MS & Bone Loss: Building Stronger Bones Is Possible

Kevin Ellis

Well, Dr. Wahls, first, thank you so much for having me because this is an important topic. I am Kevin Ellis. A lot of people know me as bone coach. And my whole focus has been on helping people build stronger bones. And the reason I even got into this area as a younger male, because usually, it is not younger males talking about osteoporosis, is that I received an osteoporosis diagnosis myself in my early thirties. And part of that was I had a variety of different health issues that were contributing to that bone loss. One of which was celiac disease where I was malabsorption nutrients for many, many years. My body still needed those nutrients to execute its daily function. Where did it go to get those nutrients? It went to the largest reserve of minerals I had which were my bones and started pulling from there and then I was subsequently diagnosed with osteoporosis at an early age. 

And at that point in time, when I got the diagnosis, it was hard for me to even believe at first because I got a bone density scan and I got the results of a letter in the mail, and all that I was told to do was go on a gluten-free diet and I was like, what is osteoporosis first? I Googled it and it basically just said medications and fractures were going to be my future. And I was scared, honestly, when I read that I was scared and I just wanted to figure out what I needed to do. That is why I went down the path of the research and consulting with people and getting the right plan in place and eventually, I ended up becoming a coach to help other people building on a team of credentialed experts to help in this area. And then we have got programs that have now helped people all over the world.

Terry Wahls, MD

And I am so glad that you are doing that. My journey is not too dissimilar. I have the MS diagnosis. I am getting more and more frail and in 2004, I get my bone density. And I had one earlier, I am a farm kid, so I had really dense bones. I was almost three standard deviations above because I am a farm kid and I work so hard and suddenly I was almost osteoporotic in 2004, that was, I think, 49 at the time ad they wanted me on all those drugs and I read and I was like, well, it does not really look like that solves the problem. Let us get into how we better solve the problem. And again, let us talk about the difference between osteopenia and osteoporosis because people may not know that.

Kevin Ellis

Yeah. This is important. Osteoporosis literally means porous bone. And it is a condition that is characterized by either not enough bone formation, excessive bone loss, or it is a combination of the two of those things. And in osteoporosis, both your bone density and your bone quality are reduced and that is going to increase your risk of fracture. The way you find out you have osteoporosis is through a bone density scan. It does a scan, you lay down on a machine, it does a scan, it is very low levels of radiation and it tells you the actual mineral content of your bone and then it generates a score. And if you have got a score of plus or minus one you are going to be told that is normal and healthy if you are in that range, if you are at minus 1 to minus two point five you are going to be told that is osteopenia. We would call that low bone mass that is like a precursor to osteoporosis and if you are minus two point five or lower, minus two point six, minus two point seven, and so on and so forth, that is considered osteoporosis. And the greater that negative number becomes the more severe the osteoporosis. 

Now, most people do not get these scans done until later in life, 60s, 70s. They do not really know where their bones are, what state they are in until later in life. I always encourage people, to get it done earlier, and get a baseline so you understand, did you not build up enough bone in your younger years? Did you not reach peak bone mass? That is an important point to look at. And then also one single bone density scan that is not going to tell you what is going on in your bones right now, present day. Are you still actively losing bone? A single bone density scan will not tell you that. There is a test that you can look at called the serum CTX test, the CT low peptide test, it is a blood test and it looks at the activity level of cells that are breaking down bone. And if that activity level is elevated or even really high that can be an indicator of active bone loss and a root cause issue that needs to be addressed.

Terry Wahls, MD

Okay. I am a young person. And anyone who is in this summit, we are at risk for accelerated bone loss. And we will talk about that in just a moment. Can I just call my primary care person and say, hey, I am thinking I should get a bone density scan, I know I am only 24, I know I am only 31, how do I get them and how do I convince my primary care doc or my specialist to get me a bone scan?

Kevin Ellis

Great question. Because if you do that, if you are in your 20s or your 30s and you do not have any other things that we can talk about in a second you might get brushed off or you do not need that, you will not need it to your later in life, even people that are in their 56 years sometimes get brushed off. You do not need to worry about that, I hear that quite a bit too. We have to understand the point at which you might ask for that is probably going to be number one, either you are primary osteoporosis is when you have a decrease in estrogen in postmenopausal women. Estrogen has a protective effect on bone as estrogen levels decrease as they do during menopause that causes an increase in the activity level of cells that break down bone. When you are in that category you can use that as justification to say, hey, this is I know, this is something I need to be aware of, can we get this bone density scan ordered.  But then there is another cause of bone loss in osteoporosis. That is secondary osteoporosis and that is where it occurs as a result of behaviors, disorders, diseases, medications, and conditions. And this is the category that a lot of people who are younger would fall into. But you can still have a secondary cause and be in your 50s and 60s 70s also. What could some of those contributing factors be? Well, let us tie it into this summit specifically. There is mounting evidence that MS is associated with an increased risk of osteoporosis and fractures. And there that is for a variety of reasons. I think one of them is physical inactivity and that reduced mechanical load on the bones. Your bones need healthy stress placed upon them to maintain their strength and to even get stronger but if you have a physical activity or you are reducing that load that can be one contributing factor to osteoporosis and MS. Other ones could be low vitamin D levels, maybe it is the use of medications such as glucocorticoids, prednisone, and anticonvulsants some of those medications can contribute to bone loss. 

And then the underlying inflammatory process too, that could be something that is contributing to and fueling bone loss. Also, if we zoom out a little bit more and we look at digestive health. If you are somebody who has Crohn’s disease, ulcerative colitis, if you have celiac disease, that is where I was at, and that is where I am at. Celiac disease is this autoimmune condition where when you ingest gluten it damages the villi, tiny little nutrient absorption centers that are responsible for absorbing the nutrients from the food you eat and then shuttling those nutrients to where they are needed in the body, but if you have this condition it is damaging and blunting those villi. And I call them your roots, they are like roots in your soil. It is damaging your roots and you effectively, you are having a hard time getting those nutrients in your body that will pull from the bones to get what it needs. Those are some of the bigger ones that I would say could be contributing factors to bone loss. And when you have those situations that can be a justification that you go to your doctor and say, look, I know this is a risk factor for osteoporosis, all I am asking for is a bone density scan, can you help me? I am just looking to get some more information, some more objective data, can you help me?

Terry Wahls, MD

Yeah. And again, everyone who is listening, if your specialist does not want to order that go talk to your primary care team. I think the primary care team, I predict, would be really much more receptive to getting a bone density. Now, let us talk about food, it is one of my favorite topics. What foods are really going to be harmful to my bones and do you have food recommendations for my bones?

Kevin Ellis

Absolutely. I think this is one that, I know you talk about this, Dr. Wahls, and then also just in general most people in the health space they are talking about reducing your sugar intake. It is just important for your health in general. But I am going to give it one more for bone health because most people do not understand for just bone health why you would want to reduce your sugar intake. Sugar damages bone by triggering an inflammatory response, it helps lower your vitamin D levels, it depletes your bone, healthy minerals, calcium, your magnesium, your chromium, your copper, it inhibits the intestinal absorption of calcium and it blocks the absorption of vitamin C. Vitamin C is key for developing and maintaining a healthy skeleton. Think about this, your bones, the underlying structure is a collagen protein matrix upon which minerals are laid. Vitamin C stimulates procollagen and enhances collagen synthesis and stimulates something called alkaline phosphatase activity which is a marker for bone-building cell formation. If you are taking in lots of sugar and treats and things like that you are going to have a hard time with that, it is going to block back the absorption of vitamin C and you need it. That is one of those things that we would want to avoid is high-sugar foods.

Terry Wahls, MD

We got to get rid of the sugar. I am going to throw in if I want to get rid of the ultra-processed foods that are made from-

Kevin Ellis

The bread, the chips, the cookies, the-

Terry Wahls, MD

The flour-based products, grains that have been milled into flour dramatically chewed up our blood glucose big part of the problem. What are the foods that are good for our bones? Because we grew up hearing drink, the milk, it is not good for our bones or not?

Kevin Ellis

I am not a fan to drink a bunch of milk. Just start out by saying that. Dairy in general, if somebody is going to include that in their plan it needs to be cultured and fermented dairy so that would be the situation. But it is not right for everybody, if somebody has an autoimmune condition that they are trying to put into remission dairy’s probably not.

Terry Wahls, MD

There may be a problem.

Kevin Ellis

Yeah, it is probably going to be part of that plan. But in some situations, if somebody is not then it could be a helpful addition also. That would be where we have our kefirs, our yogurts, maybe it is a camel or goat or sheep or something like that instead of a cow.

Terry Wahls, MD

Will you explain why to the audience? Why avoid cows?

Kevin Ellis

Yeah, of course. Of course. There would be a different type of protein. A1 protein in cows a lot of times is what would be consumed. A lot of times people have a hard time with that. And then A2 would be found more in things like the goat, the sheep, and the camel, camel can be a great option too, and water buffalo also could be another one.

Terry Wahls, MD

I can not tolerate that. And some people can tolerate that, but I cannot. It is true, my face pains. I have tried, but it was disastrous. And for 200 million years which is a long time, mammals have been raising our young with milk. So milk is a superfood before you fused your growth plates. It has a lot of growth factors really good for us. And maybe it is why the Europeans dominated the world for a long time because we were the first ones to use dairy. However, remember it has all those growth factors. Once your growth plates fuse, those growth factors can either make me fat or make me cancer and I am not a fan of either one. I prefer to have nut milk and coconut milk. And though I love cheese, I do not personally have it. My daughter has it occasionally, Jackie has it occasionally and they always have the goat cheese and that works well. They do not do it all well with milk. I expect that there are a lot of good things that happen in the fermentation process that may be managing some of those growth factors, but I do not know. Back to you, Kevin.

Kevin Ellis

And I would say too, it is not something, just like with any food that any of us have tried on our health journeys, you try it and it may not work for you and that is okay and then we just make adjustments and we try to see what else could work. And I always encourage people, especially as it relates to food, to approach things with curiosity instead of expectation. When you remove that your disappointment is going to disappear. I will say that again, approach things with curiosity instead of expectation, when you remove the expectation your disappointment will disappear. So we were just talking about dairy, for example, a lot of times people try to rely on that for a good source of calcium. Well, if I am not getting dairy, what are some other sources of calcium that may not potentially be as inflammatory for me? I like fish and specifically, I like fish that have the bones in and you would have to get them in like a can for this, BPA-free can ideally, and this would be your salmon, your mackerel, your sardines. I love these. And if they have got the bones in, the reason you want the bones in, and they are not hard poky bones that are going to hurt your mouth to almost kind of melt in your mouth. I know I am not making the case for some people for fish right now. But I will say the reason I like them is, number one, they contain protein. Again, your bones are 50% protein by volume, they need amino acids so you got to get that protein. And to support and maintain your muscles too. Your muscles and bones are tightly connected also. That fish is going to have that protein in it. And then the fish also have if they have got the bones in all the minerals and nutrients your own bones need in the right ratios that nature has put them in. That can be another great source of calcium for you also. And then it has Omega-3s. And Omega-3 fatty acids are the dampeners of inflammation. Anything contributing to inflammation, especially long-term that is going to contribute to your bonus. I really do like these fish too.

Terry Wahls, MD

Okay. And I like those as well. I think they can be super, super helpful. Now, what do we have about greens? What about kale, collards, and mustard greens? Are they sources of these minerals?

Kevin Ellis

They are a great source. One of my favorite greens is arugula. Arugula is one of my favorites. It is a leafy green, the same cruciferous family of vegetable broccoli and kale rich in potassium, folate, vitamin C, vitamin K, and bioavailable calcium, and also contains a bioactive compound called erasin which is a really neat compound which can help dampen the activity level of cells that break down bone, it is also a bitter food. And a lot of times our diets today are devoid of bitter foods. And the reason we want bitters is that it helps stimulate that bile production. And also, we need that bile to help break down and emulsify fats and absorb our fat-soluble nutrients, vitamins A, vitamin D, vitamin E, and vitamin K. Those are really important. I love arugula. And I would say that is one of my absolute favorite ones. And then I love dino kale, lacinato kale too, that is another really good favorite one of mine that can easily be incorporated. And I know you talk a lot about different greens and ways to incorporate them too. 

Terry Wahls, MD

Mustard greens really great source of calcium as well. And they have a lot of carotenoids that are really great for our retina in our brain. And they have a lot of magnesium which also in. Kevin, you can fill us in here. Magnesium is important for bones.

Kevin Ellis

Very important for bones. I think one of the most important. A lot of times people think of just calcium and vitamin D when they think of the nutrients that are important for their bone health. But magnesium is really important as your vitamin D in your calcium intake increases so too does your need for magnesium. That is important to keep in mind. And then also, as you take in your proteins, you break those proteins down and they get absorbed in amino acids and they need to be rebuilt inside your body into new tissues, into new things, into new muscle and bone. In order to rebuild anything inside your body you have to have magnesium to do that. Magnesium is incredibly important for just your general health. It is involved in so many processes in the body but also specifically for your bone health too.

Terry Wahls, MD

When I was looking at the enhanced data for another talk that I am giving, we consistently do not meet our requirements for calcium, or magnesium, or vitamin D, or vitamin A, vitamin C, and all of these really key nutrients which brings me up. We have not talked about vitamin A yet or vitamin K, what are their roles in Bone health?

Kevin Ellis

Yeah, Vitamin A’s, I mean, these are the fat-soluble nutrients that are so important. I mean, vitamin K too is so often overlooked. When we talk about vitamin K there are two different types. We will talk about K1 and K2. K1 can be converted to K2 but not efficiently. K2 is important for bone health. Also, K2 aids in bone mineralization and formation by activating something called osteocalcin and matrix GLA protein. And what that does, it helps the bone mineralization, but it also helps make sure that that calcium that you are taking in is not going to your soft tissues like your arteries, your kidneys, and things like that. That is really important.

Terry Wahls, MD

Hang on for a moment. For everyone who is listening, these same compounds, we now know at least in the animal models are important in remyelination. Vitamin K2 is a super important nutrient for us. Where do we get that, Kevin?

Kevin Ellis

Well, so if we are talking about K1, K1 is going to be your dark green veggies that we were talking about earlier too. Dark green veggies, asparagus, kale, broccoli, and chard, those are all great sources of k one. K two and K4. Now, there are a lot of different MKs but we will talk about the main ones that most people talk about, which are MK4. MK7. MK4, beef, liver grass-fed ghee and butter, dark meat chicken, pastured egg yolks, and EMU oil is actually a source of K2 and K4 also. K2 and K7 this would be your fermented foods, your sauerkraut, your kimchi, your natto, bacterial fermentation in our guts even. That is pretty amazing, the bacteria in your gut can actually produce compounds and nutrients to help support your health. That is amazing.

Terry Wahls, MD

I would remind everyone who is listening that when we are talking about the animal sources of K2 I assume that needs to be an animal that is eating grass and algae that if there is a confinement to a carefully confined agricultural feeding operation, they never see sunlight they are just getting corn. Do they have K2?

Kevin Ellis

This is such an important point. You are what you eat eats. The input into that animal becomes the input into you. And if that cow is grazing on beautiful green lush pastures far off the highway and it is really happy playing with other cows in the field, what comes from that animal is probably going to be a much better product and much more nutrient dense and rich in the things that we would benefit from with our own health than if they are sitting on a feedlot being fed corn and grains that were sprayed with pesticides, all kinds of other chemicals and things like that and they are not in a good healthy happy environment.

Terry Wahls, MD

Yeah. It is a very different profile in terms of the mineral content, the vitamin content, and the health of those animals that are from a regenerative farm or a farm that is grass-fed and grass-finished. And you want to be sure that you are looking when you are buying your meats that it is not just grass-fed but grass-finished as well.

Kevin Ellis

Absolutely.

Terry Wahls, MD

Okay. I think we have covered the foods to add and the foods to remove. Are there dietary plans that you think are particularly helpful? There are a lot out there, Paleo, Mediterranean, vegetarian, vegan, McDougall, Swank, my plans, and the various Wahls plans. Do you have thoughts about any of those?

Kevin Ellis

Yeah. I mean, number one, obviously, it varies for every single person. Some people that can be on a Mediterranean diet that are including certain foods that might not work for somebody that has an autoimmune condition also because when you are pulling out things like because you have got to pull out the grains, the legumes, those kinds of things also. Certain plans may not work for certain people. And I think what is most important is even if you are starting with, Dr. Terry Wahls, within your plan, people are finding the right foods consuming foods, but even within that I am sure they are testing things that work for their own self.

Terry Wahls, MD

Well, I want them to. I want people to pay attention and listen. And if there are foods that I have said are really good for you but every time you eat it your body says, no, I am feeling really bad, listen to your body by all means.

Kevin Ellis

100% right. Because we can listen to this superfood, it is going to be so great for our health and you have to eat this specific thing. If it creates inflammation in your body it is not a health food for you. You can make note of those things as you hear them like as we are talking to, just make note of these things and just again, approach it with curiosity instead of expectation.

Terry Wahls, MD

I love that. Let us talk about exercise.

Kevin Ellis

Exercise is so important. I mean, we are talking about nutrition giving us the inputs. And then gut health is also important. You need to actually be able to absorb those nutrients, but you can take in the right nutrients and actually absorb them. But if you are not providing the stimulus that your bones need to become stronger you are going to have a really hard time maintaining them and they are not going to become stronger.

Terry Wahls, MD

Hang on. Everyone, we are talking about gravity. You need to have gravity on your bones. And we have to have stress, the stress of gravity is a good thing. Now I hand it back to you, Kevin.

Kevin Ellis

Yeah, absolutely. The stress of gravity is really important. And most people when they are told to exercise, especially as people as they get older they are just told, hey, do some walking, that is all you need to do, that is not going to be enough, it is helpful, you want to keep walking, keep doing that, that is important to do, but it can not be your only form of exercise. Your muscles need two different types of stimuli. They need muscle pulling on bone and they need impact. The most effective interventions are going to use one or both of those things in combination. And there are different types of exercise too. You had just mentioned, Dr. Wahls, people want to incorporate weight-bearing exercise and this is where your body and your bones are working against gravity to keep you upright. There are things you are doing on your feet, that are placing a good kind of healthy stress on your bones, this would be your walking, your jogging, your hiking, your gardening, your dancing, your playing with the kids and the grandkids or it could be your pilates, your yoga, your tai chi, your qigong, those kinds of things fall in a weight-bearing also. Those are great. We want to incorporate those things. And then there is also non-weight-bearing exercise though and that is where your body and your bones are not working against gravity to keep you upright and this would be things like your swimming or your cycling. And this is the same thing actually astronauts face when they go up in space. We do not have gravity, we do not have that stimulus so you actively have to work to maintain that otherwise, you will lose it, If you do not use it you will lose it. I just touched on swimming and cycling specifically is not being weight-bearing exercises. If you are doing those things and you enjoy those things it does not mean to stop doing them, especially if they make you happy and they bring you joy, they provide a stress relief. That stuff can not be overlooked either, the benefits from that can not be overlooked either. But you have to know you can not just swim every day and just say, gosh, I got some good cardio and that is my only form of exercise because we have got to get that stimulus on the bones and that is where we bring in the next type of exercise which is resistance training and muscle strengthening exercise. And that is where we are incorporating things like resistance bands, or maybe you have got some dumbbells or some barbells, or maybe you are using machines at the gym and all of those things can help you, but you need to make sure you are incorporating that type of exercise too. Now, some of the most helpful specific exercises when it comes to your bones, squats, deadlifts, chin ups, and overhead presses, those can be some really helpful ones. But if you are listening to this and you are like, gosh, that is intimidating, or I do not know if I can do that, or that may not be the right fit for my situation, that is okay, all you have to do is start where you are as you are with what you have and you slowly start to progress up to where you are providing that stimulus that you need. You have got to be patient with yourself, work within your body mechanics, learn your body, and learn what is right for you. And one solid workout is not going to build your muscles or your bones overnight, it is a process over time.

Terry Wahls, MD

Okay. Now, if I get low bone density, osteopenia, or osteoporosis, am I definitely going to get a fracture?

Kevin Ellis

Fracture is not guaranteed. It is not guaranteed because just because somebody has low bone density the mineral content of their bone does not mean that the structural integrity necessarily is bad. There is bone density which is the mineral content, there is bone quality which is the structural integrity, the microarchitecture, and how that bone is organized, those two things combine to create bone strength. Sometimes people only have part of the picture when they get bone density, they only have their bone density score, they do not have the bone quality piece too, there is that. And then the other part of this is it is not guaranteed because there are proactive things that you can do to start moving in the right direction, to turn this around, to reverse that bone loss, to actually build bone strength. You can build bone strength and I think that is a really important part of this. And then also one of the major contributors to fractures is people’s age is falling. How can we improve our balance? How can we prevent those falls which are going to, in turn, prevent fractures in the future?

Terry Wahls, MD

Okay. Well, Kevin, this has been wonderful. I could talk to you for hours but we should really be wrapping things up. Let me ask you, what is the one thing you would like people to take from our conversation?

Kevin Ellis

I mean, I think the biggest one is on anyone’s health journey just be patient with yourself. Know that things are not going to be perfect the first time you try them or test them out and that is okay. Just be patient with yourself. You just need to know where you want to go, you do not need to know where every single step is placed just day one. Just set that vision, hold that vision, move in that direction and that is going to be just a wonderful place to be. That is what I would encourage people to do.

Terry Wahls, MD

Okay, Kevin. This has been so helpful. Where can people go to find you for even more information?

Kevin Ellis

Wonderful. You can always find me at bonecoach.com. We have a ton of free resources over there. And just helping people get the right plan in place for addressing bone loss, building bone strength and just having an active future. I think that is just so important. And then you can always find me on the social channels you can find me at BoneCoach Kevin on Instagram and @BoneCoach on Facebook and YouTube. And we have got a podcast too that Dr. Terry Wahls, you will be on there very soon, I am sure.

Terry Wahls, MD

I am totally looking forward to that. Thank you so much, Kevin.