at those vertebral levels. Technical quality of the study is good.

HIP RESULTS: Low bone density value at the hip is a T score of -0.5 and bone density of 0.967 g/cm2 at the right femoral neck. Technical quality of the study is good.

GENERAL COMMENTS: The patient has low bone mass by WHO criteria. Fracture risk is elevated. A T score of -2.0 at the spine corresponds to an increased risk of fracture approximately 4 times that expected when compared to a young adult reference population. There is significant discordance in bone density at the spine versus hip, a finding which can sometimes suggest the presence of occult medical contributors to bone mass loss. A careful search for correctable contributors to bone mass loss is therefore recommended.

I am guessing the 25 years of running 20 miles a week helps the hips, while swimming and biking do not hurt but don’t help.

Calcium 94

Vitamin D 64 ng/ml.  

No history of REDS. 

Height 5′-7″ weight 145

I am going to tr Dr. Fishman’s 12 poses for Osteoporosis. 

Do you have any good exercises? 

What the coaches say:

The yoga poses mentioned

• Based on this study:Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss
• “Yoga poses were selected specifically to produce torque and bending of the proximal femur, compression of the pelvis, and twisting of the lumbar vertebral bodies. The choice was determined because these are the most common sites of osteoporotic fractures and the anatomical regions measured by the DXA scan. However, osteoporotic fractures frequently occur in the thoracic spine, the forearm, and the ribs. These sites were not studied and might not respond to yoga directed toward them in the same way.”
• Also, maybe an unintended “side effect” and uncontrolled variable of stress reduction via this yoga practice that helped on a biochemical level? (Nutrients, hormones, gut, etc)

Literature:

Osteoporosis: Exercise Programming Insight for the Sports Medicine Professional

• Bone loss may begin to occur after the age of 30 when the rate of bone remodeling begins to decline. In women, bone loss accelerates after the age of 45 when estrogen production slows and menopause begins usually at an average age of 51 (¹¹). Women transitioning into or who have entered menopause have a much lower estrogen level, which can lead to a 2–3% loss in bone density in the first 5 years after menopause (⁴¹). (REF)
• Primary (type I) or “postmenopausal” osteoporosis is the most common type of osteoporosis which results in trabecular (spongy) bone loss (^23,41,42). Estrogen deficiency is believed to be the main underlying cause for this form of osteoporosis (²⁶), which is why women are 8 times more likely to get primary osteoporosis than men (²⁵).
• Factors assoc. With primary/postmenopausal osteo (Q: how many of these does she have?)
• Also secondary osteoporosis can occur at any age and is often caused by chronic diseases, endocrinopathies, metabolic conditions, nutritional deficiencies or absorption disorders, alcoholism, and certain medications (Table 3) (^{23,26,32,41,42}). often results from an age related vitamin D deficiency which leads to poor calcium uptake, increased parathyroid hormone release, as well as bone resorption (¹⁶). (Her D levels look good- however again blood levels may not tell the whole story of what is happening)
• E.g. ref this podcast ith Sock Doc on testing vit D levels in which he said: Vitamin D is another example that we can’ trust that one marker along- don’t jut test 25-hydroxy Vitamin D, also test the 1,25-dihydroxy vitamin D to measure the balance between the two. But few people do this. If you see levels go up with supplementation then plummet back down after you stop supplementing, then that could be indicative of needing to test both. But then where does the testing end?
• Factors assoc with secondary.

Look at from a functional/holistic/nutrition perspective:

• Ca & D are important but more to bone than calcium and vitamin D
• Manganese (Mn) is also an important bone health mineral
• Manganese supplementation can increase both bone mineral density and bone formation [24] (ref)
• Eg) for healing Stress fx  or bone injury, Your body needs a lot of Mn, eg up to 50-100 mg for a short period of time!
• Also: magnesium, copper, zinc, and silicon.
• EAs often have Cu deficiency, and we’ve talked about Mg deficiency being prevalent! Zinc… gotta be careful of chronic supp which can create imbalances, look to food form
• Silicon and bone health
• Calcium—a different perspective:
• Caution against supplementing with calcium! The issue is not often needing more Ca but rather, we need to stop stealing it from our bones. Even if blood levels are good, we could be stealing this mineral from bones.
• Body pulls calcium from bones when the blood and tissues are too acidic, i.e. excess caffeine, poor diet, chronically high cortisol issues/HPA axis dysfunction, overtraining syndrome, not resting enough, and/or too many other high stressors in life.
• Bottom line: again it goes back to addressing diet and lifestyle.
• Calcium, no evidence that you need more than a normal dietary intake.
• 1300mg/day? We get enough. Dairy, seeds (chia, sesame, poppy seeds), canned fish with bones, beans/lentils, whey protein.
• Bones are alive, they are constantly breaking down and building up and getting remodeled every day/week/month/year of your life depending on the stress and loads that they are exposed to or NOT exposed to.
• 1 in 2 women and 1 in 5 men over 50 will have an osteoporatic fracture in their lifetime.
• Consider this, from a research perspective:

Potential mechanisms linking psychological stress to bone health

Strength training thoughts

Effect of weighted exercises on bone mineral density in post …

• Results: The review revealed evidence to support the effectiveness of weight training exercises to increase BMD in postmenopausal women. The increases in BMD were site-specific and required high loading with a training intensity of 70% to 90% of 1 RM for 8 to 12 repetitions of 2 to 3 sets performed over one year duration.
• Conclusion: Weighted exercises can help in maintaining BMD in postmenopausal women and increasing BMD of the spine and hip in women with osteopenia and osteoporosis. The exercise program must be incorporated into a lifestyle change and be lifelong due to the chronic nature of bone loss in older women.

the effects of differing resistance training modes on the preservation of BMD in p

• Abstract: This meta-analysis synthesized current evidence from 24 clinical trials to evaluate the impact of different resistance training modes on postmenopausal bone loss. Exercise interventions were categorized into two training modes, namely resistance-alone versus combined resistance training protocols. The combined resistance training protocols were defined as the combination of resistance training and high-impact or weight-bearing exercise. The results suggested that the combined resistance training protocols were effective in improving bone mineral density (BMD) at the femoral neck and lumbar spine.
• Results: Twenty-four studies were included in the overall analysis of skeletal response to resistance exercise. The between-study heterogeneity was evident for the hip (I (2) = 46.5%) and spine (I (2) = 62.3%). The overall analysis suggested that resistance training significantly increased femoral neck BMD (SMD = 0.303, 95% confidence interval (95% CI) = 0.127-0.479, p = 0.001) and lumbar spine BMD (SMD = 0.311, 95% CI = 0.115-0.507, p = 0.002) in postmenopausal women. However, subgroup analysis indicated that combined resistance training programs significantly affected both the hip BMD (SMD = 0.411, 95% CI = 0.176-0.645, p = 0.001) and spine BMD (SMD = 0.431, 95% CI = 0.159-0.702, p = 0.002), whereas resistance-alone protocols only produced nonsignificant positive effects both on the femoral neck and lumbar spine BMD.
• Conclusions: Combined resistance exercise protocols appear effective in preserving femoral neck and lumbar spine BMD in postmenopausal women, whereas resistance-alone protocols only produced a nonsignificant positive effect.

Example exercises

• 2 Pulls: rows and lat pulldowns
• 2 Presses: push-ups and OH or Chest press?
• Hips: deadlifts, RDLs, kettlebell swings
• Full Body: squat, hinge, lunge, UB press and UB pull, plyos? Proprioception/balance work to prevent falls/fractures?

Lifestyle Medicine & the Roots of Wellness 

Part 3: #5-7

• Refresher (listen to these first is you haven’t already!):
• HPN 36 – Intro + #1-3
• HPN 37 -The Research + #4

Our list continues…

5. Physical movement 

• Consistency + moderation; for this crowd we can say that extremes ok as long as you’re healthy and taking time to recover from them.
• Discipline to show up; discipline to hold back. Depending on where you’re at, discipline goes both ways!
• Eg) movement snacks/strength training in kitchen and dining room while kids are eating. But also those high stress times when less is more… Figure it out!
• But on flip side if lots of red flags, don’t try to PR! Don’t force the physical exertion, maybe some gentle yoga and mobility and getting IN your body is preferred.
• Find your happy medium. Be INTUITIVE… not so stubborn and relentless, at least, this is the case when viewing as a lifestyle medicine standpoint.
• Also, don’t be AFRAID of the physical if it hurt you in the past. Trust you can do it wiser this time without the pitfalls and setbacks to health.
• For endurance athletes (obv): strength training super important in season and not just during the shoulder seasons. Low volume heavy weight to keep all your shit together as you enter that season of being in a catabolic state
• Def get to know yourself and know whether it’s time to go for it, time to dial it back, or time to take an extra rest day or 2 or a full week or 2 off. I had some early season burnout I talked about last episode and knew I had to scale back the miles, “running through it” wasn’t the way to getting my mojo back…and turns out you can still crush your race without training like a maniac! Hard work is super important and valuable in so many ways, but a lot of us tend to think “if some is good more must be better” and completely overshoot
• Fitness routines post-race.
• Fitness as a lifestyle is so critical to good health. Exactly what you said, find that happy medium. Something you look forward to most of the time, somedays do something really uncomfortable, and overall less sitting and more movement snacks over the course of the day!

6. Connection to nature 

• No matter the season, we have to get in sunshine (even on a cloudy day), practice grounding, etc.
• There are ways to offset this in dark, cold season 🙂
• If you live in a concrete jungle consider this, how often are you getting outside of the city life? How do you feel in one environment vs the other?
• The thing is, there’s plenty of research on this topic and plenty of naysayers and claims of pseudoscience, so follow your intuition and test these things for yourself, no harm in trying… only the potential to help!
• Turn your phone off and go for a long hike or walk, must turn off “the switch” – listen to the birds, the creek, the waves, whatever noise nature is giving you
• What connecting with nature does for me – allows me to breathe again. During packed weeks I feel like I am living in a constant state of inhalation, all up in my traps. When I connect with nature I’m able to exhale and connect with myself again. And there is nothing better for our health then remaining in connection with ourselves
• Helps so much with perspective – “omg, the world is so big and I am so small…does it REALLY matter if the clothes are not folded correctly? Why am I stressing so hard on the small things when the world is this big and beautiful?”

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