Mini Pause #67: Natural Ways to Boost Bone Density

TL; DR (Too Long; Didn't Read)

Maintaining bone density naturally becomes crucial as we age due to shifts in bone metabolism.

Osteopenia, the gradual loss of bone density, is a decades-long process that accelerates significantly during perimenopause and menopause, increasing the risk of osteoporosis.

Bones are dynamic tissues consisting of cortical (outer shell) and cancellous (inner, marrow-rich) bone, both of which change significantly with age.

Increasing bone density through strength training, plyometrics, walking, and adopting nutritional strategies is essential for maintaining overall health, regulating metabolism, and achieving optimal body composition.

WHY

Bone density naturally declines as we age because osteoclastic activity (bone breakdown) outpaces osteoblastic activity (bone formation). This process accelerates dramatically during perimenopause due to hormonal changes, particularly declining estrogen levels.

Estrogen supports bone density by inhibiting osteoclast activity (reducing bone breakdown) and promoting osteoblast activity (enhancing bone formation), thereby maintaining a balanced bone remodeling process.

Bones aren't just structural; they actively secrete hormones such as osteocalcin. This influences metabolism, insulin sensitivity, muscle function, and overall body composition.

WHAT

  • Cortical Bone: Dense outer shell providing structural support.

  • Cancellous Bone: Porous, spongy interior housing bone marrow, essential for metabolic and structural roles.

As we age, cancellous bone density decreases, making bones more susceptible to fractures.

Bone-derived hormones like osteocalcin regulate metabolism by enhancing insulin secretion and sensitivity, promoting glucose uptake by muscle tissue, increasing energy expenditure, and improving overall metabolic health and body composition.

Bones are the scaffolding of the body, but they are also active endocrine organs.

HOW

Practical ways to increase bone density naturally:

  • Strength Training: Increases mechanical load on bones, stimulating osteoblastic activity. Aim for consistent, progressive resistance exercises. šŸ’Ŗ

  • Plyometrics (Jumping Exercises): Improves bone density through high-impact activities, encouraging stronger bone formation. Examples include jump squats, box jumps, jumping jacks, skipping rope, and squat jumps. I personally love to do plyos on a step (complete with my leg warmers and off-the-shoulder top).Ā ā€¼ļø

  • Walking: Regular weight-bearing activity is gentle yet effective for maintaining and improving bone density. šŸ‘Ÿ

    • Try Magnesium Breakthrough and use code ESTIMA to get 10% off.

    • For vitamins, click HERE and you’ll get an automatic pop-up box discount for 25% off.

    • Getting enough protein is easy with 8 flavors of grass-fed beef isolate goodness. Click HERE and use code BETTER to get 20% off.

  • Nutrition: Ensure adequate intake of magnesium, vitamin D, vitamin K2, and protein to support bone formation. 🦓

  • Sunlight Exposure: Enhances vitamin D synthesis, crucial for calcium absorption and bone health. ā˜€ļø

NOW

āž”ļø Choose one of the above that you are currently not doing and start integrating these bone-strengthening practices into your routine immediately.

āž”ļø Schedule regular strength and plyometric training sessions, daily walks, and supplements into your calendar or set reminders on your phone! This is one of my best tips for remembering to get all these little habits dialled in.

What I Recommend

TAME STRESS WITH THE RIGHT COLLAGEN

Stress does number on your body. Cortisol, the primary stress hormone, directly breaks down collagen, leading to deterioration of skin and connective tissue. Chronic stress not only accelerates collagen breakdown but also disrupts skin barrier function, leading to increased water loss and dryness. High stress elevates cortisol, promoting glycation, which causes collagen fibers to stiffen, resulting in skin wrinkles and dullness over time.

That's why you want a bioactive collagen that effectively counters the effects of stress!

  • Avoid Heat Degradation: High temperatures can break down collagen into less effective amino acids, reducing digestibility and bioavailability. Heat degradation creates cross-links within the collagen structure, making it more gelatin-like, less soluble, and harder for the body to absorb. This is why controlled low-heat processing, like Health Nag’s patented laser technology, preserves collagen’s full bioactivity and effectiveness.

  • Choose Hydrolyzed: Non-hydrolyzed collagen is ineffective because it’s too large to be absorbed. Hydrolyzed collagen is broken down into small peptides that cross the gut lining and are bioavailable to support collagen synthesis in skin, joints, and other tissues. Hydrolysis is key for any collagen to exert real benefits.

šŸ Health Nag’s collagen offers the most unique gel form I’ve seen on the market. And wow!—the delicious green apple flavor doesn’t disappoint. And just in time for spring and summer, Health Nag launched its bioactive collagen jelly in individual packets. Super convenient when you’re on the go or traveling! Learn more and try it HERE. Use code DRSTEPHANIE to save 10%.

KICK-START YOUR PERFORMANCE, ENERGY & FOCUS

I’ve been turning to ketones regularly in the morning before my workouts. Ketone-IQ gives me the fuel I need to power my favorite strength moves in the gym. Check out these mainstay benefits:

  • Appetite Control: Helps manage hunger by promoting a state of satiety. (Pro tip for my Bettys who find it hard to eat before early morning workouts.)

  • Energy & Focus: Provides a fast and steady energy source that crosses the blood-brain barrier. (I have the energy to focus on my workout and also maintain mental clarity to plan and think through my workday.)

  • Performance & Recovery: Enhances physical endurance and speeds up recovery by supporting mitochondrial function. (I don’t cut corners when it comes to recovery, but I do like the benefits of recovering more quickly and efficiently.

šŸ’„ Try Ketone-IQ (with or without caffeine) in several flavors: peach or green apple for me, please! Visit https://ketone.com/STEPHANIE to get 30% off your first subscription order. No code needed; discount automatically applied at checkout.

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

Mini Pause #60: The Hips Don’t Lie: Especially When They Have Bursitis

TL; DR (Too Long; Didn't Read)

Hip bursitis is a common source of hip pain, especially in women over 40. Yay us!

It occurs when the bursae—fluid-filled sacs that cushion the hip—become inflamed. Symptoms include sharp or aching pain on the outer hip, discomfort when lying on the affected side, and stiffness.

The good news?

A mix of movement modifications and training (hello glutes), rehab exercises, and targeted nutrition can significantly reduce pain and improve mobility.

WHY

Women in perimenopause and menopause are more susceptible to hip bursitis due to hormonal changes, particularly the decline in estrogen and testosterone, which impact collagen production, tendon elasticity, and joint lubrication.

These shifts can lead to increased inflammation and a greater likelihood of soft tissue irritation, making conditions like bursitis more common in perimenopause.

And whatever you do–don’t ignore it!

If you leave it, the persistent inflammation can lead to compensatory movement patterns, where other muscles and joints take on extra strain, increasing the risk of secondary issues such as lower back pain, knee problems, or even gait abnormalities. The ongoing pain can make weight-bearing activities more challenging, leading to muscle atrophy and further weakening of the stabilizing muscles around the hip.

WHAT

Hip bursitis is the inflammation of the bursae, small sacs of fluid that cushion the hip joint. The most common type, trochanteric bursitis, affects the outer hip.

It typically develops due to repetitive movements such as prolonged walking, running, cycling, and excessive stair climbing. Clinically, I would always see it in runners.

Poor biomechanics also can leave you susceptible–things like weak gluteal muscles, leg length discrepancies, improper gait patterns, and poor pelvic movement, all of which contribute to uneven stress on the hip joint and bursa.

Estrogen normally gives us great tissue resilience. But when this begins to decline, we are at a higher risk for bursitis developing.

Common symptoms include:

  • Sharp or aching pain on the outer hip and thigh.
  • Tenderness when pressing on the area.
  • Increased pain after prolonged standing or walking.
  • Stiffness that worsens after periods of inactivity.
  • Pain sleeping on the affected side.

HOW

MOVEMENT & REHAB

Modify Activities: If you are experiencing symptoms, avoid prolonged running or repetitive movements that worsen symptoms.

Strengthen Your Peach:Ā Focus on glute-specific resistance training, including exercises such as:

  • Hip thrusts
  • Bulgarian split squats
  • Step-ups (these can be done on a box or a bench or even a Hack Squat Machine)

All of these work to strengthen the gluteus medius and maximus, both of which play a crucial role in stabilizing the hip joint and preventing excessive strain on the bursa. It also makes you look great in jeans…so there’s that consolation prize, too.

I would often add in activation and hip stability exercises like:

  • Clamshells
  • Glute bridges
  • Some sort of abduction movement like lateral leg raises or an abduction machine

Foam Rolling: I don’t know why foam rollers are so controversial (I literally see doctors arguing about foam rolling daily on social media), but I really like them as a way to help relieve pain.

Obviously do NOT roll directly on the bursa but some gentle (key word her Bettys, GENTLE!) release in the glutes and IT band.

Correct Posture & Gait: This one might need some in-person coaching from a chiropractor or physical therapist, but poor posture, such as excessive anterior pelvic tilt (overarching the lower back), rounded shoulders, or an uneven weight distribution while standing, can lead to improper biomechanics that increase strain on the hip.

A weak core and gluteal muscles contribute to instability, further exacerbating poor posture and inefficient movement patterns. Now, I’m not a fan of planks (I hate them if I’m being honest), but I do like hypopressives and stomach vacuums as a way to improve core strength. Core strengthening and improving walking mechanics both help redistribute load.

NUTRITION & SUPPLEMENTS

Anti-Inflammatory Diet:Ā  First the basics: Don’t eat ultra-processed food. Drink lots of water and sleep. You KNOW this.

Key Supplements:

  • Omega 3 is the ultimate anti-inflammatory supplement. 2-4g daily
    • Try BodyBio Balance Oil or Fish Oil+. Click HERE and use code DRSTEPHANIE to get 15% off.
  • Collagen supports connective tissue health and repair. Aim for 25-30 g daily, ideally in a hydrolyzed form for better absorption.
    • Try Equip Foods Grass-Fed Collagen. Click HERE and use code DRSTEPHANIE to get 15% off.
  • Magnesium aids muscle relaxation and recovery. Take at least 400mg daily.
    • Try BiOptimizers Magnesium Breakthrough. Click HERE and use code ESTIMA to get 10% off.
  • Vitamin D & K2 is essential for bone and joint health. Ensure you get at least 2,000 IU of vitamin D daily with K2 for optimal calcium metabolism.
    • Try Adapt Naturals. Click HERE to get 20% off. (A code will appear in a pop-up box when you click the link.)
  • Creatine is an incredible compound showing promise around not only muscle and brain health, but it also has some incredible anti-inflammatory properties for muscles, brain, and bone.
    • Try Create Gummies (my new favorite!). Click HERE and use code DRSTEPHANIE to get 20% off.
    • Try mindbodygreen creatine with taurine+. Click HERE and use code DRSTEPHANIE to get 15% off.

NOW

  • Apply Ice & Adjust ActivitiesĀ 

If your hip is inflamed, apply ice (15-20 minutes) and avoid aggravating movements. This will at the very least provide some temporary relief.

  • Strengthen & Mobilize

Add 5-10 minutes of targeted hip and glute activation exercises (above) to your daily routine. Also, consider some of the glute exercises above in your next leg day session.

  • Nutritional Support

Incorporate anti-inflammatory foods and consider adding collagen, omega-3s, and magnesium to your supplement stack.

What I Recommend

Peptide Protection from Sun & Stress-related Skin Aging

You know I won’t recommend a product unless I’m absolutely obsessed. I use OneSkin because it does what skincare should—it helps your skin become healthier every time you use it.

Right now, I’m loving their sunscreen, OS-01 FACE SPF. (I wore it every day of my recent ski trip. It’s truly an all-season product.) Not only does it give you broad-spectrum UV protection, but it also reduces the effects of previous UV exposure at the cellular level. [*]

All those years you spent baking in the sun? There’s a chance you could repair some of that damage. OS-01 FACE SPF goes after free radicals, too. It’s packed with antioxidants that neutralize oxidative stress, so your skin isn’t constantly under attack. It’s doing the job of your vitamin C serum while protecting and repairing your skin. [*]

Visit oneskin.co and use code DRSTEPHANIE to save 15%.

BONUS! While sun exposure is the biggest factor for premature aging, chronic stress also plays a role. Learn how stress speeds up the aging process and get four tips for mitigating how it impacts your skin in this article.

Health Optimisation Summit Comes to Austin

It’s official! I’m speaking at the Health Optimisation Summit in Austin, Texas! I'll be talking about perimenopausal strategies like muscle, meals, and stress management.

Europe’s biggest health event lands in Austin on April 12-13. You'll hear game-changing health insights from nearly 40 industry-leading experts covering topics from biohacking and nutrition to functional and preventative medicine.

Spend two full days at the Palmer Events Center surrounded by Paleo-inspired wisdom, innovative health tech, and a community that feels like family.

If you purchase your ticket now and use code DRSTEPHANIE, you'll save 10% on VIP or General Admission.

Mini Pause #7: Great Skin Health Inside & Out

How to Make Your Skin Health a Priority–One Habit at a Time

TL,DR (too long, didn't read)

We lose collagen and elastin at a rate of one percent per year, and over time, we often see more wrinkles, poor elasticity, and decreased hydration of the skin. Supplementation and a proper skincare routine can help to reverse the skin aging process.

I’ve outlined best practices in food, lifestyle, supplements, and skin routines in today’s newsletter. The links throughout take you right to the science behind this information.

WHY

As we age, many of us notice changes in skin quality. Dull skin, fine lines, and a loss of elasticity are among the most common grievances in women during perimenopause and menopause.

While fillers and injectables are certainly options, I would put them second in line after a few items well within your control–your nutrition (or your internal health), your exercise habits, and your skin routine (external topicals). All of these can address wrinkles, elasticity, and hydration both from the inside out and outside in.

While you likely won’t see immediate results, when done consistently, you may see a noticeable difference in your skin in about three months.

I’ve made a personal goal to have my best skin ever this year, and it has become such an interesting rabbit hole to go down!

WHAT

Fine Lines & Wrinkles
The facial muscles are a group of about 20 flat skeletal muscles lying underneath the skin of the face and scalp. Most of them originate from the bones or fibrous structures of the skull and radiate to insert on the skin. This is a unique feature of facial muscles–a direct insertion point to the skin.

Other skeletal muscles typically originate from and insert into bone. The insertion directly into the skin is what allows for the face to move.

Years of facial expression start to show up at perpendicular angles to the muscle fibres. For example, the infamous ā€œ11ā€ lines in between the eyebrows are exactly perpendicular to the muscle fibres of the procerus muscle. This muscle originates off the nasal bone and then flares upwards and inserts into the skin of the forehead. It is involved in furrowing or depressing the medial part (inside part) of the eyebrow.

This is in part due to wear and tear, but also an accumulation of oxidative stress, and a decrease in collagen and elastin production. As we age, this can look like a one- to two-percent loss per year.

Elasticity
It’s well known that collagen hydrolysate has several positive biological actions in the body, such as acting as an antioxidant, an antihypertensive, and being involved in lipid-lowering activities, and reparative actions in damaged skin.

Collagen is super interesting because it has a dual action in the skin where it first provides the building block components for collagen and elastin to be synthesized in the body. It then binds to dermal receptors to stimulate the synthesis of collagen and elastin as well as hyaluronic acid.

I think collagen is the heavyweight champ of skin supplements.

Hydration
Drink more water–YES! We all have to do this.

I typically aim to drink 3-4 litres daily. Most days, I settle on 2.5 to 3 litres. One thing that helps me is flavoring the water. I often add cucumbers and blueberries to a big jug. This little action makes the water feel more special.

Another component of hydration is your ability to hold onto that hydration. This is where you might find an electrolyte helpful.

Electrolytes, including sodium, potassium, and chloride, are minerals that carry an electric charge when they dissolve in water. Sodium is a cation with a positive charge (Na2+), while chloride is an anion with a negative charge (Cl2-). Other common electrolytes include phosphorus, calcium, and magnesium.

Electrolytes are involved in:

  • transporting nutrients to cells,
  • transporting waste out of cells,
  • proper function of nerves, heart, brain, and muscles,
  • pH balance, and
  • fluid balance.

Hormones
While hot flashes are often ascribed to ā€œtypicalā€ menopausal symptoms, declining levels of estrogen can have devastating effects on our skin and hair.

Decreased estrogen levels in perimenopause and menopause can look like:

  • skin dryness and itchiness (pruritus),
  • skin thinning and atrophy,
  • wrinkles and sagging,
  • poor wound healing, and
  • reduced vascularity of the skin.

Many women find that using topical estradiol on the face and dƩcolletage area improves the appearance of the skin. This topical application does not act systemically when applied only to the face. However, you must discuss this use with your primary healthcare provider and consider your individual risk factors.

HOW

LIFESTYLE INPUTS
Generally, consuming darker-colored foods like blueberries, blackberries, pomegranates, cherries, raspberries, etc., are great for skin health as they contain polyphenols that love your skin. Salmon, avocados, nuts, and seeds are good foods to be consuming often for their healthy fats.

Resistance Training: In researching for this newsletter, I was delighted to discover that resistance training also positively contributes to healthy skin by reducing circulating inflammation, increasing skin turnover rates, and by thickening the dermal matrix.

  • This is great for women in their 40s and beyond! Why? Because the tendency is for our skin to get thinner with declining collagen and estrogen levels.

Cardio: Tomato-faced cardio bunnies rejoice! Regular cardio is going to be wonderful for improving circulation to the face, which allows the blood to deliver nutrients to the skin.

  • Cardio also helps to increase mitochondrial function of the skin cells and reduce circulatory inflammation factors.

Red Light Therapy: This has been one of the interventions (above resistance training and regular cardio) with which I have noticed the biggest difference.

  • Research shows that red light therapy, or photobiomodulation, improves the enhancement of mitochondrial adenosine triphosphate (ATP) production, cell signaling and growth factor synthesis, and the reduction of oxidative stress.
  • I invested in the BON CHARGE Red Light Face Mask and the Red Light Neck & Chest Mask and I use them daily in the morning when I check my emails. This is a simple habit stack! I always check my emails at my desk, so it’s an ideal time for me to pop these on while I organize my inbox.

Supplements: Collagen Supplementation: A daily scoop of hydrolyzed collagen has been shown to augment the effects of aging including poor elasticity, fine lines and wrinkles, and skin hydration. I add a heaping scoop of Equip Foods collagen or mindbodygreen collagen to my morning water as I’m heading to the gym.

Vitamin D: Vitamin D is well known for improving many hallmarks of skin aging. Here are a few good things that it does:

  • prevents DNA damage,
  • stimulates DNA repair mechanisms,
  • regulates keratinocyte proliferation (keratinocytes produce keratin and make up 90 percent of your epidermal cells), and
  • regulates mighty antioxidative responses.

I love the mindbodygreen Vitamin D3/K2 supplements. I take 4000 IU in the spring and summertime, and pump it up to 6000 IU in the wintertime.

Electrolytes: I use LMNT, a salt-based electrolyte, daily with hot water. My current favorite is Chocolate Caramel. My regular rotation includes Watermelon, Grapefruit, and Raspberry.

OUTSIDE INPUTS
I have incorporated these steps into my skincare routine following a conversation with my friend Dr. Tony Youn on the Better! podcast at the start of this year. This cadence included Dr. Youn’s routine essentials for better skin through topicals:

Morning Skin Routine: 1. Cleanser, 2.Ā Vitamin C or antioxidant serum, 3.Ā Sunscreen

Evening Skin Routine: 1. Cleanser, 2. Retinoid, 3. Moisturizer

I am also becoming interested in peptides and stem cells and their ability to help rejuvenate the skin. Coming up:

  • Dr. Adeel Khan will be a guest on the podcast to discuss regenerative medicine through stem cells and peptides (not just for skin, but aging in general).
  • I’m visiting his clinic to have some peptide treatments done on my skin and can’t wait to share the results with you!
  • And, I’m already knee-deep in stem cell and peptide research and will have a special Mini Pause newsletter on this topic.

NOW

You may have some of these foundations already in place like eating good fats, or resistance training.

I want you to pick only one item from the HOW section that you want to incorporate into your existing skin routine. One of the best ways to make it ā€œstickā€ is to pair it with something you are already doing. For example:

  • I put collagen into water I am already taking to the gym.
  • I use my red light face mask when I am seated and already checking my emails in the morning.

Habit stacking is an efficient way to make a small–and significant change–to your routine that won’t be overwhelming. This way the new habit is not an extra step, it is blending into an existing one.

YOUR TURN!

What are your skincare questions? Which one of these steps are you going to try? Let me know at support@drstephanieestima.com.

Discover Beauty That Fits Your Style

When I find something awesome that makes a difference in my health, I want to share it with my Bettys. So, if you vist the items I’ve shared in today’s newsletter, here are discount codes for you to use. I hope you love these products as much as I do!

  • Equip Foods collagen; use code DRSTEPHANIE
  • mindbodygreen collagen; use code DRSTEPHANIE
  • mindbodygreen vitamin D3/K2; use code DRSTEPHANIE
  • LMNT electrolytes; direct link to free sample pack with purchase
  • OneSkin peptide skincare (cleanser, sunscreen, moisturizer); use code DRSTEPHANIE
  • Timeline Skin Health serum; use code ESTIMASKIN
  • BON CHARGE red light masks; use code DRSTEPHANIE
  • Bonus! In a previous Mini Pause issue, I mentioned my love affair with Rose Best Skin Ever and Rose Glow Serum by Living Libations. They are both divine in a bottle! The link auto-applies a discount at checkout.

Question of the Week

Q: What about fibre?

From the Bettyverse: Thank you, Gabi, for asking for more about this topic!

I have a question related to the comment about fibre. There seems to be so much conflicting information about whether we need fibre at all. For instance, I hear of the carnivore diet being good for autoimmune issues and as long as you have enough dietary fat (not too much, not too little) you will have normal bowel movements. But I've also heard that women benefit from fibre to rid the body of excess estrogen.

My personal issue is inflammation of my joints. (For context, I'm 45, perimenopause (regular cycles, low progesterone/ estrogen dominant), and have been healthy keto for five years. I manage everything through diet and appropriate supplements. )

Could you say more about whether we ā€œneedā€ fibre and why? And the place of plant-free/fibre-free diets like carnivore?

WHAT THE SCIENCE SAYS

This is a multilayered question and I will try to address all of it succinctly.

I guess the short answer here is, you–need fibre. Full stop. I don’t care if the carnivore community says it isn’t important. That is inconsistent with the robust amount of literature and clinical outcomes that say otherwise.

A staggering amount of evidence demonstrates that fibre consumption reduces heart disease and cancer. (Another meta-analysis review here.) fibre has an unwavering and amazing ability to reduce LDL cholesterol. Many studies have demonstrably shown a 20-25% reduction in LDL cholesterol levels with adequate fibre intake.

In cancer risk, more fibre consumption has best shown a reduction in colorectal cancer by about 20%, as well as other cancers we care about like ovarian and breast cancers. Fibre plays a role in the estrobolome (the area of the gut dedicated to processing estrogen) and does help to bind to and get rid of estrogens.

KEY POINT

If you are going to eat a lot of meat, it is probably a good idea to pair it with a lot of fruit and veg.

Typically, individuals who eat high amounts of meat often miss out on the opportunity to consume foods with fibre. That does drive up the risk for heart disease and cancer over the long term.Vegan ideology might be tempted to conclude that it is meat consumption that drives heart disease and cancer. Hear me on this: it’s the lack of fibre consumption in individuals who consume meat that drives up cancer risk.

Clinically, this is where we need to think with a little bit of nuance.

SHORT-TERM VS. LONG-TERM BEHAVIOR

Going carnivore for a year, in the grand scheme of your 85+ year life doesn't affect health outcomes. Just like if you have elevated LDL cholesterol levels for one year in the context of 85 years of healthy LDL cholesterol levels also doesn’t marginally affect outcomes. What is far more important is the chronic elevation of LDL over many decades that drives up the risk for these multifactorial diseases.

Imagine it another way. Remember when you were a silly, naive teenager and did dumb stuff with your friends because you thought you were invincible? While the activities you engaged in (and compounds you ingested) were probably really bad for you at the time, they aren’t going to be predictive of health for your entire life. It was a year, or two (or five) of doing dumb stuff. And then you came to your senses and corrected your behavior.

Now, before you send me a message about why I am hating on carnivore and how great the carnivore diet was for you–I get it! I, too, have used carnivore interventions in autoimmune patients with great success. The big idea I am trying to convey is that the intervention, while it worked in the short term, is designed to be transient. It doesn’t last forever.

Because the diet you need when you are sick is not the same one you need when you are well.

YOUR TURN!

I'll be answering your questions every week right here in the Mini Pause! Let me know what's on your mind. I'll be checking for both questions and feedback at support@drstephanieestima.com.