How to Build Stronger Bones | Peter Attia AMA 37

So I think where we're going to go next is starting to look at what people can do to improve their bone health. I think we laid a lot of the groundwork that we need to do. And this next section we'll get into kind of everything people can do to improve it individually. But before we get to kind of like how you, the person can do it. We did have some questions from subscribers who said, you know, they have kids and they want to improve their bone health. And we've talked about how important it is. So before we get to the individual, yeah. So the next set of questions fit perfectly with where we're going, which is, you know, a lot of questions on what does physical activity have to do with bone health? You know, you kind of hinted at it. We got a lot of questions on, are there certain types of physical activities that is better for bone health than not? We talked a little bit about it just now with kids, but as people who are adults are also thinking about this, what would you say to them? Well, again, I just want to go back to what it is about, um, muscles that have such an impact on bones. And this is, this is not always clear, right? So the more force that a muscle is applying to a bone, which is directly related to how much force you're trying to put on the muscle, you know, picking something up, contracting a muscle under an enormous external load. Um, and by the way, I think that can be isometric. I don't think that has to be isotonic. In other words, I don't even think the muscle has to change in length necessarily for that force to be experienced. So there are lots of safe ways to do this. Um, you're applying force to the receptors there. Those receptors are translating that tension into signals that say, lay down more bone. Okay. So, you know, we looked through some of the literature on this and I got to tell you, this is one of those things where I was kind of surprised. Um, I saw some things that I just didn't expect to see. I already mentioned one of them, right? I kind of thought running was going to be really great. Um, it turned out that studies looking at resistance training found them to be significantly better at retaining BMD. Um, when compared to anything aerobic, you know, running, swimming, cycling, and even impact things like pure jumping. So power lifting turned out to be more effective than just regular strength training in maintaining BMD in postmenopausal women. So think about that for a second. When we talk about power lifting as a sport, we're talking about, and I've seen women do this at all ages. We're talking about someone doing a squat, a deadlift and a bench press. And the squat and the, um, deadlift are, you know, that is lumbar spine. That is hip. I mean, that is really stressing the lower body. Um, more than just going into the gym and lifting. Okay. And then we talk about high force impact sports such as football and MMA were associated with the highest BMD values on the flip side of that, these low weight bearing, low impact things like walking, swimming, cycling, don't really seem to do a lot to improve, uh, BMD. And again, I don't know the studies, you know, it hasn't been done, but my suspicion is that when you make those things a little bit harder, especially with, you know, walking with a rucksack and walking uphill, um, you're going to apply more strain also walking downhill. So again, when I'm rocking, I'm always trying to find the maximum elevation change. And I actually, you know, the walking uphill is harder cardio, but the walking downhill puts more strain on the muscle. And again, the take-home point here is the more this strains your muscles, the better this is for your bones. Yeah. I'm going to pull up that figure as well that you mentioned metrics and colors and graph for people to see this too. Yeah. This is, this is an interesting figure. So on the, on the, on the left here, you're just looking at the absolute BMDs. Um, you may also recall just where these units sit, right? So all of these athletes have very high BMDs compared to, you know, what we were looking at is the average man and the average woman. Um, we don't have to flip back to that, but I just, I'm familiar with the numbers. 1.2 grams per centimeter squared was considered a really good BMD for a middle-aged man or woman. Do you remember how we've seen that? That number 1.2 is pretty common, right? Yeah. Okay. So when you're looking at this, just to put it in perspective, even the swimmers or, you know, the resistance training, females and females are tending to be a little bit lower than men. Um, they still have excellent BMD. So I, you know, we do not want to be suggesting that some sports are bad for BMD. That's not the take-home message here. The take-home message here is if you really have to juice it, what do you want to be doing? Again, even the distance runners here, all of them. So you're in the brown one in the black one, you know, you have to look at which ones separate men versus women, right? So for example, like blue, um, sorry, um, red versus, um, green is showing you the difference between male and female resistance training. Whereas all the swimmers, all the distance runners, all the track and field athletes are in the same bucket. Now, again, compare distance, the track and field, what's the difference track and field, more power, right? A sprinter has more force being applied than a distance runner. Um, what I find amazing is the MMA and the football, like just staggering, right now, I'm going to say something else that's kind of unpopular, not really sure playing college football is a great strategy for increasing your BMD when it comes with so many other injuries, um, not to mention all the head trauma. So the purpose of this analysis is not to say you got to go be a college football player. No, it's to just give you a sense of what types of forces are involved in generating higher BMD. And I think most people who have even watched a football game can appreciate the kind of forces that those athletes are experiencing. And as you talked about with MMA, um, you know, incredibly strong forces applied across muscles transmitted to bones. Yeah, no, yeah. Good for the bones, bad for the brain. Right. So what's the sweet spot here to me? The sweet spot is resistance training, right? All of these things come with risk if you don't do them correctly. I mean, hell, if you don't swim correctly, you're going to tear your shoulders apart. So we just have to think about this through a risk reward lens. Um, MMA can, I don't know anything about it, but I'm guessing it can be done safely. I'm guessing there are ways to do it and not be, you know, not put yourself at risk to tear your meniscus or tear your shoulder or, you know, have a lumbar spine disc blow up because you get folded into a, you know, half like a pretzel. Um, you can hurt yourself resistance training, but also you can not. So, um, if you're going to take one thing away from this, just notice that walking isn't on here and gardening is not on here and golf is not on here. So I just, I want people to understand that if they're in the business of trying to increase their BMD, they have to get wicked forces on their muscles. I feel like you didn't have to do golf like that. I feel like I know I just, I'm making enemies like none. I'm just, I'm just killing myself today here. I know. I feel like that has the potential to be the most thing that we get feedback for. It's like, yeah, you can insult the different organizations, but once you talk about golf like that, and I'm not saying don't play golf, look, race car driving is not on here. Okay. Archery is not on here. My favorite things in the world aren't on here. Let's do that. All right. Is that, is that an appropriate, you know, a mea culpa? Like the things I love doing are not on here. So I just don't want to be diluted into thinking that all that time I'm in a race car, I'm increasing my BMD. It's, it's not enough, you know? Yeah. Got to be in the gym. Got to be hitting it. Kind of on that realm, moving from exercise to nutrition and supplements. We do get a lot of questions on how nutrition supplements can impact BMD. Um, one of the first kind of questions we got was what are some essential nutrients that are important for optimizing bone deposition that people should think about? Yeah. So if you don't mind, pull up figure 12, cause I think, you know, uh, one of our analysts put this together and I, I think it's, uh, I think it's just a great way to lay all of this out. I think there were the big three you want to think about. Um, so there, there are other things that matter. Protein matters. Total calories matter. All of those things other matter. But when we think about kind of the micronutrient side, the big three are calcium, vitamin D. And when I say vitamin D, I mean D three and magnesium. So in the first column here, you can see the required daily amounts. Uh, and I consider this a minimum, right? So, so this is, you know, this would be like a letter grade C, right? So you, you might want to think about having a B or an A. So calcium about a thousand to 1200 milligrams daily vitamin D 800 to a thousand IU daily and magnesium 300 to 500 milligrams daily. Now these can be supplemented. So if you can't get this in food, if you're, if you're not sufficiently getting this either through sunlight in the case of vitamin D and food, calcium carbonate, calcium citrate are reasonable options in the magnesium school. Um, you know, it really depends on what your gut can tolerate, right? So magnesium citrate, glycinate and oxide are fantastic. If you're looking for a little speed up of the bowel, if you aren't, you want magnesium carbonate. It's also worth noting magnesium carbonate more fully absorbed than mag oxide citrate or glycinate, which is actually why those three help with bowel regularity. So personally I like to mix them up. Um, I'm sort of using three forms of magnesium. So I'm supplementing with mag carbonate in the mornings. I use mag oxide, um, at night. And I also use a bit of mag glycinate with L three and eight as well. So, you know, I'm routinely hitting about a gram of magnesium supplemental. And then the final column here is you can sort of see the foods where these things reside. And you can see why I believe most people are magnesium deficient. Um, you know, it's pretty hard, I think to get 500 grams predictably of absorbed magnesium. Every single day. And by the way, I think that's a real minimum, right? I mean, I think a gram is really where you want to be. It's, you gotta, you gotta do a little bit of work to make sure you're getting that from your nutrition. Um, the same, I think calcium is a bit easier to get if you consume dairy, but you know, look, a lot of plant-based people aren't going to eat dairy. They have to sort of look to other things. And some of those other things, I don't think you really want to be eating a bunch of like, look at how high figs are dried figs. A cup of those is 300 milligrams of calcium. So that's, you know, a quarter of your daily minimum amount. But you know, I don't know that I want to be eating a cup of dried figs every day for other reasons. Um, I love tofu. So, you know, but I'm not eating it every day. So, um, again, I, I, I, I think this is something we need to be paying reasonable attention to, uh, both from a dietary standpoint and then for a number of us also from a supplementary standpoint. I'm Peter Atiyah. This podcast relies exclusively on premium subscribers for support, which allows us to provide all our content without taking a single penny from advertisers. I believe this keeps my content honest, making it a trusted resource for listeners like you. As a premium member, you'll get immediate access to our entire back catalog of AMA episodes and all future AMA episodes. You'll get longevity focused premium articles packed with actionable insights. You'll get unrivaled show notes for each and every episode of the drive, every topic, every study, every resource from each episode carefully curated for you. 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