Your bones, brain, and muscles are having the same conversation—and nutrition is the translator. Duke orthopedic surgeon Dr. Jocelyn Wittstein breaks down how midlife hormone shifts accelerate bone loss, cartilage wear, and muscle decline, and why training + food choices can improve all three at once.
We cover earlier DEXA timing, the bone–brain crosstalk (osteocalcin, agility, balance), and a practical plan: progressive strength, safe impact/jump options (step drops, heel drops, rebounders), grip and toe work for fall prevention, and weighted vests/rucking basics.
On the nutrition side, we get specific: prioritize protein, aim for food-first calcium, and use targeted support where appropriate—vitamin D, omega-3s, magnesium glycinate, collagen, and turmeric—to lower inflammation, protect joints, and support cognition.
Expect clear modifications for cranky knees/shoulders, plus why consistent movement is linked to reduced dementia risk. This episode is your integrated blueprint to build bone, protect your brain, and keep muscle on your frame—so you stay strong, steady, and independent for decades.
Actionable, hopeful, and BS-free—use this episode to build stronger bones, happier joints, and real confidence for the next 20 years.
Follow Dr. Jocelyn Wittstein at https://www.instagram.com/jocelyn_wittstein_md/
Her book, The Complete Bone and Joint Health Plan, is available at booksellers.
_________________________________________
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Episode Transcript
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Michele Folan (00:00):
The holidays are coming fast, and if you're not
careful, it's easy to loseyourself in the shuffle.
So this year, what if you didthe opposite?
What if you built a healthyfoundation before the chaos
hits?
I'm Michelle Folan and my21-day metabolism reset is
designed to help you do exactlythat.
We'll tackle sugar cravings,dial in your nutrition, and get
(00:22):
you moving in a way that fitsyour life.
Beginner, I've got you.
More advanced, there's plentyto challenge you to.
This is your chance to holdspace for you.
To reset, recharge, and finishthe year feeling strong, not
stressed.
Join me now.
The link is in the show notes.
Let's build momentum together.
(00:43):
Health, wellness, fitness, andeverything in between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
Did you know that one in twowomen over 50 will break a bone
(01:07):
due to osteoporosis, oftenwithout a single warning sign?
Or that 80% of us aren'tgetting the right screenings
early enough to stop it?
I've been there, staring at myown DEXA scan, heart racing,
thinking, ugh, this can't be mystory.
But here's the truth: osteoporosis and joint pain (01:23):
undefined
don't have to steal your spark.
Today we're joined by Dr.
Jocelyn Wittstein, Dukeorthopedic surgeon, author of
the complete bone and jointhealth plan, and a powerhouse in
women's bone health.
She's here to unpack whymidlife hormone dips hit our
bones and joints hard, howsimple moves like jumping and
(01:45):
grip training can rebuildstrength, and why normal labs
might be lying to you.
From her lift more-inspiredworkouts to dementia fighting
nutrition, this conversation ispacked with hope and how-tos to
make your next 20 yearsunbreakable.
So grab your cup of coffee or aweighted vest and let's dive
(02:05):
in.
Dr.
Jocelyn Wittstein, welcome toAsking for a Friend.
Hi, thank you for having me.
Yes, I'm so glad we were ableto get this together.
This audience has a hugeinterest in bone health.
I talk to clients daily who arelike me, um, have either
osteopenia or osteoporosisdiagnosis.
(02:25):
And so thanks for being here.
I would love for you to tellour listeners a little bit more
about you.
I know you're way more thanwhat I just described.
Jocelyn Wittstein, MD (02:38):
Um well, uh I'm not sure what all you
want to know, but I um I am yes,I'm an orthopedic surgeon.
Uh, I'm a mom.
A five.
Yeah, yeah.
The the thumbnail version is umas an added fun bonus to our
life.
My husband is also um afull-time orthopedic surgeon,
and his wife before me passedaway of breast cancer.
(03:00):
So when I married him, Imarried him in a five, eight,
and eleven-year-old, and then wehad two more kids.
And so we have uh a family ofseven, and um, we mostly talk
about our children and bones andjoints.
Exciting.
Very, very boring.
Michele Folan (03:19):
Bones for pillow talk.
Jocelyn Wittstein, MD (03:21):
Yeah, bones, joints, children, what
kind of exercise we're gonna doand what we're gonna have for
dinner, and our dog, yeah.
So uh, but um we yeah, so we'rekind of an orthopedic family.
And um, I you know, I went toCornell undergrad.
I studied nutritional sciencethere as part of my pre-medical
education.
So I've always had a love fornutrition.
Uh I was a gymnast growing up,and I was a collegiate gymnast.
(03:44):
And uh I went to med school atECU, East Carolina University,
originally thinking I wanted tobe a pediatrician, and then
decided actually I wanted to bea surgical subspecialist.
Uh, I've always had a love forsports medicine, which is the
sub-specialty of orthopedicsurgery that I practice in.
Uh, and then I you know, I didall of my orthopedic training at
(04:06):
Duke.
I did a fellowship there inshoulder and knee and sports
medicine.
Uh, worked for a while for aColumbia-affiliated organization
up in New York State, came backuh to Duke, where I work now in
2017.
Uh, and I'm an associateprofessor there.
I teach and train medicalstudents and residents and
(04:28):
fellows.
And I also um very active inresearch, so I collaborate with
a lot of our PhDs on some NIHfunded research, a lot of it
related to post-traumaticarthritis.
And I work regularly with ourwith my women's health
colleagues on um some researchkind of at the intersection of
women's health andmusculoskeletal health, which
actually impacts adolescence allthe way through, you know,
(04:51):
menopause in terms of the sortof intersection between uh those
two subspecialties.
So there's um much moreintersection than people
realize.
Michele Folan (05:00):
Well, and you've probably treated some elite
athletes, you know, where you'vebeen, right?
But you've you've kind of takena little bit of a detour into
women's health.
What kind of yeah, you saidyou're doing some research, but
what kind of made you moreinterested in, you know, uh
(05:22):
postmenopause and and some ofthe joint and bone issues?
Jocelyn Wittstein, MD (05:27):
So I don't really think of it as a
detour.
I think of it as part of thewhole spectrum.
I mean, you women are veryactive throughout much of their
lives.
And, you know, I think if wetreat women like as athletes or
people just trying to stayactive, there are different
aspects of um their musculosalhealth that are impacted
(05:47):
differently um throughout theirentire life.
So there's a health span forwomen, and I like to think that
I think about all of that.
Um, like in my youngerpatients, female athletes are
more prone to ACL tears.
And if you tear your ACL,you're also more prone to
developing arthritis.
But women go through pregnancyand then they're more prone to
autoimmune types of umarthritis, actually at that
(06:08):
point in life.
And then you become aperimenopausal or menopausal
woman, and you are prone tofrozen shoulder and um faster
progression of our arthritisthan men, you know, of matched
ages.
Um, and of course,osteoporosis, and that may
manifest in a distance athleteor an endurance athlete, you
(06:30):
know, having more problems withtheir knees or stress reactions.
Uh, and of course, asorthopedic surgeons, we all
interact with patients who havefalse and trauma.
And there are just multipleareas where women are affected
disproportionately.
So, osteoporosis is one.
And it's actually a preventabledisease as orthopedic surgeons.
We usually catch it at the backend.
(06:52):
So I think I don't want to saylike my interest in bone health
or joint health and how thingsmaybe how both arthritis and
osteoporosis disproportionatelyaffect women is like kind of a a
detour.
I just think if it's part ofthe continuum of the health span
of women, and there isthroughout the life this
intersection of, you know, thefemale sex and musculoskeletal
(07:15):
health.
It's just different things attimes, if that makes sense.
Michele Folan (07:18):
No, it it certainly does.
And, you know, there's there isa little bit of a sense of
urgency, I think, because we,you know, we've got this window
where we can prevent a lot ofthis if we take early action.
But I think it's for womenknowing when to take action is
kind of the question there.
You know, because you know, youmay be asymptomatic, right,
(07:41):
with osteoporosis and you don'tknow exactly, you know, when
when you should start to get thebone scans and all of that.
So speaking of which, if youhave a family history, when
would you recommend someone gettheir first DEXA scan?
Jocelyn Wittstein, MD (07:57):
Well, that's tricky because the family
history part, I feel like ifyou have a mom, you could have a
family history of osteoporosis.
Yeah, right.
Just like so many women, if youlive long enough, you know, at
least in previous years we havedeveloped osteoporosis.
So uh I think like an earlyfamily history is uh yeah,
certainly a red flag.
But uh yeah, this question, youknow, we the standard of care
(08:21):
is like age 65 for women, andthat's definitely, I think,
later than I would like it tobe.
I think people have likemultiple risk factors, like
testing earlier.
I I think it's very reasonableto consider testing at menopause
because you're about to, uh,without interruption of the
process with hormone therapy, ifyou're able to use it, you are
(08:44):
going to have a more rapid loss,or you know, like something on
the order of 2% per year interms of loss of bone density.
So over a decade, like 20%.
You know, you you really wouldlike to know.
I think we we should know, youknow, where we are when we're
starting that.
And then I think that's mostimportant for people who want to
take that information andincorporate it into their
(09:05):
decision making.
And it can be a wake-up callfor people as well.
You know, if you're enteringmenopause, osteopenic, um, that
can be very motivatingsometimes.
Yes, it can.
Kind of take the bull by thehorns.
Um, so I mean, I think peoplewho need to be screened earlier
are people who, if you hadenergy defenselessly as a
(09:28):
younger athlete, if you hadprevious stress fractures, if
you're someone who's on likebeen on proton pump inhibitors
for years and years, likesomeone who's had reflux for
years and years has a greaterrisk of osteoporosis and
fractures over time.
People have been on steroid,people who've used a lot of
nicotine really worry about.
I sound like an old person, butthese young people vaping all
(09:49):
the time, so much nicotineexposure is not going to be good
for their bone health as theyuh as they age.
Um, anyone, you know, with ahistory of um um elevated
parathyroid hormone, uh, youknow, so there are certainly
some known risk factors thatwould tip you into being tested
earlier.
The people who need to betested really young are people
(10:09):
who had like definitely ahistory of energy deficiency
syndrome, stress fractures,especially if that's prolonged.
You know, those are like kindof the experiences at a younger
age that can make you uh more atrisk.
But I it's hard to give anexact answer.
I think for many women it wouldbe better to get tested around
menopause than 65.
I think that's pretty clear.
Michele Folan (10:27):
Will that standard ever change?
I mean, because 65 to me, it'slike the horse is way out of the
barn by then.
Jocelyn Wittstein, MD (10:34):
Well, I think it's becoming more and
more apparent that osteoporosiscan be preventable in so many
cases.
And so obviously, if you weretrying to prevent something, you
would like to catch it in anearlier phase than a later
phase.
I think more and moreaddressing osteoporosis is
becoming more of a preventativeeffort than a reactive effort.
(10:56):
You know, I we still do this,of course, because we need to,
but if I if we have a patientwho breaks their hip, we send
them to our, you know, we we wehave them test on the DEXA.
I fully expect them to, I don'tknow what woman in their 70s
with a hip fracture would nothave osteoporosis.
I mean, it's like pretty likelythey're gonna test that way and
(11:17):
they're gonna be treated, butwe're also using that study to
then like follow their responseto treatment.
So it's not that you, it's notthat the studies aren't valuable
then too, because you're moreusing them for like seeing maybe
a response to treatment and andfollowing them in that way.
But it's yeah, it's not toscreen you and see where you are
and see what your preventativeefforts might might do.
(11:39):
And there's so many tests thathaving information is valuable
because it's also motivating topeople, or can be there are
other tests that help allay, youknow, fears sometimes, you
know, the opposite, like um,like an like an MRI of your knee
if you're having knee pain andit comes back as okay, I can
(12:01):
keep being active and pushthrough.
But I I think a DEXA scan is ais is a different thing.
It's like it can be motivating,even though you might not want
to get a result that shows youhave osteopenia, it can be kind
of a sign that you are at awindow where you can still do
something.
And I think that's alsomotivating for people.
Michele Folan (12:19):
Well, certainly motivated me.
Jocelyn Wittstein, MD (12:21):
Yeah, your story is one of those.
Michele Folan (12:23):
You right, exactly.
Yeah, so but yeah, it was itwas one of those things.
I mean, I was certainly youngerthan 65 when I got that, when I
got my first scan.
So that's why I was asking, youknow, just from your
perspective.
You know, perimenopause can hithard, you know, because we we
start to see the decline inestrogen.
People get achy, you know, theyknees and and whatever.
(12:47):
You start to see some shoulderissues.
I was talking to a client thismorning that has rotator cuff
issues.
I don't know if it's frozenshoulder, but how does hormone
decline contribute to arthritisversus osteoporosis?
Are are are there correlationsthere?
Jocelyn Wittstein, MD (13:05):
Mm-hmm.
Yeah, I mean, so it'sunfortunate, but both things
accelerate uh with estrogenwithdrawal.
And so our bone density is isvery well very tightly linked to
to estrogen.
Our estrogen basically kind ofinhibits our osteoclasts, make
(13:27):
them not live as long.
So there's like less breakingdown of bone relative to making
bone, and so we can maintainbone density better, and then in
the absence of estrogen, theosteoclasts live longer and they
break down bone at a greaterrate than our osteoblasts build
bone, and so less we get thataccelerated, accelerated loss of
bone density.
But in our joints, yeah, uhestrogen has more of an
(13:47):
anti-inflammatory effect, andyou know, we know that just
systemically, in the absence ofestrogen, some of these
inflammatory markers orcytokines are a little bit you
know elevated.
The same thing is happening inour joints, and there are
estrogen receptors in the liningof the joints.
And so if you don't have thatanti-inflammatory effect, it's a
more inflammatory environment.
There is more cartilagebreakdown, more rapid thinning
(14:10):
of cartilage.
And that definitely bears outin the differences.
And if you if you look at likenumber of women with arthritis
versus men, women needing kneereplacements versus men, um, you
know, women are affected bythis much earlier than men.
So, you know, I've referencedpapers in the past that show
that women have a 40% greaterchance, you know, in their 50s
(14:31):
of having knee arthritis thanthan men.
And so that's probablyhormonally mediated.
Uh so unfortunately these twothings are kind of happening at
the same time.
Similar pathologies, likefrozen shoulder, it's not
arthritis, but it's aninflammatory process in a joint.
And, you know, to kind ofsupport that hypothesis or or
(14:51):
kind of thought process, ourpatients who are being treated
with aromatase inhibitors, forinstance, are very prone to
frozen shoulder.
There's the lining of theshoulder joint, is for some
reason seems to be quitesensitive to the
anti-inflammatory effects ofestrogen.
And there are even basicscience studies showing that um
estrogen has an effect ofbasically inhibiting fibroblast
(15:12):
or this cells that kind ofthicken the joint capsule and
make it stiff.
So all these things arehappening at the same time.
And then likewise, ourmusculature uh is you know
muscle growth, repair.
The stellate cells in themuscles are also uh stimulated
by estrogen, and so it's harderto maintain muscle mass um as
(15:34):
with estrogen withdrawal.
And you know, these things kindof coalesce, uh, and then you
get it's like wall wall.
Michele Folan (15:42):
It's like it's like we, you know, it's like we
yeah, yeah.
And so that brings me to mynext question.
Well, first of all, aromataseinhibitors tell the audience
exactly what they are.
Jocelyn Wittstein, MD (15:53):
Um, they you know, kind of prevent the
reaction that kind of createslike makes estrogen uh available
in your body.
Okay, okay.
Michele Folan (16:03):
All right.
Jocelyn Wittstein, MD (16:03):
So you you're diminishing the amount of
of estrogen circulating in inthe body.
Um, so as part of like, youknow, breast cancer um
treatment.
Got it.
And yeah, so patients who areon those medications can have
this can affect their bone anduh and their um joint health.
And then, you know, othermedications called CERMS, like
(16:24):
selective estrogen receptormodulators, interestingly, like
you know, can be protective ofbone, but then you can still
have side effects of the jointpain, and but they're can be
protective against cancer.
Um so uh of course, you know,sometimes those medications are
are are necessary.
(16:45):
And I'm I'm certainly, youknow, not like a breast cancer
doctor, but I do see a lot ofpatients that are you know going
through treatment of that andexperiencing um the side effects
and you know just trying tostay active and it's really hard
for them.
Michele Folan (17:00):
Yeah.
And for those patients thatabsolutely cannot be on hormone
replacement therapy, they can'tbe on estrogen, what other
options do you have for them?
Jocelyn Wittstein, MD (17:10):
Well, I mean, I think the data on
strength training and someimpact exercises, you know, is
very, you know, shows that likeinterventions other than
medication are really effective.
And, you know, if you look atsome of the studies on, okay,
let's talk about bone densityand estrogen therapy over a few
(17:33):
years, increasing, say, likeyour bone density by three and a
half, four-ish percent,something like that.
You know, we also know thatsome strength training
interventions, like the Liftmoretrial, showed over an
eight-month period a 3% increasein lumbar spine bone density
and a smaller percentageincrease in the hip.
So it's I don't want people tofeel hopeless if they're someone
(17:57):
who can't use uh estradiol,because some of, you know, if
you just look at like percentagepoints of improvement in bone
density, actually, some of thesestrength interventions show
almost similar benefits in ashorter period of time, which is
amazing.
Um, for people who have theluxury to or lucky enough to use
(18:19):
hormone therapy, certainly allthese things can be cumulative.
And, you know, I would neverwant someone to think that like
just just hormone therapy wouldbe like, you know, the golden
ticket to not gettingosteoporosis.
Estradiol is prophylacticagainst, you know, osteoporosis,
it stabilizes bone loss, likeover a few years can increase
bone density some, but theseother interventions, which are
(18:42):
not even medications, areactually quite helpful as as
well.
So uh it's just some peoplehave less options, and you know,
that's that's not ideal.
And then there's newmedications on the horizon.
Um, there's you know, furtherresearch going on with Duave,
you're probably aware of, whichis a combined estrogen and CERM,
(19:03):
which would be protectiveagainst bones and um showed, you
know, reduced risk of invasivecancer.
So, you know, I I think there'sso much research happening and
um potential options for peopleand also more of a shift towards
shared decision making forpeople who do have some risks.
And uh I I've really enjoyedfollowing um Corinne Mann, you
(19:26):
probably follow, and just herperspective on like shared
decision making and kind of nottreating people as like only
their breast cancer risk andthings like that.
But so yeah, in a perfectworld, like yes, cumulative
benefits of estradiol, strengthtraining, some impact training,
your diet, you know, somesupplements that may help, but
(19:46):
it's not just hormone therapy.
Michele Folan (19:48):
Well, and I that's that's an important
message because we have to getaway from thinking that a pill
is always gonna save us.
You know?
And so for me, sure, I'm onHRT, but I also am working my
butt off in the gym.
I I watch you, I you know, I Itold you I was jumping off a
(20:10):
step the other day at the gym.
I was doing a compound, youknow, compound jump.
And this woman's like, what areyou doing?
I'm like, I'm working on mybones working on my bones.
Yeah, Dr.
Wittstein told me to do this.
Um but but back to what I wassaying before is that there is
hope out there.
And I know for a lot of womenthough, you get that
(20:33):
osteoporosis diagnosis andyou're a little scared.
You're a little scared to dothe bend over, you know, pick
up, you know, do a deadlift,those types of things.
What kind of coaching do yougive patients?
Do you send them to PT to learnhow to lift appropriately and
safely?
Jocelyn Wittstein, MD (20:52):
Yes.
I mean, so many people haven'tdone strength training before,
or maybe they haven't in awhile.
And um, you know, in many ofthe studies and the benefits of
strength training, these are ofcourse supervised.
And you can't just go from notstrength training to doing this
like really heavy lifting.
And I always like to say, like,we people who are not subjects
(21:15):
in studies who were not screenedto be in the study because they
did or didn't meet exclusioncriteria.
Like in real life, some peoplehave these exclusion criteria
that wouldn't have let them evenbe in the studies, like maybe
they had a knee surgery or havesome you know limitations from
another orthopedic condition.
So we need to like take intoaccount what your own
(21:35):
limitations are.
We need to take into account ifyou haven't been doing this
heavier exercise or lifting, youhave to start light and then
you know build up.
I mean, even in thesecontrolled trials with guidance,
like in the Lyftmore trial,there was kind of like a one to
two month ramp up period fromyou know lighter to moderate to
heavier lifting.
And certainly there are a lotof studies showing the safety of
(22:00):
these exercise interventions inosteopenic patients.
You notice like a lot of thestudies are on people with
osteopenia.
That's kind of a safer group togroup to study, maybe not
directly on people who alreadyhave osteoporosis.
And that requires even morenuance so you don't hurt
yourself.
Like we want people to move andnot be afraid to move and bear
weight because that's what youneed to do to like not lose more
(22:22):
bone density, but we also don'twant you to get an
insufficiency fracture in theprocess.
So it can really help to havesome guidance of a physical
therapist and then maybe kind ofeventually, you know,
transition you to a trainerwho's knowledgeable and things
like that.
Michele Folan (22:35):
Yeah, and I did go to a physical therapist
because again, I was scared todeath.
I was like, oh my God.
I, you know, I didn't know whatI was dealing with.
And and she really walked methrough things, but there were
like certain yoga poses she toldme, yeah, you may not with with
your lumbar issue, you may notwant to do, I forget the yoga
pose because I'm not like a lotof flexion.
(22:56):
Yeah, yeah, yeah, yeah.
And I I'm not a yoga person, soI don't know the actual pose
name, but it's when you archerback, basically.
So I and and that was all good.
I'm I've been really intriguedwith the jumping piece of this
lately because I'm like almosteverybody can do that.
Jocelyn Wittstein, MD (23:14):
Well, people actually kind of forget
how to jump and skip.
And like there are things thatwhen you were a kid were really
easy and natural.
And when you go to do themsometimes as an adult, you've
like almost lost like theneuroconnectivity to move in
that way or something.
And uh Well, you do.
I mean, I really think you do.
(23:35):
I've had people message me likethe first like few days of like
doing like the little drop jumpoff a step and a rebound jump.
Like, I they're literally yousay, like, I didn't know how to
rebound, like I just like hitthe ground and I didn't know how
to do the second jump, and thenthey figure it out.
And so, yep, it's not asnatural as you think after a
while, but I think it is justlike biometrics can be a good
(23:57):
thing, agility work to kind ofkeep your you know, brain
connected to your muscles andmove in that way.
Michele Folan (24:06):
Absolutely.
I mean, the agility piece, theagility piece is certainly
important, right?
We we we've got to make surewe've we maintain our balance.
That's part of all of this, andnot wanting to fall, break a
wrist or a hip.
But there's one thing that Iwon't do, and that's box
jumping, where I jump from thefloor up onto something.
(24:27):
Knowing me, I would fall andbreak a tooth.
So I'm I that that to me.
Jocelyn Wittstein, MD (24:32):
I don't actually, yeah, that's not my
favorite thing to recommend topeople because there's a little
potential risk.
unknown (24:38):
Yeah.
Jocelyn Wittstein, MD (24:38):
You can do like I call them like frog
jumps, whatever.
You can jump and just jump ashigh as you can and bring your
knees up to your chest.
But for the bone density partof it, it's actually not even
the jumping up that matters,it's like the dropping down.
You don't have to drop downfrom a huge height, like it can
be um, like Tracy Clistold'swork showed, you could just drop
(25:01):
off of eight inches, or youcould actually do just like a
really big jump and land and arebound.
That helps as well.
And and then for people whohave, you know, they're like,
oh, my knees are bad, my hipsare bad, I can't do that.
Like you can also do the heeldrops where you go up on your
tiptoes and drop down.
You know, that can be asubstitute, doesn't have all of
that, like, you know, fasttwitch muscle activation and
(25:21):
playometric part to it, but youstill get some impact on your
bones.
Michele Folan (25:27):
Midlife can feel like you've hit a metabolic
brick wall.
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Jocelyn Wittstein, MD (26:26):
And so again, I just think people need
to find things that work forthem that they can do and not
feel like some of theseexercises are exclusive to
people who can to only to thepeople who can like lift really
heavy and only to the peoplethat can do these crazy, crazy
play metrics.
Like it's great if you can dothose things, and I like doing
some of those things, but itit's I don't want people to like
(26:49):
give up or feel intimidated byor like it's unapproachable to
them because doing some of thesemodifications is is still
actually helpful.
Michele Folan (26:59):
In one of your Instagram posts, you have a
weighted handle jump ropewithout the rope.
Jocelyn Wittstein, MD (27:04):
Oh, yeah, it's fun.
Yeah.
Michele Folan (27:06):
And I at first I feel like, oh my god, well, that
would be great for someone whomaybe worry.
You don't want to trip andfall.
Yeah.
Jocelyn Wittstein, MD (27:13):
Yeah.
It's actually and it feelsexactly the little weights.
So, first of all, you get somegrip exercise out of it and a
little shoulder work and alittle cardio, but the feeling
of the weights like droppingdown, it it actually feels like
for even though I know there'snot a rope there, it feels like
there's a rope, and you cansense like when you should jump
over it.
(27:33):
It's very interesting.
It's especially if you'resomeone who's I mean, I've had a
lot of people ask me, like, Iwant to jump rope because it's
good for agility and you getsome jumping in and cardio and
grip strength, all those things,but I'm afraid or I can't.
I've had so many women tell meI can't jump rope.
Like, I just can't remember howto do it.
And so I guess that's a realthing.
I know.
So I think the um, yeah, thelike cordless jump rope is it it
(27:58):
actually kind of helps peoplewith that.
You could transition that way,but and it's quiet, you know, if
you don't have a space oryou're not trying to, you know,
it's it's it's actually there'sa lot of good advantages to it.
How about rebounders?
Michele Folan (28:11):
Will you get much of an effect from jumping on a
little mini trampoline?
Jocelyn Wittstein, MD (28:15):
This I get a lot of questions about
this because a lot of peoplelike to do it because it's
easier on their knees.
Um and it's fun and it'scardio.
And there are limited numbersof studies on this.
And one of them that I'vetalked about before and actually
like did a little demonstrationon is basically uh showed that
if you compared people using therebounder versus not, like over
the course of the intervention,you know, at the end of the
(28:36):
intervention, like there wasn'tany difference between the two.
But the people using therebounders did see a little bit
of an increase in their hip bonedensity.
So kind of like as acomparison, there wasn't much
change, but there seemed to be alittle bit of benefit.
And so I my take on that is Ithink that they're good for
cardiovascular exercise.
I think they're good forstrength and agility and
balance, like other parametersthat might make you less likely
(28:59):
to fall.
And if anything, they may helpyour bone density a little bit,
probably not as much as jumpingon the ground.
But again, this is a questionof if you have knee arthritis
and you can't jump on theground, is it better to not do
anything or to jump on therebounder?
It's probably better to, youknow, jump on the rebounder, or
maybe you can add the heeldrops.
And so I think, you know, thereare like the most effective
things and there aremodifications that are like less
(29:21):
effective, but that you canactually do without hurting
yourself.
And for a lot of people, that'swhere we need to land or be so
that they don't get sidelined.
Because if you hurt yourself,then you can't do any exercise
for a period of time, and that'salmost you know worse.
Michele Folan (29:35):
Yeah.
All right.
So then the next one, and thenyou know this one's coming.
Weighted vests.
Weighted vests, yeah.
I knew it.
Yeah.
Jocelyn Wittstein, MD (29:44):
Yeah.
So yeah, I have weighted vests.
I love adding them to myexercise.
I also have a rucksack, which II kind of like a little better
because it's kind of a littlebit more core work, but the I I
really truly believe like in andof themselves, they're not a
solution.
But like anything, it'sadditive.
Um, there's, you know, there'sa small study that showed that
(30:05):
um in a small subgroup ofpatients that had like a
longer-term follow-up, thatthere was some improvement in
bone density with using weightedbest.
But not, it was even that studywasn't in isolation.
There were other aspects to theexercise program, like some
impact and some strengthtraining.
And so it's probably not likean isolated thing.
Now, even just walking issomething that can reduce your
risk of hip fractures.
(30:27):
It doesn't necessarily changethe arc of you know your bone
density, but like something thatyou know, you have it's you're
being mobile, you're um you'reit requires balance, requires
cardiovascular exercise.
Like walking is regular walkingis actually something that
reduces your risk of falling andbreaking a hip, even though it
(30:49):
doesn't necessarily likeincrease your bone density.
And, you know, along the linesof just walking, weight-bearing
exercise in general, with orwithout a weighted vest, the the
opposite of not doing thosethings is disuse.
And the most extreme version ofdisuse is anti-gravity, like
being an astronaut who that youknow they lose their bone
(31:10):
density very, very rapidlybecause they're just not even
weight-bearing.
So if you or if you're oncrutches, I love this example.
Like one of my friends, TammyScarpella, who's chief of worth
of Pedics in sports medicine atWisconsin, has done studies
looking at like if you tore yourACL and you were on crutches
for like even a short period oftime and you had some
modification of your weightbearing, like it in some parts
(31:30):
of your bone, it takes like twoyears for it to get back to
normal.
So disuse is always like worsefor your bone density than use.
So if you're like, I can walkand I wear a weighted vest and I
get extra cardiovascularexercise out of it, I jump on a
rebounder because it makes myknees feel good and I can do it,
and you're getting like balanceand agility, increased
(31:52):
strength, you know, lesslikelihood of falling.
These are all good things.
Yeah.
I I just I don't want anyone tothink like they have to walk
with a weighted vest to preventhip fracture.
It's it's it is a really nicecardiovascular addition to your
exercise.
Michele Folan (32:06):
Yeah, for sure.
Yeah, that was a long answer.
No, no, it's no, it's okay.
I like to let people talk.
So starting at what 5% of yourbody weight, maybe when you
start 5%.
Five or 10%.
Jocelyn Wittstein, MD (32:16):
I mean, I think if you're someone has any
like back issues or like, youknow, maybe if you've got like
osteoporosis real um or spine,five percent might be better
than 10%.
But I feel like for me, if it'sless than 10%, I don't feel
like much difference in mycardiovascular output.
Michele Folan (32:31):
And then if you did have any kind of like spinal
like stenosis or any discissues, would would you
recommend not using a weightedvest?
Jocelyn Wittstein, MD (32:39):
So yeah, interestingly, I was just
listening to a spine surgeontalk about this.
They uh and and not expressingmuch concern about it.
I think they're not too heavy.
I think if you're like kind ofwithin the like five to ten
percent of your body weight, Idon't think it's actually that
concerning.
Michele Folan (32:53):
Okay.
Jocelyn Wittstein, MD (32:53):
Um, of course, every individual is
different.
I think if you're gonna do likereally heavy rucking and you
have like an extruded disc,that's a different story than
like adding five or ten percentof your body weight.
Michele Folan (33:03):
Okay, I just want to make sure, because I I I get
these questions, so I'm likewe're gonna ask the expert.
Jocelyn Wittstein, MD (33:09):
Yeah.
And of course, the problem withthese questions is that every
individual has a uniquesituation.
Like, do you havespinalesthesis?
Do you have, you know, is itjust bad discs?
Do you have to facet arthritis?
Is it right?
Did you have a previouscompression fractur?
I mean, it's just uh it's it'sreally hard to give a broad
answer always on some of thesethings.
Michele Folan (33:27):
Yeah, I know, I know.
Okay.
I would love to talk about gripstrength and toe grip and how
they can be predictors of fallsand longevity.
Can you address that a littlebit?
Jocelyn Wittstein, MD (33:41):
Yeah.
First of all, I love grippingexercises.
I love hanging, I love carryingthings, pull like I love
gripping exercises.
The question always is like, isit that strengthening your grip
like improves longevity andmakes you less likely to be
frail and like less likely tohave dementia?
(34:01):
Or is it just a marker of youractivity and you know how
vigorous you are and otherthings you're doing?
That's like a surrogate, youknow, for something else.
Um, like I don't know that youknow, we know that like grip
strength is sort of a marker oflongevity, but if I do grip
strengthening and get my gripstronger, am I gonna live
longer?
I don't know.
Michele Folan (34:21):
Right.
That's probably maybe not thecase.
Chicken or the egg kind of athing.
Jocelyn Wittstein, MD (34:25):
Chicken or the egg, although I do think
it can help you be more likefunctional and independent um
sometimes.
And then in terms of like toegrip strength, that actually
makes more sense to me becauseyour your toe grip very much
assists with your balance.
And I always like to give beinga former gymnast, you know, on
(34:47):
TV when they show the gymnast onTV, they zone in on their foot
on the beam and they're likegripping with their toes to not
like you use your toe grip tomaintain your keep yourself
upright or to adjust.
You use your foot intrinsicmuscles to balance.
If you're standing on one foot,like you'll feel your foot
working if you're you know in atree pose in yoga.
You'll see your small, you'llyou'll dig in with your toes.
(35:09):
So foot strength definitely hasan impact on our on our balance
and can be related to to fallprevention.
So I I think you know that hasa clearer effect.
And doing single leg balancework does engage those those
muscles.
There are little purposefulexercises you could do with your
feet.
I shared a study of one wherethey just did like towel
(35:31):
scrunches and toe splaying, forinstance, but and and you can
improve your your strength inyour feet, actually.
So yeah, oh, I would think so.
Right, yeah.
Michele Folan (35:41):
Heck yeah.
Yeah, and and I did have um agentleman on the podcast, and we
talked a lot about agility andbalance.
And I just don't think our toesare something that we we think
about when we're we're talkingabout balance.
Okay, question.
Someone asked me this the otherday, and I said, Well, I will
(36:03):
ask Dr.
Wittstein this.
Uh huh.
Do we break a hip due to thefall or do we fall due to a
broken hip?
Jocelyn Wittstein, MD (36:11):
Uh in general, the break happens when
you fall.
So you fall that causes thebreak.
There are conditions that arelike that.
Like people will be like, Ifell down the stairs and tore my
quadriceps tendon.
It was like, no, yourquadriceps tendon tore,
therefore you fell down thestairs.
That's different.
But yeah, you the hip breakswith the impact.
Yeah.
The fall.
The fall causes the break.
(36:33):
Yeah.
Okay.
Michele Folan (36:34):
All right.
I thought that was aninteresting question.
Yeah.
It is a good question.
Yeah.
I I I like I like to ask thesethings.
All right.
Yeah.
You have this tremendous book.
And in there, you talk a lotabout nutrition.
And we talked a little bitabout anti-inflammatory foods
(36:58):
and that sort of thing, and howyou we want to reduce
inflammation.
What are some of your go-tofoods for not only
anti-inflammatory, but also bonesupporting?
Jocelyn Wittstein, MD (37:09):
Um, yeah, so so interestingly, there is a
bit of a connection betweeninflammation and bone loss.
Um, like some of the cytokines,which are inflammatory, like
messengers basically, um, thatcontribute to like arthritis and
joints and rheumatoidarthritis, also wear and tear
arthritis, are are also involvedin that pathway that leads to
(37:31):
breakdown of bone as well.
Interestingly, so inflammation,reducing inflammation may help
both our bone and joint health.
But food can also then be, youknow, a source of all the
micronutrients we need for bonehealth, which are, you know, not
just calcium.
So, yeah, like I think thereare a lot of foods that check
(37:52):
multiple boxes.
Um, and I, you know, I like tothink of it that way, like like
salmon has vitamin D and somecalcium, but omega-3s, which are
anti-inflammatory.
Boc Choy has calcium and fiber,which is anti-inflammatory, and
um, you know, vitamin K, whichyou also need, you know, for
(38:14):
your for your bone health.
Tempe has vitamin K and proteinand some calcium and fiber.
And so that, you know, I Ithink there are, I I tried to
sort of educate people on likewhat are some components of an
anti-inflammatory diet, but whatyou also need for your for your
bone health.
And then we um my co-author isactually one of my former
(38:34):
gymnastics teammates who's aregistered dietitian who trained
at Brown in Columbia and SydneyNitskorski.
She's a registered dietitian,also a personal trainer.
So we kind of pooled ourexpertise and interest um to
sort of bring all this togetherfor people.
So trying to kind of blendtogether aspects of an
(38:55):
anti-inflammatory diet as wellas helping your diet meet your
bone health needs, and then umrecipes that kind of bring those
things together, exercises thatare accessible to people,
because sometimes people arejust starting, you know, from
scratch, but we want you to beable to progress them.
A lot of frequently askedquestions in there, which is um
I I the frequently askedquestions section is like
(39:17):
everything my patients ask me,and everything Sydney's clients
ask her, like boiled down intoQA.
Michele Folan (39:22):
Oh, that's good.
That's really good.
Jocelyn Wittstein, MD (39:25):
It's actually my favorite section.
Michele Folan (39:26):
Yeah.
And so I agree with you.
I think diet and getting thosethings through real food is the
ultimate goal.
But we don't.
Some people don't, yeah.
Yeah.
So being realistic, I I want totalk specifically, first of
all, about omega-3s.
(39:47):
So if if we're not eatingsalmon every day, how like or
like a few days a week, somesource, yeah.
What about supplements?
Jocelyn Wittstein, MD (39:56):
Are you okay with uh your Oh, I think
fish oil supplements, the omega3, I think those are great.
And there are studies showingactually, like so many studies
on the efficacy ofanti-inflammatory supplements,
are done on patients withrheumatoid arthritis because
they have such elevatedinflammatory markers.
Not that I would ever suggestthat if someone has like, you
(40:17):
know, truly has rheumatoidarthritis, I'm not saying treat
yourself with fish oil.
Right.
Um, because I just want to makea point, and I don't ever want
to be misinterpreted this way,that osteoarthritis, where
enteroarthritis and rheumatoidarthritis are very different,
even though they have somecommon inflammatory pathways,
like some of the sameinflammatory cytokines that lead
to cartilage breakdown andosteoarthritis exist in
(40:38):
rheumatoid arthritis.
Just but rheumatoid arthritisis a truly a systemic autoimmune
condition where your body'scartilage is your joint
cartilage is just gettingdestroyed by this autoimmune uh
response in the in the joint.
Michele Folan (40:54):
Okay.
Jocelyn Wittstein, MD (40:54):
And there are medications that are
disease modifying and canactually halt the progression of
that.
We don't have that withosteoarthritis.
So just putting it out there,like if you have rheumatoid
arthritis, uh, you know, we thisis not something I would
recommend just treating with ananti-inflammatory diet, but
certainly it can help you.
So, you know, omega-3supplements, fish oil
(41:15):
supplements, there are studiesthat show that these benefit
patients with rheumatoidarthritis, like reduce knee
inflammation, help with jointpain.
Uh, and I kind of carry thatadvice over to osteoarthritis as
well.
So I I think the fish oilsupplement is great.
The the main thing I like tryto get people to really try to
get through their diet iscalcium rather than supplement.
(41:36):
But like everything, you haveto thread the needle.
If you're like, if you'resomeone who can't have any dairy
and you struggle to get it inother ways, although there are
ways, which we kind of gothrough in the book, but then
using a supplement is okay.
It's better to do that than bedeficient.
And uh, but the the main, youknow, micronutrient that I
(41:57):
really would like that we thatwe'd like people to get through
food primarily is calcium, iscalcium.
There's a little evidence thatcalcium supplementations over
time might be related to um, youknow, heart disease.
And then, of course, one of theother benefits of getting your
calcium through food is thatmany of the sources have like so
many of the other things thatyou need, especially if you're
varying your sources, like ifit's not just dairy, if it's
(42:18):
also like cruciferous vegetablesand certain, you know, other
food components.
I made a post on thisyesterday.
Like I I wish I could eatsardines, I just can't make all
that.
I can't think of that example.
There, you know, the sardineshave like with the little bones
of you know, calcium and vitaminD and protein, and like I I
(42:39):
wanna I wanna want to eat them.
I just like I just don'tsister.
Michele Folan (42:44):
I'm not eating them either.
So um I love fish, but I'm noteating sardines.
Yeah, and you know, supplementsalone that can be a real
mindfield because there's somuch out there beyond vitamin
D3, K2, calcium.
Are there any others likemagnesium for sleep or collagen?
(43:04):
Um, anything there yourecommend?
Jocelyn Wittstein, MD (43:07):
Yeah, I um I'll tell you what I take,
and I think it's reasonablyevidence-based.
So I take magnesium glycinate,400 milligrams at night.
I do think that helps withsleep.
Also, you know, one of thethings that a lot of women will
get in perimenopause ispalpitations, and you'll go to
cardiologists and have thiswhole workup, and there's
(43:27):
nothing is found, you know.
There, and um, and actually, somagnesium glycinate can help
with that as well.
Um uh, and then vitamin D, I Ido take, you know, beyond the
kind of daily value just becauseof some of the data on dementia
prevention.
So if you don't have adeficiency, you should not
(43:48):
exceed 4,000 units a day, but II take a 2,000 unit a day
supplement.
I do like collagen, umhydrolyzed collagen.
I think there actually isevidence behind that for joint
pain.
I think that there's alsoevidence behind it as long as it
includes type 1 collagen in thehydrolyzed collagen that that
can um help you with your bonehealth.
I don't take this regularly,but I also do think there's
(44:11):
quite good evidence for turmericsupplements, you know, a
thousand to 1500 milligrams aday, something in that range, in
terms of acting as maybe asubstitute for some people for
NSAIDs.
Um, there are a lot of studiesthat show that people who have
some like nearthritis who wouldnormally be dependent on motrin,
ibuprofen, things like that,that they're able to, you know,
get off of the NSAIDs byutilizing turmeric supplements.
(44:34):
Uh, we talked about um the fishoil.
If you're not someone, if youdon't, you know, eat much fish.
That's the I think that'sreasonable to do for sure.
Michele Folan (44:42):
Okay.
Those are all good.
And just so you know, I takeall this.
Jocelyn Wittstein, MD (44:48):
Yeah, I think that's that's a good, you
know, nothing too crazy.
You could you could take a lotof stuff.
I mean, you could take beetextract, resveratrol, I mean
quircetin, uh, so many thingsthat really do have some
evidence behind it.
Like quircetin has someevidence behind it.
That's something that's inapples and onions and coffee,
(45:09):
like in our diet.
But there's some evidenceagain, based on rheumatoid
patients, that that's helpful,you know, with reducing
inflammation and joint pain.
But I just I don't want peopleto go take like too many
supplements and yeah.
Michele Folan (45:20):
And and that's something I've had to kind of be
mindful of because we used tomake fun of my mom because she
took so many supplements becauseshe was always reading, you
know, reading up on her, youknow, information on
supplements.
And then I became my mother.
I was then I was taking allthose supplements.
So I have I have whittled itdown, but basically whittled it
(45:42):
down to what you had suggested.
I think at one point I wastaking boron.
Jocelyn Wittstein, MD (45:47):
Yeah, so so uh boron, I mean it's in you
know small amounts in our diet.
You don't need very much of it.
But the interest in boron isthat it it extends the half-life
of vitamin D and estrogen.
I I don't routinely tell peopleto to supplement that, but um
(46:07):
it is involved in in bonemetabolism, yeah.
Michele Folan (46:12):
All right.
Well, it was something I readand I started taking it, and
then I was like, okay, I I gottaI gotta do some elimination
here because I was just yeahjust taking too much.
Okay.
So what 2025 myths aboutarthritis and osteoporosis or
being too fragile would you liketo debunk?
Jocelyn Wittstein, MD (46:33):
So just uh I think there's a little bit
of like I don't want to say likefear-mongering, but there's
just like a lot of hype rightnow, but like I just don't ever
want people to hear hearmessages and misinterpret them.
So you will hear like 65 is toolate, you know, for your bone
density.
And I think people hear thatand they're like, oh no, I've
(46:54):
missed the boat, it's too latefor me.
And then they're kind of likefeeling helpless.
And I I don't want that to bemisinterpreted for people.
I think people are maybehearing messages like 65 is too
late.
That's kind of speaking to likemaybe our current medical
practices in the United Statesor standards or whatever.
I want to be really clear thatlike a lot of the interventions
(47:15):
that are studied are on women intheir 60s, including strength
training, some impact exercises,agility programs, showing
benefits, showing improvement inbone density, showing reduction
of um fracture risk.
And, you know, so I think thatconcept that it's too late, I
don't want to say it's never toolate, but it's it's actually
probably never too late to, youknow, to start doing things that
(47:38):
will positively impact your umyour bone health.
Other misconceptions I thinkare rapidly being debunked, that
hormone therapy is only for hotflashes and night sweats, and
that menopause is a transientthing that people go through.
Whereas a lot of the long-termconsequences are actually
musculoskeletal, like, you know,more rapid development of
arthritis, osteoporosis,difficulty maintaining muscle
(48:02):
mass, things like that.
And so, like, you know, justsort of wanting women to know
that if you're able to take it,like estradiol therapy is
prophylactic against, it's evenan FDI-proved indication for
hormone therapy.
You're not even gonna have tolike justify it.
It's just it's prophylactic,you know, against osteoporosis.
Myths about arthritis.
(48:22):
Um, I think just a lot ofpeople don't understand that
once you have arthritis, itdoesn't go away.
You can't reverse arthritis,but it doesn't mean that you,
you know, can't be activethrough it.
You just have to find ways towork around it.
I tell my patients all thetime, it's like having a sports
injury when you're a kid and youhave to work around it, except
(48:42):
for it just it's never goingaway.
And um, we don't treatpictures, we don't treat x-rays,
we treat people.
So, like I have patients thathave pretty significant
arthritis that are able to findways to strength train, they're
ways they're able to findalternative forms of
cardiovascular exercise.
Like people maybe, you know,running doesn't cause arthritis,
but once you have it, it canaggravate it.
(49:02):
So sometimes I have to redirectmy patients.
I don't want them to just belike, I can't do this, I can't
exercise.
Well, you can try rowing, youknow, like a lot of people
tolerate using an erg machine ora rower, and that's a good
cardiovascular exercise and italso stimulates bone density.
So I think that people thinkeither arthritis is something
that they can, they don'tunderstand that it doesn't go
(49:22):
away, but then when they realizethat it doesn't go away, they
feel like they have to just stopbeing active.
And it is there are a lot ofactivities you can do with
arthritis that will hopefullynot aggravate it and allow you
to stay active.
Michele Folan (49:32):
Yeah, and I get that too, you know, because you
it's that initial, like, mmm,you know, it's not well, it was
me, but it you're you're kind oflike feel like you're at a dead
end, but you just have to justshift gears.
Jocelyn Wittstein, MD (49:48):
It's your new normal.
It's not a dead end.
unknown (49:50):
Yeah.
Jocelyn Wittstein, MD (49:51):
Uh and and again, we've just talked
about there are some supplementsthat help.
You know, I think the key is totry to stay active and you
know, maybe not expect yourselfto be exactly the person you
were forever, but like, youknow, find ways to be active
with your current, you know,parts the way they are in terms
of your joint.
Michele Folan (50:11):
But you also, and you also talk about dementia
prevention and the importance ofexercise and getting aerobic
activity.
And so there's there's theother side of that too.
Jocelyn Wittstein, MD (50:24):
Yeah.
Well, my mom died of dementialast year.
And I'm sorry.
Yeah, I mean, I have so manyfriends who've lost parents to
dementia, and um so I constantlythink about things I can do to
not get dementia because I don'twant to have dementia.
And interestingly, there are aton of things that benefit your
(50:45):
bone and joint health that alsoare, you know, protective
against dementia, like vitamin Dsupplementation can reduce
joint pain, it's beneficial toyour bone health, and has been
associated with reduced risk ofdementia.
You know, regular exercise, um,you know, studies showing like
something on the order of 150minutes of moderate intensity
(51:05):
exercise.
And I don't think it all has tobe cardiovascular, there's some
studies that show benefits tocardiovascular exercise.
There's certainly, I thinkthere's also evidence there's
benefit to strength training andand and there are mechanisms
that that may work through, likeif you're doing like exercises
that stimulate your bones,whether it's through what we
call joint reaction forces fromthe loading across the skeleton
(51:26):
with like lifting weights versusground reaction forces from
jumping or impact.
When we stimulate our bones, westimulate the osteoblast.
Osteoblasts make somethingcalled osteocalcin.
Osteocalcin actually, you know,supports our neurotransmitters
and our neural connections inour brain.
So, you know, probably whenyou're doing agility and you're
doing jumping, you're using yourmuscles, that hormone is also
(51:48):
sending messages to your brainand reinforcing these like
neural pathways, probably.
So there's probably an actualhormonal connection.
Um uh and yeah, so I thinkexercise is like the most
consistent thing across theliterature that has always been
shown to reduce risk ofdementia.
So it's like kind ofnon-negotiable to me to, you
(52:13):
know, I have this weird thing inmy head that I have to, I've
always felt like this.
I no matter what, I have to getat least 30 minutes of exercise
in in a day.
It's just my non-negotiablesomehow.
If it's like 10 minutes threetimes, or 20 minutes and 10.
I mean, I would like to do morethan 30, but that I I cannot, I
almost feel nervous if a daygoes by that I didn't do 30
(52:33):
minutes of exercise.
Michele Folan (52:35):
Well, and I was gonna ask you like what one of
your core self-carenon-negotiables was.
So besides your exercise.
Okay, so okay, that's it.
Jocelyn Wittstein, MD (52:50):
It's such a stress reliever.
It's just, you know, it givesyou endorphins.
Exercise can reduce pain.
Did you know like actualexercise is like one of the
treatments for fibromyalgia?
It's like regular exercise.
You know, it's there is like areal truly like mind-body
connection with endorphins andthings like that.
So uh yeah, but yeah, I I um Ifeel terrible if I don't get to
(53:15):
exercise regularly.
And I me too.
Yeah.
Michele Folan (53:18):
You know, now, now that I I realize that.
So it, you know, because I dowork out almost every day, at
least take, you know, athree-mile walk or something.
Um, if I don't do it, I feellike crap.
Jocelyn Wittstein, MD (53:34):
Yeah.
And I used to, you know, when Iwas younger, interestingly, I
used to think like my exerciseha well, I used to be like I
have to do 30 minutes ofsomething cardiovascular, and
then I can also do more, likestrength training.
And but it was like, I now it'skind of funny.
I will also like some days now,I as a 47-year-old, I will not
(53:56):
do cardio.
I'll do a little warm-up, I'lldo a more extensive strength
training routine on those daysor some plometrics or jumping or
grip exercises or whatever.
And um, I mean, that is aworkout.
It's just kind of funny how youum shift over time.
That it in it used to be like Ihad to do 30 minutes of cardio
and then I would do other stuffif I had more time.
(54:17):
And I I am, I think, moreparticular now about making sure
I earmark certainly two days aweek where there's a lot more um
focus on the strength training.
And then if I have time, I'lladd on some more cardio, but at
least get some, you know, maybeagility and balance and grip
stuff in.
But yes, I just I I cannotstand the way I feel if I don't
get to exercise.
Yeah, yeah.
Michele Folan (54:36):
It's I I and I want people to have that
experience of oh my gosh, if Idon't work out, I don't feel
great.
And that's that's my goal withmy clients.
Like that's a good goal.
Yeah, it is a great goal.
Dr.
Wittstein, where can peoplefind the complete bone and joint
(54:57):
health plan and find your work?
Jocelyn Wittstein, MD (55:00):
Um, the book, which is by me and Sydney
Niskorski, uh, is at Barnes andNobles, also Amazon.
And then, as you know, you canuh follow me on my Instagram
account, which is just my it'sjust Dawson underscore Witstein
underscore MD.
And uh I'm believe it or not,I'm actually pretty new to
(55:20):
social media.
My 19-year-old daughter helpedme make that account in January.
But I I do I have I I reallylike health literacy, much like
I really like to educate mypatients.
So I I uh I you know I just tryto provide information that's
um educational to people abouttheir own, you know, bones and
joints and things they can useto help themselves.
(55:42):
And then um, yeah, then I I Ipractice full-time at at um I I
live in Raleigh and I practicefull-time uh Duke University
School of Medicine.
Michele Folan (55:51):
Yeah.
And I really recommend you allfollow Dr.
Jocelyn Wittstein on Instagrambecause she has so much
information in there.
And it doesn't mean, I mean,even if you don't have
osteoporosis or joint pain, giveher a follow because think
about prevention.
(56:11):
And I think you're gonna have aplethora of fabulous tidbits
and how-tos in there as well.
So, Dr.
Witstein, thank you so much forbeing on Asking for a Friend.
Jocelyn Wittstein, MD (56:23):
Yeah, thank you for having me.
Michele Folan (56:26):
Thank you for listening.
Please rate and review thepodcast where you listen.
And if you'd like to join theAsking for a Friend community,
click on the link in the shownotes to sign up for my weekly
newsletter where I share midlifewellness and fitness tips,
insights, my favorite finds, andrecipes.
The holidays are coming fast, and if you're not
careful, it's easy to loseyourself in the shuffle.
So this year, what if you didthe opposite?
What if you built a healthyfoundation before the chaos
hits?
I'm Michelle Folan and my21-day metabolism reset is
designed to help you do exactlythat.
We'll tackle sugar cravings,dial in your nutrition, and get
(00:22):
you moving in a way that fitsyour life.
Beginner, I've got you.
More advanced, there's plentyto challenge you to.
This is your chance to holdspace for you.
To reset, recharge, and finishthe year feeling strong, not
stressed.
Join me now.
The link is in the show notes.
Let's build momentum together.
(00:43):
Health, wellness, fitness, andeverything in between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
Did you know that one in twowomen over 50 will break a bone
(01:07):
due to osteoporosis, oftenwithout a single warning sign?
Or that 80% of us aren'tgetting the right screenings
early enough to stop it?
I've been there, staring at myown DEXA scan, heart racing,
thinking, ugh, this can't be mystory.
But here's the truth: osteoporosis and joint pain (01:23):
undefined
don't have to steal your spark.
Today we're joined by Dr.
Jocelyn Wittstein, Dukeorthopedic surgeon, author of
the complete bone and jointhealth plan, and a powerhouse in
women's bone health.
She's here to unpack whymidlife hormone dips hit our
bones and joints hard, howsimple moves like jumping and
(01:45):
grip training can rebuildstrength, and why normal labs
might be lying to you.
From her lift more-inspiredworkouts to dementia fighting
nutrition, this conversation ispacked with hope and how-tos to
make your next 20 yearsunbreakable.
So grab your cup of coffee or aweighted vest and let's dive
(02:05):
in.
Dr.
Jocelyn Wittstein, welcome toAsking for a Friend.
Hi, thank you for having me.
Yes, I'm so glad we were ableto get this together.
This audience has a hugeinterest in bone health.
I talk to clients daily who arelike me, um, have either
osteopenia or osteoporosisdiagnosis.
(02:25):
And so thanks for being here.
I would love for you to tellour listeners a little bit more
about you.
I know you're way more thanwhat I just described.
Jocelyn Wittstein, MD (02:38):
Um well, uh I'm not sure what all you
want to know, but I um I am yes,I'm an orthopedic surgeon.
Uh, I'm a mom.
A five.
Yeah, yeah.
The the thumbnail version is umas an added fun bonus to our
life.
My husband is also um afull-time orthopedic surgeon,
and his wife before me passedaway of breast cancer.
(03:00):
So when I married him, Imarried him in a five, eight,
and eleven-year-old, and then wehad two more kids.
And so we have uh a family ofseven, and um, we mostly talk
about our children and bones andjoints.
Exciting.
Very, very boring.
Michele Folan (03:19):
Bones for pillow talk.
Jocelyn Wittstein, MD (03:21):
Yeah, bones, joints, children, what
kind of exercise we're gonna doand what we're gonna have for
dinner, and our dog, yeah.
So uh, but um we yeah, so we'rekind of an orthopedic family.
And um, I you know, I went toCornell undergrad.
I studied nutritional sciencethere as part of my pre-medical
education.
So I've always had a love fornutrition.
Uh I was a gymnast growing up,and I was a collegiate gymnast.
(03:44):
And uh I went to med school atECU, East Carolina University,
originally thinking I wanted tobe a pediatrician, and then
decided actually I wanted to bea surgical subspecialist.
Uh, I've always had a love forsports medicine, which is the
sub-specialty of orthopedicsurgery that I practice in.
Uh, and then I you know, I didall of my orthopedic training at
(04:06):
Duke.
I did a fellowship there inshoulder and knee and sports
medicine.
Uh, worked for a while for aColumbia-affiliated organization
up in New York State, came backuh to Duke, where I work now in
2017.
Uh, and I'm an associateprofessor there.
I teach and train medicalstudents and residents and
(04:28):
fellows.
And I also um very active inresearch, so I collaborate with
a lot of our PhDs on some NIHfunded research, a lot of it
related to post-traumaticarthritis.
And I work regularly with ourwith my women's health
colleagues on um some researchkind of at the intersection of
women's health andmusculoskeletal health, which
actually impacts adolescence allthe way through, you know,
(04:51):
menopause in terms of the sortof intersection between uh those
two subspecialties.
So there's um much moreintersection than people
realize.
Michele Folan (05:00):
Well, and you've probably treated some elite
athletes, you know, where you'vebeen, right?
But you've you've kind of takena little bit of a detour into
women's health.
What kind of yeah, you saidyou're doing some research, but
what kind of made you moreinterested in, you know, uh
(05:22):
postmenopause and and some ofthe joint and bone issues?
Jocelyn Wittstein, MD (05:27):
So I don't really think of it as a
detour.
I think of it as part of thewhole spectrum.
I mean, you women are veryactive throughout much of their
lives.
And, you know, I think if wetreat women like as athletes or
people just trying to stayactive, there are different
aspects of um their musculosalhealth that are impacted
(05:47):
differently um throughout theirentire life.
So there's a health span forwomen, and I like to think that
I think about all of that.
Um, like in my youngerpatients, female athletes are
more prone to ACL tears.
And if you tear your ACL,you're also more prone to
developing arthritis.
But women go through pregnancyand then they're more prone to
autoimmune types of umarthritis, actually at that
(06:08):
point in life.
And then you become aperimenopausal or menopausal
woman, and you are prone tofrozen shoulder and um faster
progression of our arthritisthan men, you know, of matched
ages.
Um, and of course,osteoporosis, and that may
manifest in a distance athleteor an endurance athlete, you
(06:30):
know, having more problems withtheir knees or stress reactions.
Uh, and of course, asorthopedic surgeons, we all
interact with patients who havefalse and trauma.
And there are just multipleareas where women are affected
disproportionately.
So, osteoporosis is one.
And it's actually a preventabledisease as orthopedic surgeons.
We usually catch it at the backend.
(06:52):
So I think I don't want to saylike my interest in bone health
or joint health and how thingsmaybe how both arthritis and
osteoporosis disproportionatelyaffect women is like kind of a a
detour.
I just think if it's part ofthe continuum of the health span
of women, and there isthroughout the life this
intersection of, you know, thefemale sex and musculoskeletal
(07:15):
health.
It's just different things attimes, if that makes sense.
Michele Folan (07:18):
No, it it certainly does.
And, you know, there's there isa little bit of a sense of
urgency, I think, because we,you know, we've got this window
where we can prevent a lot ofthis if we take early action.
But I think it's for womenknowing when to take action is
kind of the question there.
You know, because you know, youmay be asymptomatic, right,
(07:41):
with osteoporosis and you don'tknow exactly, you know, when
when you should start to get thebone scans and all of that.
So speaking of which, if youhave a family history, when
would you recommend someone gettheir first DEXA scan?
Jocelyn Wittstein, MD (07:57):
Well, that's tricky because the family
history part, I feel like ifyou have a mom, you could have a
family history of osteoporosis.
Yeah, right.
Just like so many women, if youlive long enough, you know, at
least in previous years we havedeveloped osteoporosis.
So uh I think like an earlyfamily history is uh yeah,
certainly a red flag.
But uh yeah, this question, youknow, we the standard of care
(08:21):
is like age 65 for women, andthat's definitely, I think,
later than I would like it tobe.
I think people have likemultiple risk factors, like
testing earlier.
I I think it's very reasonableto consider testing at menopause
because you're about to, uh,without interruption of the
process with hormone therapy, ifyou're able to use it, you are
(08:44):
going to have a more rapid loss,or you know, like something on
the order of 2% per year interms of loss of bone density.
So over a decade, like 20%.
You know, you you really wouldlike to know.
I think we we should know, youknow, where we are when we're
starting that.
And then I think that's mostimportant for people who want to
take that information andincorporate it into their
(09:05):
decision making.
And it can be a wake-up callfor people as well.
You know, if you're enteringmenopause, osteopenic, um, that
can be very motivatingsometimes.
Yes, it can.
Kind of take the bull by thehorns.
Um, so I mean, I think peoplewho need to be screened earlier
are people who, if you hadenergy defenselessly as a
(09:28):
younger athlete, if you hadprevious stress fractures, if
you're someone who's on likebeen on proton pump inhibitors
for years and years, likesomeone who's had reflux for
years and years has a greaterrisk of osteoporosis and
fractures over time.
People have been on steroid,people who've used a lot of
nicotine really worry about.
I sound like an old person, butthese young people vaping all
(09:49):
the time, so much nicotineexposure is not going to be good
for their bone health as theyuh as they age.
Um, anyone, you know, with ahistory of um um elevated
parathyroid hormone, uh, youknow, so there are certainly
some known risk factors thatwould tip you into being tested
earlier.
The people who need to betested really young are people
(10:09):
who had like definitely ahistory of energy deficiency
syndrome, stress fractures,especially if that's prolonged.
You know, those are like kindof the experiences at a younger
age that can make you uh more atrisk.
But I it's hard to give anexact answer.
I think for many women it wouldbe better to get tested around
menopause than 65.
I think that's pretty clear.
Michele Folan (10:27):
Will that standard ever change?
I mean, because 65 to me, it'slike the horse is way out of the
barn by then.
Jocelyn Wittstein, MD (10:34):
Well, I think it's becoming more and
more apparent that osteoporosiscan be preventable in so many
cases.
And so obviously, if you weretrying to prevent something, you
would like to catch it in anearlier phase than a later
phase.
I think more and moreaddressing osteoporosis is
becoming more of a preventativeeffort than a reactive effort.
(10:56):
You know, I we still do this,of course, because we need to,
but if I if we have a patientwho breaks their hip, we send
them to our, you know, we we wehave them test on the DEXA.
I fully expect them to, I don'tknow what woman in their 70s
with a hip fracture would nothave osteoporosis.
I mean, it's like pretty likelythey're gonna test that way and
(11:17):
they're gonna be treated, butwe're also using that study to
then like follow their responseto treatment.
So it's not that you, it's notthat the studies aren't valuable
then too, because you're moreusing them for like seeing maybe
a response to treatment and andfollowing them in that way.
But it's yeah, it's not toscreen you and see where you are
and see what your preventativeefforts might might do.
(11:39):
And there's so many tests thathaving information is valuable
because it's also motivating topeople, or can be there are
other tests that help allay, youknow, fears sometimes, you
know, the opposite, like um,like an like an MRI of your knee
if you're having knee pain andit comes back as okay, I can
(12:01):
keep being active and pushthrough.
But I I think a DEXA scan is ais is a different thing.
It's like it can be motivating,even though you might not want
to get a result that shows youhave osteopenia, it can be kind
of a sign that you are at awindow where you can still do
something.
And I think that's alsomotivating for people.
Michele Folan (12:19):
Well, certainly motivated me.
Jocelyn Wittstein, MD (12:21):
Yeah, your story is one of those.
Michele Folan (12:23):
You right, exactly.
Yeah, so but yeah, it was itwas one of those things.
I mean, I was certainly youngerthan 65 when I got that, when I
got my first scan.
So that's why I was asking, youknow, just from your
perspective.
You know, perimenopause can hithard, you know, because we we
start to see the decline inestrogen.
People get achy, you know, theyknees and and whatever.
(12:47):
You start to see some shoulderissues.
I was talking to a client thismorning that has rotator cuff
issues.
I don't know if it's frozenshoulder, but how does hormone
decline contribute to arthritisversus osteoporosis?
Are are are there correlationsthere?
Jocelyn Wittstein, MD (13:05):
Mm-hmm.
Yeah, I mean, so it'sunfortunate, but both things
accelerate uh with estrogenwithdrawal.
And so our bone density is isvery well very tightly linked to
to estrogen.
Our estrogen basically kind ofinhibits our osteoclasts, make
(13:27):
them not live as long.
So there's like less breakingdown of bone relative to making
bone, and so we can maintainbone density better, and then in
the absence of estrogen, theosteoclasts live longer and they
break down bone at a greaterrate than our osteoblasts build
bone, and so less we get thataccelerated, accelerated loss of
bone density.
But in our joints, yeah, uhestrogen has more of an
(13:47):
anti-inflammatory effect, andyou know, we know that just
systemically, in the absence ofestrogen, some of these
inflammatory markers orcytokines are a little bit you
know elevated.
The same thing is happening inour joints, and there are
estrogen receptors in the liningof the joints.
And so if you don't have thatanti-inflammatory effect, it's a
more inflammatory environment.
There is more cartilagebreakdown, more rapid thinning
(14:10):
of cartilage.
And that definitely bears outin the differences.
And if you if you look at likenumber of women with arthritis
versus men, women needing kneereplacements versus men, um, you
know, women are affected bythis much earlier than men.
So, you know, I've referencedpapers in the past that show
that women have a 40% greaterchance, you know, in their 50s
(14:31):
of having knee arthritis thanthan men.
And so that's probablyhormonally mediated.
Uh so unfortunately these twothings are kind of happening at
the same time.
Similar pathologies, likefrozen shoulder, it's not
arthritis, but it's aninflammatory process in a joint.
And, you know, to kind ofsupport that hypothesis or or
(14:51):
kind of thought process, ourpatients who are being treated
with aromatase inhibitors, forinstance, are very prone to
frozen shoulder.
There's the lining of theshoulder joint, is for some
reason seems to be quitesensitive to the
anti-inflammatory effects ofestrogen.
And there are even basicscience studies showing that um
estrogen has an effect ofbasically inhibiting fibroblast
(15:12):
or this cells that kind ofthicken the joint capsule and
make it stiff.
So all these things arehappening at the same time.
And then likewise, ourmusculature uh is you know
muscle growth, repair.
The stellate cells in themuscles are also uh stimulated
by estrogen, and so it's harderto maintain muscle mass um as
(15:34):
with estrogen withdrawal.
And you know, these things kindof coalesce, uh, and then you
get it's like wall wall.
Michele Folan (15:42):
It's like it's like we, you know, it's like we
yeah, yeah.
And so that brings me to mynext question.
Well, first of all, aromataseinhibitors tell the audience
exactly what they are.
Jocelyn Wittstein, MD (15:53):
Um, they you know, kind of prevent the
reaction that kind of createslike makes estrogen uh available
in your body.
Okay, okay.
Michele Folan (16:03):
All right.
Jocelyn Wittstein, MD (16:03):
So you you're diminishing the amount of
of estrogen circulating in inthe body.
Um, so as part of like, youknow, breast cancer um
treatment.
Got it.
And yeah, so patients who areon those medications can have
this can affect their bone anduh and their um joint health.
And then, you know, othermedications called CERMS, like
(16:24):
selective estrogen receptormodulators, interestingly, like
you know, can be protective ofbone, but then you can still
have side effects of the jointpain, and but they're can be
protective against cancer.
Um so uh of course, you know,sometimes those medications are
are are necessary.
(16:45):
And I'm I'm certainly, youknow, not like a breast cancer
doctor, but I do see a lot ofpatients that are you know going
through treatment of that andexperiencing um the side effects
and you know just trying tostay active and it's really hard
for them.
Michele Folan (17:00):
Yeah.
And for those patients thatabsolutely cannot be on hormone
replacement therapy, they can'tbe on estrogen, what other
options do you have for them?
Jocelyn Wittstein, MD (17:10):
Well, I mean, I think the data on
strength training and someimpact exercises, you know, is
very, you know, shows that likeinterventions other than
medication are really effective.
And, you know, if you look atsome of the studies on, okay,
let's talk about bone densityand estrogen therapy over a few
(17:33):
years, increasing, say, likeyour bone density by three and a
half, four-ish percent,something like that.
You know, we also know thatsome strength training
interventions, like the Liftmoretrial, showed over an
eight-month period a 3% increasein lumbar spine bone density
and a smaller percentageincrease in the hip.
So it's I don't want people tofeel hopeless if they're someone
(17:57):
who can't use uh estradiol,because some of, you know, if
you just look at like percentagepoints of improvement in bone
density, actually, some of thesestrength interventions show
almost similar benefits in ashorter period of time, which is
amazing.
Um, for people who have theluxury to or lucky enough to use
(18:19):
hormone therapy, certainly allthese things can be cumulative.
And, you know, I would neverwant someone to think that like
just just hormone therapy wouldbe like, you know, the golden
ticket to not gettingosteoporosis.
Estradiol is prophylacticagainst, you know, osteoporosis,
it stabilizes bone loss, likeover a few years can increase
bone density some, but theseother interventions, which are
(18:42):
not even medications, areactually quite helpful as as
well.
So uh it's just some peoplehave less options, and you know,
that's that's not ideal.
And then there's newmedications on the horizon.
Um, there's you know, furtherresearch going on with Duave,
you're probably aware of, whichis a combined estrogen and CERM,
(19:03):
which would be protectiveagainst bones and um showed, you
know, reduced risk of invasivecancer.
So, you know, I I think there'sso much research happening and
um potential options for peopleand also more of a shift towards
shared decision making forpeople who do have some risks.
And uh I I've really enjoyedfollowing um Corinne Mann, you
(19:26):
probably follow, and just herperspective on like shared
decision making and kind of nottreating people as like only
their breast cancer risk andthings like that.
But so yeah, in a perfectworld, like yes, cumulative
benefits of estradiol, strengthtraining, some impact training,
your diet, you know, somesupplements that may help, but
(19:46):
it's not just hormone therapy.
Michele Folan (19:48):
Well, and I that's that's an important
message because we have to getaway from thinking that a pill
is always gonna save us.
You know?
And so for me, sure, I'm onHRT, but I also am working my
butt off in the gym.
I I watch you, I you know, I Itold you I was jumping off a
(20:10):
step the other day at the gym.
I was doing a compound, youknow, compound jump.
And this woman's like, what areyou doing?
I'm like, I'm working on mybones working on my bones.
Yeah, Dr.
Wittstein told me to do this.
Um but but back to what I wassaying before is that there is
hope out there.
And I know for a lot of womenthough, you get that
(20:33):
osteoporosis diagnosis andyou're a little scared.
You're a little scared to dothe bend over, you know, pick
up, you know, do a deadlift,those types of things.
What kind of coaching do yougive patients?
Do you send them to PT to learnhow to lift appropriately and
safely?
Jocelyn Wittstein, MD (20:52):
Yes.
I mean, so many people haven'tdone strength training before,
or maybe they haven't in awhile.
And um, you know, in many ofthe studies and the benefits of
strength training, these are ofcourse supervised.
And you can't just go from notstrength training to doing this
like really heavy lifting.
And I always like to say, like,we people who are not subjects
(21:15):
in studies who were not screenedto be in the study because they
did or didn't meet exclusioncriteria.
Like in real life, some peoplehave these exclusion criteria
that wouldn't have let them evenbe in the studies, like maybe
they had a knee surgery or havesome you know limitations from
another orthopedic condition.
So we need to like take intoaccount what your own
(21:35):
limitations are.
We need to take into account ifyou haven't been doing this
heavier exercise or lifting, youhave to start light and then
you know build up.
I mean, even in thesecontrolled trials with guidance,
like in the Lyftmore trial,there was kind of like a one to
two month ramp up period fromyou know lighter to moderate to
heavier lifting.
And certainly there are a lotof studies showing the safety of
(22:00):
these exercise interventions inosteopenic patients.
You notice like a lot of thestudies are on people with
osteopenia.
That's kind of a safer group togroup to study, maybe not
directly on people who alreadyhave osteoporosis.
And that requires even morenuance so you don't hurt
yourself.
Like we want people to move andnot be afraid to move and bear
weight because that's what youneed to do to like not lose more
(22:22):
bone density, but we also don'twant you to get an
insufficiency fracture in theprocess.
So it can really help to havesome guidance of a physical
therapist and then maybe kind ofeventually, you know,
transition you to a trainerwho's knowledgeable and things
like that.
Michele Folan (22:35):
Yeah, and I did go to a physical therapist
because again, I was scared todeath.
I was like, oh my God.
I, you know, I didn't know whatI was dealing with.
And and she really walked methrough things, but there were
like certain yoga poses she toldme, yeah, you may not with with
your lumbar issue, you may notwant to do, I forget the yoga
pose because I'm not like a lotof flexion.
(22:56):
Yeah, yeah, yeah, yeah.
And I I'm not a yoga person, soI don't know the actual pose
name, but it's when you archerback, basically.
So I and and that was all good.
I'm I've been really intriguedwith the jumping piece of this
lately because I'm like almosteverybody can do that.
Jocelyn Wittstein, MD (23:14):
Well, people actually kind of forget
how to jump and skip.
And like there are things thatwhen you were a kid were really
easy and natural.
And when you go to do themsometimes as an adult, you've
like almost lost like theneuroconnectivity to move in
that way or something.
And uh Well, you do.
I mean, I really think you do.
(23:35):
I've had people message me likethe first like few days of like
doing like the little drop jumpoff a step and a rebound jump.
Like, I they're literally yousay, like, I didn't know how to
rebound, like I just like hitthe ground and I didn't know how
to do the second jump, and thenthey figure it out.
And so, yep, it's not asnatural as you think after a
while, but I think it is justlike biometrics can be a good
(23:57):
thing, agility work to kind ofkeep your you know, brain
connected to your muscles andmove in that way.
Michele Folan (24:06):
Absolutely.
I mean, the agility piece, theagility piece is certainly
important, right?
We we we've got to make surewe've we maintain our balance.
That's part of all of this, andnot wanting to fall, break a
wrist or a hip.
But there's one thing that Iwon't do, and that's box
jumping, where I jump from thefloor up onto something.
(24:27):
Knowing me, I would fall andbreak a tooth.
So I'm I that that to me.
Jocelyn Wittstein, MD (24:32):
I don't actually, yeah, that's not my
favorite thing to recommend topeople because there's a little
potential risk.
unknown (24:38):
Yeah.
Jocelyn Wittstein, MD (24:38):
You can do like I call them like frog
jumps, whatever.
You can jump and just jump ashigh as you can and bring your
knees up to your chest.
But for the bone density partof it, it's actually not even
the jumping up that matters,it's like the dropping down.
You don't have to drop downfrom a huge height, like it can
be um, like Tracy Clistold'swork showed, you could just drop
(25:01):
off of eight inches, or youcould actually do just like a
really big jump and land and arebound.
That helps as well.
And and then for people whohave, you know, they're like,
oh, my knees are bad, my hipsare bad, I can't do that.
Like you can also do the heeldrops where you go up on your
tiptoes and drop down.
You know, that can be asubstitute, doesn't have all of
that, like, you know, fasttwitch muscle activation and
(25:21):
playometric part to it, but youstill get some impact on your
bones.
Michele Folan (25:27):
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(25:49):
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(26:11):
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Jocelyn Wittstein, MD (26:26):
And so again, I just think people need
to find things that work forthem that they can do and not
feel like some of theseexercises are exclusive to
people who can to only to thepeople who can like lift really
heavy and only to the peoplethat can do these crazy, crazy
play metrics.
Like it's great if you can dothose things, and I like doing
some of those things, but itit's I don't want people to like
(26:49):
give up or feel intimidated byor like it's unapproachable to
them because doing some of thesemodifications is is still
actually helpful.
Michele Folan (26:59):
In one of your Instagram posts, you have a
weighted handle jump ropewithout the rope.
Jocelyn Wittstein, MD (27:04):
Oh, yeah, it's fun.
Yeah.
Michele Folan (27:06):
And I at first I feel like, oh my god, well, that
would be great for someone whomaybe worry.
You don't want to trip andfall.
Yeah.
Jocelyn Wittstein, MD (27:13):
Yeah.
It's actually and it feelsexactly the little weights.
So, first of all, you get somegrip exercise out of it and a
little shoulder work and alittle cardio, but the feeling
of the weights like droppingdown, it it actually feels like
for even though I know there'snot a rope there, it feels like
there's a rope, and you cansense like when you should jump
over it.
(27:33):
It's very interesting.
It's especially if you'resomeone who's I mean, I've had a
lot of people ask me, like, Iwant to jump rope because it's
good for agility and you getsome jumping in and cardio and
grip strength, all those things,but I'm afraid or I can't.
I've had so many women tell meI can't jump rope.
Like, I just can't remember howto do it.
And so I guess that's a realthing.
I know.
So I think the um, yeah, thelike cordless jump rope is it it
(27:58):
actually kind of helps peoplewith that.
You could transition that way,but and it's quiet, you know, if
you don't have a space oryou're not trying to, you know,
it's it's it's actually there'sa lot of good advantages to it.
How about rebounders?
Michele Folan (28:11):
Will you get much of an effect from jumping on a
little mini trampoline?
Jocelyn Wittstein, MD (28:15):
This I get a lot of questions about
this because a lot of peoplelike to do it because it's
easier on their knees.
Um and it's fun and it'scardio.
And there are limited numbersof studies on this.
And one of them that I'vetalked about before and actually
like did a little demonstrationon is basically uh showed that
if you compared people using therebounder versus not, like over
the course of the intervention,you know, at the end of the
(28:36):
intervention, like there wasn'tany difference between the two.
But the people using therebounders did see a little bit
of an increase in their hip bonedensity.
So kind of like as acomparison, there wasn't much
change, but there seemed to be alittle bit of benefit.
And so I my take on that is Ithink that they're good for
cardiovascular exercise.
I think they're good forstrength and agility and
balance, like other parametersthat might make you less likely
(28:59):
to fall.
And if anything, they may helpyour bone density a little bit,
probably not as much as jumpingon the ground.
But again, this is a questionof if you have knee arthritis
and you can't jump on theground, is it better to not do
anything or to jump on therebounder?
It's probably better to, youknow, jump on the rebounder, or
maybe you can add the heeldrops.
And so I think, you know, thereare like the most effective
things and there aremodifications that are like less
(29:21):
effective, but that you canactually do without hurting
yourself.
And for a lot of people, that'swhere we need to land or be so
that they don't get sidelined.
Because if you hurt yourself,then you can't do any exercise
for a period of time, and that'salmost you know worse.
Michele Folan (29:35):
Yeah.
All right.
So then the next one, and thenyou know this one's coming.
Weighted vests.
Weighted vests, yeah.
I knew it.
Yeah.
Jocelyn Wittstein, MD (29:44):
Yeah.
So yeah, I have weighted vests.
I love adding them to myexercise.
I also have a rucksack, which II kind of like a little better
because it's kind of a littlebit more core work, but the I I
really truly believe like in andof themselves, they're not a
solution.
But like anything, it'sadditive.
Um, there's, you know, there'sa small study that showed that
(30:05):
um in a small subgroup ofpatients that had like a
longer-term follow-up, thatthere was some improvement in
bone density with using weightedbest.
But not, it was even that studywasn't in isolation.
There were other aspects to theexercise program, like some
impact and some strengthtraining.
And so it's probably not likean isolated thing.
Now, even just walking issomething that can reduce your
risk of hip fractures.
(30:27):
It doesn't necessarily changethe arc of you know your bone
density, but like something thatyou know, you have it's you're
being mobile, you're um you'reit requires balance, requires
cardiovascular exercise.
Like walking is regular walkingis actually something that
reduces your risk of falling andbreaking a hip, even though it
(30:49):
doesn't necessarily likeincrease your bone density.
And, you know, along the linesof just walking, weight-bearing
exercise in general, with orwithout a weighted vest, the the
opposite of not doing thosethings is disuse.
And the most extreme version ofdisuse is anti-gravity, like
being an astronaut who that youknow they lose their bone
(31:10):
density very, very rapidlybecause they're just not even
weight-bearing.
So if you or if you're oncrutches, I love this example.
Like one of my friends, TammyScarpella, who's chief of worth
of Pedics in sports medicine atWisconsin, has done studies
looking at like if you tore yourACL and you were on crutches
for like even a short period oftime and you had some
modification of your weightbearing, like it in some parts
(31:30):
of your bone, it takes like twoyears for it to get back to
normal.
So disuse is always like worsefor your bone density than use.
So if you're like, I can walkand I wear a weighted vest and I
get extra cardiovascularexercise out of it, I jump on a
rebounder because it makes myknees feel good and I can do it,
and you're getting like balanceand agility, increased
(31:52):
strength, you know, lesslikelihood of falling.
These are all good things.
Yeah.
I I just I don't want anyone tothink like they have to walk
with a weighted vest to preventhip fracture.
It's it's it is a really nicecardiovascular addition to your
exercise.
Michele Folan (32:06):
Yeah, for sure.
Yeah, that was a long answer.
No, no, it's no, it's okay.
I like to let people talk.
So starting at what 5% of yourbody weight, maybe when you
start 5%.
Five or 10%.
Jocelyn Wittstein, MD (32:16):
I mean, I think if you're someone has any
like back issues or like, youknow, maybe if you've got like
osteoporosis real um or spine,five percent might be better
than 10%.
But I feel like for me, if it'sless than 10%, I don't feel
like much difference in mycardiovascular output.
Michele Folan (32:31):
And then if you did have any kind of like spinal
like stenosis or any discissues, would would you
recommend not using a weightedvest?
Jocelyn Wittstein, MD (32:39):
So yeah, interestingly, I was just
listening to a spine surgeontalk about this.
They uh and and not expressingmuch concern about it.
I think they're not too heavy.
I think if you're like kind ofwithin the like five to ten
percent of your body weight, Idon't think it's actually that
concerning.
Michele Folan (32:53):
Okay.
Jocelyn Wittstein, MD (32:53):
Um, of course, every individual is
different.
I think if you're gonna do likereally heavy rucking and you
have like an extruded disc,that's a different story than
like adding five or ten percentof your body weight.
Michele Folan (33:03):
Okay, I just want to make sure, because I I I get
these questions, so I'm likewe're gonna ask the expert.
Jocelyn Wittstein, MD (33:09):
Yeah.
And of course, the problem withthese questions is that every
individual has a uniquesituation.
Like, do you havespinalesthesis?
Do you have, you know, is itjust bad discs?
Do you have to facet arthritis?
Is it right?
Did you have a previouscompression fractur?
I mean, it's just uh it's it'sreally hard to give a broad
answer always on some of thesethings.
Michele Folan (33:27):
Yeah, I know, I know.
Okay.
I would love to talk about gripstrength and toe grip and how
they can be predictors of fallsand longevity.
Can you address that a littlebit?
Jocelyn Wittstein, MD (33:41):
Yeah.
First of all, I love grippingexercises.
I love hanging, I love carryingthings, pull like I love
gripping exercises.
The question always is like, isit that strengthening your grip
like improves longevity andmakes you less likely to be
frail and like less likely tohave dementia?
(34:01):
Or is it just a marker of youractivity and you know how
vigorous you are and otherthings you're doing?
That's like a surrogate, youknow, for something else.
Um, like I don't know that youknow, we know that like grip
strength is sort of a marker oflongevity, but if I do grip
strengthening and get my gripstronger, am I gonna live
longer?
I don't know.
Michele Folan (34:21):
Right.
That's probably maybe not thecase.
Chicken or the egg kind of athing.
Jocelyn Wittstein, MD (34:25):
Chicken or the egg, although I do think
it can help you be more likefunctional and independent um
sometimes.
And then in terms of like toegrip strength, that actually
makes more sense to me becauseyour your toe grip very much
assists with your balance.
And I always like to give beinga former gymnast, you know, on
(34:47):
TV when they show the gymnast onTV, they zone in on their foot
on the beam and they're likegripping with their toes to not
like you use your toe grip tomaintain your keep yourself
upright or to adjust.
You use your foot intrinsicmuscles to balance.
If you're standing on one foot,like you'll feel your foot
working if you're you know in atree pose in yoga.
You'll see your small, you'llyou'll dig in with your toes.
(35:09):
So foot strength definitely hasan impact on our on our balance
and can be related to to fallprevention.
So I I think you know that hasa clearer effect.
And doing single leg balancework does engage those those
muscles.
There are little purposefulexercises you could do with your
feet.
I shared a study of one wherethey just did like towel
(35:31):
scrunches and toe splaying, forinstance, but and and you can
improve your your strength inyour feet, actually.
So yeah, oh, I would think so.
Right, yeah.
Michele Folan (35:41):
Heck yeah.
Yeah, and and I did have um agentleman on the podcast, and we
talked a lot about agility andbalance.
And I just don't think our toesare something that we we think
about when we're we're talkingabout balance.
Okay, question.
Someone asked me this the otherday, and I said, Well, I will
(36:03):
ask Dr.
Wittstein this.
Uh huh.
Do we break a hip due to thefall or do we fall due to a
broken hip?
Jocelyn Wittstein, MD (36:11):
Uh in general, the break happens when
you fall.
So you fall that causes thebreak.
There are conditions that arelike that.
Like people will be like, Ifell down the stairs and tore my
quadriceps tendon.
It was like, no, yourquadriceps tendon tore,
therefore you fell down thestairs.
That's different.
But yeah, you the hip breakswith the impact.
Yeah.
The fall.
The fall causes the break.
(36:33):
Yeah.
Okay.
Michele Folan (36:34):
All right.
I thought that was aninteresting question.
Yeah.
It is a good question.
Yeah.
I I I like I like to ask thesethings.
All right.
Yeah.
You have this tremendous book.
And in there, you talk a lotabout nutrition.
And we talked a little bitabout anti-inflammatory foods
(36:58):
and that sort of thing, and howyou we want to reduce
inflammation.
What are some of your go-tofoods for not only
anti-inflammatory, but also bonesupporting?
Jocelyn Wittstein, MD (37:09):
Um, yeah, so so interestingly, there is a
bit of a connection betweeninflammation and bone loss.
Um, like some of the cytokines,which are inflammatory, like
messengers basically, um, thatcontribute to like arthritis and
joints and rheumatoidarthritis, also wear and tear
arthritis, are are also involvedin that pathway that leads to
(37:31):
breakdown of bone as well.
Interestingly, so inflammation,reducing inflammation may help
both our bone and joint health.
But food can also then be, youknow, a source of all the
micronutrients we need for bonehealth, which are, you know, not
just calcium.
So, yeah, like I think thereare a lot of foods that check
(37:52):
multiple boxes.
Um, and I, you know, I like tothink of it that way, like like
salmon has vitamin D and somecalcium, but omega-3s, which are
anti-inflammatory.
Boc Choy has calcium and fiber,which is anti-inflammatory, and
um, you know, vitamin K, whichyou also need, you know, for
(38:14):
your for your bone health.
Tempe has vitamin K and proteinand some calcium and fiber.
And so that, you know, I Ithink there are, I I tried to
sort of educate people on likewhat are some components of an
anti-inflammatory diet, but whatyou also need for your for your
bone health.
And then we um my co-author isactually one of my former
(38:34):
gymnastics teammates who's aregistered dietitian who trained
at Brown in Columbia and SydneyNitskorski.
She's a registered dietitian,also a personal trainer.
So we kind of pooled ourexpertise and interest um to
sort of bring all this togetherfor people.
So trying to kind of blendtogether aspects of an
(38:55):
anti-inflammatory diet as wellas helping your diet meet your
bone health needs, and then umrecipes that kind of bring those
things together, exercises thatare accessible to people,
because sometimes people arejust starting, you know, from
scratch, but we want you to beable to progress them.
A lot of frequently askedquestions in there, which is um
I I the frequently askedquestions section is like
(39:17):
everything my patients ask me,and everything Sydney's clients
ask her, like boiled down intoQA.
Michele Folan (39:22):
Oh, that's good.
That's really good.
Jocelyn Wittstein, MD (39:25):
It's actually my favorite section.
Michele Folan (39:26):
Yeah.
And so I agree with you.
I think diet and getting thosethings through real food is the
ultimate goal.
But we don't.
Some people don't, yeah.
Yeah.
So being realistic, I I want totalk specifically, first of
all, about omega-3s.
(39:47):
So if if we're not eatingsalmon every day, how like or
like a few days a week, somesource, yeah.
What about supplements?
Jocelyn Wittstein, MD (39:56):
Are you okay with uh your Oh, I think
fish oil supplements, the omega3, I think those are great.
And there are studies showingactually, like so many studies
on the efficacy ofanti-inflammatory supplements,
are done on patients withrheumatoid arthritis because
they have such elevatedinflammatory markers.
Not that I would ever suggestthat if someone has like, you
(40:17):
know, truly has rheumatoidarthritis, I'm not saying treat
yourself with fish oil.
Right.
Um, because I just want to makea point, and I don't ever want
to be misinterpreted this way,that osteoarthritis, where
enteroarthritis and rheumatoidarthritis are very different,
even though they have somecommon inflammatory pathways,
like some of the sameinflammatory cytokines that lead
to cartilage breakdown andosteoarthritis exist in
(40:38):
rheumatoid arthritis.
Just but rheumatoid arthritisis a truly a systemic autoimmune
condition where your body'scartilage is your joint
cartilage is just gettingdestroyed by this autoimmune uh
response in the in the joint.
Michele Folan (40:54):
Okay.
Jocelyn Wittstein, MD (40:54):
And there are medications that are
disease modifying and canactually halt the progression of
that.
We don't have that withosteoarthritis.
So just putting it out there,like if you have rheumatoid
arthritis, uh, you know, we thisis not something I would
recommend just treating with ananti-inflammatory diet, but
certainly it can help you.
So, you know, omega-3supplements, fish oil
(41:15):
supplements, there are studiesthat show that these benefit
patients with rheumatoidarthritis, like reduce knee
inflammation, help with jointpain.
Uh, and I kind of carry thatadvice over to osteoarthritis as
well.
So I I think the fish oilsupplement is great.
The the main thing I like tryto get people to really try to
get through their diet iscalcium rather than supplement.
(41:36):
But like everything, you haveto thread the needle.
If you're like, if you'resomeone who can't have any dairy
and you struggle to get it inother ways, although there are
ways, which we kind of gothrough in the book, but then
using a supplement is okay.
It's better to do that than bedeficient.
And uh, but the the main, youknow, micronutrient that I
(41:57):
really would like that we thatwe'd like people to get through
food primarily is calcium, iscalcium.
There's a little evidence thatcalcium supplementations over
time might be related to um, youknow, heart disease.
And then, of course, one of theother benefits of getting your
calcium through food is thatmany of the sources have like so
many of the other things thatyou need, especially if you're
varying your sources, like ifit's not just dairy, if it's
(42:18):
also like cruciferous vegetablesand certain, you know, other
food components.
I made a post on thisyesterday.
Like I I wish I could eatsardines, I just can't make all
that.
I can't think of that example.
There, you know, the sardineshave like with the little bones
of you know, calcium and vitaminD and protein, and like I I
(42:39):
wanna I wanna want to eat them.
I just like I just don'tsister.
Michele Folan (42:44):
I'm not eating them either.
So um I love fish, but I'm noteating sardines.
Yeah, and you know, supplementsalone that can be a real
mindfield because there's somuch out there beyond vitamin
D3, K2, calcium.
Are there any others likemagnesium for sleep or collagen?
(43:04):
Um, anything there yourecommend?
Jocelyn Wittstein, MD (43:07):
Yeah, I um I'll tell you what I take,
and I think it's reasonablyevidence-based.
So I take magnesium glycinate,400 milligrams at night.
I do think that helps withsleep.
Also, you know, one of thethings that a lot of women will
get in perimenopause ispalpitations, and you'll go to
cardiologists and have thiswhole workup, and there's
(43:27):
nothing is found, you know.
There, and um, and actually, somagnesium glycinate can help
with that as well.
Um uh, and then vitamin D, I Ido take, you know, beyond the
kind of daily value just becauseof some of the data on dementia
prevention.
So if you don't have adeficiency, you should not
(43:48):
exceed 4,000 units a day, but II take a 2,000 unit a day
supplement.
I do like collagen, umhydrolyzed collagen.
I think there actually isevidence behind that for joint
pain.
I think that there's alsoevidence behind it as long as it
includes type 1 collagen in thehydrolyzed collagen that that
can um help you with your bonehealth.
I don't take this regularly,but I also do think there's
(44:11):
quite good evidence for turmericsupplements, you know, a
thousand to 1500 milligrams aday, something in that range, in
terms of acting as maybe asubstitute for some people for
NSAIDs.
Um, there are a lot of studiesthat show that people who have
some like nearthritis who wouldnormally be dependent on motrin,
ibuprofen, things like that,that they're able to, you know,
get off of the NSAIDs byutilizing turmeric supplements.
(44:34):
Uh, we talked about um the fishoil.
If you're not someone, if youdon't, you know, eat much fish.
That's the I think that'sreasonable to do for sure.
Michele Folan (44:42):
Okay.
Those are all good.
And just so you know, I takeall this.
Jocelyn Wittstein, MD (44:48):
Yeah, I think that's that's a good, you
know, nothing too crazy.
You could you could take a lotof stuff.
I mean, you could take beetextract, resveratrol, I mean
quircetin, uh, so many thingsthat really do have some
evidence behind it.
Like quircetin has someevidence behind it.
That's something that's inapples and onions and coffee,
(45:09):
like in our diet.
But there's some evidenceagain, based on rheumatoid
patients, that that's helpful,you know, with reducing
inflammation and joint pain.
But I just I don't want peopleto go take like too many
supplements and yeah.
Michele Folan (45:20):
And and that's something I've had to kind of be
mindful of because we used tomake fun of my mom because she
took so many supplements becauseshe was always reading, you
know, reading up on her, youknow, information on
supplements.
And then I became my mother.
I was then I was taking allthose supplements.
So I have I have whittled itdown, but basically whittled it
(45:42):
down to what you had suggested.
I think at one point I wastaking boron.
Jocelyn Wittstein, MD (45:47):
Yeah, so so uh boron, I mean it's in you
know small amounts in our diet.
You don't need very much of it.
But the interest in boron isthat it it extends the half-life
of vitamin D and estrogen.
I I don't routinely tell peopleto to supplement that, but um
(46:07):
it is involved in in bonemetabolism, yeah.
Michele Folan (46:12):
All right.
Well, it was something I readand I started taking it, and
then I was like, okay, I I gottaI gotta do some elimination
here because I was just yeahjust taking too much.
Okay.
So what 2025 myths aboutarthritis and osteoporosis or
being too fragile would you liketo debunk?
Jocelyn Wittstein, MD (46:33):
So just uh I think there's a little bit
of like I don't want to say likefear-mongering, but there's
just like a lot of hype rightnow, but like I just don't ever
want people to hear hearmessages and misinterpret them.
So you will hear like 65 is toolate, you know, for your bone
density.
And I think people hear thatand they're like, oh no, I've
(46:54):
missed the boat, it's too latefor me.
And then they're kind of likefeeling helpless.
And I I don't want that to bemisinterpreted for people.
I think people are maybehearing messages like 65 is too
late.
That's kind of speaking to likemaybe our current medical
practices in the United Statesor standards or whatever.
I want to be really clear thatlike a lot of the interventions
(47:15):
that are studied are on women intheir 60s, including strength
training, some impact exercises,agility programs, showing
benefits, showing improvement inbone density, showing reduction
of um fracture risk.
And, you know, so I think thatconcept that it's too late, I
don't want to say it's never toolate, but it's it's actually
probably never too late to, youknow, to start doing things that
(47:38):
will positively impact your umyour bone health.
Other misconceptions I thinkare rapidly being debunked, that
hormone therapy is only for hotflashes and night sweats, and
that menopause is a transientthing that people go through.
Whereas a lot of the long-termconsequences are actually
musculoskeletal, like, you know,more rapid development of
arthritis, osteoporosis,difficulty maintaining muscle
(48:02):
mass, things like that.
And so, like, you know, justsort of wanting women to know
that if you're able to take it,like estradiol therapy is
prophylactic against, it's evenan FDI-proved indication for
hormone therapy.
You're not even gonna have tolike justify it.
It's just it's prophylactic,you know, against osteoporosis.
Myths about arthritis.
(48:22):
Um, I think just a lot ofpeople don't understand that
once you have arthritis, itdoesn't go away.
You can't reverse arthritis,but it doesn't mean that you,
you know, can't be activethrough it.
You just have to find ways towork around it.
I tell my patients all thetime, it's like having a sports
injury when you're a kid and youhave to work around it, except
(48:42):
for it just it's never goingaway.
And um, we don't treatpictures, we don't treat x-rays,
we treat people.
So, like I have patients thathave pretty significant
arthritis that are able to findways to strength train, they're
ways they're able to findalternative forms of
cardiovascular exercise.
Like people maybe, you know,running doesn't cause arthritis,
but once you have it, it canaggravate it.
(49:02):
So sometimes I have to redirectmy patients.
I don't want them to just belike, I can't do this, I can't
exercise.
Well, you can try rowing, youknow, like a lot of people
tolerate using an erg machine ora rower, and that's a good
cardiovascular exercise and italso stimulates bone density.
So I think that people thinkeither arthritis is something
that they can, they don'tunderstand that it doesn't go
(49:22):
away, but then when they realizethat it doesn't go away, they
feel like they have to just stopbeing active.
And it is there are a lot ofactivities you can do with
arthritis that will hopefullynot aggravate it and allow you
to stay active.
Michele Folan (49:32):
Yeah, and I get that too, you know, because you
it's that initial, like, mmm,you know, it's not well, it was
me, but it you're you're kind oflike feel like you're at a dead
end, but you just have to justshift gears.
Jocelyn Wittstein, MD (49:48):
It's your new normal.
It's not a dead end.
unknown (49:50):
Yeah.
Jocelyn Wittstein, MD (49:51):
Uh and and again, we've just talked
about there are some supplementsthat help.
You know, I think the key is totry to stay active and you
know, maybe not expect yourselfto be exactly the person you
were forever, but like, youknow, find ways to be active
with your current, you know,parts the way they are in terms
of your joint.
Michele Folan (50:11):
But you also, and you also talk about dementia
prevention and the importance ofexercise and getting aerobic
activity.
And so there's there's theother side of that too.
Jocelyn Wittstein, MD (50:24):
Yeah.
Well, my mom died of dementialast year.
And I'm sorry.
Yeah, I mean, I have so manyfriends who've lost parents to
dementia, and um so I constantlythink about things I can do to
not get dementia because I don'twant to have dementia.
And interestingly, there are aton of things that benefit your
(50:45):
bone and joint health that alsoare, you know, protective
against dementia, like vitamin Dsupplementation can reduce
joint pain, it's beneficial toyour bone health, and has been
associated with reduced risk ofdementia.
You know, regular exercise, um,you know, studies showing like
something on the order of 150minutes of moderate intensity
(51:05):
exercise.
And I don't think it all has tobe cardiovascular, there's some
studies that show benefits tocardiovascular exercise.
There's certainly, I thinkthere's also evidence there's
benefit to strength training andand and there are mechanisms
that that may work through, likeif you're doing like exercises
that stimulate your bones,whether it's through what we
call joint reaction forces fromthe loading across the skeleton
(51:26):
with like lifting weights versusground reaction forces from
jumping or impact.
When we stimulate our bones, westimulate the osteoblast.
Osteoblasts make somethingcalled osteocalcin.
Osteocalcin actually, you know,supports our neurotransmitters
and our neural connections inour brain.
So, you know, probably whenyou're doing agility and you're
doing jumping, you're using yourmuscles, that hormone is also
(51:48):
sending messages to your brainand reinforcing these like
neural pathways, probably.
So there's probably an actualhormonal connection.
Um uh and yeah, so I thinkexercise is like the most
consistent thing across theliterature that has always been
shown to reduce risk ofdementia.
So it's like kind ofnon-negotiable to me to, you
(52:13):
know, I have this weird thing inmy head that I have to, I've
always felt like this.
I no matter what, I have to getat least 30 minutes of exercise
in in a day.
It's just my non-negotiablesomehow.
If it's like 10 minutes threetimes, or 20 minutes and 10.
I mean, I would like to do morethan 30, but that I I cannot, I
almost feel nervous if a daygoes by that I didn't do 30
(52:33):
minutes of exercise.
Michele Folan (52:35):
Well, and I was gonna ask you like what one of
your core self-carenon-negotiables was.
So besides your exercise.
Okay, so okay, that's it.
Jocelyn Wittstein, MD (52:50):
It's such a stress reliever.
It's just, you know, it givesyou endorphins.
Exercise can reduce pain.
Did you know like actualexercise is like one of the
treatments for fibromyalgia?
It's like regular exercise.
You know, it's there is like areal truly like mind-body
connection with endorphins andthings like that.
So uh yeah, but yeah, I I um Ifeel terrible if I don't get to
(53:15):
exercise regularly.
And I me too.
Yeah.
Michele Folan (53:18):
You know, now, now that I I realize that.
So it, you know, because I dowork out almost every day, at
least take, you know, athree-mile walk or something.
Um, if I don't do it, I feellike crap.
Jocelyn Wittstein, MD (53:34):
Yeah.
And I used to, you know, when Iwas younger, interestingly, I
used to think like my exerciseha well, I used to be like I
have to do 30 minutes ofsomething cardiovascular, and
then I can also do more, likestrength training.
And but it was like, I now it'skind of funny.
I will also like some days now,I as a 47-year-old, I will not
(53:56):
do cardio.
I'll do a little warm-up, I'lldo a more extensive strength
training routine on those daysor some plometrics or jumping or
grip exercises or whatever.
And um, I mean, that is aworkout.
It's just kind of funny how youum shift over time.
That it in it used to be like Ihad to do 30 minutes of cardio
and then I would do other stuffif I had more time.
(54:17):
And I I am, I think, moreparticular now about making sure
I earmark certainly two days aweek where there's a lot more um
focus on the strength training.
And then if I have time, I'lladd on some more cardio, but at
least get some, you know, maybeagility and balance and grip
stuff in.
But yes, I just I I cannotstand the way I feel if I don't
get to exercise.
Yeah, yeah.
Michele Folan (54:36):
It's I I and I want people to have that
experience of oh my gosh, if Idon't work out, I don't feel
great.
And that's that's my goal withmy clients.
Like that's a good goal.
Yeah, it is a great goal.
Dr.
Wittstein, where can peoplefind the complete bone and joint
(54:57):
health plan and find your work?
Jocelyn Wittstein, MD (55:00):
Um, the book, which is by me and Sydney
Niskorski, uh, is at Barnes andNobles, also Amazon.
And then, as you know, you canuh follow me on my Instagram
account, which is just my it'sjust Dawson underscore Witstein
underscore MD.
And uh I'm believe it or not,I'm actually pretty new to
(55:20):
social media.
My 19-year-old daughter helpedme make that account in January.
But I I do I have I I reallylike health literacy, much like
I really like to educate mypatients.
So I I uh I you know I just tryto provide information that's
um educational to people abouttheir own, you know, bones and
joints and things they can useto help themselves.
(55:42):
And then um, yeah, then I I Ipractice full-time at at um I I
live in Raleigh and I practicefull-time uh Duke University
School of Medicine.
Michele Folan (55:51):
Yeah.
And I really recommend you allfollow Dr.
Jocelyn Wittstein on Instagrambecause she has so much
information in there.
And it doesn't mean, I mean,even if you don't have
osteoporosis or joint pain, giveher a follow because think
about prevention.
(56:11):
And I think you're gonna have aplethora of fabulous tidbits
and how-tos in there as well.
So, Dr.
Witstein, thank you so much forbeing on Asking for a Friend.
Jocelyn Wittstein, MD (56:23):
Yeah, thank you for having me.
Michele Folan (56:26):
Thank you for listening.
Please rate and review thepodcast where you listen.
And if you'd like to join theAsking for a Friend community,
click on the link in the shownotes to sign up for my weekly
newsletter where I share midlifewellness and fitness tips,
insights, my favorite finds, andrecipes.
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