Boost Bone Health: Key Strategies For Better Health

Kevin Ellis

I’m doing well. How are you doing today?

Laurie Marbas, MD, MBA

I’m good. Thank you for joining us. Some people might have bone health issues and hypertension, but there are going to be some underlying elements that have some overplay. But we’ll get to that in a minute. But I’d just like to highlight your story because I think it’s an important one and that some people may not be aware of young men being diagnosed with osteoporosis.

Kevin Ellis

Yes, this is so important. I mean, no matter what age you are, your bones are typically forgotten about. We don’t think about it. We just think about our bones as these structures that carry us through life, and they hold us up, and they do a good job of that. But they’re living tissues, and they help do a lot of other things. For me personally, my journey with all of this started when I was much younger and I had a lot of different health issues. One of them was chronic digestive issues, and I was diagnosed with celiac disease. I was malabsorbing nutrients for many years. Then I had a physician’s assistant who said, Hey, you’ve got celiac disease. Has anybody done a bone density scan on you? I don’t need a bone density scan. I’m a strong young male. They gave me one, and it came back and said I had osteoporosis. 

The reason for that is that when you have chronic digestive issues, your body still needs to absorb the nutrients. Specifically, calcium is the primary mineral constituent of your body, and you need it to execute daily functions; nerve impulses, muscle contractions, and all those things. If you’re not absorbing that, your body is going to go to where it can get at the most, and it’s going to go to the bones and pull from there. That’s what happened to me. I ended up developing osteoporosis right around 30 years old. This is so important for anyone who has chronic digestive issues. There’s a connection between digestion, gut health, and hypertension, too. All of these pieces that we’re talking about here are connected. It’s just that you may not be aware of or focused on a specific area or know how that’s impacted. I can tell you that your bones are affected by all the things that are taking place in your health.

Laurie Marbas, MD, MBA

Absolutely. I think it’s interesting because osteoporosis, which I’ve always tried to explain to patients, should be a pediatric discussion. Your pediatrician and your family practice doctors should be having this discussion with young parents about raising their children. You need to pay attention.

Kevin Ellis

What is interesting about that? One of our team members is a bone health and osteoporosis exercise expert who’s done this for over 20 years. She always says, Dr. Sherri Betz, that it’s a pediatric condition with geriatric manifestations.

Laurie Marbas, MD, MBA

Yes.

Kevin Ellis

I think that is so true.

Laurie Marbas, MD, MBA

Yes, absolutely. You said that even older men, people don’t think about it, but what is it? A quarter of osteoporosis is in older men, not just women.

Kevin Ellis

Absolutely. It’s men. It’s men; it’s women. Most women are the ones to be diagnosed because, right around menopause and postmenopause, there’s this decrease in estrogen in postmenopausal women, and estrogen has a protective effect on bone. When those levels decrease, that causes an increase in the activity level of cells that break down bones. But there are other causes; there are secondary causes of osteoporosis, and those could be behaviors, disorders, diseases, conditions, or medications that you’re taking. Those things can contribute to bone loss, which eventually can contribute to osteoporosis. It can happen to men, can happen to women, can happen to you if you’re 20 years old, can happen if you’re 90, and anywhere in between.

Laurie Marbas, MD, MBA

Yes, absolutely. I guess we can jump on with calcium; calcium has that dual role. You said it’s crucial for bone health and vascular function. For bone mineralization strength, but also in blood vessel constriction and relaxation. which, of course, would be blood pressure. Can we talk a little bit about calcium regulation? We talked about the absorption piece, but what is the regulation piece?

Kevin Ellis

Yes, well, you have parathyroid glands—these tiny, rice-sized glands that are responsible for regulating calcium levels within your blood. One connection there is that when you are doing any of your lab work and you’re getting your comprehensive metabolic panel done, you get your calcium levels done, and you get your vitamin D done. You also should look at your parathyroid hormone levels, because if you have a parathyroid hormone level that’s high,  and you have a calcium level that’s persistently above 10, that’s one of those hidden causes of osteoporosis that could be a parathyroid tumor. Now, these adenomas are benign most of the time, but the way to address them is to get them removed. If you’re looking at your bloodwork and you see persistently elevated levels above 10 calcium levels; 10.1, 10.4, and 11, and you see that over time, that’s not normal. You need to get that checked out, and you have to get that checked out. That’s one way to look at it. That’s one set of markers that you need to look at, too.

Laurie Marbas, MD, MBA

Absolutely. What else can help with calcium absorption? We see the regulation piece with parathyroid and some other things. I’m assuming that when we do vitamin D, which is often when we order these in labs, they are not covered unless you have a diagnosis of vitamin D deficiency or osteoporosis, it’s frustrating from that standpoint. But can you talk a little bit about vitamin D and why that is so crucial? What are your optimal levels?

Kevin Ellis

Yes, I sure can. vitamin D. For most people, if they’re thinking about their bones, they are thinking about the two primary nutrients for their bones. Calcium and vitamin D. Vitamin D helps increase intestinal absorption of calcium. If you’re bringing in additional calcium to your diet and you are taking vitamin D, let’s say before you start taking vitamin D. I do encourage people to get a test, get the 25-hydroxy vitamin D test, get that ordered, and see where your levels are at that range, which is wide, 30 to 100 mg/ml, that’s a pretty wide range. If you’re at the low end of that 30 mg/ml, you’re probably going to be told, still, it’s normal. If you’re at the high end, 100, 100, and G-mail, you still might be told that’s normal. 

If you’re on the low end, you should be boosting those levels. You need to bring that closer to the center, right from that range. If you’re in the 50s, some people even benefit from higher levels, especially those with autoimmune conditions, who could be in the 60-80 range too. That can be a good target to be on, and just monitor your levels. If you’re taking a supplement, for example, in the wintertime or the cold weather months, the sun’s rays aren’t going to be strong enough to generate enough vitamin D production. Supplementation could be beneficial for you. But if you start supplementing, check your levels every three months or so to see if the supplements are working and if you’re getting what you need to take in those additional nutrients. The last note I’ll make is that magnesium also plays a role in hypertension, too. But as you’re increasing your calcium and your vitamin D intake, your need for magnesium is also increasing; don’t take additional magnesium. You’re going to increase cardiovascular disease risk again. Super important; magnesium is important for so many functions in the body. It’s also important for rebuilding your bones, too. 

Laurie Marbas, MD, MBA

Absolutely. Can we talk about how people think about calcium embedded in me? They don’t ever get educated on the intricacies of things like magnesium and other things as well. Can you just highlight the high-level things that we should be paying attention to, whether they are diet or activity, when it comes to bone health? Honestly, if you’re looking at your bone health, many of the things that we’d encourage you to do will also help with hypertension. Can we speak to that a little bit?

Kevin Ellis

We sure can. Just to bring up one other nutrient that’s important for calcium, if we’re talking about calcium specifically and making sure it’s going to where it needs to go, we talked about calcium. Calcium; we’re talking about vitamin D; we talked about magnesium. We did not talk about vitamin K2, which is so important. K2 is going to activate osteocalcin and matrix GLA proteins. That’s going to make sure calcium goes to the bones where it’s supposed to be to help you build stronger, healthier bones and not to the soft tissues—the kidneys and the arteries. You have to make sure that you have K2. Vitamin D, and K2, those two are fat-soluble nutrients. When you’re taking these nutrients in, you’re going to want to take them with a meal. That’s going to be a good tip there. 

If we’re also talking about diet and nutrition to support your bone health, prioritizing protein is important. You want to get enough protein in your diet for your muscles and bones, and most of the advice that you’re probably sharing and that the other practitioners here are sharing is all the processed, packaged foods and all that stuff. All the stuff that we hear about is not good for us. It’s just another reinforcement. That stuff is not going to be good for your bones either. Just because it doesn’t matter how good the marketing is, if it’s got a bunch of things that you don’t understand what they are on the label, it’s probably not going to be that beneficial for you. How can we stick to better choices on the perimeters of the stores, getting healthy veggies and leafy greens? Arugula is a fantastic leafy green. I love that. Getting that healthy protein and then incorporating things like berries, too, and other good sources of vitamin C can be beneficial.

Laurie Marbas, MD, MBA

I love the soy as well as some nice benefits for your bone health, high blood pressure, and other things. Can we speak a little bit about chronic inflammation because, as you may know, processed foods in particular would be a component of that because that can increase hypertension as well? You have the inflammatory cytokines and different things that have to do with bone resorption. Can we talk a little bit about that as far as inflammation?

Kevin Ellis

Yes, inflammation is absolutely a contributing factor to bone loss. If we’re talking about nutrients, just a tie in inflammation in nutrients, one of my favorite sources of food is small fish. This could be sardines, mackerel, or wild sockeye salmon with bones. If you get them with the bones and they have protein, they have all the minerals that your bones need in the right ratios, including calcium, and they have omega-3 fatty acids. Omega-3s are dampeners of inflammation. Anything that is contributing to inflammation, especially if it’s chronic, especially if it’s long-term, that’s going to contribute to fuel, not just any of the other health issues that you have. It will also contribute to and fuel bone loss. That can be another nutrient or specific thing that you’re taking in to help combat that as well. But also prioritizing things like stress reduction and sleep improvement; those two things alone, they’re free.

They’re interventions you don’t have to pay for, and you can automatically start applying them to your life. They can help with that. They can help bring that down. If you don’t have a healthy meditation practice, gratitude practice, prayer practice, or something else that you’re doing on a given day, you might want to consider adding that. It doesn’t have to be long—20 or 30-minute sessions. It can start with a minute, work your way up, be patient with yourself, and approach that with curiosity instead of expectation, and that can turn out to be a good thing for you. I’m speaking from personal experience, being somebody who was a marine who couldn’t clear thoughts for 3 minutes at a time. Now, I  used to laugh at the thought of meditation, but now I can’t imagine my life without it. 

Laurie Marbas, MD, MBA

Well, it’s the Marines who are doing the box breathing. I’m in the Air Force, so I appreciate your service. 

Kevin Ellis

Hey, you too.

Laurie Marbas, MD, MBA

Yes, stress is the parasympathetic sympathetic play, and hypertension is a huge one. Honestly, if we can start working on the mind work and if people can’t even start the meditation, they just start with being mindful, being present, and taking a breath. You’re here; that’s the beginning. No, that’s one of my favorite things to talk about. But as far as when someone enters your program, can you describe what that looks like? Who are your clients that you’re looking for and that you would like to help? What does your program structure look like? Because again, anything we’re doing to improve bone health is oftentimes going to improve your hypertension.

Kevin Ellis

Yes, agree. There’s an overall process that, whether someone does our programs or not, they need to follow if they want to support strong, healthy bones. The first part of that process is that if you have root-cause issues contributing to bone loss or any of your other health issues, you need to address those things. There are markers that you can look at specifically for bone health, too. You can look at your bone density. You can look at your bone quality. Bone density is the mineral content of your bones. Bone quality is the structural integrity of your bones. Those things combined to create bone strength. You can get both parts of that picture. You can look at your bone turnover markers and see the activity level of cells that are building up and breaking down bone. Once you get those pieces of the picture, you start to understand, Okay, these are the interventions I need to make. Here’s how I monitor it over time: every 3 to 6 months or a year, and then you move on. You can address some of the other pieces, such as diet and nutrition. We talked about reducing the processed foods, not the high-sodium packages, and processed things too that are not going to be good for hypertension, and then incorporating stress reduction, sleep improvement, hormone optimization, and exercise. Exercise, which is so important for your bones. You can resolve your digestive issues. You can take in the right nutrients. If you do not provide the stimulus that your bones need to become stronger, they will not become stronger. If we’re talking about the specific types of exercise that you should be doing, including weight-bearing exercise and muscle strength, muscle strengthening, and resistance training exercises, 

Weight-bearing exercise is an exercise where your body and your bones work against gravity to keep you upright. You’re doing those things on your feet. They’re placing good, healthy stress on the bones. walking, jogging, hiking, gardening, playing with the kids, with the grandkids out in the yard, yoga, pilates, tai chi, and qigong. Those are all weight-bearing exercises. You want to incorporate those into your plan, but if you’re only doing swimming or bike riding every day, it’s not to say you can’t do those things, or if they make you happy or bring you joy in life, you should stop doing them. But you can’t count that as your only form of exercise because you’re not placing that healthy stress on the bones. You got to go to muscle training and strengthening and resistance training, exercise, and that’s where you’re incorporating—barbells, dumbbells, the weights at the gym, the machines at the gym. That’s where your comfort level is. Or it could be resistance bands. I use variable resistance bands. Then you want to incorporate very specific exercises. Some of my favorites for bone-building are squats and deadlifts. I know that sounds intimidating if you haven’t done it before, but you can easily ease your way into that and then have somebody work with somebody to look at your body mechanics and tell you, Are you doing it right before you start to progress up and overhead presses with axial load? Doing an overhead press, as long as you don’t have a compression fracture, is great. and then incorporating some impact box jumps or not just standard walking in the same pattern all the time, maybe going side to side. If you don’t have balance issues, go side to side, walk backward—those kinds of things.

Laurie Marbas, MD, MBA

Well, I think balance is a good thing to point out, though, because the fall is often the diagnosis or the trick for the diagnosis in many cases. Are there any other balancing activities or things that you encourage clients to partake in?

Kevin Ellis

Yes, you want to improve your balance. I mean, there’s a reason why we went out, and we have some of the top bone health exercise people on our team that specifically work with people on training in these areas. But you can do things like yoga, pilates, tai chi, and qigong. Some of these other exercises can help improve your balance as well.

Laurie Marbas, MD, MBA

Perfect. When someone comes to you and says, Hey, I’ve been diagnosed with osteoporosis or osteopenia. Can we talk about this? Is this someone who, maybe before the medications, is looking for alternatives? Do you help them understand what medications might or might not be required or have side effects? How does that process work for you and your team?

Kevin Ellis

Yes, we have a spectrum of people that we work with. Some people have relatively few health issues. I eat healthy, and I exercise. How did I get this diagnosis? Other people have lots of different health issues, including digestive issues, autoimmune conditions, and cancer. Some people have a bone density in the negative range, which is not that low. Some people have a bone density in the negative fives, which is low. Some people have had no fractures. Some have had 15 or more fractures. Some are, I would say, trying to do everything they possibly can naturally first before ever considering medication as an option. That’s where most people fall. Some people have already started one medication, realize it wasn’t the right fit, or have a bad reaction to it. They came off or wanted to come off. 

Then some people have started medication and decide they want to continue. But in any of those situations, medication is here, and all of those other things that you and I talk about still have to be done, regardless of whether the medication is a picture. It’s not; it’s frustrating because I see this every single day. Some people are,  what? I think I’m just going to stick with what I’m doing with the medication. I’m not an either-or; I’m not an either, and you still have to do all these things because you can take the medication and still have the negative effects underlying all of that too. Or you could still have a root-cause issue that’s underlying that hasn’t been addressed. But yes, we guide medications and other things too.

Laurie Marbas, MD, MBA

Yes. I care because sodium is a risk factor for hypertension and osteoporosis. Can you talk a little bit about what’s causing the bone loss with sodium excess?

Kevin Ellis

Well, part of it is that you have to have the right balance of minerals, too. If you don’t, that’s one of the things that can set off a whole chain reaction of events that can contribute to bone loss. If you’re taking in high amounts of sodium, if you’re not balancing that out with other important nutrients—your calcium, your magnesium, or your potassium—all those kinds of things, you’re going to have some issues there. Usually, you’re not going to overdo the sodium. If you’re doing the things that we talk about, where you’re saying to the perimeter, you’re incorporating healthy fruits and vegetables and lean proteins and then sprinkling in the sea salt and not just the regular sodium that you get in the diner. Incorporating sea salt and still sprinkling it on your food, I would say, is okay for most people. You’ve got to figure out what’s the right amount for you and your situation. But it’s going to be much better than just the regular table salt that you would be incorporating.

Laurie Marbas, MD, MBA

Yes, it’s probably 50 milligrams max for someone with hypertension just on that end. But let’s take a small break here, and I just want to say thank you so much for joining us today. I hope you found this conversation insightful and engaging. If you’re a summit purchaser, stay right here, because we’re about to dove a little bit deeper into this interesting conversation. If you’re not, please click on the button below or to the side and get access to the rest of the conversation. If you’re watching this, thank you for being a valuable member of our community, and let’s continue. My question would be, What is your protocol to help people? Are there other supplements? Are you ordering tests from your practitioners? Or do you tell me, having these types of things, how does that look, your customer journey?

Kevin Ellis

Yes, we use a three-step process: identify, nourish, build. Identify, and address root cause issues of bone loss, nourish the body, absorb your nutrients, and build strength of body, mind, and bone in a way that prevents fracture and injury. From a high level, it’s easy for people to understand what to do and get behind it. In that identify section, that’s where you’re figuring out what the root cause issues are that need to be addressed. That’s where you’re going through and doing the lab testing. You’re getting your comprehensive metabolic panel. You’re there looking at your calcium levels; you’re looking at your bone turnover markers; you’re looking at the bone turnover markers. We look at a specific one called Serum CTX. That’s a CT low-peptide test that looks at the activity level of cells that are breaking down bone. If that activity level is high or even elevated, that can be an indicator of active bone loss and a root-cause issue that needs to be addressed. 

There is also a marker for bone formation. If you’re looking at bone resorption, you want to look at bone formation. Two bone formation markers would be P1NP, that is pro-collagen type 1, and terminal pro-peptide. We can look at these markers in between bone density scans for 3–6-month periods. We can see bone resorption coming down; is bone formation coming up? Is the ratio between the two improving? We see that all the time, you don’t have to guess at the things that you’re doing if you’re making improvements, and with these issues, you can start to see progress in the near term before those long-term scans. I know we touched on gut health and absorption. I want to touch on one other piece that is so, so important, which is that, again, your bones are not just static tissues. They’re living tissues, their endocrine organs. 

Inside your bones, you have something called bone marrow. Bone marrow is this soft, spongy material that produces 95% of the blood cells in your body. If you need help with preventing bleeding and clotting, red, white, pardon me, platelets are going to help with that. But if you need help carrying oxygen to the body’s tissues and carrying carbon dioxide away from the tissues back to the lungs, that’s where red blood cells are going to help out. But if you need help fighting infections, healing wounds, or anything related to the immune system, that’s where white blood cells come in. The cells that break down bones are a form of white blood cells. Anything that stimulates that immune system is speaking in the same language as the cells that break down your bones. Where does 70% of the immune system reside? 

Laurie Marbas, MD, MBA

Your gut. If you have digestive issues, it’s not just a matter of whether you’re absorbing these nutrients; it’s about whether those issues stimulate the immune system, speaking in the same language as the cells that break down bones, leading to additional bone loss. If you’ve got digestive issues, too, that’s important to resolve. Yes, absolutely. That’s a definite, so many things start in the gut, and the input is so important, I guess. I’m curious: do you see people reverse osteopenia and osteoporosis without medication by just following your program?

Kevin Ellis

Yes, we see that. Our program, in its current format, has run for four years. We’ve had thousands of people come through it at this point. and it’s beyond just anecdotes at this point; now that we’ve got it, you can see improvements in the bone turnover markers I talked about. You can see those in 3 to 6 months. We see that all the time. You can see improvements in bone density, bone quality, and bone strength in one year, one and a half years, and two years. We see people making meaningful improvements in their bone density and their bone strength all the time. We can monitor them over time, too. You can do it without medication. One note I will make is that I am pro-doing everything you possibly can naturally first before ever considering medication as an option. But I am not anti-medication. I have seen situations where it’s necessary and lifesaving for some people. But for the majority of people, there is so much more that you can do. It’s not either or so before you even get to that point. There’s so much more that most people can do.

Laurie Marbas, MD, MBA

I agree 100%. This has been very enlightening, and I hope people can understand that we’re a system where all of this is interconnected. Gut health, hypertension, and bone health are also very important to pay attention to. Thank you for spending time with us today, Kevin.

Kevin Ellis

Thanks for having me.

Laurie Marbas, MD, MBA

Bye.