Latest / Clearly Hormonal / Ep 24: Lifestyle Strategies for Bone Health

Transcript

Ep 24: Lifestyle Strategies for Bone Health · Clearly Hormonal

• 0:02
  Dr. Komal Patil-Sisodia: Welcome to Reset Recharge, the podcast where women's health takes center stage.
• 0:07
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:08
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert.
• 0:13
  Dr. Komal Patil-Sisodia: This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider.
• 0:24
  Dr. Komal Patil-Sisodia: Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place.
• 0:31
  Dr. Komal Patil-Sisodia: As a physician, my goal is to educate on this podcast.
• 0:34
  Dr. Komal Patil-Sisodia: The content shared here is for informational purposes only and should not replace personalized medical advice.
• 0:41
  Dr. Komal Patil-Sisodia: If something we discuss resonates with you, please talk to your healthcare provider at your next visit.
• 0:46
  Dr. Komal Patil-Sisodia: Now let's dive in and help you reset, recharge, and take control of your health.
• 0:53
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:54
  Dr. Komal Patil-Sisodia: Today is the second episode of our Bone Health series, and we are going to focus on what I like to call, lifestyle strategies for osteoporosis prevention or osteoporosis treatment.
• 1:07
  Dr. Komal Patil-Sisodia: Today we're going to focus on non-drug interventions, the practical day-to-day lifestyle choices that can help protect your bones for years to come.
• 1:16
  Dr. Komal Patil-Sisodia: So if you're over 50, post-menopausal, or simply planning to try and be stronger in the future.
• 1:23
  Dr. Komal Patil-Sisodia: This episode has lots of tools that are going to help you take control of your bone health starting today.
• 1:29
  Dr. Komal Patil-Sisodia: Let's talk a little bit about why osteoporosis matters.
• 1:32
  Dr. Komal Patil-Sisodia: Osteoporosis literally means porous bones, and it's a condition where the bones become fragile and more likely to fracture.
• 1:40
  Dr. Komal Patil-Sisodia: While it can affect anyone, women, especially after menopause, are at a much higher risk due to hormonal challenges that are going to make bone loss happen faster.
• 1:51
  Dr. Komal Patil-Sisodia: In fact, 50% of women over the age of 50 will suffer an osteoporosis related fracture in their lifetime, and these fractures can lead to pain, disability, and a significant loss of independence.
• 2:04
  Dr. Komal Patil-Sisodia: But here's the good news.
• 2:06
  Dr. Komal Patil-Sisodia: While we can't change our age or genetics, there's a lot we can do naturally and holistically to strengthen our bones and reduce risk.
• 2:15
  Dr. Komal Patil-Sisodia: Let's start with lifestyle habits.
• 2:17
  Dr. Komal Patil-Sisodia: According to the American Association of Clinical Endocrinologists or ace, there are two things that are particularly harmful to bone health.
• 2:27
  Dr. Komal Patil-Sisodia: The first one is smoking.
• 2:29
  Dr. Komal Patil-Sisodia: Tobacco use weakens the bone because it reduces the activity.
• 2:33
  Dr. Komal Patil-Sisodia: Of the osteoblasts, which are the cells that build bone.
• 2:37
  Dr. Komal Patil-Sisodia: And then the second is excessive alcohol use.
• 2:40
  Dr. Komal Patil-Sisodia: Alcohol, especially if you're having more than two drinks per day, can interfere with the way that your body absorbs calcium.
• 2:47
  Dr. Komal Patil-Sisodia: It can also affect balance and increase the risk of falling and falls lead to fractures.
• 2:52
  Dr. Komal Patil-Sisodia: So if you are smoking, quitting is one of the most powerful things that you can do.
• 2:57
  Dr. Komal Patil-Sisodia: Not just for your bones, but for your whole body.
• 3:00
  Dr. Komal Patil-Sisodia: We already know that there are implications for the lungs and for the heart and for your blood vessels, so that is definitely something to consider.
• 3:08
  Dr. Komal Patil-Sisodia: And if you drink, try to eliminate your intake to no more than two alcoholic beverages per day.
• 3:14
  Dr. Komal Patil-Sisodia: There's actually data on breast cancer risk as well with alcohol, and it's been shown that having more than two alcoholic beverages per day will increase your breast cancer risk.
• 3:25
  Dr. Komal Patil-Sisodia: So while these things may sound simple, they're pretty foundational to making sure that you have healthy bone.
• 3:31
  Dr. Komal Patil-Sisodia: And changing these habits drastically can reduce fracture risk over time.
• 3:36
  Dr. Komal Patil-Sisodia: If you are struggling to quit either one, you can always talk to your primary care doctor.
• 3:41
  Dr. Komal Patil-Sisodia: There are so many resources out there, including things like nicotine patches or medications to help with quitting tobacco, and then there are medications and other counseling interventions that can help with cutting back on alcohol.
• 3:57
  Dr. Komal Patil-Sisodia: So please know that your primary care doctor is pretty well equipped to help you with these things, and they will have a huge impact on your bone health if you're able to cut back on both of them or quit altogether.
• 4:11
  Dr. Komal Patil-Sisodia: Let's talk about nutrition and how we feed our bones and make sure that they're healthy.
• 4:16
  Dr. Komal Patil-Sisodia: The first thing that comes to mind when people think about bone health is calcium, and it's for a good reason.
• 4:22
  Dr. Komal Patil-Sisodia: However, calcium is just one part of the nutritional puzzle.
• 4:26
  Dr. Komal Patil-Sisodia: The most common recommendations you'll hear for supplementation for bone health and osteoporosis are to take calcium and vitamin D.
• 4:36
  Dr. Komal Patil-Sisodia: The American Association of Clinical Endocrinologists recommends that people get about 1200 milligrams of calcium per day.
• 4:43
  Dr. Komal Patil-Sisodia: For postmenopausal women and between a thousand to 2000 international units of Vitamin D three calcium is absorbed from food sources.
• 4:54
  Dr. Komal Patil-Sisodia: Much better than it is from supplements.
• 4:56
  Dr. Komal Patil-Sisodia: And so whenever you can get your calcium from a food source, like think dairy products, leafy greens, tofu fortified plant milks, your body will absorb it better than if you took a supplement.
• 5:08
  Dr. Komal Patil-Sisodia: Vitamin D has been a hot button topic for the last few years, and it's important to know that while we can get vitamin D from diet and sun exposure, a good majority of the world, especially post-menopausal women who are older are vitamin D deficient, mostly because we just don't get enough sun exposure and then.
• 5:30
  Dr. Komal Patil-Sisodia: We also are not getting enough through our diet as much as we try.
• 5:34
  Dr. Komal Patil-Sisodia: So supplements are really an inexpensive, effective way to help improve your bone health.
• 5:40
  Dr. Komal Patil-Sisodia: And when you take vitamin D supplements, if you take them with your calcium, you actually absorb the calcium much better.
• 5:49
  Dr. Komal Patil-Sisodia: So let's talk a little bit about some other micronutrients that people bring up Frequently.
• 5:55
  Dr. Komal Patil-Sisodia: In my clinic, I often have women who are asking me.
• 5:58
  Dr. Komal Patil-Sisodia: About things like magnesium, vitamin K, and strontium, and there's so much information out there in the media about all the different things that you should be taking.
• 6:07
  Dr. Komal Patil-Sisodia: It can get really confusing.
• 6:09
  Dr. Komal Patil-Sisodia: So I want to break this down for you so you understand.
• 6:12
  Dr. Komal Patil-Sisodia: Outside of calcium and vitamin D, is there anything else you need to do in terms of supplements?
• 6:17
  Dr. Komal Patil-Sisodia: So let's start with magnesium.
• 6:18
  Dr. Komal Patil-Sisodia: Magnesium is another mineral that's involved in bone structure and metabolism.
• 6:23
  Dr. Komal Patil-Sisodia: It's actually what we call a binding co-factor for calcium, and when you don't have enough in your body, it can make it harder for your body to hold onto calcium.
• 6:31
  Dr. Komal Patil-Sisodia: The good news is that most women get enough through their diet, especially if you were eating whole grains, nuts, seeds, legumes, and green vegetables.
• 6:41
  Dr. Komal Patil-Sisodia: Those things are fortified with magnesium and you will have enough in your diet.
• 6:45
  Dr. Komal Patil-Sisodia: Supplementation of magnesium should actually be considered in people who are magnesium deficient, and that is the only place where in the studies it's actually shown benefit.
• 6:55
  Dr. Komal Patil-Sisodia: And some considerations may be in people who have malabsorption issues.
• 6:59
  Dr. Komal Patil-Sisodia: People who struggle with chronic alcoholism, if there is long-term use of diuretics or proton pump inhibitors.
• 7:07
  Dr. Komal Patil-Sisodia: And also patients with type two diabetes tend to be a little bit more magnesium depleted.
• 7:13
  Dr. Komal Patil-Sisodia: And despite that, there's still not strong evidence that magnesium supplementation actually improves your bone mineral density or reduces fracture risk in women who have normal magnesium levels.
• 7:25
  Dr. Komal Patil-Sisodia: So routine use is probably not necessary unless you have a known deficiency.
• 7:30
  Dr. Komal Patil-Sisodia: Let's talk about vitamin K two next.
• 7:33
  Dr. Komal Patil-Sisodia: So Vitamin K two helps regulate the calcium in the body by directing it to the bones and away from the arteries.
• 7:40
  Dr. Komal Patil-Sisodia: And there are recent studies that have shown potential benefits in improving bone mineral density in the spine and forearm and reducing the levels of osteocalcin, which is a marker of bone turnover.
• 7:52
  Dr. Komal Patil-Sisodia: There are some studies that even suggest a reduction in fractures, but, and this is important, that data is inconsistent and most clinical guidelines, including the American Association of Clinical Endocrinologists do not yet recommend using Vitamin K two as routine therapy.
• 8:10
  Dr. Komal Patil-Sisodia: We need to do more studies.
• 8:12
  Dr. Komal Patil-Sisodia: It.
• 8:12
  Dr. Komal Patil-Sisodia: Looks like it's promising, especially in women who have low dietary intake or high turnover rates of Vitamin K two.
• 8:19
  Dr. Komal Patil-Sisodia: But we definitely have to do more research before it becomes the standard of care.
• 8:24
  Dr. Komal Patil-Sisodia: My other warning is that for people who are on things like Coumadin, otherwise known as Warfarin, which is a blood thinner, if they start taking vitamin K supplements and they're on these medications, it can actually.
• 8:36
  Dr. Komal Patil-Sisodia: Impair the way that the Coumadin Warfarin is working in order to prevent blood clots.
• 8:42
  Dr. Komal Patil-Sisodia: So it's important for your doctor or whoever is prescribing that for you to be aware if you are going to start Vitamin K two supplements so that they can monitor you appropriately and you don't.
• 8:54
  Dr. Komal Patil-Sisodia: Mess up the way that the Coumadin is working for you.
• 8:57
  Dr. Komal Patil-Sisodia: Last on my list for minerals that we should be looking at is strontium.
• 9:02
  Dr. Komal Patil-Sisodia: There is a lot of buzz around strontium and for me, I'm gonna start off by saying, proceed with caution because there is some data that strontium, ranelate.
• 9:15
  Dr. Komal Patil-Sisodia: At a pharmacologic dose has shown fracture reduction benefits in clinical trials.
• 9:20
  Dr. Komal Patil-Sisodia: But here's the thing.
• 9:21
  Dr. Komal Patil-Sisodia: It's not available in the United States as a dietary supplement.
• 9:25
  Dr. Komal Patil-Sisodia: Over the counter strontium products are not supported by current guidelines, and there's no clinical evidence that the over the counter strontium actually helps bone health in women.
• 9:36
  Dr. Komal Patil-Sisodia: So in short, leave this one alone, and if it ever does become available by prescription in the United States, I'll be curious to see how that gets incorporated into the guidelines.
• 9:47
  Dr. Komal Patil-Sisodia: So I would hold off on that.
• 9:49
  Dr. Komal Patil-Sisodia: I don't think that's something anybody should mess with on their own.
• 9:52
  Dr. Komal Patil-Sisodia: So that's what you need to do for nutrients.
• 9:54
  Dr. Komal Patil-Sisodia: Let's talk about movement.
• 9:56
  Dr. Komal Patil-Sisodia: We all know that exercise is good for us in terms of a cardiovascular health perspective for reducing the risk of heart attack and strokes, and for reducing the risk of insulin resistance, prediabetes, and diabetes.
• 10:09
  Dr. Komal Patil-Sisodia: But it is essential for bone remodeling.
• 10:12
  Dr. Komal Patil-Sisodia: We need exercise in order for our bones to remodel in a healthy way and continue to remain strong.
• 10:19
  Dr. Komal Patil-Sisodia: The American Association of Clinical Endocrinologists encourages lifelong participation as much as tolerated in weight-bearing exercises like walking, dancing, stair climbing.
• 10:32
  Dr. Komal Patil-Sisodia: Resistance training, which has the strongest evidence for increasing your bone mineral density.
• 10:37
  Dr. Komal Patil-Sisodia: And this is lifting weights, Pilates, any sort of resistance exercise, and then balance and core training like tai chi and yoga, because those actually help prevent falls.
• 10:49
  Dr. Komal Patil-Sisodia: The amazing thing about any of these exercises is that they do double duty.
• 10:53
  Dr. Komal Patil-Sisodia: They are strengthening your bone and they're improving your balance, which is reducing your fall risk, which is a major cause of fractures and you don't need fancy equipment.
• 11:02
  Dr. Komal Patil-Sisodia: Even body weight squats, light hand weights or resistance bands can be effective.
• 11:08
  Dr. Komal Patil-Sisodia: My friend, Dr.
• 11:08
  Dr. Komal Patil-Sisodia: Ali Novitsky, who owns a company called the Fit Collective, has put together an amazing strength training program.
• 11:15
  Dr. Komal Patil-Sisodia: She has one that is called beginner strength training, and there are three phases that you can cycle through.
• 11:23
  Dr. Komal Patil-Sisodia: This program has 10 minute workouts for three days per week, and she has three phases to this program.
• 11:30
  Dr. Komal Patil-Sisodia: The first of which, if you've never done strength training or exercise before you do the moves in a chair so that you don't injure yourself.
• 11:37
  Dr. Komal Patil-Sisodia: The second would be.
• 11:39
  Dr. Komal Patil-Sisodia: A harder move with less support.
• 11:42
  Dr. Komal Patil-Sisodia: And then the third is where you're much more advanced in your strength training.
• 11:45
  Dr. Komal Patil-Sisodia: There is data that shows that consistent strength training will help your bones.
• 11:49
  Dr. Komal Patil-Sisodia: So if you've never done exercise, this is a really great program.
• 11:53
  Dr. Komal Patil-Sisodia: I have no financial affiliation with this particular product.
• 11:57
  Dr. Komal Patil-Sisodia: I just really like it.
• 11:58
  Dr. Komal Patil-Sisodia: I actually have.
• 12:00
  Dr. Komal Patil-Sisodia: Her version of a fitness program called Total Fitness Program, and I do recommend that to my patients as well if they've never done exercise and they're looking to do that while they're embarking on their journey for obesity, or if they're more experienced with exercise.
• 12:16
  Dr. Komal Patil-Sisodia: Both programs are fabulous, and you can find them on her website, which is the fit collective.com.
• 12:21
  Dr. Komal Patil-Sisodia: There is some new research that is going on right now that suggests that if you exercise after a weight maintenance meal, especially one that has protein and a weight maintenance meal is basically breakfast, lunch, or dinner that may enhance your bone forming response.
• 12:37
  Dr. Komal Patil-Sisodia: So if you're eating protein and then you're exercising afterwards.
• 12:41
  Dr. Komal Patil-Sisodia: You can have better bone formation and doing another strength training workout later in the day can actually provide maybe a little additional stimulus.
• 12:50
  Dr. Komal Patil-Sisodia: So if you wanted to break up your strength training routine into 10 minutes in the morning and 10 minutes later on.
• 12:57
  Dr. Komal Patil-Sisodia: If you do the first 10 minutes after you eat protein and then you do the second, 10 minutes later in the day, you might actually get more bone remodeling and stronger bones.
• 13:06
  Dr. Komal Patil-Sisodia: And while we're still learning more about this, I think it's fascinating that nutrition and movement, when they're paired together, can work in a way that is synergistic and improving your bone strength and health.
• 13:21
  Dr. Komal Patil-Sisodia: Now let's talk about the last thing on my list, which I think is an overlooked strategy.
• 13:25
  Dr. Komal Patil-Sisodia: And while anyone can fall, women who have osteoporosis are especially vulnerable to fractures.
• 13:31
  Dr. Komal Patil-Sisodia: And that's why fall prevention is absolutely vital to part of any bone health strategy.
• 13:37
  Dr. Komal Patil-Sisodia: In my patients that come into my office, if I think they're at high fall risks, sometimes I'll even call occupational therapy or put in a referral to occupational therapy for them to go out to the house.
• 13:47
  Dr. Komal Patil-Sisodia: They can come in and assess for fall hazards.
• 13:50
  Dr. Komal Patil-Sisodia: I do this.
• 13:51
  Dr. Komal Patil-Sisodia: More frequently with some of my older patients who may not have help at home, and they look at are there rugs that are a trip hazard?
• 13:59
  Dr. Komal Patil-Sisodia: Are there cords that are getting tangled up?
• 14:01
  Dr. Komal Patil-Sisodia: Is there furniture that hasn't been arranged in a way that people can move around it effectively without tripping on it?
• 14:08
  Dr. Komal Patil-Sisodia: There are a lot of different things you can do to make your environment safe in order to prevent falls and prevent fractures.
• 14:15
  Dr. Komal Patil-Sisodia: I have a list of a few things that you can do that can actually make your home significantly safer.
• 14:19
  Dr. Komal Patil-Sisodia: Number one will be installing grab bars in the bathroom.
• 14:22
  Dr. Komal Patil-Sisodia: I know this is not aesthetically pleasing and some people don't want to put it into their homes for that reason, but it will keep you safe.
• 14:30
  Dr. Komal Patil-Sisodia: The next thing you can do is improve the lighting in the hallways and stairs.
• 14:33
  Dr. Komal Patil-Sisodia: One of the things that happens often is that if areas are dimly lit, you may not see a step clearly.
• 14:40
  Dr. Komal Patil-Sisodia: You may miss a step.
• 14:41
  Dr. Komal Patil-Sisodia: You may fall.
• 14:43
  Dr. Komal Patil-Sisodia: Removing loose rugs and clutter will also help prevent any falls.
• 14:47
  Dr. Komal Patil-Sisodia: And then adding non-slip mats in your shower are very easy ways to make your home safer.
• 14:53
  Dr. Komal Patil-Sisodia: The other thing you can do is review your medications.
• 14:56
  Dr. Komal Patil-Sisodia: There are certain medications like sedatives or certain antidepressants that can make you sleepy and increase your risk of falling.
• 15:03
  Dr. Komal Patil-Sisodia: So talk to your doctor about alternatives, dose adjustments, or whether you need to shift the timing of those medications to keep yourself.
• 15:12
  Dr. Komal Patil-Sisodia: And then if you've already had a fall or if your balance is changing, I will oftentimes suggest physical therapy and occupational therapy so that they can work on balance training as well as a home assessment and putting together a fall prevention program that actually helps a lot of my seniors build confidence and mobility, and it helps'em feel safer in their homes.
• 15:35
  Dr. Komal Patil-Sisodia: So here's your takeaway toolkit for lifestyle strategies for osteoporosis prevention.
• 15:41
  Dr. Komal Patil-Sisodia: Number one, quit smoking and limit alcohol.
• 15:45
  Dr. Komal Patil-Sisodia: Number two, eat smart.
• 15:46
  Dr. Komal Patil-Sisodia: Make sure you're getting 1200 milligrams of calcium, either through diet or supplementation if you can't get it through diet.
• 15:53
  Dr. Komal Patil-Sisodia: And then a thousand to 2000 international units of Vitamin D three.
• 15:57
  Dr. Komal Patil-Sisodia: Let's talk about the other minerals.
• 15:58
  Dr. Komal Patil-Sisodia: Magnesium should be considered only if you're deficient for the purposes of bone health and osteoporosis.
• 16:07
  Dr. Komal Patil-Sisodia: Vitamin K two looks promising, but it's not standardized yet, and it has not been incorporated into the guidelines.
• 16:13
  Dr. Komal Patil-Sisodia: Additionally, it can mess with your blood thinners, so please talk to your doctors about it in case you're considering starting it or you've already started it, especially if you're on Coumadin warfarin, which is the same thing.
• 16:24
  Dr. Komal Patil-Sisodia: And then strontium.
• 16:26
  Dr. Komal Patil-Sisodia: There is data that shows prescription strength can be beneficial to bone health and reduce fractures, but remember that the prescription strength is not available in the United States.
• 16:37
  Dr. Komal Patil-Sisodia: And the over the counter supplements have not been proven to do the same thing.
• 16:41
  Dr. Komal Patil-Sisodia: So that is one that I would recommend that you skip.
• 16:44
  Dr. Komal Patil-Sisodia: And finally make sure that you are exercising for strength and balance and that you are fall proofing your environment.
• 16:52
  Dr. Komal Patil-Sisodia: And making sure that your space is clear and you're going to be safe in your home.
• 16:57
  Dr. Komal Patil-Sisodia: All of these strategies are safe and powerful and completely within your control.
• 17:01
  Dr. Komal Patil-Sisodia: And while medications are still likely to play a role for most women, these lifestyle changes are the foundation of what are going to keep you healthy with or without the prescription.
• 17:12
  Dr. Komal Patil-Sisodia: So this is something that everybody should be doing at a baseline, and then your doctors will talk to you about whether medication is indicated for you or not.
• 17:21
  Dr. Komal Patil-Sisodia: So that wraps up today's episode, and our next one will be talking about all of the different osteoporosis medications that are out there and breaking them down to understand how they work and myth busting some common things that you may see on the internet about these medications.
• 17:39
  Dr. Komal Patil-Sisodia: When they first came out, they got a super bad rap.
• 17:42
  Dr. Komal Patil-Sisodia: Because they were not used particularly well, but we will get into that in the next episode.
• 17:46
  Dr. Komal Patil-Sisodia: I appreciate you all being here.
• 17:48
  Dr. Komal Patil-Sisodia: Stay strong, stay steady, and remember your bones are listening.
• 17:52
  Dr. Komal Patil-Sisodia: I will see you on the next episode.
• 17:55
  Dr. Komal Patil-Sisodia: Hey there.
• 17:56
  Dr. Komal Patil-Sisodia: Quick announcement before you go.
• 17:58
  Dr. Komal Patil-Sisodia: I've officially opened my own practice.
• 18:00
  Dr. Komal Patil-Sisodia: It's called Eastside Menopause and Metabolism based right here in Redmond, Washington.
• 18:04
  Dr. Komal Patil-Sisodia: I'm so grateful to be helping women navigate perimenopause, menopause, and metabolic health.
• 18:09
  Dr. Komal Patil-Sisodia: It's truly some of the most fulfilling work I've ever done.
• 18:12
  Dr. Komal Patil-Sisodia: If you're interested in working with me, head over to eastside mm.com.
• 18:16
  Dr. Komal Patil-Sisodia: You can book a consultation and stay tuned.
• 18:19
  Dr. Komal Patil-Sisodia: I'll be launching a membership program as well as an online course for those of you outside of Washington.
• 18:24
  Dr. Komal Patil-Sisodia: Lots more to come, so keep listening and thank you for being here.