Kevin Ellis

Sharon, thanks so much for having me. It's great to be here.

Sharon Stills, ND

Yes, such an important topic. One I deal with with my patients every day, and something that's on everyone's mind. So I actually did not know that you had your, we always think of osteoporosis as we own that, the women own that, but tell us your story.

Kevin Ellis

Yes, so it is kind of shocking, right? When you see a younger male or hear about a younger male having been diagnosed with osteoporosis at a young age, and for me, it was equally as shocking. At the time that I was diagnosed, I had all these other health issues that were taking place. I had poor sleep, high stress, and fatigue. I had hormone issues and digestive distress, digestive issues. And then all my health issues came to fruition, and I was diagnosed with celiac disease and then subsequently diagnosed with osteoporosis. Celiac disease, for those who are not familiar, that's where the ingestion of gluten damages the villi in the small intestine and prevents you from absorbing nutrients. Those nutrients, like calcium, vitamin D, and phosphorus, are super important for your bones. I was having a hard time absorbing those nutrients. My body still needed those nutrients to serve, to execute its daily functions. And those nutrients were being raked from my bones. And that's what ended up contributing to osteoporosis at such an early age for me. And I was completely shocked at that point in time because I had young kids that were on the way, that I was just worried I wasn't going to be able to be there for them. And I set down this path of, How do I figure this out? I have to make improvements. I have to improve my health. My father, he passed away at a really, really young age. When I was, my mother was five months pregnant with me; my father was told he had cancer; and two months after I was born, he passed away.

Sharon Stills, ND

Oh.

Kevin Ellis

So I had this fear growing up that I was going to follow down that path. And when we had kids on the way and I was told I had osteoporosis, I was like, Oh my gosh, I am living this nightmare that I never wanted to live. So I had a really strong reason to figure this out, so I went down the path of reading, and research, and consulting with experts, and spending a lot of money, and trying to figure all these things out. And I started making progress; I was improving my health, improving my bones. And I got to the point where I realized that, in this journey, it is not the average 30-year-old male that's trying to figure this out. It's the average woman who is 45, 65 plus, that has osteopenia, osteoporosis diagnosis, and they're presented with four things. Take your calcium, vitamin D, go for a walk, and take a bone drug. And that's woefully inadequate. And that's really the reason why I set down this path to create BoneCoach, became a coach, built out a team, developed these programs, and created Bonecoach.com, because this was such an important area that I knew I could affect some great change in. So that was really my passion story leading into this whole journey.

Sharon Stills, ND

Wow. I am sorry of the loss of your dad at such a young age, but such a good reminder that we are not we are not our family history necessarily, that we can change the way our genetics express themselves. I see that all the time in practice where patients get really nervous because they're turning 53 and that's the time their mom died, and that we have the power to make differences. And your story is so inspiring that from a serious condition, you totally turned it into rainbows, and happiness, and health and benefit for the world. So that's super. So, all right, let us do this now that we know why, because I would imagine some women are like, Well, why is this man going to tell me about my bones? This is a woman's thing.

Kevin Ellis

Oh Yes! Trust me, I get that all the time. Once people come into our ecosystem and they understand me a little bit and where I come from, they start to come around they realize I am pretty knowledgeable in this area.

Sharon Stills, ND

Yes, you are in the trenches. You are there. And that's common with celiac disease and gluten. So that's just a good connection for women to have. So let us talk about it, just in case most people have an idea of osteopenia, osteoporosis, but let us hear exactly what it is, just so we all start out on the same foundation of understanding what this actually is.

Kevin Ellis

Absolutely. I think that's a great place to start. So osteoporosis literally means porous bone, and it's a condition that's characterized by either not enough bone formation, excessive bone loss, or it's a combination of those things. And in osteoporosis, both your bone density and your bone quality are reduced. So the way you find out if you have osteoporosis is through what's called a DEXA scan. Dual Energy X-ray Absorb Geometry. It's a painless test, kind of like an x-ray, with very low levels of radiation. You go, you lay down on the machine, the machine does a scan, and it tells you your bone mineral density, the actual mineral content of your bone. And then what it does is it generates a score, and that score is called a T-score. And the T-score is telling you how much your bone mass differs from the bone mass of a healthy, average, approximately 30-year-old adult. And if you've got a T-score of plus one or minus one, or zero, that's an indicator that your bones are normal and healthy, right? If you've got a score of negative one to negative 2.5, that's considered osteopenia, or low bone mass. And that's like a precursor to osteoporosis. And if you have a negative 2.5 or lower, a negative 2.6, a negative 2.7, and so on and so forth, that's considered osteoporosis. And the greater that negative number becomes, the more severe the osteoporosis and the greater the risk of fracture. So most women are, you are not getting these scans done, and usually, in my opinion, until it's too late. I would prefer to see people get them done, baselines done in their 30s and 40s, but a lot of times they're not getting them done until their 50s or 60s. As a check in the box, their doctor orders them, they get this scan done, and then they realize, Oh my gosh, I have low bone density; what do I have to do now? And that's kind of the starting point; usually, where I am meeting people at is right at the point of diagnosis.

Sharon Stills, ND

Right. I think that's really important. If you are going to use DEXA as a way to measure, then you should be doing your own, because everyone has different bone structure, and it is inaccurate if you are all of a sudden showing up at 50 or 60 and doing a scan, and now you are being measured against this amorphous average 30-year-old. And so it can be really misleading. And so in everything, it is always good to get your own thumbprint of what you are so you can measure against yourself. it's why I have my patients get their children to start doing blood levels and things, just so we can be tracking and seeing. it's much easier to prevent or to understand if we have something to look back at. So yes.

Kevin Ellis

You are speaking my language. You are speaking my language here. Okay, so you actually, you just touched on something though, which is great, right? Just because you get a bone density scan, that's not the whole part of the picture, right? When you get your bone density scan, that's telling you your bone density. The measure of how much bone you have. The actual mineral content of your bone. But there's another part of that picture you probably don't have, and that's your bone quality. And that's how that bone is organized. The microarchitecture is the structural integrity of that bone. Bone density and bone quality combine to create bone strength. So a lot of times, you only have part of the picture. Now, to get that full picture, that full bone quality picture, there is an add-on software to a bone density scan called a TBS, a Trabecular Bone Score. And you can ask for that, and there is also you can go look it up and see if there's one in your area that may or may not have it. But if you can get those done at the same time, you can leave with a measure of your bone density and your bone quality and a better representation of your bone strength. Because bone quality is really, really, really important. I have seen people that have been in the negative threes with their bone density that have never fractured, right? I have seen people that have been in the negative ones, and what would technically be considered osteopenia, that have fractured multiple times. And a lot of the reason for that's that bone-quality piece.

Sharon Stills, ND

Exactly.

Kevin Ellis

So super, super important part of the picture.

Sharon Stills, ND

Super, super important. And while we're just talking about testing, from a functional perspective, N-Telopeptide or urinary, can you speak to that also?

Kevin Ellis

Absolutely. So I love this question because it goes a little bit further than just taking the bone density scan, as that's the final result; here is your medication, because there is still more to the picture that we need to understand. And you don't know, for example, if, when you get that bone density scan, if you are still actively losing bone right now, right? And you have to understand that before you move forward. And I always tell people to imagine your body is like a bucket, right? And the water within that bucket represents your bone mineral density, the measure of how much bone you have. Imagine that bucket has a tiny hole in it with a very tiny leak. And over time, over years and years, that water level gets lower and lower and lower. That is what's happening with your bone density, right? Until one day you go and you get that scan, and you realize you have low bone density. But when you get that scan, you don't know if there are still holes in your bucket. If your bucket was just not full to begin with. And you have to make, you have to understand those things before you start jumping into a medication. So in terms of understanding if you are actively losing bone, there's a test called the C-Telopeptide test. A Serum CTX. That is a great measure for bone resorption and bone breakdown. There's also NTX, N-telopeptide. That is another way to look at whether your bones are actively breaking down or not. Because if that activity level is elevated, that can be an indicator of active bone loss. At the same time that you are looking at the activity level of bone loss or bone resorption, you also need to be looking at bone formation markers too. The bone formation markers are P1NP, Procollagen Type 1 N-terminal propeptide; that's a good one. Osteocalcin is another one. And bone-specific alkaline phosphatase. That gives you a really good picture, and if you, I would always suggest, when you get a bone density scan, try to get as many of those as you possibly can. At the very least, get your C-Telopeptide, or urine NTX, or something like that, at the very least. But if you can get more of those for your baseline, get them, because that's what we need to monitor future changes from three to six months down the road, especially if somebody is still actively losing bone and something is contributing to that loss. In three to six months, we need to see if we're addressing those root-cause issues and if those markers are improving.

Sharon Stills, ND

That is great, so now you have it, like you have the information and you have why, so you can go to your physician. And if, in hearing why you want this and why they are important, your physician does not want to run these levels for you, it is time to go find a different physician, right? Like-

Kevin Ellis

True. Absolutely. Sharon Stills, ND I run these levels on patients and I am always open. If someone comes to me with something I am like, Oh, I'll just add that into my blood levels that I run.

Kevin Ellis

So why might a physician not want to run those tests? Well, let us see. If you are going to your general practitioner, for example, and they've just gotten your DEXA scan results back and they're giving you the results and they just say, Here's your Fosamax, well, that might not obviously be the right approach moving forward, then you ask for some of these bone turnover markers, and they say, No, they're not going to order them for you. Part of the reason may be because they're not familiar with their interpretation. If a physician orders a test and they don't know how to interpret that test, it could create a liability for them also. So what they may do is they may try to refer you out to an endocrinologist, who then may or may not actually order that test for you. So I like what you are saying here, Dr. Sharon, because in these situations, if you have somebody that has a functional background or understands that side of the picture, they're more likely going to be able to order those tests and understand the interpretation of them.

Sharon Stills, ND

Yes, and you could tell your doctor that they could get educated and learn how to interpret it. I mean, I am constantly on the phone with labs when I am running new levels, learning how to interpret them. So it just takes a little extra effort on the doctor's part. And so you want to have a team who is willing to put in the extra effort for you. So, let us talk about you mentioned Fosamax. So before we get to root causes, let us just have the pharmaceutical conversation.

Kevin Ellis

Yes, for sure.

Sharon Stills, ND

What is the standard treatment protocol, and why is it not acceptable?

Kevin Ellis

Yes, so the standard treatment protocol is kind of like what I outlined at the beginning. Calcium, vitamin D, go for a walk, take a bone drug. Now, when you are presented with different options for bone medications, and it's not just Fosamax, there are a lot of other options for bone medications, and there are different use situations where a drug might be used, or maybe it's better to use a specific medication. But what I always caution people with is that these drugs are not like taking an aspirin. They have a dramatic effect on bone physiology. So you really have to understand the short- and long-term implications of use and things like that. So there are two categories of these medications. There are antiresorptives, which include bisphosphonates and Rank Ligand inhibitors. So bisphosphonate would be like Fosamax. Rank Ligand inhibitor would be like Prolia. And then there's another category of medications called anabolics. And the antiresorptives, their whole job is to help slow down the activity level of cells that break down bone, okay? And the reason why that could be a challenge and why it may not be the most effective thing long-term is that yes, there are short- and long-term implications and side effects, and uses with those drugs. But, probably the biggest concern is that as you are going about your daily life, and this is normal for every single person, whether they have osteopenia or osteoporosis or not, you are going, you are doing activities. you are starting to get these little microcracks and fractures that your body; that's just normal and natural for all of us. And then what happens is that you have these cells within the bone that say, Hey, we're starting to get these little microcracks. We need to build stronger bones, right? So you have these bone cells that come in called osteoclasts, and they scoop out that damaged bone. And then these next cells come in, called osteoblasts, and they fill in stronger, healthier bones. That's normal for every single person, right? You need those cells to come in and scoop out the damaged stuff, so the new, fresher, stronger bone can be laid down. When you are taking one of these medications that slows down the activity level of cells that break down bone, you are going to continue to accumulate those tiny little microcracks and fractures as you go about doing your daily activities. But if you slow down the activity level of those cells too much, you can't then scoop out that damaged, worn, and weakened bone. And you won't have that new bone come in and fill it in later. So what happens is that five years down the road, three years down the road, whatever it is, you can start to accumulate more of those, and that's going to lead to weaker bones in the long term. So that's one of the biggest concerns with those medications. That's for bisphosphonates. And I am not saying that in every situation, that might not be helpful for some people. There may be, I see smaller percentages of people where that may be necessary and important, but for the vast majority, there's so much more to be done before you even do something or get to that point. So that's one of those categories of medications. The other one are anabolic. And a lot of times in anabolic medications they're designed to help build bone and build it faster. And the reason why those drugs might be important is because if somebody is coming in and they have poor-quality bones and they have maybe fractured multiple times, that's usually going to be a situation where a physician is recommending an anabolic medication. And if you take an anabolic medication, those drugs usually have a length of time that you can use them for—13 months, two years—there's like a maximum limit on how long you would want to use those medications. But what a lot of them don't tell you is that you have to then follow that medication with an antiresorptive medication. So there are just a lot of things, and there's a lot of education that has to be done before you consider going that route. So I would say that for 85 to 90% of the people we work with that I talk to, there's a lot that can be done before you would ever even get to that point or consider that point.

Sharon Stills, ND

Absolutely. I will up the ante to 100%. I never put patients on those medications. I mean, you did a good job of explaining why they don't really work very well, and also they just have a myriad of side effects that are nasty. And so we're trying to solve a problem, but we're not really even solving it, and then we're creating a whole other host of problems. So, I am sure some of you who are listening are on these medications, and I am not saying to stop them today. But this is a wake-up call. There are other ways, and you can go on a journey of figuring out how to get off of those and what you need to do. So let us talk about some root causes. Why does this occur to begin with?

Kevin Ellis

Well, so let us talk about there are different types of osteoporosis, right? So there's primary osteoporosis. That occurs as a result of a decrease in estrogen in postmenopausal women. Estrogen has a protective effect on bones. When estrogen levels decrease, as they do during menopause, that causes an increase in the activity level of cells that are going to break down bones, right? So that's primary osteoporosis. But then we have a whole other cause of osteoporosis, which is secondary osteoporosis. And that's where bone loss and osteoporosis occurs as a result of behaviors, disorders, diseases, medications, and different conditions. And that's the category I fell into, and a lot of times that's the category people, because we have worked with people that have been anywhere from their late 20s to their mid-90s. And so a lot of times, it's not just hormones that are the contributing factors. So we don't want to make an assumption that, Oh, it's just hormones, and move forward. You have to rule out the root causes of the issues too. So we can, in terms of the actual root cause issues, let us get into some of those. So there are multiple different ones. Medications. I will talk about some of the more common medications that contribute to bone loss. Glucocorticoids. So these are steroid medications that are designed to suppress inflammation. And what they are doing is they are mimicking natural steroid hormones produced by your body. They are often used to treat things like asthma, autoimmune diseases like rheumatoid arthritis. Prednisone and cortisone—those are some of the big names there, right? Bone loss is a common side effect with those medications, and that's for a couple of different reasons. The first one is that it's reducing the intestinal absorption of calcium, and it is increasing their urinary excretion of calcium. So you have got a calcium deficit. The primary mineral constituent of your bones is calcium. The other part of this is glucocorticoids; they are directly acting on those bone cells that break down bone, the osteoclast, and they are increasing their lifespan, which is going to reduce your bone density. So if somebody is on those medications, just know that bone loss is going to be a side effect of those medications. SSRIs, selective serotonin reuptake inhibitors. That's a class of drugs that are typically used as antidepressants. There was a review in 19 studies on the effect of SSRIs on bone that indicated they have a negative effect on bone marrow density, and increase the risk of fracture. So that's an important one too. And then antacids. This is a big one that a lot of people, a lot of people are not aware of. So a lot of times, when someone has heartburn, right, or acid reflux, what are they taking? They're taking Tums. They're taking some kind of something to reduce that stomach acid. But usually they have too little stomach acid that they're trying to suppress. And the drugs that they're taking are proton pump inhibitors like omeprazole, Nexium, Prevacid, as well as H2 receptor antagonist drugs like ranitidine or Zantac. I took those for a number of years, and I was suppressing the little stomach acid I did have. And the reason that's a problem is because you need stomach acid to properly break down and extract nutrients from your food. Amino acids, calcium, magnesium, iron, and B12—all those nutrients are nutrients that you need. And if you are suppressing that stomach acid and you've got low stomach acid, that's going to be an issue for you. You are going to have a hard time with those nutrients. So that can be something that contributes to bone loss and osteoporosis in the long term also.

Sharon Stills, ND

I am loving this interview. You are just hitting everything. I have to tell you, one of the very first things I do is check the hydrochloric acid, stomach acid. And for most people, it used to be—I mean, I have been practicing for over 20 years; it used to be, it was like, over the age of 30, 35, it started declining. It's declining now; I have children in my practice who have no stomach acid, and it leads to asthma and all sorts of issues. it's a chronic condition, and there are different ways to check. You can do the fancy Heidelberg machine if you have someone near you who has it, or you can do a hydrochloric acid test by challenging yourself. Also, something just for you listening: in your complete metabolic profile, you can look at your globulin levels, and globulin should be between 2.4 and 2.8. And if it is lower or higher, that often means you have hypochlorhydria or don't have enough stomach acid. That's such an important piece of bone health that no one ever really puts it together. So I am so excited that you brought it up.

Kevin Ellis

Absolutely, Yes, no, it's so important. So important. Gosh, let us say, let us talk about some other conditions, right? Some of the other things that can contribute to bone loss are secondary causes. Any GI disease, right? If we have got a Crohn's disease, ulcerative colitis, or celiac disease, that is a perfect example, right? Perfect example right here. When you have those, nutrient absorption issues are going to be a contributor most likely. And if you have celiac disease, you also have an autoimmune component there too. So it's not just a matter of not being able to absorb certain nutrients. It can actually be that if you've got one autoimmune condition, that opens up essentially Pandora's Box into other autoimmune conditions where you could potentially have an attack on bone cells too. So especially if somebody has an autoimmune condition, we need to start approaching things in a way that's going to help us put that autoimmune disease into remission. So that's one of the first places you have to start if you have an autoimmune condition. And if you have an autoimmune condition and you are still eating things that are leading to joint pain, digestive issues, or whatever, you've got to start there first. Start with your nutrition, improving your sleep, reducing your stress—all that stuff that you probably already learned and talked about and that Dr. Sharon probably does an amazing job with. That's the stuff you have to address.

Sharon Stills, ND

Can never hear it enough.

Kevin Ellis

I know.

Sharon Stills, ND

It's easy to say. Hard-

Kevin Ellis

Let me add another note in there for that.

Sharon Stills, ND

What about, you mentioned behaviors associated? What do you mean by that?

Kevin Ellis

Well, so leading a sedentary lifestyle, for example. That's one. We were talking about the metaphor of a bucket before, right? And I mentioned how some people might not actually start with a full bucket. They might not reach peak bone mass. So 90% of your bone mass is put on by the time you turn age 18. The remaining part of that bone mass, the remaining 10% approximately, fills in by the time you turn 30. By the time you turn 30, your bucket is about as full as it's going to be. Okay? So if, when you were younger, you had poor diet nutrition, if you led a sedentary lifestyle, if you smoked or drank excessively, if you had an eating disorder, all those things can contribute to bone loss, or not achieving peak bone mass, or even to this day, that could be a contributor to active bone loss as well.

Sharon Stills, ND

So can’t go back and fix what you did, 'cause I was able to check a few of those off myself, but it's right.

Kevin Ellis

Me too. Me too.

Sharon Stills, ND

It's what you do now, what you do with that information in the moment. So prevention is always preferred, but taking action anytime is always also a good thing. So diet. What do you recommend for bone health?

Kevin Ellis

Well, I am sure you've already touched on this one, but I'll go ahead and reinforce it from the bone health perspective also, because I feel like you and I are jiving really good on this. So, sugar, okay? Let us talk about sugar for a sec. Reducing your sugar intake is key for bone health. Sugar damages bones by triggering an inflammatory response. It lowers your vitamin D levels. It depletes your bone-healthy minerals, so your calcium, magnesium, chromium, and copper. It inhibits intestinal absorption of calcium. And it blocks the absorption of vitamin C. Vitamin C is super, super important for maintaining a healthy skeleton basically. And when I am talking about sugar, a lot of us think about just the white Domino sugar, whatever it was. That's not just sugar I'm talking about. I am talking about your breads, your cakes, your cookies, your processed, your pizzas, and your crackers. That kind of stuff all breaks down to sugar in your body. So you just have to be aware of those things. And that was one more plug for reducing your sugar intake, if you needed it.

Sharon Stills, ND

Are you okay with, in your program, fruit, or do you feel like that's-

Kevin Ellis

Yes, fruit is okay. We would focus on, like berries, which are great, and high-vitamin-C foods; those are great. But then you also want to, you obviously want to mix in other important nutrients in foods as well. So your lean, healthy proteins, and yes, that can include animal proteins. So that's an okay addition to have and probably an important one to have as well. And let us even just talk about protein for a second. Your bones are 50% protein by volume. So they need amino acids. A lot of times, this is one of the areas where I see people falling very short on. They think they're getting enough protein, but they're actually not. So I would highly recommend that, for insurance purposes, if you are getting 30 grams of protein per meal, that's great. That's really, really good. But you need to at least be getting about 0.55 grams of protein per pound of body weight. So if you are weighing a 100 pounds, you are getting at least 55 grams of protein a day. But I would probably, just from an insurance perspective, I would try to get about 30 at two different meals.

Sharon Stills, ND

Yes, and we have spoken about like pound per pound, like an even.

Kevin Ellis

Yes.

Sharon Stills, ND

Eating your weight in protein in grams, so.

Kevin Ellis

Yep, and, like, that's the very, very minimum. So what I am talking about is that some people don't even hit that when I see them. So you've at least got to get there. But then, if we're talking about actually building muscle strength, which is going to help improve your bone strength as well, your muscles are made of protein, right? And amino acids too. So you need additional protein to help support that growth.

Sharon Stills, ND

And I am just going to go back to 'cause I'm hydrochloric acid obsessed. You have to make sure you have enough hydrochloric acid, because I see so many patients who are eating enough protein and they're not absorbing it because their hydrochloric acid levels weren't optimized. So you've always got to be thinking, We're not just what we eat; we're what we absorb. And we always got to be thinking kind of backwards, 'cause it's good to do these things, but we want to make sure that if we're doing them, we're actually getting the benefits from them.

Kevin Ellis

Absolutely. And then one of my favorite sources of protein, which also has a great source of minerals as well, is any of those smaller fish, especially if they still have the bones in. And I am not talking about the hard, pokey bones that might poke you in your mouth. If you go to Vital Choice, for example, they've got canned salmon and canned sardines. Those are great, because what do they have? They have protein in them, which is a great source of protein. But then, if you get them with the bones in, those bones have all the things that your bones need as well. They don't just have the minerals; they have different growth factors, proteins, and things like that that are going to support your own healthy bones. And, as a bonus kicker, if it doesn't feel like I am already selling you on sardines, this is the final kicker. Omega-3s, right? Omega-3s are the dampeners of inflammation. Anything that contributes to inflammation in the body is going to help accelerate bone loss. So it's a great, great addition to include in your plan.

Sharon Stills, ND

I love it, I love it. So don't be picking out those bones.

Kevin Ellis

Don't do it, don't do it.

Sharon Stills, ND

You mash them up and eat them. I've always eaten the bones. I guess I just intuitively knew it was a good thing to do. People would think I am weird.

Kevin Ellis

No, there are plenty of cultures that do that too. They'll pulverized different bones, and things like that to incorporate them, to make sure they get enough calcium in their diets as well. So super, super important.

Sharon Stills, ND

But you mentioned omegas, and you've talked about hydrochloric acid. You mentioned calcium. Could you talk just a little bit about calcium, vitamin D, what other nutrients you like for proper bone health?

Kevin Ellis

Absolutely. Okay, so vitamin D—that's a no-brainer, right? That's one of the most important nutrients, not just for your bone health but for your overall health. So, super important. And then I would also, in terms of supplementing with vitamin D, ideally, we're trying to get as much as we can from the sunlight and things like that, if you are able to. But that's not always going to be enough, right? Especially because when you get to winter time, and probably most of the areas where most people are living, the sun's rays are not going to be strong enough to generate enough vitamin D production. So sometimes that may be a case where you are going to want to supplement in colder weather months and things like that. But before you just start supplementing blindly, get those levels tested get your parathyroid hormone tested, right? Get your calcium levels tested. Get all those things tested before you start supplementing, because you don't want to just start supplementing and then find out you have some other health issue that needs to be addressed first. And then you can actually have too high of vitamin D levels, right? So the normal range for vitamin D is, well, what 30. If we're in the U.S., 30 NGML to 100 NGML That's a wide range. That's a really wide range. And if you are over 100, that can actually be a contributor to bone loss as well. So you don't want to have too high levels of vitamin D also. So vitamin D is important. Vitamin K2 is also really important. Another fat-soluble vitamin. There are, I would say there are a lot of different forms of vitamin K2. MK-4 and MK-7 are probably the most important ones that people hear about most when it comes to bone health. MK-4 has a shorter half-life. It means it stays in your blood longer. And then MK-7 has a longer half-life. So it stays in your body for a couple of days. You can get these from different dietary sources, which is great. So the K2 MK-4 you are going to get from things like beef liver, grass-fed ghee and butter, dark-meat chicken, or pastured egg yolks. That's where you can get that MK-4. The MK-7 is going to come from hard cheeses, fermented foods, sauerkraut, kimchi, natto, and bacterial fermentation in your gut also. So the reason why K2 is important is because K2 is actually making sure that the other nutrients, especially the calcium, is going to where it's supposed to, which is in the bone, and not in your soft tissues like your arteries and your other soft tissues too. So super important nutrient, especially if somebody is trying to figure out that whole supplement picture. So.

Sharon Stills, ND

Yes, thank you. Yes, I don't let patients take vitamin D without taking K2. And my experience with vitamin D is that because it's a fat-soluble vitamin, you really want to take it in a liquid form where it's emulsified, so your body will absorb it better. I've just seen this time and time again. So just a little tip there. And circling back to the sugar, I just want to acknowledge that we know it's easy to say stop sugar. And we also know that sugar is more addictive than cocaine. And so don't beat yourselves up. If you are a sugar junkie, you might need to work with someone. It might be a process. But if you can do it cold turkey and you can suck it up for three days, and those three days are not going to be fun because you are going to be craving, but once you get through those first three days, the cravings really stop, and often, when you've been craving sugar, it's because, ding, ding, ding, you don't have enough protein. So while you are going off the sugar, really listen to what Kevin was saying about really getting your protein levels up. It's going to help with that process.

Kevin Ellis

Absolutely. Absolutely. There is one other nutrient that I think is important to give a special shout-out to, which is magnesium.

Sharon Stills, ND

Woo-hoo!

Kevin Ellis

So important. One of the primary functions of magnesium is that we need it to make proteins in our body. So like when you eat proteins, we're talking about protein here and how important it is for your own health. What happens is that you obviously break those proteins down into amino acids, that we can then rebuild in our bodies into various proteins. In order to rebuild those proteins, you need magnesium to do that. Just about everything in the body is protein or is made of proteins. That's just really, really important for people to understand. And then magnesium plays a key role in converting vitamin D into the active form that promotes calcium absorption, right? That's super important too. And then people have to understand is that as your calcium and your vitamin D intake increase, so too does your need for magnesium. If your doctor has ever just said, Take your calcium and your vitamin D, but you have never heard about magnesium, your need for magnesium is going to increase as you start to increase those other things as well. So really, really important.

Sharon Stills, ND

Very important. Do you have a special form of magnesium you like to recommend?

Kevin Ellis

A bisglycinate chelate is great. Magnesium bisglycinate chelate or glycine is, those are great forms as well. Yes.

Sharon Stills, ND

And magnesium is one of the most depleted nutrients in our body. So if you are craving chocolate, another sign you are probably magnesium deficient.

Kevin Ellis

Yes.

Sharon Stills, ND

And stress depletes it. I talked about stress because it's such a major factor. And the way to check your magnesium, don't just let them run it in your serum. Get an RBC, which stands for red blood cell, because that's where magnesium hangs out inside the red blood cell, so you will get a more accurate level of how depleted you are or are not.

Kevin Ellis

Yes. And another good form of magnesium, magnesium malate is another good form too. So. Yes, those are good ones.

Sharon Stills, ND

Well, this has been fantastic. Have we missed anything? I feel like-

Kevin Ellis

Well, do you want to touch on exercise for a second?

Sharon Stills, ND

Sure, absolutely. Yes, you had mentioned being sedentary not being a good behavior. So what do you recommend for movement?

Kevin Ellis

Yes. So exercise is super, super important for your bone health. It plays such an important role, and you need two different types of stimuli. You need muscle pulling on bones, and you need impact. The most effective interventions are using one or both in combination. And what's happening is, let us talk about the muscle pulling on the bone. You have a mechanical signal that sends a chemical signal that's telling those bones to become stronger. And then the impact is also important too. A lot of times I've mentioned that when somebody's told they have osteoporosis, the last part of what to do is go do some weight-bearing exercise. Go do some walking. I am going to tell you right now that walking is not enough, okay? That's not enough. Even if you've addressed all your underlying root cause issues, walking may help you maintain, but it's not going to; you have to have more to your plan. So the other weight-bearing exercises you can incorporate, and when I say weight-bearing exercise, I mean weight-bearing exercise is exercise that your bones and your muscles have to work against gravity to keep you upright, right? They're activities that you are doing on your feet. So that's running, jogging, hiking, dancing, gardening, playing tennis, high-impact aerobics, jumping rope, and playing soccer. Any of those things can fall into that weight-bearing exercise, which is great. There are a lot of activities that fall into that, and probably a lot of things people love doing in there. But then there are other activities that are not weight-bearing and are not going to be helpful for bones. So cycling, paddling, canoeing, or kayaking. Swimming, right? Those are not providing the stimulus your bones need for actually becoming stronger. Now, that's not to say that you shouldn't do those things, right? If you love to cycle and ride your bike, and it makes you happy and reduces your stress, and you are just looking at the sunset as you go off into the distance, that's great; do it. But don't count that as your only form of exercise. Same thing with swimming. Don't count it as your only form of exercise. Doesn't mean you should avoid the pool. Get into it if you love it and do it, but don't let it be the only thing. Now let us talk about the other part of exercise that you have to be doing, which is muscle-strengthening exercise. Resistance training. You can use heavier weights or you can use heavier resistance bands. You can use free weights. You can use barbell weights. But the movements that we want to be doing are the bigger compound movements, right? The squats, the dead lifts, and the overhead presses. Those kinds of movements are the ones that we want to incorporate. Now, for somebody listening to this, you might be like, Wow, that sounds intimidating. Especially if you haven't done any working out or anything like that before. Or at least in a setting like a gym where you've got a bunch of weights. That's okay. Find somebody who can look at and evaluate your body mechanics first. Don't just go on YouTube and say, I heard this guy say go do some deadlifting, and then we jumped in and did it. You want to find somebody who evaluates your body mechanics. Make sure you have good form. And take your time progressing up to, the five- to 10-rep range; that's the intensity that the studies show is going to be best for supporting your bone health. Okay. But you don't just want to ramp up to that point right from the start. So be patient with yourself. You will eventually get there. And the last note I'll make is that it's not like one or two exercises are going to be the end all be all for your bone health. Bone remodeling is a really slow process. So developing a plan, being consistent with that plan, and doing the right things over time that's what's going to give you the best shot of improving your bones long-term.

Sharon Stills, ND

Mm, fantastic advice. And I would also just like to say, I know you mentioned hormones, but we didn't really talk a lot about hormones, and hormones are so important. It's one of the things I always tell patients: even if you are not symptomatic and you are not trying to get rid of hot flashes, you still want to be using bioidentical hormones. And one of the reasons is the prevention of osteoporosis, among other things. So could you just speak to that before we finish up?

Kevin Ellis

Yes, and I'll just reinforce what you just said. I mean, considering bioidentical hormone replacement therapy, especially the earlier on too, like preventing bone loss, it's so much easier to slow and stop and prevent more bone loss, than to build it once you lose it. Both are possible. You can build bone strength at any age. It just becomes more challenging. The older you get, the more bones you lose. There are fewer cells involved in that process. That process becomes less efficient. So the more you can do up front on that side of prevention, bioidentical hormone replacement therapy can absolutely play a role in slowing, stopping, and preventing more of that bone loss. You are going to be better off, longer term. So.

Sharon Stills, ND

So this is definitely an interview that you are going to want to share with your children, your daughters, your sons, your nieces, and your nephews, because it's something we want people to learn about early. And like Kevin said, there's still hope that we can still make differences. I have women come to me in their 60s and 70s, and we can still make changes; it's never too late. But if we can learn earlier, so share this episode with everyone, because it's so important. So this has just been fantastic. How can we learn more about you and your three-step program? What is the three-step program?

Kevin Ellis

Well, so the three steps are to identify and address the root cause issues of bone loss. Nourish your body and absorb your nutrients. And build strength in the body, mind, and bones in a way that prevents fracture and injury. So we teach people that through different programs that we have where we guide them step-by-step along the way. So if you have osteopenia or osteoporosis, or somebody who does, and they're struggling to make sense of all this, know that there's help out there; there are people who understand this and who know how to help you. And Sharon, you brought up a really great point is that I've had many, many conversations with people—thousands of conversations at this point, and one of the things that I hear is that people don't just want to learn for themselves. They are talking about their daughters, their daughter-in-laws, or somebody else that they want to learn so they can help prevent that in that person as well. And that's why I love working with the people we work with. I work with people mostly 45 to 65 plus. My real passion is on the side of prevention, too. And eventually, our focus is going to be on preventing disease and osteoporosis in kids from a really young age. So super, super important. But, Yes, that's a little bit about us.

Sharon Stills, ND

Love it, love it, love it. And I was just sitting here thinking, How much time do we really spend thinking about our skeleton? It's covered with all our skin and hair and everything, but perhaps take a moment after listening to this, and just really meditate and give thanks to your skeleton that supports you and helps you move through life, and show it a little TLC. So this has been fantastic. I know everyone learned a lot. Thank you so much for being here and contributing a super important piece for women and men on their hormonal journey and Mastering The Menopause Transitions. So we'll see you all soon. Bye.

Plan Your Course For Sturdier Bones And An Active Future

Sharon Stills, NMD

Kevin Ellis

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Sharon Stills, NMD