As we age, maintaining strong bones becomes increasingly crucial to our overall health and well-being. Margie Bissinger shares her expertise on how to prevent osteoporosis and treat osteoporosis effectively. She highlights the significance of lifestyle changes, nutritional support, and the role of cortisol in bone health. You'll learn practical tips and strategies to fortify your bones and ensure their strength for life.

Key Points

✅ Osteoporosis prevention starts in early in life and there are many things we can incorporate to avoid this disease
✅ Some of the most important ways to treat/prevent osteoporosis is through resistance /strength training and impact/aerobic activity on a routine basis
✅ Even stress levels and high cortisol levels can affect bone health and so happiness and stress resiliency are also critical components of bone health.

Our Guest – 👩🏻‍⚕️ Margie Bissinger

Margie Bissinger is a physical therapist, integrative health coach, author, and happiness trainer. Margie has over 25 years of experience helping people with osteoporosis and osteopenia improve their bone health through a comprehensive integrative approach. She hosts the Happy Bones, Happy Life Podcast and has hosted three summits on Natural Approaches to Osteoporosis and Bone Health. Margie oversees all the osteoporosis initiatives for the state of New Jersey as a physical therapy representative to the NJ Interagency Council on Osteoporosis. Margie has lectured to Fortune 500 companies, government agencies, hospitals, and women’s groups throughout the country. She has been featured in the New York Times, Menopause Management, OB GYN News and contributed to numerous health and fitness books.

Website – https://margiebissinger.com
FB- https://www.facebook.com/p/Margie-Bissinger-MS-PT-CHC-100063542905332/
Instagram – https://www.instagram.com/margiebissinger/?hl=en
YouTube- https://youtube.com/@margiebissinger6980?si=uU0y6JRDzxlY8eZU

Dr. Jill Carnahan, MD

Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy.

As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs. 

A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.

Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names. 

The Podcast

The Video

The Transcript

234: Resiliency Radio with Dr. Jill: Resilient Bones, Strong Bones for Life with Margie Bissinger

Dr. Jill  00:00
Hello everybody! Welcome to another episode of Resiliency Radio, your go-to podcast for the most cutting-edge insights in integrative and functional medicine. I'm your host, Dr. Jill, and with each episode, we dive into the heart of healing and personal transformation. Join us as we interview renowned experts, thought leaders, and innovators who are at the forefront of medical research. My goal is always to empower you with helpful healing advice, new ideas, and new concepts. I know I learn new things at every single episode. And that's one of the secrets to podcasting: I just get to be along for the ride and learn from my awesome experts. 

Dr. Jill  00:36

Today I'm interviewing a friend, colleague, and expert on bone health. I know there are a lot of our listeners who either have a woman they love who's in their life who is menopausal or [at] risk of bone loss or themselves, mother, sister, friend. So hopefully today this information will be really practical for a lot of women out there who may be suffering and men too. But I know you'll enjoy it. 

Dr. Jill  01:01

Let me introduce my guest. Margie Bissinger is a physical therapist, integrative health coach, author, and happiness trainer. This is what we share in common, Margie. Whenever we talk, it's just such a great energy because I love what you bring to the world! Margie has over 25 years of experience helping people with osteoporosis and osteopenia improve their bone health through a comprehensive integrative approach.

Dr. Jill  01:22

She hosts the Happy Bones, Happy Life Podcast, which I've been on, and has hosted three summits on natural approaches to osteoporosis and bone health. If you're watching this on the day it's out, that's coming up in January 2025. We're going to be sure to link that up. I think we just decided January 13th [is when] it starts. If you're watching after that, you can catch the episodes, you can purchase them, you can check them out. And we'll also have a guide and a gift from Margie at the end of the show. So stay tuned. And if you are driving or wherever you're listening to this, you know we always have it in the show notes so don't worry. Anything you need or hear about in the show, you'll be able to find there. 

Dr. Jill  02:01

Margie oversees all the osteoporosis initiatives in the state of New Jersey as a physical therapy representative of the NJ Interagency Council on Osteoporosis. She's lectured to Fortune 500 companies, government agencies, hospitals, and women's groups throughout the country. She's also been featured in the New York Times, Menopause Management, and OB GYN News and contributed to numerous health and fitness books. 

Welcome, Margie!

Margie Bissinger  02:31

Oh, I'm always so happy to be here with you, Dr. Jill. We have so much fun together.

Dr. Jill  02:37
We do! And today will be no different. Like I said, I love your energy. It's always such a pleasure. 

Let's just start with your story because I always love to know how you got into physical therapy and then how you got into bone health because that's not a super common jump for most physical therapists. But clearly, you're an expert. Tell us a little bit about that journey.

Margie Bissinger  02:56

I've been a physical therapist since 1979. I got into physical therapy because I really enjoyed working with people, and I enjoyed exercise and how the body worked. So that's how I fell into that. My background is orthopedic physical therapy. So I'm working with back pain, neck pain, joint pain. And then we moved. I moved to New Jersey, and I was working in an outpatient clinic. 

Margie Bissinger  03:22

I had my own practice, and a group of doctors asked me—could I see their osteoporosis patients? I had had courses on women's health, so I had the background for this. I'm like, “Sure!” I was absolutely mortified by what I saw at the time. Well-intentioned people were told by their doctors to do exercise, and they were coming in doing all the wrong exercises. They just didn't know where to turn. In those days, we didn't even have the internet. But whether it was a personal trainer or a magazine or fitness books, they just did it. So I realized this area needed help. So that's how I got started way back.

Margie Bissinger  04:01

Then from there, my son had diabetes and I saw how a health coach helped him so much, and I realized that piece was also missing—the food and nutrition piece—in terms of osteoporosis. So I decided someone helped him so much that I ended up going back to school and becoming a health coach so I could add that piece to the picture. 

Margie Bissinger  04:21

But then, the good news was when I saw all of those pieces and saw how empowered people could be… Because, unfortunately, where there are so many good things about conventional medicine, they were sort of missing the boat on bone health. And people were just taught: “Oh, you know, exercise.” No guidelines. “Take some calcium, vitamin D.” Then typically, once the medications came out, they were put on medication. And there was so much more. I just felt, “Wow, this area needs help.” And I knew so many integrative doctors like yourself who were doing wonderful things and getting to the root cause of issues, which is what's needed in osteoporosis. So that's what I've been doing. 

Margie Bissinger  05:04

I've been teaching happiness also as a physical therapist. I found way back that my chronic pain patients, when I had gone through not a good situation, were like, “You're so happy!” I was like, “What are they talking about?” They knew my situation. But then I realized that I was sort of happy despite my situation. It wasn't a good situation. But I decided to start teaching my patients what got me through. And chronic pain was getting better quicker. It was quite miraculous. So that's also been something that I've been involved with. So those are all the pieces put together and how I've been involved in this work.  

Margie Bissinger  05:39

It's very gratifying because when people figure out the root causes—and you know this better than anybody—not only do their bones get better but their whole life is transformed. So it becomes a blessing in disguise. And they become healthier and happier, and it's the catalyst that got them to take action.

Dr. Jill  05:59
What a great story! I always love how we just kind of happened into these things and get asked… But you know what it also is? How we show up in the world. Someone saw your talent in physical therapy. And maybe those bones—you saw a problem that needed a solution and became that solution. And you've been doing this for longer than almost anyone I've known in this field. You've got a great experience. I think that's really valuable. And you've even seen in integrative medicine how things have opened up and changed in our time. 

Dr. Jill  06:26

Let's frame it first as far as how big of a problem… I see people every day who are worried about their bones. I would say 50% of my women over the age of 50 have some degree of osteopenia or osteoporosis. So it's very common. Do you want to first just frame how common it really is? And maybe men too, because there are men as well.

Margie Bissinger  06:44

Sure. In the United States, 50% of women—just like you said—over the age of 50 will have a fracture in their life due to osteoporosis, number one. In terms of men in the United States, it's one in four. Worldwide, it's a little different. Worldwide, it's one in three women and one out of five men. So it's very, very prevalent. And a lot of people don't realize how serious this is, and they look at it as something [like]: “Oh, I'll worry about that when I'm older; it's an older person issue,” where it's so far from the truth because at every age, starting from our children, there are things people can do to strengthen their bones. It's like a bank: You make deposits and then when you're older, if you lose some, well, you've built up your bone. People don't realize that it's never too early and it's never too late. But it is very prevalent, and unfortunately, the consequences are quite dire. 

Margie Bissinger  07:46

If someone has a hip fracture, 24% of people will die within the year after the fracture due to the consequences. A high percentage will end up in nursing homes and lose their independence. None of us want to be one of those statistics. I really feel it's not something that's prioritized, like heart disease or other things like cancer prevention. It's just something [that] until people have to worry about it, they don't.

Dr. Jill  08:17

Gosh, I couldn't agree more because it is one of those things I see all the time. It's in my diagnoses and then, of course, we're addressing it like we're going to talk about today. The other thing that's so interesting of what you said is I really want to empower those 20, 30, 40, early 50s women or men that they can do something because I think that's one reason I don't have osteoporosis and I'm menopausal—because I've been doing hopefully most of the right things. 

Dr. Jill  08:43

Let's frame it as far as root cause. We love to do that kind of functional approach. What are some of the things—the most common to maybe lesser common—metabolically and physically that lead to bone loss? Give us a framework there.

Margie Bissinger  08:58
One of the big reasons for women is [when they're] post-menopausal, where we don't have the hormones and don't have the estrogen. Estrogen has a protective effect on the bone. Women will lose bone earlier than men, and there's a big slope because of menopause. So that's one reason. But there are so many other reasons and there are so many other root causes that are not looked at. People just think, “Oh, okay, you have bone loss; that's it.” But you need to figure out the root causes. 

Margie Bissinger  09;27

So common is any type of digestive issue, anything with the gut: Dysbiosis, people who aren't absorbing their nutrients. The bones need calcium and magnesium. They need all the myriad of nutrients. If you're not absorbing your nutrients, your body takes them from your bones because you need them. So any kind of digestive issue—there are so many—will cause bone loss. That's number one. 

Margie Bissinger  09:55

Number two: Any type of inflammation. When there's inflammation in the body—and that happens from mold; you've spoken on that—it can affect many different systems. Oftentimes, the inflammation causes an increase in the cells that break down bone, the osteoclasts. So we get an inflammatory response. The osteoclasts are activated, and they break down bone. It also reduces the ability of the osteoblasts, the bone-building cells. And that can be from autoimmune conditions. There are so many different areas where people have inflammation, and it's breaking bone down. 

Margie Bissinger  10:39

Also, certain medications. People who've been on steroids, people who have been on anticonvulsants. Even people who are on antidepressants have an effect on osteoporosis or the proton pump inhibitors, which so many people are on. So medication can also be a reason. When people have been on that for extended periods of time, that has an effect on bone loss. 

Margie Bissinger  11:01

One of the big ones I see is gluten. Everybody knows about celiac disease but not gluten sensitivity. And a lot of times, that will be another root cause of inflammation. Also, in terms of exercise, people who are couch potatoes and haven't been exercising their whole life. And then people who have had eating disorders. That's another big one. Even early on in life, during those bone-building years, that can affect their bones.

Margie Bissinger  11:29

It's very important, though, when people get diagnosed. The thing is, in terms of root cause, did this happen 20 years ago? You just get a number, so we don't know. There are tests. It's so important in terms of treatment: Are you actively losing bone now? Do you have something going on? Or were you a couch potato and had anorexia and never acquired your peak bone when you were younger? And you can figure that out. But it's very important because the treatment is so different.

Dr. Jill  12:00
This is so helpful. I have a couple of patients I can think of right now: A woman in her late 20s who had steroids for not a very long period of time for an autoimmune condition and has pretty significant osteoporosis. And because they knew the steroid use… She had a fracture. Something happened to instigate an early workup. And another young man who had only maybe two weeks of high-dose steroids—certainly that can happen, but it was shocking to me that a shorter course, it's not years, but very high dose—caused significant bone loss. Both of these were working—and they're in their 30s now—to maintain that bone. So I loved that you said there are things we can do in our 20s, 30s, and 40s. 

Dr. Jill  12:44

Give us some examples of maybe each decade or just in general. What would you recommend to someone? Say a woman who's premenopausal, who is having cycles and not at risk of estrogen loss at the moment. What could she be doing to protect her bones for her 50s and 60s?

Margie Bissinger  12:58
I think one of the most important things—again, being a physical therapist—they're showing this more and more, is exercise. It's what the bones' response to the force is placed upon. And a lot of people [say], “Oh, I'm walking 20 miles” or whatever, but that's not enough. They found in the research—and it's very specific, premenopausal/postmenopausal—a couple of things. Strength training, but serious strength training. Not just like two or three pounds. Weight training where you're working at a high level. I'm doing that currently—working at a very high level of strength training. But [when] younger, really doing squats with weights on your shoulders and doing overhead presses and things where we're lifting significant weight. Even five sets of five repetitions so that it's hard. I wouldn't do any more than—if someone's just starting out—maybe 12 or 15. But you want to go even lower in terms of 8 to 10—what's been shown. Weight training is really important, or resistance training, whatever you want to call it. 

Margie Bissinger  14:11

And then impact. Impact could be jumping or running. Things where you're getting forces against gravity through the bones. But they've done numerous studies. They have a study where someone's hopping on one foot and not the other, and they gained bone in the leg that they were hopping on and not the other. And they've shown tennis players have increased force in the arm that they're playing tennis with, their dominant arm. So the point is getting impact. So that's definitely that woman. 

Margie Bissinger  14:43

And [when] younger—hops. Our kids just aren't doing all the things. So jumping, unless people have issues. And if you have an issue, I would see a physical therapist. A lot of people say, “Oh, I'm just going to live with the pain.” There's no reason to do that. But jumping, impact, and resistance are the main things. Even twice a week just to make time. And it's good to do all the other things. 

Margie Bissinger  15:09

I love Pilates; I love yoga. I think all of those things are great, but they're not enough unless you have significant resistance to stimulate more bone to be produced. So I would say it's very protective to—twice a week—get strength training and resistance. An impact program. So that's number one.

Margie Bissinger  15:30

Besides that, balance. As we get older, if we don't use it, we lose it. So not everybody could do the strength training but everybody can work on their balance. And I have exercises in one of the [inaudible] that people can do. But when you work on that, you don't lose it; it just keeps improving as you age. Most fractures happen because of a fall, so if you really work on your balance—I love tai chi and different things—it's so protective. So exercise is one thing. 

Margie Bissinger  16:02

Then nutrition. All the things you teach, Dr. Jill. A good nutritious diet where you're getting your nutrients, your calcium, and your magnesium. Vitamin K2 is a big one with osteoporosis. Vitamin D. And just eating from the rainbow and having a very healthy diet and enough protein—that's one of the things we see lacking, especially as people get older. But a good diet is very important. 

Margie Bissinger  16:27

And correcting. Correcting any underlying causes of inflammation. So if they're working with a good integrative doctor like you, or if they have the mold or whatever it is, deal with it. Don't just let it go. Deal with it now before it becomes something that's also going to impact your bones. 

Margie Bissinger  16:46

And then the last thing is stress and happiness. A lot of people poo-poo this and don't realize that cortisol, the stress hormone, also breaks down bone. It increases those osteoclasts and reduces the ability of the osteoblasts. They've done research on this. Plus, why not enjoy your life and be as happy as you can? All those pieces are things you can do. And it really makes a difference. It really does. 

Dr. Jill  17:14

I love how you broke it down because it really feels very accessible, very easy, and not super complex. I think when we first started—for maybe our patients, clients, or listeners—the gut and all these things. And it is true: If you really have an issue or you're concerned, you do want to see a functional/integrative doctor because you're going to have to look at the gut; you're going to have to look at micronutrients; you're going to have to look at all of these things. And I love that you mentioned diet as an initial source. But say we have someone—a 55-year-old. They have a diagnosis of osteoporosis. Are there specific nutrients or supplements that you would recommend? Give us a basic list of the core.

Margie Bissinger  17:50
Yeah. I think calcium. We want around 800 now. It's changed a little bit because they definitely don't want too much. So 800 milligrams that people are thinking in the research is good. But you want that from food and supplements. Basically, you want people to look at their food and see where they're getting calcium from good sources. Or there's something called Cronometer, which is a great app. You can put your food in, and it will tell you the amount of calcium you're getting. But you cannot count the oxalate foods. That's a little caveat because some of the foods, like spinach and things, have very high oxalates. So that's going to bind to the calcium and not count that. But you calculate your calcium. Around 800 milligrams. So calcium is one. If you're not getting it from food, then supplements. I don't like calcium carbonate. That tends to be one that people take. And you need enough acid. It's not the best-absorbed calcium. They can get calcium citrate. There are some other calciums as well. 

Margie Bissinger  18:52

Then vitamin D3, which is something that I believe they need to work with their doctor and see what their level is on testing so that they have enough vitamin D3. Most doctors do talk about that. Most doctors will make sure. 

Margie Bissinger  19:07

I see people on too much calcium because sometimes the doctors are saying, “Okay, take a thousand.” You don't absorb more than 390 milligrams at one time—the most. So when people are giving them 600 milligrams in a pill, it's too much. But sometimes I see their doctor prescribe calcium, and they're taking calcium and getting calcium in their diet. And it's too much, which is not good. This is a more-is-not-better situation because too much calcium can cause problems with the heart and calcification in other places—in the kidneys—that we don't want. 

Margie Bissinger  19:45

Anyway, K2 is a big one because K2 will take the calcium and make sure it gets into the bones. It helps sweep it out of this soft tissue. The best-researched one is MK4 when it comes to [inaudible] factors. Both are good. There are MK7 and MK4. But most people don't get enough in their diet, so that's a supplement I usually have people on. 

Margie Bissinger  20:06

And then it depends. Magnesium—that's another huge, huge one. Most people are deficient in magnesium. That's critical for so many things, but that also is important for vitamin D and important for calcium absorption, and also you feel better and you're more relaxed. But minimum, half the amount. Years ago, people were getting a one-to-one ratio of calcium to magnesium. Now they feel at least half the amount of magnesium. But magnesium is such a win-win.

Margie Bissinger  20:34

If someone's starting out, I would say those are the absolute essentials. There are other things that are great. Boron is great. Zinc is great. But we can't overwhelm people either, but I think that is something that is critical as well as protein. People, unfortunately, a lot of times are not getting enough protein, so they can have supplements if necessary too.

Dr. Jill  20:57

I love that because [it's] very accessible—everything you talk about. I knew this would be the case. It's really, really practical and easy. Even if you don't have a functional doctor, these are things that you could probably incorporate to get started. So a couple of questions. One is the MCHC. There are these fancy types of calcium that are out there that are often in bone support. Do you feel like there is evidence for an advantage over calcium citrate? Or are all calciums somewhat created equal? What are your thoughts on that?

Margie Bissinger  21:24
It's interesting because that has phosphorus, and it has these other elements. I've used that, and I haven't had problems. However, one of the doctors I work with very closely, Dr. Kim Millman, who specializes in integrative osteoporosis for the past 15 years and has had really great results—she found that people couldn't tolerate it as much as the calcium citrate or the calcium dimalate. There's nothing bad about it at all, but she found that a lot of people couldn't tolerate it and were getting more GI upset from that. So I'm fine with that as well as the calcium citrate. And again, it has phosphorus and other things. But that was her feeling. She stopped prescribing that. 

Margie Bissinger  22:07

I have people do both. I think it's absolutely fine. But in turn, she's found that more people can absorb and feel better with the calcium citrate. So I'm open to both. I think it's certainly a good source. Just make sure that it's clean and where they get it from in terms of the sourcing. 

Dr. Jill  22:28
Another thing that I've heard—and I'm curious about your opinion on all these—is alkaline and acidic diets. Say, for example, we're drinking a lot of filtered water from our RO system and not replacing the minerals. I think this goes back to what you started to talk about with micronutrient deficiencies because if we don't have enough minerals, we can't build bone. If we either have a very acidic diet—which would be like coffee and cheeseburgers and french fries and processed foods—or maybe we drink all RO water without any mineral repletion, is there any evidence of alkaline and acidity in the diet affecting the bone?

Margie Bissinger  23:06
It's so interesting because that was a very big theory—a huge theory—in terms of “Oh, if you have this, then your body has to use the calcium to buffer the acidity.” Because we have kidneys, we have systems in our body that protect us. So the research hasn't been there for that. However, we don't want an acidic diet. So I do believe in the pH paper and seeing how acidic we are in general. But even stress can make us acidic. It really is bigger than that. So we want to make sure that we do have more of an alkaline lifestyle. I think it's a good idea when people do check to see where they are, where their pH is, from everything involved. 

Margie Bissinger  23:59

But in general, we want to have a combination. We want our diet to be mostly alkaline. But they haven't really found, “Oh, these real acidic diets are actually breaking down bone.” There haven't been studies showing it is that simple because we have systems in our body that will release carbonate and that will do other things to help protect us. I'm certainly not a person who believes in a high-acid diet at all. But the research isn't as simple as a lot of times people thought with that concept: “Oh, I have to make sure I have more alkaline versus acidic,” and so on and so forth. 

Margie Bissinger  24:36

But overall, you certainly want a lot of greens and you certainly want an alkaline diet. And in terms of the water, it is important to put the minerals back to make sure that you have enough minerals because a lot of people are deplete of the minerals. So that's a good point.

Dr. Jill  24:50
What a great answer! I love that answer because I do agree. Granted, those leafy greens and all the things that produce alkalinity in our bodies are so good for us, but I did not know what the research was, so I'm glad I asked. So often we do think: “This makes sense, so surely it will cross over into the literature.” And the truth is, we don't really have the evidence to support that exact recommendation. So I like that you said that.

Dr. Jill  25:12

Hydrochloric acid. You talked about anorexics, especially anorexia nervosa, early in life, which makes perfect sense because typically they are very nutrient-depleted, at least for a period of time, and then, later on, have a risk of bone loss. And then, of course, the digestive disorders. What about stomach acid? Is there any evidence with hypochlorhydria and lack of stomach acid production for any reason? How does that equate with bone loss?

Margie Bissinger  25:39

Yeah, it's very interesting. There's a Dr. Wright who used to measure the stomach acid. He found 90% of people with osteoporosis had low stomach acid. And I see this all the time. And we're not going to be absorbing our nutrients or breaking down our proteins. So I think this is very, very important. On the summit that I had, we had a whole talk on stomach acid because, as you brought up, it's so important. And it's so prevalent—that people don't have enough stomach acid. So it's something that absolutely needs to be addressed. And even figuring out “Why, what's the root cause of this?” as well as treating it, because they're not going to be absorbing their nutrients just from that. 

Margie Bissinger  26:20

It's one of those things. It's sort of like a foot on the hose. You're trying to get food in, but if something's blocking it, people are deplete in the hydrochloric acid. People don't get it. “Wait, I'm not supposed to be acidic.” But your stomach's supposed to be very acidic and your first line of defense against all sorts of things. So besides reducing your ability to break your nutrients down and absorb everything for your bones, it has so many other negative health consequences that it certainly is something that needs to be addressed.

Dr. Jill  26:51

Yeah, gosh, I'm glad we're talking about this. One thing I'm thinking is, say you have a patient—50s, osteoporosis—and you're treating them. Do you give them prophylactic—a trial—on HCL? Or do you do any testing, like protein in the stool? Or how do you decide if they need it?

Margie Bissinger  27:06

Yeah. I work with integrative doctors, typically. What I will do sometimes is just have people do a baking soda test. Sometimes just some general things in terms of taking some baking soda in the morning and just seeing, do you have a burp? It's a very crude test. But usually, I like people to work with doctors on doing the HCL challenge, with a very low dose to start. This is for the people listening: Basically, you're taking some hydrochloric acid and you're seeing if you have any burning or anything in your stomach. And if you do, you know then you don't need that. But for many people, they do need it so they can test it out. So yeah, a lot of people use that. 

Margie Bissinger  27:53

On a lot of people they'll test, they find out—whether the stool test or they do other testing—to see. So, as I said, a lot of the people I work with are working in conjunction with an integrative doctor who's been doing this testing. But on a level with people who are in class and things like that, they can start very simply taking some lemon juice, taking apple cider vinegar, or [taking] bitters. There are some simple steps we can do that will help before a meal with the hydrochloric acid. But a lot of people really benefit from being on it, and it can make a very big difference.

Dr. Jill  28:31
I love that. That's very personal because, at 14, I became a vegetarian because I didn't like the taste of meat. Looking back, I was undiagnosed with B12 deficiency, silent celiac, and probably severe hypochlorhydria from a pretty young age. And all those things led to this. I don't really like meat because it didn't feel good because I didn't have stomach acid to break it down. And when you lack zinc, you often don't like the taste of meat. So looking back, I'm like, “Oh, that 14-year-old needed more nutrition than a vegetarian diet.” And then I didn't really find out that it wasn't the right diet for me until I got cancer at 25. But ever since then, when I was diagnosed with Crohn's and celiac and all these things, I'm like this classical… You described the risk factors. I've got a lot of them for malnutrition. And again, hypochlorhydria, low zinc—all of these things early on. 

Dr. Jill  29:14

Fortunately, because of my passion for functional medicine, I've done all the replacement. And it's kind of surprising and really beautiful to me at 48 and being menopausal that my bones are normal. But that's also a testimony to those listening out there that even with severe… I had severe gut issues with Crohn's, celiac, and hypochlorhydria—I probably had half the risk factors—and I'm still maintaining good bones. But what I did was, in my 20s, I changed my diet, got the protein, I did the exercise, and I added the zinc. And I've been on calcium for probably 20 years, which I don't typically put 20-year-olds on calcium. That's not a normal thing that I do if they have risk factors. I wanted to just share that because I think I'm a living example of the bones that can be healthy even despite my many, many risk factors and all the things you mentioned.

Margie Bissinger  29:57
Yeah, that's such a good point. Good for you. I'm always so impressed with what you've done, and you are a role model for all of us. However, it's so true! There's always something that can be done. Even today, I have to say, even people who have lost a tremendous amount of bone. There are people where I do believe in medication. And it's interesting because I'm very into holistic and integrative, but I don't want anybody fracturing. When there are people who have low bone density and the quality of their bone, they have problems and they're falling and fracturing or have had a fracture or whatever, we don't want that. So now there are medications that build bone that people can go on for a short period of time in conjunction with all the integrative work, figuring out the root cause. It just helps them build some more bone while they figure this out so that they can live without fearing fractures. 

Margie Bissinger  30:59

And I think for a lot of people, when they heard that on the summit, they took a breath, like: “Oh, it's okay. I can do that. I can do that while I'm working on all the other things.” Because sometimes people think, “Okay, it's either medicine or integrative.” It's not like that at all. The two can be mixed. If you are at risk for fracture, we want to do everything possible to prevent fractures, or if you've had a fracture, to prevent another fracture. So that's where you can use the best of both worlds. The point is there's always something to be done. It's never too late. And that's the exciting news. 

Margie Bissinger  31:40

Usually, people become really into exercise. I find that's one of the most exciting things. I'm personally doing a program. We're all 60- and 70-year-olds. We're lifting… Oh, I don't know, there are people lifting 100 pounds. We're doing all sorts of stuff. And it's so empowering when you can do your own suitcase, you can change tires. At all ages.

Dr. Jill  32:04

Yes. I love that so much. I couldn't agree more. I just think we have so much potential if we just dive in. And this is a good reason to do that. 

Two things come to mind. And then I want to talk about happiness before we wrap up. But the two other questions that I was thinking of are: Say someone has had a fracture or is at high risk. You mentioned the medicines. Let's just talk real quickly about the very basic classes. We know you're not a doctor, but you do work with the doctors and you know how to advise in this realm. So I want to hear your take on the evidence behind medications like bisphosphonates and biologics.

Margie Bissinger  32:36
Okay, great. The first thing is—I think it's really important—there are two tests that I think everybody should get. It's called the CTx—C-telopeptide—and the P1NP. What the CTx measures—that's the osteoclast. That's bone breakdown. And the P1NP measures the osteoblast activity, where you're building bone. When you get that DEXA, you don't know what's going on. I also like the TBS, which shows the bone quality. But you don't know what's happening. 

Margie Bissinger  33:14

Let's start with the bisphosphonate. That's Fosamax, Actonel and Reclast, which is an injection once a year. It's a little stronger. Those medications are if you're breaking bone down—there's fast-breaking bone down. That's where those can help. The Fosamax and the Actonel are oral. If you have any GI problems, you really shouldn't be on them because they can exacerbate that. And then there's the Reclast, which is an injection, which you're not going to get the GI problems. It's stronger. 

Margie Bissinger  33:48

Then there's Prolia. Prolia can be a little better on the hips. Those don't increase bone quality at all; they just stop bone breakdown. They stop those osteoclasts from going crazy. So it's important to get the CTx. And the thing about that is you can take it for a short time while you're figuring out what inflammation is going on and what's happening. There are other things you can take besides. There are some supplements, but sometimes people will use those short-term because you can just get off them; you don't have to do anything for those I spoke about. 

Margie Bissinger  34:28

But again, you want to see it, CTx, and see if the CTx is changing the bone breakdown. Because you may go on that; you may not get another DEXA for a year at least, where three months later you can get a CTx to see if those medications are working. So that's one. And one of the people I love is Dr. Keith McCormick. He's in the summit, and he has a whole talk on this about how you can combine medications into an integrative approach. Anyway, so that's the bisphosphonate. 

Margie Bissinger  35:00

Prolia is something that's given very frequently. The problem with Prolia is that it's hard to get off it. So you really should only be on short-term, because the osteoclasts then sort of morph, and sometimes you can have a rebound effect. You can't just get off Prolia. You have to then go back on Reclast. So it's just something to note: Prolia, you should not be on for long periods of time because what happens sometimes is it gets worse. If you stop it, your bone density will get worse. So you need to then follow that with something like Reclast. So doctors [have] mixed feelings on the Prolia. 

Margie Bissinger  35:38

The newer medications, another class. Those are the bisphosphonates that stop bone breakdown. But then there are medications that build bone. They're called anabolics. There's Forteo. There's Tymlos. And then Evenity is the newest one. They work in different ways. I'm not going to go into all the different pathways because it can take a while. But Evenity will build the most bone. And it's not for everybody. It's used for short term, but people have built a significant amount of bone. All of them really have benefits because they build bone. But again, you don't just go off those either. You would have to be on maybe a year of Reclast or something else. But the doctor can help you with that. 

Margie Bissinger  36:29

But I've seen numerous people who were in a very dangerous situation with their bones, and they did one of these. But something interesting is they found that if you go on the anabolics first—someone who really has lost bone—you do better than going on bisphosphonates than if you do it the opposite way. The anabolics are not as effective if you go on those first. 

Margie Bissinger  36:54

So anyway, lots of information. I do have a really good talk on that on my summit that's coming up with Dr. Keith McCormick, who goes into detail. But a lot of doctors will have their one medication that they put everybody on. Prolia. They put everyone on this. And it's not like that at all. It really matters what your testing is. And the same thing, that P1NP, if you go on Forteo, then you can three months later see the P1NP building bone. It should be way up. So you know you don't have to be on it two years or a year and say, “Oh, it's not working.” So monitoring with those before you go on is really important. 

Margie Bissinger  37:35

And so often, people always recommend, “Tell your doctor,” because I work with people and their physicians. And you don't want to throw your doctor away; you just want to make sure they can help you so that you do the best. Conventional doctors. But a lot of times, if you just explain that you'd like these tests and that… There are certain ways to do them, though. It has to be first thing in the morning for the CTx and you don't want to take calcium or a couple of other things beforehand. I don't want to go on and on—I don't want to confuse people—but the point is, those two tests are really important. There are medications if you are at high risk for losing bone. And there's a way to figure out which ones will work best for you because they're not all the same at all.

Dr. Jill  38:21

I love that. I am a medical doctor, but I've learned something just [by] listening to you on all these different things because I don't consider myself the bone expert. I can do the integrative things, but this is so helpful. And I hope that anyone listening who's a physician will check out your summit because I feel like there's going to be a lot of really important content at a high level with what you've told me. I'm definitely going to be listening to Keith McCormick and probably most of the others as well. 

Margie Bissinger  38:46
His book is great. And he's one. He's in his 70s, I think, and he does triathlons. He had, as a younger person, major osteoporosis [and] so many fractures. So he had to figure it out himself. He went on medication first for a short time. He sort of lived that. And now he does that with patients. And it works.

Dr. Jill  39:08

I love that. So good. 

In our last couple of minutes, happiness. This is a huge topic, so it's hard to cover short term. But maybe a few pearls, because I feel like this is such a thing. You and I get so excited when we talk about this because we both have the same view of life—how in the suffering, in the dark moments, often there are some of the most beautiful things if we're looking. Tell us about maybe a few pearls for someone struggling or wondering: “You know, Margie, how am I supposed to be happy?” Give us a little bit of what you might talk to a client about happiness.

Margie Bissinger  39:41
Yeah. Look, life is challenging, number one. Life is challenging. We all have our roots, and we all have our paths, so we can't sugarcoat it. What we can do is build ourselves up and build our resilience up so that we can navigate it. And I think for one thing, just start being a detective for the good because even in those dark times, there are good things that exist. What we focus on grows. And if you start focusing and living in the present, and even in the midst of things, to enjoy and to really savor—they've even done research on savoring the good, magnifying the good, and celebrating the good—it becomes more because, as I said, we focus on good. So if we focus on what's good, what's working, we get more of that. 

Margie Bissinger  40:32

And then, the negativity, we can't just put it in the closet. But to start questioning your thoughts, because we know 80% of the average person's thoughts are negative. When we start questioning our thoughts—”Is that true?”—and really start seeing, “What are we absorbed with the majority of our day?” I find there are so many areas. I teach a whole entire happiness course. Working on our thoughts, focusing on the good. 

Margie Bissinger  41:02

But I think the other thing is just turning a switch, being a victor in life versus a victim, because nobody but nobody gets anywhere—”Oh, poor me”—when they're feeling sorry for themselves. So instead of being in that frame, which I found as a physical therapist that nobody heals, versus, “Okay, instead of focusing on the problem and dwelling on that,” which so often people just go on and on. And it's easy to do—to just stop and say: “Okay, you know what? What are my solutions? Let me be a victor in this. What are some solutions here?” So with the bones: “Okay, I'm going to start exercising. I'm going to look at my nutrition. I'm going to work with my functional doctor” or whatever it is, even one step. I don't believe in overwhelm. Totally. One thing: If you say, “You know what? I'm going to start resistance training,” great. Do it. Celebrate it. Yay! So I would say those are the couple of things that I would start with because it changes your life. 

Margie Bissinger  41:58

And no matter where you are, people who practice happiness habits—it doesn't matter if you start out and you're the biggest negative Nelly, ever—the research has shown that you can increase your base level of happiness regardless of where you start out. So just something to prioritize because we're here once. Why not live the happiest, most joyous life we can? And it's possible. I promise you it is possible.

Dr. Jill  42:24
Oh, Margie, I love that. And like I said, I always love talking to you. It reminds me of Byron Katie's work. When the negative thoughts come, we say: “What if that weren't true? And how do we know that to be true?” And we question our thoughts, which is what you just said. It's so powerful, right? Because we have these auto-program things that if we get into a slump or we get into that space, we [say], “What if that wasn't true?” And I always say, “What if something else is possible? Or, “What else is possible?” And there's just magic about that because it opens your mind to think about, “Well, how do we…” It's perspective. And you've so well described that. I really, really appreciate it. 

Dr. Jill  43:00

And at first, you might say, “Osteoporosis and happiness—how do those go together?” To me, it makes so much sense because there are so many people who have been given a diagnosis of osteoporosis. And there's so much disempowerment in traditional medicine: “Take a drug.” “You're probably not going to get better.” You might get a…” And the happiness piece is, just like we said, reframing. And also, say you have osteoporosis and you're feeling overwhelmed, but it causes you to shift and change your mindset and start exercising, doing strength training, throwing tires, or whatever kinds of things you're going to do. And then all of a sudden you realize you're empowered and it shifts something. So surprisingly, they go together really well.

Margie Bissinger 43:37
It's so funny because they did a study showing that people who were happier and more content with life had higher bone densities. So it all goes together. [inaudible] me. In my work, happiness: Not that it's non-negotiable but there's not a program I teach where I don't teach people happiness habits because I feel that when you have that base—like you do, I mean, that's part of your world—and you're working at that level, everything falls in place, and it just makes it easier to navigate the other pieces. And it's fun! 

Dr. Jill  44:13

I couldn't agree more. People sometimes will say, “Oh, you're so lucky.” I'm like, “No, no.” I am lucky in that sense, but I know my mindset manifests in my world. So I expect good things from people. I expect good things in my own life. And they do happen. And it may sound like magical thinking, but there's power to shifting how we view things. And of course, this topic—you and I could talk all day long.

Margie Bissinger  44:38

We could go on and on! 

Dr. Jill  44:39

I know, right?

Margie Bissinger  44:40

Great, great! I know when I read your book… Can I just tell them the story real quick? I was at Summit, and I was coming home. I had a ton of work to do, and there was no WiFi. But your book—I had gotten an early copy. It hadn't even come out. So I had your book. I did not stop reading that the whole time. I came home and didn't even do what I wanted to finish. I had to finish the book. I loved it so much, and I related to every single thing! It was so good!

Dr. Jill  45:11
Thank you, Margie. And thank you for all the support you've given me. It's such a delight to have you on Resiliency Radio. Let's tell people where they can find the summit because if you're just listening to this, as it comes out, you can either find it live in January or you can listen to the replay. But go ahead and tell us about the summit and then also about your other programs. 

Margie Bissinger  45:28
Oh, sure. I'm so excited about the summit because I have so many different speakers and Dr. Jill is one of them. But all areas of what could be a root cause of osteoporosis. And then I think one of my favorite parts of being a physical therapist—really, my favorite physical therapy—is teaching exercise. I have a Qigong master's teaching, “What's Qigong for?” So you'll learn the exercise and how to set up a home gym. So there's a lot of really amazing exercises, a lot of root cause. Dr. Keith McCormick showing about the medications. And then integrative doctors who've been doing this, like Dr. Kim Millman, going through case studies, really going through what we need to know. So there's a lot of things, a lot of doctors sharing what works for them. Really, you'll get whatever you need. There was a parathyroid surgeon. Twenty people, Dr. Jill, found out they needed parathyroid surgery from listening to the talk. Can you imagine? 

Dr. Jill  46:29

Wow.

Margie Bissinger  46:29

Yeah. So there's lots of information, lots of tools. That was my goal. My goal was to give people tools so that they can start on their journey. So there are all different doctors from all over the place. All sorts of people from different walks of life. But people who specialize in osteoporosis. So there's things on cooking and there's people on health coaches. Lots of information. I'm really excited about that. I'll have new talks as well this year. It's starting on the 13th of January. And it's free. It's free. It's going to be seven days. There'll be free gifts when people sign up. Awesome, you'll have the link. I'll give you the link.

Dr. Jill  47:12
How exciting! If you're listening or in your car or whatever, like I said, show notes are going to contain all the links that you need for this. And we'll put Margie's Happiness Program, the courses, and all the other stuff. What's your main website?

Margie Bissinger  47:25
My main website is just MargieBissinger.com, and it talks about my courses. But the other I'll give everybody… The summit's over. We talked about exercise. So I really wanted to give people tools. So I had a handout on osteoporosis exercises or fracture prevention and strength. It goes through posture. Posture is something everybody [inaudible]. So there are posture exercises, there are balance exercises, and too-easy weight-bearing exercises they can do throughout the day, as well as I talk about strength training and why it's so important. So it gives you a little synopsis of things you can start right away. So I'll have that handout for you.

Dr. Jill  48:01
Awesome! We will have the link for you guys if you're listening out there. As you know, please stop and leave a review. Subscribe if you're on YouTube. We always appreciate that, to get more listeners and to share it with the world. If you found this helpful, share it with a friend or family [member] or some member of your community that you know that needs this information. 

Margie, as always, it's a pleasure to talk to you. Thanks so much for coming on the show!

Margie Bissinger  48:23
Oh, thanks so much! It's always a pleasure to be with you, Dr. Jill, and everybody. And I feel this great energy.