Bone health is a concern many think they don’t have to worry about until they are older. Many think about it as mostly an issue for older women. That is not always the case, however. This week Dr. Sandi talks all about bones and bone health with expert Kevin Ellis, aka The Bone Coach.
Kevin Ellis was diagnosed with osteoporosis at a young age. After learning that he had celiac, a doctor suggested that he take a bone density test as celiac leads to nutrient malabsorption. That test would change his life. After learning all that he could about the condition and becoming a certified health coach, Ellis created a program to help others combat bone loss naturally. Osteoporosis doesn’t make a person weak. Actually, according to Ellis, the best way to fight back against bone loss is to become stronger, healthier, and optimistic.
- What tests are available to get a full picture of your bone health?
- The difference between osteoporosis and osteopenia.
- How are gut health and bone health connected?
- Dr. Sandi shares her routine for building bone strength.
Meet the Guest
Founder, Bone Coach
Kevin is an Integrative Nutrition Certified Health Coach, Stronger Bones Solution™ Program Instructor, osteoporosis “thriver,” and founder of BoneCoach™.
He has made it his mission to help over 1+ million people around the globe address bone loss, build bone strength, stop fearing fractures, and lead active lives. He’s most famous for helping people with osteopenia and osteoporosis gain clarity and confidence that improving is possible.
Dr. Sandi: Hello, everybody, and welcome to “Health Coach Talk.” Today, I have a special guest. His name is Kevin Ellis, aka the Bone Coach. He is a health coach. He’s an integrative health coach, and he had a diagnosis of osteoporosis at a very young age in his 30s. So, he’s here to talk about this condition, about osteopenia, and we will talk about why this is important for you to know if you are a health coach or thinking of becoming one and perhaps you want to work with a health coach if you are suffering or afraid you are going to develop this condition, which seems to be epidemic. So, welcome, Kevin.
Kevin: Thank you so much, Sandra, for having me on. I’m looking forward to this conversation.
Dr. Sandi: So, start by telling us about your journey. How did you get to this place where you are now the Bone Coach?
Kevin: Yeah. So, it has been quite the journey. So, present day, we have about 250,000 people in our community. Most are women, 50 to 70 plus with osteopenia/osteoporosis. And we’ve got programs featured in Forbes and a lot of other places. And a lot of thousands of people have come to these programs. That is very far placed from where I started.
My journey started with a lot of different health issues. Like many people in the health space or who are inspired to help others, mine started out of my own personal struggle. I would actually take my health journey back before I was even born. When 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. He was 35 years old at that time, and he was a Marine. He served 22 months in Vietnam and got cancer from Agent Orange of all things. And that is what took him from us.
So, as I was growing up, I wanted to be a Marine, and I wanted to make him proud and follow in his footsteps. So, I went into the Marine Corps. I spent about five years there, and I was in the infantry, did a couple deployments. And when I came back, I had all these health issues. So, I had high stress, worse sleep, chronic digestive issues. There were days I could barely even get out of bed. My energy was just non-existent.
I was diagnosed with celiac disease, so I was malabsorbing nutrients for many years, and I was subsequently diagnosed with osteoporosis. And the only reason I was diagnosed with osteoporosis is because all the doctors that I had been working with, none of them suggested a bone density scan with someone with celiac disease, but I had a physician’s assistant who said, “Hey, has anybody done this test, a bone density test?” And I was like, “Oh, I’m a tough Marine. No, my bones are fine.” And they did the test, and it turns out I had osteoporosis.
They sent me a letter in the mail. Nobody called me. They just said, “Hey, you have osteoporosis. Go on a gluten-free diet.” That was the extent of my treatment plan, and I realized… First, I was scared. When I read this and then I went and I Googled it, I was scared. What is this condition? What does this mean for my future? And I just read about fractures and medication. And I was like, “Oh, my gosh, I have to do something.” I wanted to be the father mine didn’t get the chance to be for me for my own kids.
So, I had a really strong impetus to do the research, to build out a plan, to focus on healing and improving myself. And when I was on that journey, I realized there are a lot of other people that I could be helping. And it’s usually not the younger male, 30 years old, right? It’s the woman 50 to 70 plus. So, I became a health coach. I developed a program. I worked with a bunch of different people who are experts in their fields, 10, 20, 30 years of experience in their fields. Many of them have gone through The Institute for Functional Medicine as well. And I just said, “Hey, this is what I’m doing. I’d love for you to be a part of this.” And many of them just joined.
And we’ve now helped thousands and thousands of people at this point. So, it’s a beautiful journey, but it has not been without struggle and challenge for sure.
Dr. Sandi: Well, that’s remarkable. And it is a story of courage, of perseverance, of really becoming the person who is going to be the architect of your own health. So, this is reaching epidemic proportions. I literally do not know one person in my age group who I’m friends with, my colleagues… I’m turning 74, and everyone I know has a diagnosis of osteoporosis. I’m not kidding. Every one of my friends. And of course one of them was even told like, “You are going to die if you don’t go on medication.”
So, I’d love to have you address… Well, first of all, what exactly are we talking about? What is osteopenia versus osteoporosis? And then what about medication? Is that the only option? Because that’s what I’m hearing. That’s what my friends are saying. They didn’t say I had any other options, that literally this was it.
Kevin: Yeah, so osteoporosis, it 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 the two of those things. And in osteoporosis, both your bone density and your bone quality are reduced, and that’s what increases the risk of fracture.
And the way people find out they have osteoporosis is through what’s called a bone density scan. So, this is a scan, very low levels of radiation, but you lay down on a machine. It does the scan. It tells you your bone mineral density, the actual mineral content of your bone. And then it generates a score, and that score is what determines what they tell you the diagnosis is, right?
So, if it’s plus 1 or minus 1, that’s considered normal and healthy. If it’s minus 1 to minus 2.5, that’s what they would call osteopenia. We would call that low bone mass. It’s like a precursor to osteoporosis. And minus 2.5 or lower, so minus 2.6, minus 2.7, so on and so forth, that’s considered osteoporosis. Now the greater that negative number becomes, the more severe the osteoporosis.
A couple important notes is that, just because somebody is told they have osteoporosis, even though fracture can happen, it doesn’t mean it’s guaranteed, because a lot of times when people get a bone density scan, they only have part of the picture. So, your bone density scan tells you your bone density. Oftentimes what it does not tell you is your bone quality. So, density is the mineral content of your bone. Quality is the structural integrity of that bone, the microarchitecture, how that bone is organized. Those two things combine to create bone strength.
So, a lot of times people only have part of the picture at the time of diagnosis, so that’s important. The other part of the picture that they don’t typically have is they don’t typically know if they’re actively losing bone right now, present day, as we speak. If there is active bone loss taking place, it has to be addressed.
So, the way you find out if you have active bone loss is through what’s called bone turnover markers. Now, bone turnover markers look at the activity level of cells that are breaking down and building up your bones. And if that activity level is elevated or even really high, that can be an indicator of active bone loss and a root cause issue that needs to be addressed.
So, we’re talking about… One test is called the Serum CTX test, C telopeptide test. It’s a blood test. You do it in the morning first thing while you’re fasted. And this test can tell you…it’s the most sensitive marker for bone resorption, right, so how much your bones are breaking down. And then there are some other tests you can look at. The other test is, if you want to understand your bone quality, the structural integrity, there’s something called TBS, trabecular bone score. This is an add-on software to the bone density scan. Call the facility ahead of time. Ask if they have that capability, and you can get it at the same time as your bone density scan. If they don’t have that capability, that’s okay.
There is another technology that is more prevalent in Europe. It’s trying to make its way into the U.S. right now. It’s called REMS, Radiofrequency Echographic Multi Spectrometry technology, or it’s a device called Echolight. And this device uses ultrasound technology to tell you your bone density, your bone quality, and a five-year predictor of fracture, so fragility score. So, those are some tools that you can use on the diagnostic side that can really help you understand what your current bone health picture is.
Dr. Sandi: Yeah. So, we’re getting more and more sophisticated regarding diagnosis. I was diagnosed with osteopenia years ago, and I went to a nutrition professional and she said, “Of course, look at your size. You have wrists that are like a child’s. Of course, this is going to…” And what she had said was that the norms were based on somebody who was average height and that this was at the time. And she said, “Well, look, it’s about the muscle, the tendons, the ligaments, what hugs the bone.” And so I have been focusing on building muscle, looking on balance exercise, doing some pounding, jumping. I have a trampoline and do jumps in ballet and all those kinds of things.
So, could you address this medication? How would somebody [inaudible 00:09:56.353] because they might be overwhelmed? Should I take these medications? What are the dangers? Are they really important? And then what else could I do? Are there alternatives out there?
Kevin: Yeah, I’m happy to address that. So, medications, first thing I will say is I am pro do everything you possibly can naturally first before ever considering medications as an option, but I can’t be anti-medication. I have seen situations where it is necessary and even lifesaving for some people, but I’m pro do everything you possibly can naturally first, because there’s so much more people can do than what they’re typically told at that point of diagnosis.
So, you get your bone density scan. You’re in a 15-minute conversation with your doctor, and they say, “Hey, you have osteopenia or osteoporosis. Take some calcium. Take some vitamin D. Go for a walk. Here’s your bone drug. We’ll see you in two years for your next bone density scan.” That’s the standard prescription for 90% of the people that get diagnosed. That is woefully inadequate.
So, especially when it comes to medications, I liken their use to that old economic adage, “There’s no such thing as a free lunch,” right? There’s risks and side effects and short and long-term implications of use with using these medications. There are two different categories, at least for this conversation, of medications that we’ll talk about, antiresorptives and anabolics.
Antiresorptives are designed to slow down the activity level of cells that break down bone. Can they do that? They absolutely can, but there are side effects that come with that, too. The different types of medications under antiresorptives would be bisphosphonates, so Fosamax, Reclast, Boniva, Actonel, those are your bisphosphonates, or RANK ligand inhibitors like Prolia.
The bisphosphonates, safety and efficacy of these drugs is not really well-known beyond five years. And, as you and I are going about our daily lives, doing our daily activities, doing chores around the house, exercising, doing all those great exercises, we’re starting to get these tiny, little micro-cracks and micro-fractures in our bones. That’s normal. It happens for everyone all day long. And what happens is you have these cells within the bone that sense that damage, osteocytes, and they send out a signal that says, “Hey, we have weakened bone. We need to become stronger.” There are these other cells within the bone called osteoclasts. They come in and scoop out that damaged bone. And then right behind it, we have osteoblasts that come fill in stronger, healthier, new bone. That is a normal process that happens throughout our lives.
When you’re taking these medications for too long, especially years of use, you can actually slow down that process too much where you start to accumulate that old, worn, damaged, weakened bone. So, even if your bone density shows higher on a scan if you’ve been on these medications, your bone quality, that structural integrity may not actually be there. The bones may not actually be stronger. I think that’s a really important note.
And then the other medication that’s prescribed quite often is Prolia. And with Prolia, with this medication, once you start taking it, if you try to come off of it, there’s what’s called a rebound effect where it can actually increase your risk of vertebral fractures if you start it and then try to stop, especially if somebody is on multiple rounds. A round of this medication is every six months. If you take one round, you have to take a bisphosphonate medication just to not have the rebound effect, right? You have to transition. If you take three rounds of Prolia, you’d have to have Reclast, which is the strongest bisphosphonate, again, just to not have that rebound effect.
And what I’m saying here is a lot of times, in that short 15-minute conversation, you don’t have the full picture, and people aren’t sharing with you. The doctors aren’t typically sharing with you what I’m sharing right now. If you are committing to one medication, you may actually be committing to multiple medications, or for many years. So, keep that in mind.
And then the last category, just to button up the medication piece, the anabolic medications. These are drugs that build better-quality bone and build it faster. This would be your Forteo, your Tymlos, your Evenity. Can they do that? Yeah, they absolutely can. These are typically prescribed to people that have poor-quality bone, or maybe they’ve already had some fractures. And they can be helpful in those situations, but you also have to know, once you stop taking that medication, you can’t just not take another medication. You have to follow it with an antiresorptive, otherwise you will lose all of the bone that you just gained.
So, again, try to do everything you possibly can naturally first. If that is not working out for you or you’re at a place where you’ve had a lot of fractures, just be aware of some of the things I’ve shared here when it comes to medication use.
Dr. Sandi: So, medication is the last resort, and it’s absolutely not, but it’s a decision to be entered into cautiously, and only if you’ve tried others if that’s not working, or you are at perhaps such an advanced stage or you have other health conditions. There’s many reasons why this would be a good option for you but not something to jump in blindly when you’re first diagnosed.
What would be some of the other approaches that are not involving medication? And I got to say that… We know resistance. I’ve heard resistance training, and I go into gyms, and I see the cardio room is filled with women. They’re on the treadmill, the elliptical. They’re not running. They’re not pounding. They’re walking. But there’s no one in the weight room. It’s the rare person in the weight room. And if they are lifting the three-pound, the five-pound, they’re in a Pilates class with the pink weights, and they think that they are doing resistance training. Or, if they have been diagnosed, and I’ve seen this a lot, with osteopenia and osteoporosis, they’re afraid to lift a weight because they might get injured. And that might be true for many people. That could be legitimate, but it keeps them out of the weight room. So, I wonder if you could comment on, again, what should we be doing for this.
Kevin: Yeah, I sure can. So, the first thing is understand if you are still actively losing bone right now. So, initially getting those tests, understanding where your current picture is, that’s a great starting point. If you’ve never had a bone density scan before, go get one just so you know where you’re at. And I always encourage people just because you don’t want to know the answer to something doesn’t mean you shouldn’t do it, too. So, get the answer, get the objective information, and just take steps to move in the right direction of making improvement. That’s the first starting point.
And once you actually get tests and you know where you’re at and if you’re still actively losing bone or not, if you are, then start addressing those underlying causes or issues of bone loss, whether that’s current medication use, whether that’s chronic digestive issues, whether that’s hormone imbalances, right, or maybe you need bioidentical hormone replacement therapy. Maybe it’s something to do with your diet and nutrition or maybe you’re just not exercising and you have high stress, poor sleep, those kinds of things.
So, one of the biggest levers that you can pull from a natural perspective is what you just talked about, which is exercise. Exercise is so important. You can eat healthy, you can fix your digestive issues. You can get all the nutrients and take all the supplements you want. If you do not provide the stimulus that your bones need to become stronger, they will not become stronger.
So, we need two different types of stimuli for our bones. You need muscle pulling on bone, and you need impact. So, when you have muscle pulling on bone, you have this mechanical signal. It sends a chemical signal to tell the bones to become stronger. Then, from an impact perspective, so most people are just told, “Hey, go do some walking. Walking is going to be just fine.” I can tell you right now walking is not enough. It’s not enough to support stronger bones. Should you be walking? Absolutely. It’s great for your health. It should be in your plan. We would consider that weight-bearing exercise. So, you want to do that.
You also want to make sure you’re doing weight-bearing exercise and resistance training. So, weight-bearing exercise would be anything you’re doing where your body and your bones have to work against gravity to keep you upright. The things that you’re doing on your feet and they’re placing a good healthy stress on the bones. So, this would be walking, jogging, hiking, dancing, gardening, playing with the kids or the grandkids outside, right, or maybe it’s Tai Chi, Pilates, yoga, Qigong, those kinds of things. Those are all weight-bearing exercises. Those are great to incorporate into your plan.
There’s also non-weight-bearing exercise, and these are activities where your body and your bones are not working against gravity to keep you upright. This would be like you’re swimming or you’re cycling, especially swimming. I would say that’s where you really don’t have that stimulus there. This is the same thing astronauts face when they go up into space. They don’t have that stimulus, and you can rapidly lose bone density. So, it’s very much a use it or lose it.
So, if you enjoy swimming, it’s not to say you shouldn’t ever swim again. So, I would just say make sure that if you are swimming, don’t just get out of the pool after doing five sessions a week and say, “I got my exercise in.” You got to do the next form of exercise, which is resistance training. So, resistance training is…that’s where you are actually incorporating maybe it’s barbells or dumbbells or the machines at the gym, or I really like variable resistance bands. So, whatever you can do to bring that additional stimulus to your muscles and to your bones.
So, some of my favorite types of exercises would be the ones that work lots of muscles at the same time, so your squats are great, your deadlifts, your overhead presses. As long as you don’t already have vertebral fractures, your overhead presses can be great. Box jumps and landings, those can be really helpful, too. I would say they may be intimidating for some people when you first hear that. If you’ve never done a deadlift, that’s a big one. When people hear that, it sounds scary but it doesn’t have to be. Find somebody who can look at your body mechanics so you can make sure you know exactly what you need to do to get started and help you slowly progress up to where you’re doing the intensity that’s actually going to be enough to stimulate supporting stronger bones. So, those are just some helpful notes on exercise.
Dr. Sandi: I love hearing that because that is my routine. The deadlifts were scary at first, but I have a trainer who helps me through it and slowly increasing the weight, doing squats, doing push-pulls, and also something where I can build grip strength as well. And jumping. I try and jump every day, do 100 jumps. And you have the rebounder for that or just heel drops or anything to stimulate that. In ballet, I do jumps.
So, just, yeah, to have that whole variety, but also I think imagery is really important to picture yourself as strong. And I find many people with osteoporosis, women, they now think of themselves as frail, and they’ve been told they’re frail. So, that mindset then feeds into not feeling strong, not imagining that they can do something, not wanting to lift. If they’re in the grocery store and they’re checking out, “Oh, can I carry those to the car for you?” “Oh, yes.” And I always say, “Nope, I’m going to…” I don’t take the cart out to the car. I carry them myself. So, there’s many things you can do throughout the day to… And then feeling like, “Oh, I’m strong, I can do this. I can lift this.”
Kevin: Yeah, mindset is such an important part of this because you’re right. When you’re told you have osteoporosis… I remember when I was told I had osteoporosis, when I was walking out of the doctor’s office too, because I went for a second opinion to get it confirmed and they confirmed it. And everything was a blur, and the sidewalks and the curves were hazards in my mind. I actually carefully sat down in the driver’s seat for the first time in my life, because I was intentionally thinking about trying not to fracture the vertebrae in my spine.
That is the effect that it had on my mind, my psyche. And it was really… For somebody like me who was a tough Marine, my identity was wrapped up in my activity, my physical nature, to be told I’m now fragile, it was like the antithesis of who I saw myself as. And it took some work to even work through that, which is there’s a big mindset component to this too. And you have to focus on those things to successfully move forward. And I think it’s really important.
Dr. Sandi: So important. What about gut health? What is the connection between gut health and bone health?
Kevin: Major connection. So, number one, if you have overt digestive issues, there’s a good chance you have some nutrient absorption issues too, right? Even if you don’t have overt digestive issues, you could have some nutrient absorption issues.
For me, I had celiac disease. So, celiac disease for those who are not familiar… I’m sure most people are, but for those who aren’t, it’s an autoimmune condition where when you ingest gluten, it damages the villi, these tiny, little nutrient absorption centers in your small intestine. It blunts them and prevents you from absorbing really helpful nutrients for your body and for your bones.
So, what happens is I wasn’t absorbing those nutrients, so my body still needed the nutrients to execute its daily function. So, where was it going? It was going to the largest reserve of minerals that I had, which were my bones, and it was pulling it from there. So, if you’re not absorbing these nutrients, your bones aren’t going to have what they need and there’s going to be some bone loss that happens because of that. That’s one way the gut health affects bone health.
The other way is that, within our bones, we have bone marrow is actually… So, our bones are living tissue. They’re not just these static structures that keep us upright and help us get through life. They do that and they do a really good job of it, but they’re actually living endocrine tissue. So, inside your bones, you have bone marrow, soft spongy material that produces 95% of blood cells in your body, so platelets, red blood cells, white blood cells. So, if you need help with clotting or preventing bleeding, that’s where platelets are going to come in. If you need help with carrying oxygen to the body’s tissues or carrying carbon dioxide away from the tissues back to the lungs, that’s where red blood cells are going to come in. And if you need help with fighting infections, healing wounds or anything relating to the immune system, that’s where white blood cells come in. Where does 70% of the immune system reside? In your gut, right?
So, anything that is stimulating that immune system is actually speaking in the same language as the cells that break down bone. So, the cells that break down bone, the osteoclasts, are actually formed of white blood cells. So, if you’re stimulating those digestive issues, you’re stimulating the immune system. It’s speaking in the language of the osteoclasts. And if you’re going to have more bone loss, it happens because of that. So, that’s another lesser-known connection, but it’s a very important one too. So, you have to resolve those digestive issues.
Dr. Sandi: So important. And I think that’s one of the ways that health coaches can be very supportive of clients who are diagnosed with osteoporosis to help them to see these connections and to also help them to see options that they have, including changing their mindset. So, I wonder if you could comment on the role of health coaches. You train as a health coach and then you’ve decided to specialize as a bone coach.
Kevin: Yeah, health coaches are so important. We have a whole team. I’m a health coach. I’m also like the quarterback of our team. We’ve grown our team. We’ve got about 25 people on our team now, so we’re a pretty sizable team, but we have a whole team of coaches as well.
Coaches are so important. They are the people that are on the ground, working with the clients, helping make sure that the client is overcoming any challenges, any obstacles but helping the client help themselves reach better health. Not just being the person to give them the answers but helping them build the healthy habits and do the things that they need to do to keep moving forward without you.
So, it’s a really rewarding job to have when you get to be on the ground with that person, having those daily interactions or whatever the frequency is, and really just seeing that health transformation where they’re scared, they’re worried, they’re overwhelmed, they’re not in their best place and you get to bring them into the light, help them find the light and lead their best, healthiest life. It’s a beautiful thing.
Dr. Sandi: That’s the beauty of health coaching. It is so tied to having meaning and purpose, really helping people to take charge of their health and to see that they don’t have to be a victim. And they’re not defined by their condition, helping them as an educator, but also support as they make these changes that will lead not only to better bones but better life, better health, better mental as well as physical health.
Kevin, this has been such a great interview. You have shed so much light on osteopenia, osteoporosis, what we can do to combat this condition and how, as health coaches, we can support people through this process of getting healthy, building stronger, better bones. So, where can people find you? Because I know we have a lot of listeners who are going to want to connect with you, potentially want to be a health coach in your business.
Kevin: Well, we do have frequent times when we do hire people, so we’ve got one of those coming up too. So, yeah, you can always find me at bonecoach.com, and that’s where we’ve got bone health resources, we’ve got podcasts, we’ve got recipes, we’ve got all kinds of stronger bones resources over there. So, bonecoach.com is always the best place to find me.
You can also find me on all the major social channels, too. Instagram. We’ve got the “BoneCoach” podcast. We have YouTube. What are the other ones? All the other ones that are out there. We’re on pretty much all of them.
And, yeah, we’ve got a community of about 250,000 people, and we really love what we do. I’m very passionate about helping people improve their bones.
Dr. Sandi: And check out. He has a wonderful podcast, so check it out. Check out his social media.
Kevin: And you were on my podcast, too, and it was great.
Dr. Sandi: And I was a guest on… That was an honor to be interviewed. So, thank you so much for being with our audience today. It’s always a pleasure. I learn so much from you every time I’m with you or listening to your podcast.
Kevin: Thank you so much, Sandra.