Episode Overview

This week, I’m joined by Kristie Howlett, NP, founder of Howlett Integrative Cancer Care, for a conversation that I’ve been wanting to bring to you for a long time. Bone health becomes a real concern for so many women after a breast cancer diagnosis, especially when menopause and aromatase inhibitors collide, and Kristie has such a grounded, deeply informed way of explaining what is actually happening inside the body.

Kristie breaks down the role of estrogen, why muscle and bone work as a team, and the specific metabolic patterns she sees in her practice that influence bone strength. We talk about DEXA scans, vitamin D, magnesium, sunlight, strength training, and how individualized care creates far better results than a one-size-fits-all prescription for calcium. Her insights are practical, hopeful, and empowering for any woman navigating survivorship.

Resources:
Smart Scale Laura uses and recommends.
DMinder app.
Howlett Integrative Cancer Center

Follow Kristie on:
Instagram: https://www.instagram.com/kristiehowlettnp/
Facebook: https://www.facebook.com/kristie.alexanderhowlett

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Read the full transcript:

0:00
You're listening to better than before breast cancer with the breast cancer recovery coach. I'm your host, Laura Lummer. I'm a certified life coach, and I'm a breast cancer thriver. In this podcast, I will give you the skills and the insights and the tools to move past the emotional and physical trauma of a breast cancer diagnosis if you're looking for a way to create a life that's even better than before breast cancer, you've come to the right place. Let's get started. Hey, then my friends, you're listening to better than before breast cancer. I'm your host, Laura Lummer, I am so excited to bring you this episode today, because if there is any top three fears that stand out to me when someone is going through breast cancer treatment, and that's not just the active surgeries, chemotherapy, radiation, but especially the use of aromatase inhibitors for five to 10 years after that active treatment has ended, we know that those aromatase inhibitors can come along with a lot of side effect, side effects. Some women tolerate them better than others, but one of the primary concerns that I often hear about is bone health and the struggle with osteopenia and osteoporosis after menopause while on aromatase inhibitors. So I am super excited to introduce my guest to you today. Who is Christy Howlett. We are going to have a discussion about bone health and the terrain approach, the integrative approach to supporting your bone health, even if you are on an aromatase inhibitor. So let me tell you a little bit about Christy. She is absolutely amazing. You're going to love her. She's a nurse practitioner. She is the owner of Howlett integrative cancer care, which is a telemedicine practice that serves patients across the country. In her role, Christie helps clients with a personalized, integrative approach to survivorship, wellness and prevention. She originally attended University of Nevada, Reno, where she received a Bachelor of Science degree in nursing. She worked as a bedside nurse and later moved into a clinical manager role for the next eight years. During that time, she completed her Masters of Science with a focus in oncology nursing, graduating from the University of California in San Francisco in 2008 as an oncology clinical nurse specialist. She then worked as an oncology CNS in both the inpatient and outpatient setting for six years in 2012 she went on to complete a post masters nurse practitioner certification in adult geriatric care from the University of Massachusetts in Boston. She's obtained education through the Institute for Functional Medicine. She has completed the metabolic approach to cancer. Master course for practitioners. She is board certified as an Adult Nurse Practitioner. She maintains her advanced oncology certified nurse practitioner certification, and she is accredited as a metabolic health practitioner through the Society of metabolic health practitioners accreditation a lot. This woman is amazing. She's got an incredible background. She's incredibly intuitive, intelligent, well rounded, kind. I cannot wait for you to hear this discussion on bone health, and so I'm not going to make you wait. I'd love to introduce you to Christy. Howlett. Welcome Christy. Thank you so much for making the time to come on the better than before breast cancer podcast today, it's an honor to have you here.

3:49
Oh, it's an honor to be here. So thank you for having me,

3:53
of course. So we have a really important topic to talk about, because bone health is a huge issue with women who have had a breast cancer diagnosis, who are going through treatment, who are on aromatase inhibitors or in menopause, right? The full perfect storm. And, you know, there's so much, I think, misinformation, confusion and a ton of fear, and the things that I hear most commonly, you know, as a doctor says, technosium. And then I look at people, and I sometimes in their lab see extraordinary levels of calcium that they're taking for bone health, but not extraordinary levels of vitamin D, of magnesium, no strength training. And there's just so much, I think, utter confusion around what it is that gives us healthy bones. And a lot of it, I think, is again, very siloed, as we see a lot with allopathic medicine, it's all about the bone. Take the calcium for the bone. So let's have this conversation. I want to hear your incredibly informed perspective on how do we support bone health for menopausal. Men, Women on aromatase inhibitors. What does this look like? And how can we broaden our perspective so we're not just so focused on calcium supplement to save

5:10
us, right? Well, I think first we have to start with what is happening in the body, right? So whether we're going through menopause or we are in menopause, and now somebody is starting on an aromatase inhibitor. You know that that lack of estrogen, which we know is a key regulator in bone health. So as we age, our estrogen starts to drop. When we have low estrogen from menopause, we have the risk for weakening bones or leading into osteopenia and osteoporosis. And then when you add an AI or an aromatase inhibitor, which profoundly lowers the circulating estrogen level, which then accelerates the potential bone loss, then you have kind of the perfect storm, right? So we know that there is an increased risk of osteopenia and osteoporosis in menopause, and especially with aromatase inhibitors. So I think starting with, okay, it's relate. There's a relation to estrogen, and that's kind of where we start. But it can't just be solely about take your calcium supplement, right? Because what most of the time, at least, what I have seen in clinical practice is the docs just say, Oh, you're post menopausal. Maybe they don't even have a DEXA scan. Maybe they have not even had a calcium level done. It's just you're now post menopausal. You should take calcium and do weight bearing exercise, right? But what does that even mean? Because a lot of people don't know what that means, and when we're not considering all other aspects of health, we're kind of missing the boat, right? So it can't just be about just calcium, because there's multiple studies and meta analyzes that will indicate that too much calcium can be problematic from cardiovascular disease, you know, can be associated with cancer, hypertension. So there's other risk factors that we have to take into consideration. And are we even looking at what is the dietary intake that somebody's taking in, right? So there's a lot of variables. I'm kind of hitting on your question. I think,

7:40
yeah, absolutely, yeah. I'm just like, so many more questions are forming in my mind. As you say that a couple of things that so one thing, yes, I often hear that doctors that say, then, well, we just don't take labs into consideration. If you're postmenopausal, we give you calcium. Another thing is, I hear this question a lot. I'd love to hear your answer to this. They put us on aromatase inhibitors, but we're already in menopause, and many women say to me, well, they don't check my estrogen levels, and I'm in menopause, so doesn't that mean I'm not making estrogen, right? So what's the answer to that? Well, the

8:17
easiest way to explain that is, even after menopause, we still have low levels of estrogen circulating in our bodies. And actually, the way, you know, I had a wonderful oncologist that I worked with who explained it to me this way. She said, You know, the easiest way when explaining it to women is aromatase inhibitors, very simplistically, block aromatase, which converts fat tissue to estrogen. Now there's multiple steps in the in the middle of that, but that's kind of how you can look at it, because we also see that as women age and they gain weight, their risk for breast cancer goes up as well, right? And so there's this, this dynamic of, is it because there's greater circulating estrogen, because there's more fat storage and there's more aromatase activity happening? So the whole idea is, how can we suppress your estrogen levels even greater. Does that make sense? Yeah.

9:26
Can you speak to that for a minute? How is excess adipose tissue impacting estrogen production?

9:34
Well, the more fat tissue. Well, it's multifactorial. Let me just back up and say that. So we, you know, we have to look at, when we are carrying extra weight, we're going to be potentially more estrogenic, especially in menopause. Then you've got insulin dysfunction, then you've got potential for diabetes. And, you know, the. All of those dynamics. So then you're you don't have as much muscle mass, then that also contributes to the bone mass component. So it's multi factorial, especially as women age, when they're like, Well, wait a minute, my ovaries have stopped working. I shouldn't be producing any, any estrogen. But no, really, we are at very low levels still from the fat tissues because of aromatase and how the body is working with this dysfunctional terrain, because of metabolically, what's going on in the in the person.

10:37
Yeah, I love that picture, you Pina, because to me, that is a picture of so much empowerment, because it's so much opportunity to do things we have control over, to change the way the metabolism works. So let's say here we are. We're postmenopausal. We've chosen to take an aromatase inhibitor because we believe it's going to support us. Is there hope to improve or support good bone health in that situation, and if so, how do we approach it from a terrain perspective?

11:09
Well, so I think first and foremost we have to look at is, is there the ability to reverse osteopenia or osteoporosis when on a romantase inhibitor? And there's really no good research that shows that that can be done. I mean, I think there's many of us in clinical practice that have seen it when you layer in these lifestyle factors that help improve metabolic health, but where I think our resources are spent are, how can you prevent, stabilize, or even reduce the risk of fracture, right? So those are important components, especially when we're considering this, this dynamic, but, but I, I think I would start with Laura the first and foremost. I think you have to know what is your bone density, right? And the the recommendation is that everyone who is placed on an aromatase inhibitor should have a DEXA scan prior to starting. And I'm actually surprised at how many do not.

12:19
I've never had one. I mean, not by my doctors. I've gotten them outside, uh huh, but yeah, in 14 years of being treated and in five years with metastatic disease, my doctors never ordered a DEXA scan.

12:32
So it's interesting, because if your health care system or your hospital that you go to is has an accreditation in cancer care that is one of the check the boxes, if you will, like one of the things that should be looked at. And so those systems can technically get dinged if they have not met that criteria so over so many patients, but no you should have a DEXA scan before starting an aromatase inhibitor, so that you know what you're starting with. Because if you in two years, or maybe they'll finally look at it when you hit 65 and then it's part of that whole Medicare package. Now you do a DEXA scan. Now you're osteoporotic. Well, what if we looked at that when women were 4045, even 50, before maybe they go into menopause, or maybe before they have a diagnosis of cancer, then we'd have a good baseline of what their bone health is, right? So knowing where you're starting is super important, and then from there, it becomes not just what supplements can we layer in, but it's nutrition. So with a DEXA scan, what I love is that not only do you get bone density, but you can get fat mass and percentage of body fat, which is really helpful so that then we've got other markers to track over time. But, you know, to use kind of what doctor Gabrielle Lyons talks a lot about is we are an under muscled over fat society, right? So can we build more muscle? And, you know, unfortunately, as women, his historically, as we've aged, you know, we've tended, you know, many of us grew up in an era, and especially, you know, those who are older than me, even more so where it was all about cardio, and if I lifted weights, I was going to get too bulky. Yeah, right, yes. And so just learning how to change that mindset and helping women understand that that's going to help their bodies improve and get stronger and be able to manage the aromatase inhibitors and the potential side effects around. Them. Now, the cool thing about that, and I know I'm kind of going off on a little bit of a tangent here, is more and more oncology programs and survivorship programs within those cancer programs and the accreditation process are building in exercise programs love it. Can we refer somebody to an exercise program with physical therapists with weight training equipment so that they can learn what weight training looks like and how to do it safely, so they don't walk into a gym because so many women I know have never, never gone to a gym. Yeah, they don't want to go to a gym, or they're so intimidated, or, you know, they what am I going to how do I lift these weights? What? How do I use that machine so to have a cancer program that has access to these or has built in that exercise program into their program for patients? I think that's huge, too. Yeah.

16:11
Is that something that so as a patient with the information you just shared about DEXA scan, if someone hasn't had one, can they ask for one? And should they expect to be able to get it? If they're 100%

16:25
I actually have never when I've made recommendations in my practice, you know, as an independent telemedicine practitioner, when I've educated the patient, you've started this aromatase inhibitor, you need to ask for a DEXA scan. I've never had one. Had a patient come back and say, My doctor said, No,

16:45
okay, great. And is there a recommendation for how frequently you should do a DEXA scan?

16:51
I personally think that they should be done probably on a yearly basis. Okay, you know, especially if we see osteopenia, osteoporosis, I know the recommendation, you know, as we age, is every two years for sure. When I was in the healthcare setting, you know, working in a traditional oncology office, if I was ordering them yearly, patients were having that approved. But I think that especially if people are do, if women are doing the work. I think it's so motivating when they can see there's change. It's like, okay, I did. I put all of this effort in, and now I've seen, oh, I've Yeah, I have improved my muscle mass and my my body fat percentage has gone down, and, oh, look, they're seeing some changes in the dexus or in the bone density. So it might not be big changes initially, but slowly starting to see that t score move can be really empowering, especially if you have a clinician who can review that with the patient to say, Wow, I can tell you're doing something.

18:01
Yeah, I love to recommend for my clients to get smart scales, and even though they may not be obviously, DEXA skin is a gold standard, but the BMI thought process is just so and the number on a scale. But to have that smart scale to see the change in muscle. You can see bone, you can see protein, you can see body fat and visceral fat, which obviously is very important as well. Let's talk about so I want to go back a little bit because we started to say there's really no studies that have shown that we could reverse osteopenia, osteoporosis, and yet, you've seen in your practice improvement. What's, what's the combination?

18:44
Well, I want to say, I'll just stop for one second and say, so. There's no real research in women taking aromatase inhibitors that show reversal of osteoporosis, but there is, there are some studies in women who are doing lifestyle changes who are not taking an aromatase inhibitor. So there is research to support it. It's small, but yes, it can happen,

19:09
yeah, and it's not necessarily that research doesn't support it. Is it as much as there's not a lot of research in it, correct, right? So we don't know correct. So, and I think that they're like you said, women are intimidated by gins, but after breast cancer surgery, they're terrified of lifting weights. They're terrified of reinjuring something in the chest. So in the conventional oncology system, if they're in that, can they expect to ask for a referral and get one for physical therapy or for personal training or specialized training, is that something they should be able to ask for as well?

19:46
I absolutely hope so. I mean, and I tell a lot of my patients that if you ask for these things, and your doctor poo poos them. Lummer said, I don't think you need that. That might be a red flag, but to look for another oncologist, because the reality is, you don't, especially after surgery, I think every woman should get the opportunity to work with physical therapy, especially if there's lymph nodes involved. You know, you want to make sure that you're doing everything that you can to prevent lymphedema, and so that should be an automatic referral. I know that some systems, a lot of systems, have actually built that into their program, but not everybody has made that leap. So a lot of times, women do have to ask for these things, but absolutely they should. They shouldn't get any pushback. Unfortunately, they may see the pushback from their insurance and more so than their oncologist.

20:52
Interesting, yeah, and there are channels also that they can push back to their insurance right. 100% challenge that, yeah, so can you explain? Because I think a lot of women might hear, build muscle, what in the world does that have to do with improving bone density?

21:09
Right? Well, here's, I think this is the very cool part, in my opinion, is that we think we've been told weight bearing exercise, that's what you need to do to strengthen your bone. And yes, that helped. But many times when women might be taking a walk, which would be considered a weight bearing exercise, it might be a casual stroll, right? So they're not putting enough compression on the bone. Now, if you throw on a weight vest, or you're climbing up a hill, or you're you're causing more pressure on the bone, or you're jumping, or you're up, stepping up and down off of a step, those things that are going to put more compression on the bone, that's going to help with that bone strength and that remodeling, if you will. But when we talk about strength training, you can your muscles. There's this beautiful cross talk between muscle and bone and muscle. You know you're you're doing your strength training, and you're building your muscle, and the muscles will send chemical messengers over to the bone that say, Hey, I'm really trying to get stronger here, but I need you now to get stronger so I can get stronger. So the bone kind of takes that information and says, Okay, I'm getting stronger, and then it sends chemical messengers back to the muscle that says, hey, I'm now stronger. Now you can build more again, because you can only build your muscles as strong as the bones will allow, right? So this cross talk between the two of them is just an absolutely beautiful process that allows strength training to not only help with bone bone strength, but also, you know, we have to think about things like balance and coordination, and you want to have the muscle and the strength to break a fall or to catch yourself so that that muscle supports and protects you, but also, you've now caught yourself from falling and breaking a hip, which can be catastrophic, right? Absolutely, so that that cross chalk is so beautiful, but in order for for all of that to work, we also need all of the other things to kind of put into place, so things like adequate protein. You know, how often do we see that women are so afraid to eat protein, and especially in a cancer setting,

23:48
yes, right? Oh, I guess people say no meat, no meat, yes.

23:53
Or I've been told I need to go vegan, or I need to go vegetarian. And, you know, I should back up and say, That's why I that because of nutritional factors in how women have eaten over their lifetime that should dictate when you do a DEXA scan, because we are seeing younger and younger women with osteopenia and osteoporosis, because they were nutritionally deficient for so many of their formative years of when they would be building strong bones. So taking that into consideration, so when I get a client who might be younger, who may even just have a, you know, maybe in their 30s, and they have an early stage breast cancer, so they're probably not going to go on an aromatase inhibitor, necessarily. I always say you should ask for a bone scan, a DEXA scan from your your your team. But. But if they can't get that, there's places in just about every city in town that will do a DEXA fit, which is like 100 bucks, and it's pretty darn comparable to a medical grade DEXA scan. And then you layer on your smart scales, and those are really pretty comparable. I mean, they're off by very small percentages. So when we know what your baseline is, and then we can look at, okay, what's your nutritional status, what's your vitamin D, level, your calcium, your magnesium, your k2 you know, how are you able to traffic the calcium into the bone and then you add in that strength training piece or that and that weight bearing component, then that's where kind of the magic happens.

25:54
Yeah, I love that you just said that whole combination there, because so many times I'll have that conversation with people and say, I don't think I've ever had a client start with me who had adequate or what I would consider optimal vitamin D levels, right? Ever, right? And even as they try to bring up their vitamin D levels, a lot of time, their standard of care doctor will say, Whoa, like mine does with me. He's like, You are at toxic levels of vitamin D because it's 95 you know? And I say, No, I'm not, you know, this is so that there's a fear there of, oh my gosh, my doctor said, don't take any more vitamin D. And their serum level is 35 right? You know. So it is that the magnesium. Again, I see deficiencies in magnesium all the time. You see that as well, yeah, and hear about the muscle spasms and all the things going on that are indicating your body is telling you it needs more nourishment, right?

26:50
100% Yeah, 100%

26:54
and also, going back to, I love the way you described the interaction between muscle and bones, our bodies are so magical. They are so magical. And I it's such a disservice, I think how in standard of care medicine, everything gets siloed, and so we start to think about the body in silos, and it just nothing works in a silo. It's all integrated. But the beauty of what you described also increases our insulin sensitivity. Yes, right? Moving that muscle helps with the insulin sensitivity, which we should all be concerned with, mindful of all the time,

27:29
well, and that that reminds me, you know, one of the thing, one of so not only is exercise near and dear to my heart. You know, I always say I'm I'm I'm exercising so that I can walk into my 80s strong. You know, that's my goal, or 90s, or whatever I get to live to. But one of my other favorite things that I think we don't talk enough about in how it can relate to, not only bone health, but also kind of the overall metabolic function, is sunlight? Yes, right? So sunlight is absolutely essential in how it regulates our vitamin D, how it regulates our circadian rhythm, how it improves our insulin sensitivity. And I think what's hard right now, you know, we're going into winter months, and it's estimated that the majority of people in general, get less than 15 minutes of outside time daily. That's on the average, right? And then you take because, you know, we get in our cars, we go to work, we come home. You're busy with life. We just never get outside. And then you go into winter months, and then nobody goes outside because it might be cold or might be rainy or whatever it is. But you know, getting time outside really helps, especially if people have low vitamin D and they're not eating enough fat, which that cholesterol and the vitamin D dynamic within the skin is like the best vitamin D you can have. And then if you have vitamin D receptor issues, then you might have to push on, you know, supplementation a little bit more, but that influences multiple layers of the bone building process and that and helps inflammation as well. So just being able to get sunlight is a huge variable. I think that is a missing link that we don't often consider.

29:37
Yeah, that is so true. And you know what I love that you brought up vitamin D receptors. I think in general, for the most of the general population, we don't understand that language, right? I know you and I both work with snips and nutrition genomics, and we know the value of that. But as we said, like here's a standard of care. Here's a RDA, here's a an expected level of vitamin D when they're taking a normal lab. Can we speak to how is that different from what we perceive as an optimal level? And then what is a vitamin D receptor, and what does that have to do with our levels of vitamin D and our overall health and immunity?

30:20
Well, I think that, you know, the in the integrative side of care, we kind of lean into having a vitamin D level of at least greater than 60. For most, I think integrative providers, some would say even, you know, 80 or higher, I tend to be one who I'm comfortable somewhere between the 60 and 100 range, and even in some patients that are even higher than that, it doesn't give me pause, especially if everything else is in alignment, right? Yeah, right. Now, when we look at vitamin D receptors, you know, we think about them in relation to their little the snips, those single nucleotide polymorphisms are like, as I like to call them. For patients, these little hiccups in your DNA that have the behavior have the potential to behave badly, right? So, if you have these hiccups in your DNA that makes it more difficult for you to have adequate levels of vitamin D. Then doing a little bit more to support that process is important. You know? I will for me personally. I'll give you my personal example. I'm a whore. I've got horrible snips around vitamin D. And I love the sun, so it took me, I mean, I was, I could barely get my vitamin D to budge above 40, and that was with supplementation. Like I just, it was like trying to start a car engine like this wouldn't go. And what I found for me personally, what worked, and this is what I love when I work with patients, it's about finding that personalized approach. For me, it was getting my body into ketosis, number one, so that I could optimize the fat that I was taking in. But then, when I was in the sun, in ketosis, all of a sudden, I watched my vitamin D levels go through the roof, really, yes, without supplement support. So you know that I thought was really an amazing dynamic for me, and you know it was my own personal in of one experiment where I went outside at the height of sunshine. You know when they tell us don't go in the sun, make sure you wear your sunscreen, and then if you do, you block all your ability to absorb that vitamin D. But I would sit out there for an hour, hour and a half, not burning anymore, because I wasn't taking seed oils in. I had good, healthy fats on board. And I was able to not only track with there's a great app called D, dimer, D, D, minder, which E, minder, minder, which you can put in, you know where you are at in the world, and how much sunlight Are you getting, and how much clothing you have on, how much skin is exposed. So I was tracking that amount, and it kind of tells you how much vitamin D you're producing, basically in that time period, which is kind of fun. So if you're doing these little experiments on yourself, it was fun for me to go, Okay, today I picked up 5000 units just from being in the sun. But again, it's that personalized approach to figure out what works for the person in front of me, like I had to figure out what was going to make my vitamin D do what it needed to do. I wanted to try and figure out if I could do it as naturally as possible. Because the other thing about vitamin D is it's not just about the bone. It's about every hormone in your body working better,

34:18
and then you layer in ketosis and the utilizing of fat makes every hormone in your body work better, and you get this decrease of inflammation. So you mentioned earlier that you know, we often want to put systems or processes that the body does into the silos, and the reality is that we are not siloed beings or processes. Everything works together, yeah, to make everything work better, yes? Yeah, right. So beautiful, yeah, absolutely, yeah. Yeah, and I think that it's just such an important conversation, because you know, you and I, we both focus. And you said it over and over, which I love, individualized, personalized. It's like you are special each individual body, and they all function differently, right? And that is why that integrative approach is so important, but we're so conditioned in the RDA, right, which is the average, and this says this amount is the best on average for everyone. And you know, most, most of the population, isn't really that educated in what RDA is mean, or Dris, or anything of that nature. And so it's fascinating. I say, you know, if we get a car, we know what kind of gas to put in the car, we know what kind of tires it needs, we know what kind of oil it needs. We don't ruin our car. But if we could just spend a little more time getting to understand our body and its needs and spend a couple $100 on a nutrition genomics report that is literally like a blueprint that says, This is you. You know, it's fascinating. Even when I go over a nutrition genomics report with a client, oftentimes will be like, so is this just genetics in general? Is this actually me? It's like, No, this is you. This is your body, and just your body, and this is what it's saying. It will, it prefers, it doesn't prefer how it works. It's such valuable information well.

36:29
And what I think is interesting is when I've looked when I've had those tests, most, almost every patient has said to me, oh my gosh, this tells the story of me. Now I know why I've been I have this, or have that or this didn't work for me. I'm like, exactly, yeah.

36:48
And I think, you know, in the world of cancer, once you have a diagnosis, it is a fear based world in standard of care. It is a powerless world where we don't understand the jargon and the treatments. And the treatments. And many times we're not asked. We're just told, here's what we're going to do for you. And if you don't know, you can ask you just say, okay, save my life. I don't want to die. And so I think that, you know, as an integrative approach, it gives us so much more power when we have a diagnosis of osteopenia or osteoporosis, again, it feels powerless. And we're told, take calcium or go on this infusion. By the way, don't clean your teeth while you're on that infusion, or your jaw can rot away, you know, right? More fear, more fear. So I really wanted to have this conversation so that women could understand, like we have so much power here, understanding that whole combination magnesium, k2 vitamin D, strength training, and what strength training actually means to the body, like how it works. And I love you said something, which I over the years, because I have a history also as a personal trainer. And how many women are like, I don't want to look like a man. Yeah. And again, just says to me, you don't understand how the female body works, because if you want to look like a man, you're going to have to do a whole lot of work and take a bunch of steroids, right? Yes, that is never going to happen. But especially, I mean, most breast cancer diagnoses happen in women over the age of 50. Have many clients in their 60s and 70s. Let's talk about the chances of them looking like Arnold Schwarzenegger if they decide to lift weights. Okay, yeah,

38:25
it's not gonna happen. I and I will tell, I'll tell women, are you gonna spend six to eight hours in the gym every day and only eat tilapia, chicken and broccoli? I mean, exactly like. It's not gonna happen. And you know, it's, it's, it's, it's fun when I can get women to make that transition and that leap, and then really go, oh, wow, I, I didn't realize that I could feel stronger, yes, you know, AND, OR, and I'll explain it like you're, you're, you know, deadlifts are so that you can bend over and pick up your grandchildren, or your squats are so that you can get up off the toilet. Or, you know, just your bicep curls are so you can carry in the groceries. You know, it's these things that, if you can pull it around to the why they should do it, you know, we can say, oh, it's for your bone health, but that, I think at times, doesn't feel tangible, right? It's like, well, I can't really see my bones. I can't feel my bones. So how do I know? But if there's a spin around, you know, do you want to be able to get up and walk and go play with your grandchildren, or, you know, things like or you want to continue to golf or whatever the activity or where they find value in their life, then it's easier to make that leap right when you have a why that makes sense, that feels. Good, then you can kind of push through the uncomfortableness, because, you know, there's going to be a good outcome on the other side.

40:08
Yeah, absolutely, well said. And I think because obviously it takes intention and it takes time, and it takes commitment to exercise consistently. And in our world of Amazon Instant deliveries. We like to see stuff happen right now. Yes, let's be realistic. So if I say to you, oh my gosh, I have osteopenia and I'm on an aromatase inhibitor, and you give me a program and say, Let's optimize, make sure these minerals and these vitamins and hormones are optimized in your body, and let's get you on a strength training exercise program. What would be your realistic expectation to start to see signs of improvement

40:50
in bone health, or just in overall their body? We'll see both, let's say overall and bone health. So you know, I don't know that we really have that data to show the time like we're not. I haven't seen any literature that says we're looking at DEXA scans like every 369, months so. But if we're looking at a DEXA every year, I would expect that we can, we should see some changes in that time period if they're looking at, you know, using a smart scale, they can probably start to see things a little bit sooner. We just don't have that really objective data. But as far as overall body composition, women can easily start to see those changes in as soon as a month. You know, noticeable by three months. I think you and I, we both have clients that, you know, within a couple of weeks, they were like, Oh my gosh, I can already lift heavier than I was expecting to lift weights, or I can go for a longer walk than I ever thought I could. So everybody's a little bit different. And I and I also think that, you know, if you've got people in your practice who maybe they have a history of exercising like they're not afraid of it, but it's been a long time, I always remind them, like you have muscle memory, like your muscles will start to go, oh, wait a minute, we know how to do this, and they'll kind of jump on the bandwagon with the patient. And things can happen a little bit faster than if you're starting completely from scratch. So I and I also think that it, and know that it depends on how much time you're going to put in. So the reality is, you know, when we look at studies, and there's been small studies looking at women post menopausal on aromatase inhibitors, when, how can we what the timeframe seeing body composition changes in a three month period of time, and that was with exercising, with strength training, two to three times a week. So it doesn't have to be crazy amounts of time. I mean, they do not. I don't go. I my gym is in my garage, so I don't I roll out to my garage three days a week. That's it from a strength training perspective. But I do think on the other days or in addition to adding in, you know, that weight bearing component, so maybe it's taking a walk with a weighted vest. You're getting outside. You know, especially if you can do that at sunrise or sunset. Is optimal. Can you throw in, maybe jumping rope or just stepping up on a block and stepping down? Those little things can be a huge addition to adding to not only that muscle, but also the bone.

43:59
Yeah, and you know, what else to the confidence a 100% right? It's like muscle is the physical form of confidence, yeah. And we start feeling stronger, we start feeling more capable, we start believing in ourselves more. And you've mentioned a weighted vest a couple of times, and my God, those things are heavy. You get some heavy weighted vests, and, you know, I have one that you can take the little weights out of it so you can adjust it right from 11 pounds to 20 pounds. And there are some days that I pick it up when it's got all the weights, I'm like,

44:35
Yeah, well, I think that that's the beauty is you don't have to add in a lot of extra weight depending on what your your strength level is at. So maybe it's just five pounds. Yeah, you know, it can be as simple as that, and when we talk about confidence, the other beautiful part is the endorphins that come from exercise. So. You get these endorphins that help your brain work better. But then, if you carry inflammation, the myokines, these chemicals that are released upon muscle contraction, helps that acute dynamic helps calm chronic inflammation, so you've got that level of dynamic in the body that's occurring. So there's it's so multi factorial. And then you look at those who are exercising, doing some strength training, they are helping decrease their risk of recurrence. They're in decreasing their progression to disease, or recurrent dynamics around progression. Progression free survival, is what I'm trying to say. And so anytime you're optimizing that metabolic health piece, you're going to help decrease risk of recurrence. So it's kind of a win win win on so many different levels and it we can't just make it about bone. It's about everything.

46:05
Yes, I love that, right again, we can't be siloed and just think we're only giving it to the bone. Yeah, such a such a beautiful conversation. Thank you so much. I am putting contact information for you and your center thing in the show notes here for this episode. Is there anything else you would like people to know about you or your practice, or anything in summary for their overall bonus?

46:32
No, I think I would just say first and foremost, thank you so much for having me on. I mean, this was, this was a wonderful conversation, and I love the directions that we took. I would just say that, you know, in my practice, I am all about that individualized approach, because I see too many times. I mean, the easy thing to do is to make a protocol, and everybody gets the same thing, but, yeah, the protocol doesn't work for everybody, and we really have to take into consideration who's the person in front of me, what's going on with them metabolically, you know, with their cancer, with everything else, and make a plan that works for them, and that includes, you know, their bone health, their mental health, their emotional health, their physical health, it's all the pieces of the puzzle, because we're so distracted in today's world by all the things when if we just focus on those foundational principles of moving our Body, eating good food, getting good sleep, reducing our stress, spending time with the people we love, and sunlight our lives would be a complete in a completely different place.

47:50
I agree 100% and you know what? People hear that, and I think they think it's too easy, that's just too too simple. That can't be that powerful. It really is that powerful. And I think also working with someone who has that individualized approach, again, is so powerful, because after a cancer diagnosis and we get into the system, so many women just feel unseen, unheard, like you're not listening to me, I'm just a number. And sadly, you know, that can just be the way that the conventional medicine medicine system works oftentimes. But finding that individual approach, again, I think, is so healing and empowering to to see someone sees me. You know, they really see me and understand what I need. And I just think that's beautiful. So I agree 100%

48:40
thank you so much. Thanks, Laura and amazing.

48:47
You've put your courage to the test, laid all your doubts to rest. Your mind is clearer than before, your heart is full and wanting more. Your Future's at the door.