Mind Body Evolution Podcast

Osteoporosis

In today's episode of the mindbodyevolution podcast, Dr. Josh Stout discusses how to maximize bone density early and maintain it throughout life.

Dr. Josh Stout, PhD

15 May 2024 — 37 min read

How to maximize bone density early and maintain it throughout life.

Please scroll down for links below the transcript. This is lightly edited AI generated transcript and there may be errors.

Eric 0:07

Friday, May 10th. Hey, Josh, how you doing?

Dr. Josh Stout 0:11

Hi, Eric. I'm doing well. I wanted to. I want to talk today about sort of really focused science related health things. I wanted to cover osteoporosis.

Eric 0:22

Very good.

Dr. Josh Stout 0:23

Just because it's so important for us and it is a topic that I cover in my classes, so I'm pretty familiar with it.

Eric 0:30

Why do you cover it in your classes?

Dr. Josh Stout 0:32

Why do I covered my classes.

Eric 0:34

Like a regular thing that you do?

Dr. Josh Stout 0:35

So I teach human evolution and I teach Darwinian medicine. And Darwinian medicine is sort of a subset of human evolution as a as a topic. And both of them bones are everything. So if you're if you're a paleontologist, what you dig up is bones. And it's our biggest way to look at the health of of ancient peoples is to look at their bones and look how they've developed and look how they changed. And one of the things that we see in in modern humans is osteoporosis. And we don't see that in earlier humans. Now, a lot of them didn't live past age 50, So osteoporosis is usually associated with menopause. And so if you don't live past age 50 as a woman, you're not going to get osteoporosis. But enough did that. We can see that they still didn't get osteoporosis. So this is this is purely a disease of the modern world.

Eric 1:25

You teach this as as a as as, you know, just in due course, because evolutionarily it's a thing.

Dr. Josh Stout 1:31

It's a thing. And, you know, it's absolutely a thing. How our bones develop is the focus of a lot of paleontology biology, because that's what we know. Nothing else survived. We don't have a lot to go on except for the bones.

Eric 1:44

It I had no idea that osteoporosis was a regular course of studies.

Dr. Josh Stout 1:48

Well, it's not a course of studies, but I have a I have a class on and I have a lecture on it and it and it relates to other things just as teeth. Right. The other thing we have a lot of our our particular, you know, really specialized bones, our teeth and their what survive as well. And so we talk about teeth a lot. And so these are these are major things to think about in how bones form and how they look and how they develop. And so it is it is definitely something I look into.

Eric 2:13

I hope that for, you know, people who have been your students, these questions that I'm asking are not boring, but I've never actually sat in your classes. We've only spoken informally.

Dr. Josh Stout 2:22

Students don't ask why you teach things.

Eric 2:25

Okay, very good.

Dr. Josh Stout 2:26

They just want to know what your teaching.

Eric 2:28

So that I can pass the test.

Dr. Josh Stout 2:30

Pass the test. And they figure, you know, that's why you're the teacher, right? And it into a lot of them, I think, would be impertinent. It's sometimes it might be. Why are you teaching me this? It's it's kind of not a great question — from you, it’s a great question. From students, I don't necessarily need that question all the time. All right. So anyway, in my Darwinian medicine class, the focus of that class is to compare how we live today with how we used to live mostly as hunter gatherers, how we evolved, what, what, how our bodies and minds evolved, and the difference between our, you know, cubicle living, fast food eating reality today. And one of the real differences is osteoporosis. As I was mentioning, hunter gatherers do not have this problem. Modern humans do. And so it's fun to look at what those differences are and why we might get into it. So first of all, what causes osteoporosis? Osteoporosis is a thinning of the bone, particularly the the structural fibers that are sort of like the the cables of a bridge that hold everything together that support the bone when they thin they can be replaced. But once it fiber has been eliminated, it can no longer be replaced. And so you go from a somewhat porous fibrous inside of a bone, particularly at the ends, basically at the joints, to something that has lots of holes in it because it's lost those fibers. The fibers no longer cross that space.

Eric 3:58

They actually disappear?.

Dr. Josh Stout 3:58

Yeah. So osteo: bone porosity: pores. So you, you actually develop holes in your bone mostly on the inside. You wouldn't see it from the outside. You might notice somewhat a little bit of a pitter, but I don't think much of that. It's still going look smooth on the outside, but the inside of the bone is going to be almost hollow and thin, you know, So it starts becoming eggshell like. And it's and it's super dangerous, not just because your bones are weaker, which is going to lower your activity rates, which is also going to lower all of your exercise and stuff like that. But it will get thin enough that the bones can break on their own. So they now think that, for example, one of the leading indicators of of of mortality in women is is hip fracture and that this might not happen from a fall but just walking along because if you think of the way the femoral head comes into the hip socket. Right, it makes a right angle turn. And if that isn't very, very thick bone and really, really strong, that right angle turn where the where the where the hip socket is coming in. The female head just breaks off.

Eric 4:57

For those who are not sitting and looking at me. I have been cringing for the past forty-five seconds.

Dr. Josh Stout 5:01

Sorry I don’t mean to…

Eric 5:04

No, no, no. You have to do that. Yes.

Dr. Josh Stout 5:06

I'm trying to say it sort of clinically and not not get into the details of how horrible that would be. So there often double hip fractures. So you break one hip as you're walking, which causes you to fall over on the other side. And then the impact on that right angle head also causes another snap.

Eric 5:22

So osteoporosis can be terrible.

Dr. Josh Stout 5:24

Absolutely terrible. Any any any bone can break, but it's usually the hips that go and that that's where the most stress as as as bipeds. And you know, we evolved to be bipeds very, very quickly. And so there's there's a lot of compromises that were made in our evolutionary history. We only did it in about, you know, maybe a million years, which is not a long time for evolution. And then we kept it. We've been bipeds for 6 million years and we've improved a lot of the pieces, but it's still not that long for evolution, just like our lower backs ache all the time because we evolved as quadrupeds and turned into bipeds very quickly. There was some compromises made in structure and strength. The same thing is particularly true of the hips because as as bipeds, we put a lot of stress on that spot and so it doesn't hold itself together. And so bones are made by a kind of cell called osteoblasts. So blastocyst, meaning cell essentially, so bone cells, Bone cells make bones and they're they they are stimulated by estrogen. And so estrogen tells osteoblasts to take calcium and turn it into the calcium phosphate bone material. And so osteoblasts go along making this scaffolding so they can follow an existing fiber and make it thicker. They can take the outer core of that bone and resurface it and make it make it thicker as well. But they they can't replace something if it's not there, if there's no bone there at all, there's nowhere for them to cross. They crawl along bone fixing it as they go. And if there's no bone there, that's that's why they can't improve it once you once you've lost it. So the key thing is keeping your bone density and not losing it, because you can you can always thicken things a little, but you can't replace it once it's gone. And all of this has to do with early life style, how you were as as a child and getting your your bones thick ahead of time early on. So anyway,

Eric 7:24

You’re saying, you're saying that getting your bones thick early on is the key to not losing the bone density later on.

Dr. Josh Stout 7:31

Yeah. So what really matters is, is puberty and it matters for menopause.

Eric 7:37

And what about those of us who are past puberty but not yet at menopause?

Dr. Josh Stout 7:41

Well, we'll get there. There's still things you can do. Okay. But the most important time is puberty.

Eric 7:46

Okay?

Dr. Josh Stout 7:46

Absolutely. You're filled with anabolic steroids. They're building your muscle mass. They're building your bone density. It's when you have the most estrogen in your life. So estrogen tells your bones to get thicker by communicating with the osteoblasts. The osteoblasts make the calcium and they they they lay it down. Now, you might say, but I am a man. I have testosterone, not estrogen. Well, what happens is testosterone is turned into estrogen in the bones. So men maintain their estrogen in their bones because of their testosterone. Men have a decline in testosterone over life, but it is not the plummet that happens to the estrogen in women in menopause. And so that's why men's bones do get weaker with age. But women's bones get weaker really fast in really about a year time. Suddenly they're losing all that estrogen.

Eric 8:35

Wow.

Dr. Josh Stout 8:36

And so they go off a cliff in terms of bone density. And that's why a lot of people recommend estrogen replacement. It's not necessarily for everyone, but it is something that can maintain that bone density and really help you live a better and longer life because your hips don't break and you have more possibility of activities. So back back to sort of how this is all working. So the osteoblasts make bone and then there's something called osteoclasts which remove bone. So like iconoclasm was de destruction of the the the icons. Osteoclasts are destruction of the bone. So you've got the bone cells and the bone destroyers. And so the bone destroyers are what go in and actually remove things so that the osteoblasts can go in and fix them. So every time you exercise or you put any stress on a bone, there's tiny little breaking of those fibers. Bone is made up of a mixture of collagen fibers with the the mineralization sort of around it and over it. And so when those collagen fibers snap due to pressure put on it from from actually pulling on a muscle, the osteoblasts go and they start removing that broken portion of it. Imagine, imagine a rope that started to fray. So some of those little fibers start to break, but the rope is still there. And so the the osteoclasts will get rid of all that frayed material and the osteoblasts will go and make a new rope, essentially. But if the rope is gone, there's nothing to work with. And so this is why it's really important to not lose too much because you can't rebuild it again later. So this a normal process of osteoclasts breaking things down osteoblasts repairing them, making them thicker, rebuilding it, making it stronger. But what happens when you're missing the missing, the estrogen? Then you have more osteoclasts than osteoblasts and you just start reducing your overall bone structure all over your body. The osteoclasts are now outnumbering osteoblasts and everything starts getting thinner and weaker. And so this happens to everyone. But, you know, particularly at menopause. And the reason it happens to us, unlike other creatures out there. So this is sort of the interesting evolutionary side of it, is one, we are so evolved to never have anything extra. Most animals don't want to have anything extra. It's extra costs. But we are super evolved for efficiency, you know, That's why we became bipeds. We didn't become bipeds to become the fastest. We became bipeds to become the most efficient. To get from point A to point B costs us the least calories really, of any large animal Just walking slowly to get there, maybe even a slow jog. This is how we can kill things by just chasing them down because they take more energy to get from one place to the next. So anytime we sit still, we delete our muscles because muscles are energy expensive and we start deleting our bones as well. So any time you're not moving, you're going to get rid of any extra cost you can get rid of. You want to reduce your caloric load because all you want to do is maximize calories to keep your brain alive. Evolutionarily speaking.

Eric 11:41

Again, about the big brain, it's all about the big brain.

Dr. Josh Stout 11:44

It's all about the big brain. Yeah, exactly. And your brain needs a constant load of calcium to work its how nerves work. And so your.

Eric 11:56

Calcium makes bone and calcium makes brain and nerves.

Dr. Josh Stout 12:01

Yeah, basically. So nerves send, well, people call it electrical signals, but it's actually a depolarization across a membrane of charged ions and one of those ions is calcium. And so it's, it's these calcium ions moving across the membrane is what send nerve signals, calcium ions. Flooding between the nerves is what is part of the signal between nerves. So when calcium ions flow between cells, it causes depolarization and a signal to continue. If your calcium levels get too high or too low, the whole system breaks down. You know, first things you start to notice things like muscle cramps and stuff and stuff like that. But if you don't have enough calcium in your brain, you're just dead within seconds. Really, There are nerve toxins that flood you with calcium also dead within seconds. So calcium has to maintain within a very narrow, narrow region. So this is where you start to get into sort of the dietary side of things. You need calcium in your diet because if you don't have enough calcium intake, the calcium has to come from somewhere. And so if you don't have calcium in your diet, it comes from your bones. And so your body starts thinning out the bones and so your body is programmed to just go right to the bones, try and thin them out as much as possible so we don't have to carry around that weight again for efficiency. Again, to keep that very big brain going. But it's never going to let the blood levels of calcium get below a certain level. So even skipping calcium for a short amount of time, this is in in short periods of time, you'll start thinning your bones right away. So if you don't exercise and you don't have calcium in your diet, even over a couple of days, you're going to get thinner bones. So you need to keep that calcium coming in constantly. You need to exercise constantly to maintain that cycle of refinishing the bones and keep those osteoblasts making new bones. Any time you're not exercising, the osteoclasts are just thinning the bones, thinning the bones, thinning the bones, setting those calcium ions into your blood, keeping your brain working, but making you overall weaker. And it's doing this in the name of efficiency because less bones means less stuff to carry around. It's easier to get from point A to point B so we can gain more calories. So evolution just wants you to sit still and get fat. That's the only thing it wants and then make babies. Right? Two things since they'll make fat and make babies, these three things. All right. Anyway, you're you're programmed to like these things. You're not programmed to to do the things you need to do because it figured being hungry would get you to do that. Right? So evolution was designed to make you sit still as much as possible and then get up and go find some food. When you were hungry.

Eric 14:37

Evolution did not think of canned food, microwaved food…

Dr. Josh Stout 14:40

Refrigerators. All of that.

Eric 14:42

All of it.

Dr. Josh Stout 14:42

All of that. Yeah. Now you should be, you know, walking six miles to get your food and then six miles to come back. And then you have to like, spend an hour or two pounding and chopping it, and then you get to eat it.

Eric 14:51

You think it's nice to take a little walk after dinner?

Dr. Josh Stout 14:53

Yeah, exactly. And, you know, you should chew on your food for hours and hours and hours because it's so tough and difficult to get through, which goes back to the bones. Our bones are absolutely designed for all of these things. I mentioned it before that a 19th century strong man could bite through an iron spike. They're not genetically different from it. They're just using those bones. And so when you use bones, they get thicker, thicker jaws. You know, there's there is a sort of stereotype that the thick jaw is manly. We've lost that because of our lack of of of chewing. Essentially, our jaws have gotten thinner, our teeth have gotten smaller. We didn't need to use to have our wisdom teeth removed. We had enough room for them. They would come in. They were nice and thick and you could just bite through anything. And that was simply because of the differences in use. So the same way our our overall skeleton gets thinner when we don't use it, Our teeth are a special case of bones. You know, the only exposed bone, but they fall into the same set of categories When you're when you're young and you're chewing, particularly in puberty, you're going to be strengthening everything. Everything is going to get thicker and larger amounts of bone, and it will be reduced if you don't do these things. And once it's lost, there's no going back. And it's particularly true of the teeth. You can't remodel your teeth after they've formed themselves. So this is this is a really, really important system where. So first of all, you need to keep your calcium intake. You need to have exercise so that you're always strengthening your bones because your bones will just go away when you don't do these things. And you also need vitamin D, So vitamin D we get from sunlight. It can be also, you know, people put it in milk products, etc., but it's naturally coming from sunlight, interacting with proteins that are already in in our foods and it modifies them the vitamin D, then actually is what tells our intestine to take up calcium. So that's what the vitamin D is doing. If you don't have vitamin D, you can't get the calcium intake and again, you very quickly start losing bone density.

Eric 17:06

Vitamin D basically activates your body to be able to take in calcium. Exactly. You need vitamin D in addition to dietary calcium of some form.

Dr. Josh Stout 17:20

Exactly. Exactly. And there's a lot of debate on this. Some people say the calcium in in green leafy vegetables is easier to uptake than the calcium in milk. Obviously, the calcium in milk is much higher percentage, but it's difficult for us to absorb for some people more than others. So there's there's some debate on that. But regardless of sources, you absolutely need the calcium and you need the vitamin D or you can't use it.

Eric 17:46

Well, what a coincidence. They put both in milk.

Dr. Josh Stout 17:49

Exactly. Well, there, yeah, there was a reason for it. But, you know, hunter gatherers wouldn't have had this part. They just eat the whole egg shell it all if they was, you know, bird with bones and they just chew up the bones, that's where they got. Their calcium. They didn't they didn't drink milk. That wasn't an option. So they were getting it through their diet and they never had a lack of it just because it was everywhere and they always were outside. So they never had a lack of vitamin D.

Eric 18:10

You know, they didn't go away very long ago. I remember my father's sister, my aunt, who would just chew up the chicken bones and the the eat the entire apple. Yeah, yeah, yeah. All that stuff. Yeah. It was just that was just a generation or two ago.

Dr. Josh Stout 18:23

My, my, my father worked in a law firm in England where the people in England had been in Shanghai when the Japanese came in and took over the city. And the the English prisoners of war, not prisoners of war prisoners, I guess I don't know what you call like children who are being kept in a concentration camp, but they're not as badly off as the Chinese children being kept in wherever they are. They would be allowed to leave the camp and forage for garbage, and their main food that they were really hunting for was egg shells, because each egg shell had some had some protein left on it. And so this this, you know, lawyer working in a law firm in England was talking about his childhood scavenging egg shells from garbage cans as the way he got through the war.

Eric 19:09

And they would eat the egg shells?

Dr. Josh Stout 19:10

Eat the whole egg shell. Yeah, there's a lot of food in an egg shell. So, yeah, we've we've been ignoring a lot of things that we are well evolved to do and things that seem really nasty become tasty and delicious under the right circumstances. So anyway, yeah, we need, we need a constant form of calcium. The people who didn't eat those eggshells, those boys would not have developed bones properly. I assume there were girls out there too, but I sort of in my head I picture a kind of Neverland with the Lost Boys running around through the streets. But I'm sure it was mixed group had to be. And then what happens is I mentioned puberty. So when you're going through puberty, estrogen and testosterone, these are anabolic steroids. They build muscle density, but they also build bone density. And so this is the primary time when you get your body ready for, you know, future bone strength.

Eric 20:04

How do we feed the needs of that moment?

Dr. Josh Stout 20:07

Weight training, exercise? Anything that puts stress on the bones using muscles is going to make them thicker.

Eric 20:13

During puberty or start in prepubescence.

Dr. Josh Stout 20:15

Well, the habits should start in prepubescent weight training. Anything, anything that puts stress on the bones, you know, a push up or a handstand or any anything that's actually doing it. Strangely, the two things that later in life really seem to help prevent against osteoporosis are literally weight training or gardening. And if you think about gardening, it's awfully similar in some ways to what we did as hunter gatherers. The kneeling, the pulling, all of these things are bending down, standing up. Exactly, Exactly.

Eric 20:50

Pushing, digging, exactly.

Dr. Josh Stout 20:51

So it doesn't need to be lifting weights. It just needs to be this kind of active movement that's putting pressure and stress on the bones.

Eric 20:58

So basically during puberty, doing things that you would never want to do.

Dr. Josh Stout 21:05

For most people. Yeah. Yeah. I mean, most girls and boys are not going to be gonna.

Eric 21:12

Spend 20 minutes a day lifting weights.

Dr. Josh Stout 21:15

Or gardening. Yeah, actually, it's actually might be easier to get them to lift weights. But anyway, so these are these are the things that in your life can really help maintain bone density. Is that kind of movement of foods. So the foods are the ones that are rich in calcium and things that can maintain vitamin D, So either exposure outside or actually just taking a supplement. I'm I'm, I'm agnostic on sunlight. A lot of people used to be in favor of it. People are now generally against it. We do know it that it ages the skin and can cause skin cancers. However, skin cancers have gone up as we've gone inside. Farmers didn't used to get skin cancers at the same rate that our cubicle living world does today. So there is there is there is a problem with the way we're thinking about this. I'm not sure what it is. I suspect it has to do with sunburn.

Eric 22:11

Do do do lotions and sun blocks stop the effect of of vitamin D in from sunlight?

Dr. Josh Stout 22:22

That's an interesting question. I don't I don't think they stop the effect of vitamin D. They definitely keep you from burning. But some people think they don't stop the problem of skin cancer either. So it's it's some people think the rise in skin cancer is due to the lotions. I don't think so. I think it's I think it's that what we do is we go inside and, you know, those of us with pale skin, it gets even paler when we spend time inside. Again, our body eliminates anything we're not actively using. So we eliminate the melanin so we have no protection. We go out in the sun and the first thing we do when we go out in the sun is we get sunburn. I think it's the damage that causes the cancer. This is a sort of separate issue, but in many cases, the reason cancers develop is because of damages to some sort of tissue. And so.

Eric 23:09

Even if you heal, you might have caused damage that will not be manifest until years.

Dr. Josh Stout 23:13

Later. Until years later. Exactly. Yeah, yeah, yeah. So so the number of times you've had sunburn as a child correlates strongly to the number of skin cancers you have later in life and the severity of the sunburn, One really bad sunburn is worse than, you know, many summers where you didn't have a bad sunburn on it. It's really the damage that that that you see problems with later of life. I think it's true for you know, intestinal cancers as well.

Eric 23:41

I don't want this to promote helicopter parenting like this is No.

Dr. Josh Stout 23:45

No no, no, no.

Eric 23:46

You feel like you just want to.

Dr. Josh Stout 23:48

Let your.

Eric 23:49

Kids out.

Dr. Josh Stout 23:50

At the beginning of the summer naked so they get sun and they start to adapt and they start in April naked and they go right through the summer, barefoot, naked until they're, you know, well, tanned and healthy by by fall. And you, like, take them in again.

Eric 24:06

Like you said, the problem is not is not necessarily the sun exposure. The problem is the damage from the sun.

Dr. Josh Stout 24:13

Right. Right. And the sun will age your skin and you'll get more wrinkles and such. You know, you think of the 40 year old farmer who looks 70.

Eric 24:23

I'll live with wrinkles if I know if don't have to deal with cancer.

Dr. Josh Stout 24:26

They don't have as many skin cancers. Exactly. So I think there's probably a balance between too much and too little as there are in many situations. You don't.

Eric 24:34

Live in the sun but.

Dr. Josh Stout 24:35

The sun. But but, but the we are definitely evolved to take in sunlight and turn it into vitamin D, And this is one of the few cases where there is actually differences between what people call races incorrectly, but people with different amounts of melanin, their skin have a different relationship to sunlight. Obviously, when you have darker skin, you have more protection against sunlight, but you're not going to take in as much vitamin D. So some of these lotions may be actually blocking the vitamin D. I don't know much about that topic, but I know the melanin is and so that if you were evolved.

Eric 25:09

The melanin is blocking some of.

Dr. Josh Stout 25:11

The vitamin D, Absolutely. So evolution doesn't care about skin cancer because that happens later in your life. But evolution does care about forming bones as children.

Eric 25:21

In other words, you procreate. And so evolution is done with you, right?

Dr. Josh Stout 25:24

But you do need vitamin D to develop good bones. And if you don't develop good bones, you're not going to be strong enough to reproduce. Evolution cares about that. And so evolution has maximized melanin in towards the equator and minimized it further north because of two things Vitamin D and folic acid. So folic acid is needed in pregnancy. Sunlight tends to destroy folic acid. So you need to maximize melanin to protect against sunlight. But as you start heading north and you lose sunlight and you need to take in more to get enough vitamin D to develop properly as children. So these things are important and you have to, you know, see your where you are in evolution to understand what you're going to need.

Eric 26:10

That's fascinating what you're saying, that we you know, whatever whatever the body isn't using, it's getting rid of the things that we're using are not necessarily things that we have chosen to use, the things that we're using without even knowing it is from our environment, from where we are.

Dr. Josh Stout 26:24

Absolutely. Yeah. Yeah. We don't think about using sunlight. We just walk around outside and. Right. But it happens.

Eric 26:30

To other parts of our body that have to adjust to that.

Dr. Josh Stout 26:33

Exactly. Exactly.

Eric 26:34

And that's in whatever and whatever, like living in the city. Yeah. Yeah. Does other things and.

Dr. Josh Stout 26:40

And the, the, the calcium building bones was so important in our early evolution that we actually didn't just get less melanin. We changed it. You melanin is the kind that you see in equatorial regions. We have this sort of more yellow tone to the melanin. If you're from a European area, this may be a Neanderthal gene, but not not from the Neanderthals in in Europe, the Neanderthals in the Middle East, actually. So the the pale skin that Europeans have came with the Middle Eastern farmers who brought farming to Europe, the hunter gatherers from Europe were basically eliminated. The people the Nazis worshiped had dark skin and blue eyes, and the the farmers came in with brown skin and pale skin, and we ended up with many Europeans with the blue eyes and the pale skin. And the reason they got pale skin was to allow more calcium in. But they changed the kind of melanin to separate gene probably from the Neanderthals. Eumelanin actually does better cancer repair. So skin cancers are inhibited by the the the eumelanin that some people have and the the the other kind of melanin actually somewhat encourages skin cancers. So we traded a later in life problem for early calcium uptake to produce good bones early in life. So we were willing to trade off yeah we'll all die of skin cancer when we hit 60, but we can now trade this for stronger bones earlier in life. So this is how important stronger bones are in development. It's something that evolution is really focused on and it's very, very important for us. Now, there are other ways to train bones that most people don't know about in in our country.

Eric 28:33

So now, you know, you're moving towards what we can do after puberty.

Dr. Josh Stout 28:37

Or in puberty, but also after puberty. But so in our kung fu practice, there's the saying that kung fu trains the bones and karate trains the muscles. I think all of the martial arts are going to be training the bones.

Eric 28:51

Yeah.

Dr. Josh Stout 28:51

But one of the reasons we think about this is it's not just the muscle use that encourages bone formation, but also impacts. And so this is where most health discussions aren't actually going to talk about.

Eric 29:08

You were saying that impacts impacts on the bone.

Dr. Josh Stout 29:12

On the bone.

Eric 29:12

Train, the bone.

Dr. Josh Stout 29:14

Train the bone, make them longer, make them stronger. So the same way that the when when a lot of these small fibers breaks the osteoclasts go remove the broken part and then the osteoblasts fix it. The same thing happens when you actually just hit a bone, one bone hitting on another bone. Both of those bones are going to be slightly damaged. And then when they're repaired, they're going to be stronger and thicker in response to it. And so this is this was known obviously within, you know, martial arts communities for thousands of years, but it was not well understood by scientists until relatively recently. I in the in the late nineties, I went to a talk at Rutgers where they had people who were working on astronauts and astronauts have the problem of when you go into space, you don't have any gravity pulling on your bones. Again, as soon as you're not using something, your body gets rid of it. And so astronauts many times will have to be in wheelchairs.

Eric 30:07

That must be catastrophic to the body. Like, yeah, losses.

Dr. Josh Stout 30:10

Everywhere, losses everywhere. Plus a high GI environment as you're coming back at, things can be pretty bad. And so they have to go through rehabilitation. When they come down is space, is space is not good for you. And one of the problems of space is, is the low gravity eliminating bones. So these guys at Rutgers wanted to know how how you make bone stronger. And so they were doing terrible, terrible things to goats as as ways to strengthen them. They would they would make, you know, stresses on one leg of a goat and then compare it to the other legs of the goat that didn't have those same stresses. So they looked at muscle stresses and they also took one of those little rubber mallets that you use to check your nerve reflexes and just hit the goat on the leg for, you know, a minute or two each day. And they look at that and both of these things were able to change the bones of the goat. So it's not just muscle activity, but it's also the impact on the bones.

Eric 31:03

And it's not it's not a woo woo kung fu.

Dr. Josh Stout 31:06

Oh, absolutely not. No. You really literally make them bigger.

Eric 31:09

This is something that science can support.

Dr. Josh Stout 31:11

And interestingly, again, this doesn't get into much of the literature, but in this study from Rutgers, where they these were serious scientists doing terrible things to goats and doing really serious work on how bones grow and how they work was there. There are there are two layers to bones. You have the the pancreas, the periosteum and the endosteum. So the periosteum and the the posterior the periosteum is the outer outside core of the bone. It's a core of the bone, the outside of the bone. And the endosteum is the is the inside core of the bone. So the endosteum is where these fibers are, where you're you're often gettingthe osteoporosis. That's the inside, that's the center core of the bone. That is what you mainly build in your youth. So that's what you're building when you're when you're when you're child, when you're in puberty. It's that inner inner density. And so you can really only build that in your youth up through the age of I think it's 24 girls and maybe 22 for boys. You can build that inner core, but after that you're mostly done with that or a core. But the the periosteum, this part can actually be changed throughout your life, so you won't build that inner density that you can build earlier in your life. But the periosteum you can build by banging your arms into things or through exercise, you're going to build the outer core stronger. Now, you can imagine in a bridge that inner truss work is really the important part of the bridge. But if you just make the outside bars thicker, it will also build some strength. So you can build strength later in life. You can build the outer bone density. But that outer part is is mostly fibrous. It's layers of of collagen and reticular fibers. It's not it's not it's not as solid as that inner portions are. And it so it responds more quickly. So if you if you say, you know, bumped your arm into a piece of wood every day for a week, at the end of the week, you would notice a bump, a raised bump on your arm. Some of that would be the outer tissue that's responding. But some of that is the bone itself is these fibrous collagen fibers are actually building up. And it's not as hard as inner bone, but it is part of the bone. It's there. And again, it can happen in very real time, not something that happens over, you know, ten years, but can happen over a matter of a week or so.

Eric 33:52

But also could be lost.

Dr. Josh Stout 33:53

And [unintelligible] could be lost is as as quickly. And so then that sort of that lumpy area of soft bone would gradually become mineralized over time and become harder bone, but it would still be on the outside. So the the the, the general sort of set of stages would be this softer collagen region on the outside of the bone that would then then getting denser.

Eric 34:16

Is the bone is react as skin does in like way if you get a callus from a from a use area repeated use area you're also going to have that on bone.

Dr. Josh Stout 34:27

Yeah exactly. So very, very very true and that's that would be more of the outside than the inside. The inside, again, you build up when you're younger, but that that sort of coalescing effect that you're describing would be true of of everyone's bones and throughout your life.

Eric 34:45

So then if we are expecting that the hips would be a weak area, we could work on the improving the strength of the hips.

Dr. Josh Stout 34:52

Yeah, anything that bounces up and down on the hips, but you can't just go right into it, particularly later in life if you start putting stresses these bones and there's some damage to them and you don't have enough osteoblasts, you only have osteoclasts, the osteoclasts are going to go remove that damage, but nothing is going to get built. So, you know, if if you are a woman and you've already gone through menopause and you want to start building, building bone, you're going to have to take it very, very slowly. And you might want to match it to added estrogen, because then you can actually rebuild that bone.

Eric 35:25

Added estrogen will increase the number of osteoblasts.

Dr. Josh Stout 35:30

Yes, exactly.

Eric 35:31

Is there a is there a dietary way to promote the production of osteoblasts that does not involve.

Dr. Josh Stout 35:38

I don't know of one. I don't know if anyone knows of one. Mostly It's all about keeping your calcium levels high because, again, this is done in real time.

Eric 35:47

So if you were if you were going to do that, if you were going to undertake a, you know, a regimen of slowly increasing exercise and estrogen, that that's something you would need to do that concurrently, continuously, Right.

Dr. Josh Stout 36:01

Continuously. And you're not going, Yeah. Otherwise it will quickly be lost and you might consider a calcium supplement depending on your diet. You'd want to be careful with that sort of thing. Again, consult a doctor.

Eric 36:14

Yes, yes, yes. I'm I'm not I'm not… I'm just saying that that what I'm thinking through is that this kind of a thing could make real changes. But then were you to stop those changes would literally just most of them would just go away.

Dr. Josh Stout 36:27

They will go away. Yeah. And your body's designed to make them go away. But it's just like any other exercise. When you build muscle, if you stop exercising, you're going to lose that muscle again. And so all of these things are directly linked. Yeah, there's no there's no easy solution. Calcium supplements just provide more calcium. But if you're not using that calcium, it doesn't help you at all. It's just going to make you constipated, essentially. So, you know, you can't you can't just have a diet that's going to cure your problem. What else but the diet can cause the problem. If you don't have enough calcium, you won't be able to build the bone.

Eric 36:59

What else will help calcium absorption other than, I mean, vitamin D in the sun, I guess. Vitamin D in supplement.

Dr. Josh Stout 37:05

Vitamin D in supplements. But also, you know, thinking about the stages of your life. So getting those bones dense early in your life so you have them later in your life. Also, pregnancy, when you are pregnant and breastfeeding, you're losing a lot of calcium, you're making babies bones and then you're giving milk to the babies. Again, this is a time when you're going to start drawing down your own bones. So you need calcium supplements at this time or your bones are going to get weaker. I've heard a saying that for every baby you lose a tooth and so you'll actually start losing the jaw bones, because that's some of them. That's some of the stuff that responds quickly to lack of calcium is your jaw is going to change some of the fastest because what it's the most important right if you're if you can't eat you can't do anything. And so evolution reconfigures your jaw faster than other places. And so it responds to changes in hormones very, very quickly. And so during pregnancy, your estrogen is pretty high. So if you can maintain exercise and maintain calcium, you're not going to have so many problems. But you will very quickly if you're just eating soft foods and you're not getting enough calcium and you're sitting around because you're pregnant and you feel like you absolutely deserve it, which you do, you're going to start getting losing, losing bone density and you're likely to lose a tooth because the roots of the tooth are going to are still you know, they're still alive. And so they're going to lose material and the bone around it. Even more importantly, the teeth are going to get loose in the sockets because the bone starts shrinking around them. And so this is this is another way that women have a difficult time and just because of the stages of their life are going to impact their bones significantly. But if you, you know, keep in mind that that estrogen is there in high amounts when you're pregnant, you can using diet and exercise to keep those calcium levels high and keep keep your bone density up so you don't lose teeth and bones, etc., while you're pregnant. So, you know, you really have to think about every every stage in life like that puberty, pregnancy, menopause, etc.. This is an issue, obviously, that I'm talking about for women in particular. But these things are true for men as well, that you need to exercise during puberty to get that bone density up. And then as as bone density goes down, as you age, you're losing testosterone. So you're losing the estrogen in your bones so you don't make as many bones, you know, same, same problem, not as many osteoblasts. You need to maintain exercise. And again, it has to be paired with calcium uptake, vitamin D, calcium levels. Calcium is just really weird thing that this ion is involved in so many parts of your brain and nervous system. You really need to maintain level second to second. And so your bones are just seen as a as a reservoir for this. And so it's you really can start drawing down bones instantly as soon as you need it elsewhere in your body. If it's not coming from your diet.

Eric 40:12

You shouldn't shouldn't a good supplement that has both vitamin D and calcium help this be maintained without bone loss? Yes. Combined with exercise. Yeah.

Dr. Josh Stout 40:24

Yeah. Without the exercise, it won't do anything. Yeah, it'll. It'll just pass right through you. You need all of these portions to it.

Eric 40:31

Literally need to stress your body in order to cause it to rebuild itself.

Dr. Josh Stout 40:35

Absolutely. And other things make it worse. So cigarettes inhibit calcium uptake.

The the I was just thinking about slightly off topic, but the calcium ions in your brain are often the source of damage. During a stroke, for example, because part of what they do is they they start leaking through membranes, causing further depolarization of the membranes. And then once they go through the membranes, they start signaling I these these enzymes that destroy the membranes themselves. So they there is they they start signaling these phospholipids is so your membranes are phospholipid bilayer. So basically like a soap bubble cell membranes form themselves. Even if you're not alive, they'll just make themselves. And so they're literally like a kind of like a soap bubble. And these light pieces go and just destroy that soap bubble. So everything in the cell comes leaking out.

Eric 41:35

This is signaled by calcium ions leaking out erroneously.

Dr. Josh Stout 41:39

So if you have too much calcium just floating around in the, you know, in the liquid or outside the cells, they'll start being pulled into into the cells. And when they get pulled into the cells and they reach too high a level, they'll signal the destruction of the cell membrane, thus releasing more calcium. And so this is part of the damage cycle caused. Once you have damage in your brain and this the calcium ions themselves basically delete the damaged areas. So they end up being protective sort of in the long run in that the calcium ions because they signal muscle contractions are going to signal vasoconstriction. And so you're not going to have as much blood flow to the area. So it's not going to take those calcium ions that are now destroying all the nerves in this particular area are now confined. And so you end up confining this destruction, but also deleting all the nerves involved, whatever was wrong with them, they're now all just gone.

Eric 42:36

Closed the bulkheads.

Dr. Josh Stout 42:37

Exactly. I just seal off the bulkheads and let it all die. And so that's what was happening. When a stroke happens, a lot of that tissue probably can be saved if you stop this sort of domino effect of destruction. But it is actually there for a reason. And that's something that we need to think about in the way we treat neurological disorders is understanding what needs to be prevented because it's a sort of cascade of damage and understand what needs to be allowed because it's part of your body's defense mechanism, essentially. So anyway, calcium is is is tremendously important. It's not just the bones, but trying to give you an idea of why this is a second to second problem where if you're if your calcium levels drop even a tiny bit, you're immediately siphoning it off for the rest of your body and you're never going to allow your calcium levels to drop. You will turn to Jello and dissolve all your bones before your calcium levels drop, because you're just going to to have that constantly.

Eric 43:37

Without the right calcium levels, you're dead immediately. Without the right calcium levels in your bones. It can take a while. You can fix that maybe.

Dr. Josh Stout 43:43

Yeah, yeah, yeah. And there are and there are and there are supplemental hormones that can actually help with that. So for example, Calcitonin takes the calcium out of your blood system and puts it in your bones. But if the osteoblasts getting the correct signals because you're not exercising, that won't work very well. If there isn't enough calcium in your blood, calcitonin won't do anything. So all of these pieces need to be part of the puzzle for for the strength to happen in.

Eric 44:11

Terms of in terms of the self improvement in protection. It's the same as almost all the other issues that we've discussed pretty much since the very first episode, which is that movement is in in the very beginning of our of our evolutionary history.

Dr. Josh Stout 44:30

The diet and exercise need to go together. They've always gone together. And if they don't go together, something falls apart. So we evolved the way we move to get the food we eat. And if we don't eat the right food and we don't move the right way, our bodies fall apart and are programmed to fall apart faster than most other animals. We need to stay as efficient as possible to feed this giant brain while using no energy. I know it's like what occurs, but it's fascinating.

Eric 45:01

Yeah. The the and whatever level you look at it that you know, the proper diet and and being being active is just key to health. Just across the board from every from you, whether you're looking at it from an early stage of life to the later stages or you're in the later stage of life. Absolutely.

Dr. Josh Stout 45:23

It doesn't matter. No. The same things we need when you're young, you still need when you're old, and the same things that go wrong when you're young go wrong when you're old. However, you know, it is really important to think about your future. Yeah, and exercise now for how you're going to be later. Yeah. And again, it doesn't matter what stage of life you in puberty you should be thinking about menopause, which is unimaginable during puberty. But, you know, if you're 50 years old, you should be thinking about your mid sixties, right? You need to be thinking about how am I going to maintain this bone density longer in life for as long as possible.

Eric 45:59

The ending is in the beginning. Start up the way you mean to keep up, that’s…

Dr. Josh Stout 46:03

Absolutely. Yeah.

Eric 46:05

Fascinating.

Dr. Josh Stout 46:06

Well, thanks, Eric.

Eric 46:07

Thank you. Josh. All right, folks, until next time.