119: How to keep your bones, muscles, tendons and fascia strong through menopause with Buff Bones' Rebekah Rotstein (Part 2)

In part 2 of her interview with Buff Bones' Rebekah Rotstein tells Hotflash inc founder Ann Marie McQueen about the complexities of health during perimenopause and menopause, highlighting the importance of both mineral density, muscles, tendons, collagen and fascia. 

She outlines the Buff Bones comprehensive exercise plan to hit all the targets in a week, emphasizing personalized care and the importance of mobility and motor control exercises. They explore the impact of collagen, estrogen and (briefly) progesterone on bone health and dive into the fascinating role of fascia in the body's connective tissue system – and in menopause. 

02:01 Building bone and muscle through menopause
04:38 The importance of mobility
07:03 Collagen and bone density
09:40 Hormone therapy and bone health
18:46 The role of fascia in health

NB: These episodes were recorded in late 2023. 

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Transcript

Rebekah: 0:00

It's not just about weight training, great density, but there's more that you need for strong boat density. It's not just the, the mineralized calcified part of bone. Bone has the density part, but there's also the collagenous side, which gives it its resiliency. But it has just a slight bit of dispensability and bend to it, because we don't want it to be super brittle.

Ann Marie: 0:28

I'm Anne Marie McQueen, journalist and proud 50 ish woman, and we are here looking for the true truth in perimenopause, menopause, midlife, and beyond. Opening our minds to other possibilities is not always easy. Hot flash ink. You're all woman to me. All right, Anne Marie.

0:51

Anyone who listens to the hot flashing podcast will know I've had a hard time finding help with my perimenopause and menopause symptoms, whether it was trouble sleeping or extreme anxiety or vagina stuff. I've encountered roadblock after roadblock in doctors who didn't know anything about taking care of women like me. It made everything harder than it had to be. That's why I'm so happy that there are companies like MidiHealth stepping into the gap and sponsoring podcasts like this one. Their supportive, comprehensive, and holistic approach to the menopause transition will provide you with what we all need most, a personalized care plan. Their virtual care clinic is easy to use and covered by most insurance plans. You can chat with your specialists during an appointment or message 24 seven. You don't have to deal with this alone. Any longer book your visit today at join midi. com. That's J O I N M I D I. com.

Ann Marie: 1:46

Someone mentioned that to me. I had IBS for years and I've just, it created a whole bunch of problems and I've just healed them all. I thought, and then she said, Oh, I'm worried about you with that IBS. And I was like, Oh, great. So I'm curious if you could have a perfect recipe. an easy to follow recipe for building and maintaining Bone and muscle through and past menopause. What would it be? This isn't a very complicated french recipe that not many people can follow This is like Most people could do it.

Rebekah: 2:25

So a little bit more of your your mainstream, maybe like an eine garten I'm glad you asked this because this is what I do, this is what we advocate with Buff Bones. So, you have two days, maybe three days if you can, of your moderate to intensity weightlifting. And you'll notice that I use, I distinguish between the strength training and weightlifting. Because we, we include. Within, within just our regular BuffBones programs, you have strength training, but the kind of weight training that I'm talking about is something that is going to be one on one supervised. And if within the BuffBones framework, if we have any instructors that are personal trainers that are guiding you great, but otherwise you'd be going to a personal trainer. to oversee you and supervise you for two or three times a week for that moderate to ideally, if you can, high intensity weight training. And so when we're talking about that, we're talking about, um, like anywhere from 65 to 85 percent essentially of your intensity. Um, and then you would spend another two days doing other elements, say, of our Buff Bones program, which is really this entire element of body conditioning and, uh, joint integrity. So joint protection, because a lot of what isn't paid attention to enough is tendinous changes that happen at midlife. And with. shifts and menopause. And there are, there's, there's an interesting growing bit of research to share about that. And so if you're having tendinous issues, how is that going to be beneficial to you to put these heavy loads on that? And this is also why I think a lot of tendinous problems happen. It's partly, I think this is not the science, but I think it's not just the, the hormonal shifts. I think it's repetitive stress. At this point, we're now looking 45 usually to say 65 or more years of pathomechanics, so bad movement mechanics, So working on the entire conditioning of your body with balanced practice in there as well that includes mobility to and motor control elements so that you have a really good efficiency within your movement. And then you spend another two days a week, doing something that's of your choice that you love. Maybe it's a safe Pilates class or a Pilates reformer class. Maybe it's a safe yoga class. Um, maybe it's Tai Chi. Maybe it's Zumba. Maybe it's hiking. So that, you know, you have your six days a week. And maybe even on the seventh, you're doing something that is just like a walk in the neighborhood with your dog at the park. Um, that would be, that is my, that is my recipe.

Ann Marie: 5:41

Okay. Yeah. And that's why we're seeing a lot of mobility. We're seeing a lot of, you know, people hopping up on their counter and bending down on one leg and walking around like animals. And that's kind of what you're talking about, right? Like, just that.

Rebekah: 5:56

Not exactly. When I'm talking about mobility, there's an element to that. What you're referring to with the animal stuff is, um, there's a, there's been a trend, uh, in recent years toward animal style movements. Part of it relates to developmental movement patterns, part of it doesn't. But, um, a lot of it has to do with mobility. So there is, uh, part with that. And I think, There's a big play with mobility, even outside of, uh, forget about bone health, just in the general world, because I think a lot of the athletics and pro sports teams have identified that mobility has been lacking in their strength training, which goes right back to my point that I've said for a long time. It's not just about weight training, great density, but there's more that you need for strong boat density. It's not just the, the mineralized calcified part of bone. Bone has the density part, but there's also the collagenous side, which gives it its resiliency. But it has just a slight bit of dispensability and bend to it, because we don't want it to be super brittle.

Ann Marie: 7:04

Now that you mentioned collagen, uh, I'm curious, what's your take on taking collagen? Do you have an opinion?

Rebekah: 7:13

So I have a couple opinions on it. And interestingly, you know, as far as I know, and I'm, I'm not a thorough researcher on collagen. But as far as I know, there is not evidence to support its use for, certain specific health benefits. And I know that many nutritionists have pointed that out and it's not a complete protein, by the way, it's, it's lacking usually tryptophan. So don't think of it as I, I did at one point thinking, Oh, I could just take this as my protein source in the morning. And then that was, uh, pointed out to me that I was wrong. But what I can tell you is that there are two studies, um, on collagen related to bone density. So again, it's like, well, is collagen useful for what? And that's always the thing that I'm, I'm trying to clarify when people ask stuff. So for density, so from a bone health perspective, there is evidence to show that collagen may be beneficial for, for helping bone density. Um, and improving bone density and specifically I guess I should say increasing bone density interestingly, I had a large round of PRP exactly 12 years ago, 12 years ago 12 months ago, December this time last year. for my foot and my hip SI joint. Whole other story we'll talk about, uh, maybe in another time. PRP for those who don't know, platelet rich plasma is a form of regenerative medicine, non operative, uh, injections of your, your plasma, basically that's extracted, um, from, uh, a blood, uh, draw. And the idea is it's a way to help regenerate your tissues. It didn't really work for me, but what was interesting is the physician told me as part of my recovery to take the collagen peptides to help in the healing process. I don't know the research on how, I don't know the research as to whether it helps that tenderness repair, but clinically, that was the information that I was given. So I think when it comes to collagen, the question is for what for bone density, it may actually help, for don't use it as a pure protein source because it's not complete and, talk to a nutritionist about your individual needs.

Ann Marie: 9:38

That nutrition is a minefield. Uh, okay. Another minefield is hormone therapy. Uh, I always ask practitioners when they come on my show, do you think I need to take hormone therapy if I'm okay with symptoms and I've made changes and I'm feeling fine and the majority say no, but a few have said, yes, you need to for longevity. And, hormone therapy for bone density is included in the official guidelines of I think all of the menopausal guiding body, like guiding bodies, because the body of research shows that, but do you think that you need it? To, or can you achieve the, gaining bone and not losing bone without hormone therapy? So, it's going to relate to my

Rebekah: 10:30

answers to everything, which is it's so individual. Which is that, you know, if you're somebody like myself, who is small boned, who has a family history of osteoporosis, whose both parents had osteoporosis, who've had a number of female relatives who have fractured bones due to osteoporosis, Um, that may be a different experience and who already had low bone density prior to menopause. So I'm perimenopausal now. I'm not yet in menopause. but already with those probably going to be a different answer than somebody who perhaps. And I would say has a different bone structure, but we also know that, you know, it's not only small boned women that have, um, that are predisposed to osteoporosis. They may be more predisposed, but that's Osteoporosis doesn't discriminate, um, as opposed to somebody maybe who has a different bone structure, who has no osteoporosis running in their family, who's, also that's looking at something that's never talked about is secondary risk factors. Let's talk about your medical history. If you're telling me you, had breast cancer and you went under radiation, that changes things for sure. You are at greater risk. Your bone quality is compromised. If you've been on the corticosteroids because you have Crohn's disease, that changes the quality of your bones. Like, we have to look at the whole medical history as well. For somebody who is who is concerned about osteoporosis and maybe has risk factors, I think that again, I am not a physician, I do not prescribe, but I would definitely tell them to talk to their physician about hormone therapy to see if they're a good candidate, because from a bone health perspective, it sounds like they could be. I think, and I'll say with full disclosure as well. I already take some hormone therapy, and I will, I, when it's appropriate, I do plan to take, estradiol. Because of my history of osteoporosis, um, And even I should say really my history of low bone density, since it's already low, I want to do everything I can with exercise and also with the estrogen to mitigate further loss because we know the loss is going to happen.

13:06

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Ann Marie: 13:59

You said you already take some so do you take progesterone? Which is not considered full hormone therapy, but you know what I'm saying,

Rebekah: 14:07

I will take the estrogen, which obviously requires progesterone alongside it.

Ann Marie: 14:12

Yeah, I wondered if you were taking progesterone for any reason to do with your bones.

Rebekah: 14:18

Not to do with my bones. It's actually to do, uh, with my cycle and sleep. My physician recommended it. Yeah. But, recommended, you know what? Cause I said, should I be starting estrogen? Yeah. Because I said, you know, I'm, I've been reading up on the last 20 years of information and such. Um, and again, from a bone health perspective, I'm making my choice that that is what I would like to do. And she said, and actually two different physicians have said not yet. Yeah. Uh, but, but I also, and I want to clarify, you know, I have a history of breast cancer in my family with my mother, not BRCA, uh, no BRCA gene, um, no, her to positive. Um, and so I'm aware of all of these things and I'm also aware of what has been debunked of, breast cancer. etc. But again, I think it's just, I think it's so individual. So, you know, I feel like one other thing I should mention is that I do a lot of consults with people who are trying to figure out not just like what they should do for exercise and, and how to exercise, but also the questions to prepare them Or their physician, because you go into a, into a physician's office, tell you that you have osteoporosis, and then, unfortunately, they have very limited time, they tell you, this is what you should take, long names that are complicated, that you can't remember on TV, and, and then you're stuck, and then you feel kind of blindsided. So one of the things I do is these consults to help look at their decks as to help them understand where things fall. What are the questions to ask so they can go in and be really informed when they meet with the physician. And one of the things often that comes up is the discussion of hormone therapy. If they are, to see if they are a candidate for it. Because more often than not, I get people coming to me saying that they do not want to take the medications. And there are a lot more options of the medications than there used to be. There are different classifications and we go over what each of these are and the questions to talk to your doctor about. But for those especially who really don't want to be taking a bone Changing medication, it may be appropriate for them to ask, or it may be appropriate for them, um, hormone therapy. And it's something that I bring into the conversation for them to talk to the doctor about.

Ann Marie: 16:47

Yeah. Okay. Um, yeah, it, that is one thing I've noticed is that there's a, a posse of people who are like estrogen first, estrogen always, estrogen, you know, we wouldn't even give you progesterone if we didn't have to kind of thing. But then I've noticed the, the integrative side, integrative functional side is very much like, no, progesterone was a great way to start. I look at it as sort of like a low and slow way into hormone therapy, but there's definitely a, um, contingent that's like, no, you should, estrogen, you should be having, I'm always interested to hear when people, what choices people make because sleep and mood and, those are the things that can be an early perimenopause, the problem and estrogen can be quite high. It just makes common sense, but it's science hasn't really caught up with this. It's like mainstream doctors that kind of don't really rate progesterone, I find.

Rebekah: 17:39

Like, what's also interesting is something I actually admittedly have to do some more research into, but is the role of progesterone on bone health. I

Ann Marie: 17:48

was gonna ask you, like, that's what I'm really curious about because it has a protective effects in the brain, it has protective effects all over the body, but you never hear anyone talking about it except all integrative, functional, holistic type practitioners.

Rebekah: 18:04

I mean, there's one study that I've seen about it, but, I really have, that's something I have to dive into, so I can't really speak too much about it. It's something that I want to dive into because we, we know the protective effects of estrogen. But what would be really interesting is, you know, for a woman without a uterus, where they don't need the progesterone. Um, what, how does that relate to the bones? And I, and I'd have to look at some of obviously the data, but really talk to some of the physicians who, who have sleuthed out, uh, all of that data. Cause they can look at it much better than me to ask. All right. So how does that actually play in when we're locking, looking without the progesterone?

Ann Marie: 18:46

One last question, because I'm I've been obsessed with fascia for so long and no one would talk to me about it. They I bored my friends when I got into it. And I think it was like, before I left Canada, it was around 2005 or four when they had the first international fascia Congress. I became completely obsessed and yeah, bored people. I tried to sell a story to women's health and the editor finally said, we just, we don't know what you're talking about. Like we can't, you know, and then I saw it on the cover 10 years later, you know, I've been in yin yoga and everything to me. It is the most fascinating thing. Can you just tell a little bit of what you know about it? And is there, should we be studying it in the perimenopause menopause transition?

Rebekah: 19:29

100%. Oh my god. So, yes. So first of all, um, fascia is the connective tissue of the body, which, It supports, it wraps, it runs through, it provides, uh, tissues, it provides hydration, it provides communication. It's literally what my, uh, what my colleague, friend, and mentor from all my cadaver dissections, Gil Hedley, refers to as, it's not in the books, meaning the medical books, because it's in the bucket. In other words, for years and years and years in, in anatomy and in medical school and dissections, they would strip this tissue away thinking it was the gunk because it was getting in the way of seeing the nerves and the muscles and the organs and not recognizing that it has value and it is an organ unto itself and it is the largest organ in the body, the fascia, not the skin. fascia. So, you know, when you have dissected a body and removed the skin and seen how there's still so much shape that is there from the fascia, it's pretty eye opening. So there's different types of fascia. And so without getting into the complications of that, adipose though, is part of that fascial network. And I think But that's also part of the reason that it has not been valued because who values adipose, right? Our goal in Western society has been to remove adipose as much as possible. And yet, there's loads of lymph and nerve and so much that's traveling through that adipose area. Um, and also let's think from a, we talk about feminism, let's talk about that for a moment. But Traditionally, you're gonna have more of this type of the looser, um, not even the looser, but this adipose element of the fascia on the female bodies. And why are we gonna value that as much? You see that more in the cadavers. The shapes are different. So, um, should we be Exploring more of the fascia. Absolutely. And thanks to a number of groundbreaking researchers and leaders in the field, including Robert Schleife, the colleague then and teacher of mine that I was referencing previously. And unfortunately, a late colleague of mine, Tom, Finley, who passed away, he was the one, he was one of the leaders of this, the fascia research congresses, do, there's, there's a movement to bring more attention to this, and even at Harvard Medical School now, they're looking at, at the relationship of fascia even in cancer, so we're acknowledging now that there's a lot that has been overlooked due to this connective tissue in the body, And, you know, when you see different programs with foam rolling, that's often what is being related to, but in different elements. You hear sometimes people trying to, like, smash it, which I'm not a big fan of, because, or, like, blast it. You know, there's, there's integrity and importance to this tissue, so I don't think we really want to beat it. But. Now, one of the problems that people incur is that there can be restrictions, so that the tissues don't necessarily move and slide in the way that they should, and that's a restriction, say, within the fascia, and that's often what relates to stiffness. And this is also why in our Buff Bones method, this is the very beginning of a workout is addressing these fascial restrictions, which can create restrictions in other areas of your body. So basically the, the underpinnings of the fascia is this connectivity, this ability to connect. This continuous web throughout throughout the body that's pretty fascinating and that is responsible for so much because it relates to every single tissue and every single structure and, Carla Steko is another leader in the fascia research field. She is one of the women researchers there. And, um, she has done a little bit, but we still need more, but has done a little bit, research related to fascia and hormones. And we need more with this though. And this is also because of my background and work in fascia, this is also why probably I take a different approach to bone health because it's not bones, it's the fascia. Bone is mineralized connective tissue, really, both are, and you know, if you, if you go back to basic physiology and the four types of connective tissue you have, connective tissue is one branch, you got muscle, you got nerve, right, epithelial, in that connective tissue branch, bone, blood, and also. Bone is connective tissue, which is mineralized. So there's a really big, strong relationship between the fascia and the bone. And again, it's just really reductive in my view to just look at bone health as just making your bones strong. Yes, we want them strong, but really, you care what your bone density is. No, you care that you don't fracture, so let's keep our eyes on the bigger picture.

Ann Marie: 25:09

I can't wait to, I cannot wait to see what we're going to know 20 years from now. It's going to be shocking because we, you've said a whole bunch of times today and I think about it all the time. What we didn't know 20 years ago or 25 years ago, it's just absolutely shocking, right? Like there's just so many things that we just take for granted today. Thank you so much for talking. This is an epic. I've taken a ton of your time. Thank you.

Rebekah: 25:32

Absolutely. And I salute you, you know, it's so clear, this background and the questions that you ask, um, just are really refreshing and I, I love, uh, how you put forth the information to the world. So I would love to, to keep talking with you and I salute you and all you do.

Ann Marie: 25:52

Oh, thank you so much. It's great to finally connect with you. It's like, can nerd out.

25:58

Hot Flash Inc. was created and is hosted by Anne Marie McQueen, produced and edited by Sonia Mack. The information contained in this podcast is intended for informational purposes only and is not intended for the purpose of diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider, read all labels, and heed all directions and cautions that accompany the products. Information podcast should not be used in place of a consultation or advice from a healthcare provider. If you suspect you have a medical problem, i. e. menopause or anything else, or any healthcare questions, please promptly see your healthcare provider. This podcast, including Anne Marie McQueen and any producers or editors, disclaim any responsibility from any possible adverse effects from the use of any information contained herein. Opinions of guests on this podcast are their own and the podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about a guest's qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have direct or indirect financial interest in products or services referred to herein. This podcast is owned by Hot Flash Inc Media.