Strong Bones For A Strong, Long Life With Perry Eckert

Lisa: Well, hi everyone, and welcome back to the show. This week I have Perry Eckert, and Perry is the master franchisee and CEO of OsteoStrong, which is a system to help you make your bones stronger. So today's episode is all around osteoporosis, osteopenia, sarcopenia, what you can do to prevent it, why it's important that you consider doing something to make your bones strong, the risks that are associated with having osteoporosis or having a lack of bone density as you get older, and their system and the way that they use their machines to increase bone density, which is really, really fascinating.

Lisa: He also gives us a lot of background information on the science behind bone density and why you need to be — what you need to do from a nutritional and supplementation point of view, as well as your training point of view. So really an interesting podcast today with Perry.

Lisa: Before we head over to the show, I've got some exciting news. I've just released a book called Thriving on the Edge, which is an interview series with some of the world's top athletes. So elite athletes, ultra endurance athletes of course are in there, quite a number of them, people like Dean Karnazes, but also people like Sir John Kirwan from the rugby scene, Conrad Smith from the rugby, we've got Ray Zahab, we've got also a number of people who have had disabilities and done extreme sports. Anyway, so make sure that you check it out. It's called Thriving on the Edge, and it's all about the mindset of a winner, the mindset of athletes, what we can learn from extreme athletes, and I hope you enjoy that. That's over in my shop. If you go to shop.lisatamati.com, hit the books, Lisa's books, you'll see all my books there: Running Hot, Running to Extremes, Relentless, and What Your Oncologist Isn't Telling You, and then the latest one, Thriving on the Edge. So make sure you check all of those out.

Lisa: I've also just launched a new company called Avam Labs, and you'll be hearing more about this in the coming months. I've teamed up with some top people, so stay tuned. It's a longevity and anti-aging supplement range that we're going to be launching in the next few months. So it's going to take us a little bit of time to get organised. You'll still see all the other great supplements that I have in my existing shop over on lisatamati.com, but we're going to be doing some specific longevity and anti-aging supplements, so stay tuned for that as well. Really, really exciting stuff going on here. So without further ado, now over to the show with Perry Eckert.

Lisa: Well, hey everyone, and welcome back to Pushing the Limits. Today I have Perry Eckert with me. Perry, welcome to the show. Fantastic to have you here.

Perry Eckert: Hello Lisa, how are you?

Lisa: I'm doing better than you, probably, because it's 6 AM where you are and you had to get up early, so I've cut your sleep short. Apologies for that. Perry, we're here today to talk about something that's very, very important. Can you give us a little bit of a background before we get into OsteoStrong and what that's all about? Can you give us a little bit of a background about yourself and where you come from, so we can introduce the listeners to you?

Perry Eckert: Sure. My name is Perry Eckert and I'm the master franchisee for OsteoStrong in Australia and New Zealand. We've been here for coming up four years, during the lovely COVID, which has obviously had a big impact on most people's lives and the health and wellness business in total. So my background is health and wellness. I've had a lifelong interest in biohacking, extending my lifespan as well as my health span. I'm an avid biohacker, if you understand that term.

Lisa: Oh yeah.

Perry Eckert: And I've probably spent the best part of my life exercising in some form or another. I'm not medically qualified, but obviously that does not affect what we do, because we are an exercise programme in the truest sense. OsteoStrong is physical medicine. It's built around Wolf's Law, which is from the 1890s. It's one of the only medical laws still taught to doctors today, based around the concept that bones adapt to the forces we apply to them repeatedly. My other background is in manufacturing. I have a global manufacturing business, we do supply into New Zealand. We don't have any OsteoStrongs in New Zealand unfortunately yet.

Lisa: Not yet, hopefully.

Perry Eckert: We have eight in Australia and more than 175 worldwide.

Lisa: Wow, that's pretty amazing. So the law that you mentioned there — bones, when they're put under stress... because I've got a background as an ultramarathon runner and people are constantly asking, "Aren't your bones in trouble? You've run all those distances, aren't your knees worn out?" And after 70,000 kilometres or so, no. Because I'm a true believer that the more you use something, the body responds and adapts to it, and we need to put our bodies under load — not overloading, but we need to load them in order to keep them strong. Is that sort of the principle that goes behind this law? Is that what it's all about?

Perry Eckert: The short answer is no, the long answer is yes. Obviously we do adapt, both muscles and bone, to forces. It's important though that there are dose requirements. So running, jumping, skipping, hopping — many of the exercises that the average person would be involved in — if you go to a doctor with a bone issue, the doctor will advise you to apply loads to bones, which from a functional perspective, if you're running, jumping, hopping, skipping, you load those bones appropriately and you're able to continue doing those activities as you age. If you stop doing them, they become deconditioned. If you continue doing them, they stay conditioned. What has become deconditioned can become reconditioned, so people can not run and start running, and likewise they can be a runner that stops running and ends up on the couch. The question you're asking though is, does that sort of exercise improve your bone density? The short answer is no. You need a minimum impact to grow bones strong.

Perry Eckert: So perhaps if we get into why it's important to have good bone health. Obviously as you age, you get weaker bones. So we reach peak bone density at about age 30, and from age 30 you start to lose one to two percent of your bone mass per year. Men lose less than women — it's a hormonal condition. Certainly during menopause, women lose between two, three percent and six percent per year.

Lisa: Wow.

Perry Eckert: So by the time you're age 60 — we were all meant to be dinosaur poo by then, and physiologically bones haven't changed from those early days — we can have a skeleton that's between 30 and 60 percent less in mass. And for women in particular that means they're at high fracture risk. For men, less so, but men go through manopause or andropause in their 70s due to reduced testosterone, and they go through the same process where they'll lose some bone density there.

Perry Eckert: The upshot of that component is bone density. The second part of the equation is obviously loss of muscle mass. So as we do less as we age, we have two things that happen. Firstly, your central nervous system can't hold as much signalling for bone density, so we also reduce our muscle mass. The skeleton determines how much muscle mass we can hold — the less muscle we have, the less skeletal mass, and vice versa. So an ageing person typically gets what we call sarcopenia, which is a loss of muscle mass, but they also get dynapenia, which is a loss of muscle strength. So a combination between all of those things is a loss of muscle mass, leading to bone mass loss and vice versa.

Perry Eckert: We can get a combination of what we call osteoporosis or osteopenia. Osteopenia is low bone density, osteoporosis is where a lot of bone has been lost, and there's a score system which doctors use to evaluate that. If you've got osteoporosis, you're a high fracture risk. Osteopenia is heading in that direction and is a warning signal. So you can be osteopenic, osteosarcopenic — a combination of the two, osteosarcopenia — new terms which refer to the ageing process in general. It's a natural process, it isn't necessarily a disease, it's just a condition of ageing. Some people do though have physiological reasons why they lose a lot of bone density either early or later in life, and they're at higher risk than the average person. But it's something that affects most people in their life, either directly or indirectly. One in three women, one in five men, by the time they're 60 years old.

Lisa: One of my teachers and mentors is an orthopaedic surgeon and longevity and regeneration specialist, and she says — I've forgotten the exact stats — but if you break your hips or your pelvis after the age of 65, I think it was, you've got a one in two chance of dying within the next year. And people forget that this is one of the major killers, is having a lack of bone density. We all know about heart disease and cancers and all these risk factors, but actually if you break your hips or pelvis, that's pretty much a death sentence right there, and that happens very quickly.

Lisa: And hormones play a huge role. I've talked on a number of podcasts about hormone replacement — bioidentical hormone replacement under the guidance of someone who knows what the heck they're doing can be valuable for supporting bone density as a piece of that puzzle, so to speak. But what about the argument that people give to me — like in general when I'm talking about supplementation, they're like, "Well, do I need supplements, because I eat a healthy diet?" That's always a relative term anyway. And then, are supplements enough, or is that still not enough? Your calcium, your vitamin D — calcium's got pluses and minuses, vitamin D, all of those sorts of things. Are they an important piece of this bone density puzzle or not?

Perry Eckert: Not — it's not enough. So I say to people, if you sit on the couch and you drink a protein supplement, will you get stronger muscles? The answer to that is obviously no. So if you eat a healthy diet, you take vitamin D, you're getting sunlight, you take a calcium supplement, and you walk around the block occasionally, which is what the doctor tells you — will you get stronger bones? The answer is a clear no. Our body, our central nervous system, needs the adequate dose required to trigger what we call osteogenesis, which is bone growth.

Perry Eckert: So our bones have two specialised cells, osteoblasts and osteoclasts. Up to age 30, osteoblasts are the cells that eat away old brittle bone, and osteoclasts are the new cells that come along and deposit new healthy bone. This bone remodelling process is constant and continues during your life, and normally the balance is that osteoclasts are above osteoblasts, but due to hormonal changes as we age, after 30 it swaps around, so we see a net loss of bone mass.

Perry Eckert: Having all of the nutritional requirements is one tick. I would question that most people don't have adequate nutrition, and there's a big list of things that people need to keep healthy bone. So bone isn't calcium, it's 35 percent collagen, and the collagen is there — it's a protein, it's one of the amino acids — it's there to keep your bones flexible and to be able to walk, run and jump. It's a functional part of bone architecture. Vitamin D is one of the minerals, it's the main mineral in the balance of the 65 percent, and we use the calcium from the bone in blood as part of that normal metabolism, and it's something that's very important that

Perry Eckert: ...we have adequate vitamin D. But in today's diet, most people get — sorry, with calcium, most people get enough calcium in their diet.

Lisa: Yeah, they don't need to supplement generally.

Perry Eckert: The other vitamins and minerals — so vitamin K2 is like a traffic cop that tells the calcium where to go. If you're not getting vitamin K2, and you take calcium supplements, you're likely to get kidney stones or blocked arteries. There are upsides and downsides.

Lisa: That's a really important point. I want to pause there and just reinforce that. I never give any of my clients a vitamin D3 supplement without a K2 MK7 attached to it, and generally don't supplement with calcium unless there's some particular reason to, because as you say, we do generally get enough calcium in our diet. And if you take it wrong — the traffic cop needs to be there to put it into the bones and the teeth and the places where you want it, and not into the arteries where you don't want it, or kidney stones, as you said. I just wanted to pause on that point, and sorry to interrupt, but just to double down on that one, because it's a crucial point.

Perry Eckert: So if you're getting enough calcium, you need the vitamin D obviously, because it aids the absorption of calcium in the gut. But then you've got magnesium, manganese, zinc, boron, copper, iron — there's a number of other vitamins and minerals that are in trace, very important to bone metabolism and the processes that we go through. So it's not just one thing.

Perry Eckert: The other important component is protein. It's overlooked in many diets, certainly vegetarian and vegan diets — it's more difficult to get adequate protein. And we know today that the minimum dosage, which is 0.8 grams of protein per kilogram of body weight, is probably not sufficient for bone and muscle growth.

Lisa: Yeah, agreed.

Perry Eckert: The number is hotly debated, but it's somewhere between 1.2 and 1.5 grams, and certainly if you're an athlete or someone who is performing muscle exercises, then the higher limit of something like 1.5 is necessary. The second component to that is: are you getting digestible amino acids or protein? When I look at that personally, obviously meat is the best source. There are complete proteins in vegetables, but they're not always bioavailable. And I quote to people the example that they currently use, which is the DIAAS score, the digestible indispensable amino acid score. DIAAS, in short, is the protein quality score. If you compare a small beef steak to three large peanut butter sandwiches that are half an inch thick in peanut butter, then from an amino acid score, from the digestibility of that amino acid, they're equivalent — but the calories are very different.

Lisa: Yeah, so this is one of the problems.

Perry Eckert: Yeah. If you're getting sufficient amino acids through a vegan or vegetarian diet, it's something to be mindful of — the calorie load. And one of the other aspects of bone density is BMI. Obviously the body mass is something that comes into consideration, both high and low. So we see a lot of very thin women who look trim and terrific in middle age. They might do Pilates, they might do some other form of yoga, but they typically score only 50 percent in functional strength testing. So they're not getting enough heavy weightlifting to develop fast twitch muscles. They've got a strong core, they've got great balance, they've got all the benefits that Pilates and yoga add, but they're not getting heavy weightlifting, they're not stimulating bone growth, and they're not particularly strong. So their risk in older age of developing osteoporosis and then falling and fracturing...

Perry Eckert: When you look at balance, it's a critical component of fall and fracture risk. Balance is a number of components. It's the proprioception as to where you are in time and space, it's the muscle strength to be able to recover if you stumble, and it's also the reflex speed to be able to get your foot out quick enough. So a combination of fast twitch muscles, adequate muscle strength and good balance combined. Perhaps Pilates and yoga are not enough for that. They're great exercises, I encourage people to do cross training in a range of things, and OsteoStrong, which we'll get to in a minute, is just one of the components of functional health. And it's not something that you can replace easily and safely. So the heavy weightlifting component of what we do is the safety aspect — being able to lift heavy weights safely as you're older, and particularly if you've got low bone density, is a real challenge for most people.

Lisa: Yeah. I do genetics in my practice, and there's a genetic component as well. You can have people who have more muscle and bone mass from the get-go. For example, my mum is one of those people, and people who listen to my show know that I share a lot of stories from her journeys because there's so much learning in them. She had an aneurysm, stroke and cancer and was meant to die 100 times and still hasn't. But we have to do weight training, we have to do balance training, we have to do all of these aspects, and she's still at massively high risk of falls because of her balance from the brain damage. That's of massive concern to me. So I do whatever I can on the balance, and then we do a lot of weight training.

Lisa: I'm a big proponent of women, especially over the age of 40, really getting into their weight training — and we'll get into OsteoStrong in a minute, and the specific types of what you do. But to me, it's more important, I'd say, from the age of 40 onwards, that a big component of your training, your cross training regime, is lifting heavy stuff in some way, shape or form. Because if you're just doing cardio — and I see a lot of women doing this, and God knows I did it for decades, where I just ran and ran and ran and ran — it doesn't cover all the bases. You need to be thinking more of a holistic sort of point of view, with your Pilates, your yoga, your balance training, your reaction training, your speed, all of these things, which is really difficult to do. And we don't need five hours running on a treadmill every week, or running outside. We don't actually need that much of the cardio — dialling that back a little bit, unless you've got a specific training goal for a marathon or something, then go for it. But don't neglect, is what I'm saying, this other side of the equation.

Lisa: This is where, like, OsteoStrong — when I heard about it through my colleague Dr Elizabeth Harris, she was like, "Oh, you'll be into this, this is fabulous." So let's dive into a little bit about what OsteoStrong is specifically, and how and why did this come about, sort of thing?

Perry Eckert: Dr John Jaquish was the inventor of OsteoStrong in America, and his mother had a bone T-score, which is the comparison of your score compared to a healthy 30-year-old. She had a T-score of minus three, which was in the osteoporosis range. He was doing his medical course in science, and he decided to look at the reasons for why people develop osteoporosis, and whether there was a cure in some physical medicine. So he developed a piece of equipment that emulated high impact. He looked at gymnasts and found that they had the highest bone density. So when a gymnast spins through the air and lands on the ground, they're absorbing up to 10 times their body weight.

Lisa: Wow.

Perry Eckert: And that impact, he discovered, triggered osteogenesis, or new healthy bone growth. So he set about to build a machine or a piece of equipment that put you in your strongest biomechanical position. So if I use my arms as an example, when I bend my arms at 120 degrees and I'm in that position where I would absorb a fall, I'm 10 times stronger there than through the full range of motion. I'm quite weak back here and I'm quite weak out here, but here I'm 10 times stronger.

Perry Eckert: So he looked at the upper body machine, and there's a lower body machine, one for your spine and one for your core rib cage, and built these four robotic machines that adjust to your specific body size and shape. So you sit or stand on these machines, you're in your strongest biomechanical position, and you apply a self-applied load. So nothing moves on the machine. You hold the handles and you push, pull, lift. The core machine is like a chest core press, but it's quite different. So they're not isometric exercises, but they are a one-exercise maximum. You hold a position, you apply your load to your maximum comfortable level, and then you relax. It's a one-on-one machine, in that you do one exercise on each machine and you're fully supervised one-on-one with a coach. So we make sure you're in the correct body position and that the load you apply is quite safe, that you don't lock your elbows or get into a dangerous situation. And that reduces a huge amount of the risk.

Perry Eckert: Obviously older people can't do a triple front somersault and land on the ground. They can't stand on a table and jump off. So being able to apply that sort of load that they do — and I'll give you some examples. Most people in a leg press type machine can press — women, older women, 60, 80, maybe 100 kilograms if they're lucky; men can get up to perhaps 200 kilograms safely. On our equipment, we start with what we call a slow start programme, where older people are generally just put on the machine and asked to press until they're comfortable, or lift until they're comfortable. And over a period of literally months, we build up their grip strength, their forearm strength, the muscles that connect, because it compresses not just bones, but muscles and tendons, ligaments, fascia, etc.

Perry Eckert: And so, to prevent that person from being or feeling uncomfortable or in pain or soreness — remembering that in a gym, young people, no pain no gain, they crawl out of the gym and they think that's great. An older person goes into a centre and if anything hurts, they automatically think that's an injury. It's not. It could be a muscle compression, it can be activating a muscle that hasn't been switched on for 20, 30 years. Obviously it's going to complain and they'll have an ache or a pain, and they'll go to the doctor, and the doctor will say, "If it hurts, don't do it." In our centres, the slow start programme prevents that from happening in the first place. So we keep people highly safe and connected to their body, and we slowly work up to a level where they are able to apply a force.

Perry Eckert: So this isn't lifting a weight or moving a weight through time and motion, it's being able to apply a force far in excess of what they can do in normal weightlifting. So for example, on the leg press machine, I'm now able to exert a force of over a ton.

Lisa: Wow.

Perry Eckert: Yet in the gym, I can only leg press several hundred kilograms.

Lisa: Wow.

Perry Eckert: Now, going back to Wolff's Law: if bones adapt to the forces we apply to them, and I'm leg pressing 200 kilograms, my bones adapt to that level of force. But if I go to an OsteoStrong centre and I'm able to exert a thousand kilograms, then I can obviously adapt to that level of weight, and it's a significant increase.

Perry Eckert: So we'll take one step back and look at why certain exercises don't trigger osteogenesis and why some do. So there was a study in 2012 by Deere...

and others in the UK that looked at running, jumping — the exercises that kids do up to age 18 — and they determined that a force of 4.2 multiples of body weight was necessary to trigger bone growth, healthy bone growth. Forces under 4.2 did not trigger bone growth.

Lisa: Wow.

Perry Eckert: We come forward, there was a study in 2015 that looked at high impact aerobics for women. Premenopause, 3.9 multiples of body weight, which is the maximum you can do in a high impact aerobics class — premenopausal women had a reduced rate of loss of bone, but didn't gain bone. Postmenopause, 3.9 had no effect. So we knew that from the Deere study: 4.2 multiples of body weight, which means if, for example, you weigh 50 kilograms, you've got to be pushing over 200 kilograms to get a response in the bone in the hip and femur.

Lisa: Wow.

Perry Eckert: Now that's a significant amount of load. Walking, running, jumping do not get to that load. Swimming and cycling in fact deload bones, so you get mature age cyclists, ballerinas, very lightweight women who don't exert weights — they're never getting near those limits with any exercise they do. Certainly yoga, Pilates, most gym exercises, even lifting weights, don't get to 4.2 multiples for hip and femur. Which is why when you go to a doctor and the doctor says, "Ensure you have good nutrition, make sure you take the right supplements, and of course the exercise, do that, whatever that may be, or take a drug" — he knows the dosage for drugs, he knows the dosage for supplements, he knows the dosage for food, but I'm giving you the finger. That's what happens with osteoporosis. You might as well just drink water, because typically doctors don't cure osteoporosis. They may reduce the rate of loss, they may address some of the deficiencies in your diet, and if they do extensive blood tests and look at P1NP and other components of blood that indicate either bone breakdown or bone deposition, then they may be able to direct you in the right area. But most doctors don't do the blood tests, so they don't necessarily know what the pharmaceuticals that you're on are doing. They have a toolkit, obviously doctors have a toolkit, and that's what they work with and they know what they're doing, but from a dosage perspective in exercise, they don't.

Perry Eckert: And that's where OsteoStrong steps in. We know that there are not only a minimum load dose, but in the case of the legs there's a rapid growth trigger, which is 7.6 multiples of your body weight. So if you can trigger that, we know from our studies you'll get a significant improvement in bone density, provided the physiological aspects of your health otherwise are okay. Because there are many things that can prevent you from building strong bones. There are many drugs that you take, there are things that people do they're not aware of. They may have something like antacid tablets, which can be Mylanta, which is aluminium containing, or Nexium, which is a proton pump inhibitor — they prevent you from growing strong bones. You can be on antidepressants, immunosuppressants, androgen deprivation drugs, glucocorticoids, which are steroids for inflammation or some form of allergy. Those drugs all interfere with the bone pathways. And then early menopause, low testosterone — there's a series of things. Diabetes, cancer drugs, all interfere with bones. And then there's the nutrition component: they're not getting enough protein, they're not getting enough collagen, they're not getting K2, so the calcium's going to the wrong place, they're not getting sunlight, which is why in the northern climates, Northern Hemisphere, Nordic countries, a lot of them have extremely low bone density.

Lisa: That's right. Wow. There's a lot there. Just a couple of comments on that. One of my pet problems is proton pump inhibitors. They do so much damage and they're given out like candy, as if they're really benign drugs, which they're not. They should only ever be used for short-term use. They cause protein synthesis problems and mineral density problems and nitric oxide problems and therefore cardiovascular problems, and there's just so many reasons to get off proton pump inhibitors or antacids. So that's one of the pet things that I try to get people to understand, because most people just think they're benign. They're not.

Lisa: And then steroids are often used for so many things. And I see a lot of cancer clients and of course they're on some heavy duty stuff that really interferes, and often on steroids as well, and that can have massive impacts on the bone density. Or if you've had breast cancer or prostate cancer and they've wiped out all your hormones, that of course is a massive problem — it ages you quicker. Or women who have gone through hysterectomies early and/or gone through early menopause, these are all reasons for that process to speed up. And one of the reasons why you try not to have those things. I mean, sometimes you've got to, but I do think we often take out hysterectomies too quickly. In my own life, they told me I needed to have a hysterectomy or die, because I had fibroids and I was bleeding to death. I didn't die and I didn't have a hysterectomy, and one of the reasons I didn't want a hysterectomy is because I didn't want to age faster, I didn't want my bone density to go down, I didn't want to drop all my hormones off a cliff. So yeah, there's so many pieces to this puzzle, as with the body.

Perry Eckert: Yeah, and look, we haven't touched on malabsorption syndromes. So this is something that most people don't understand, the link between obviously some sort of irritable bowel or SIBO or candida, fructose intolerance, lactose intolerance, coeliacs. Anyone that's got a problem with the gut, they have to understand that that's affecting the gut lining, which is affecting the absorption of vitamins, minerals and amino acids.

Lisa: Huge.

Perry Eckert: And that doesn't include a whole range of parasites that people have — hookworm, threadworm, various other infestations, infections similarly. Everyone I know just about has some form of digestion problem at some point in their life. I think someone said the other day that half of all Americans have candida. All of those aspects to bowel health affect muscle and bone health in some way, and some of these problems are systemic, long-lasting, and they'll have a devastating effect on bone density in time.

Perry Eckert: So in our OsteoStrong centres we obviously don't do medical screening in those areas, but we do analyse the results of the people coming through our centres quarterly. So every person that comes through, we have an expected improvement in both muscle strength, balance and bone density. We test for those regularly. So we see, typically of a healthy person that's getting the correct nutrition, a 14.9% improvement in bone density in the hip and femur and a 16.6% improvement in spine over a period of six to seven months. We also see a 290% improvement in muscle strength over three years with an average 65-year-old. We see a 77% improvement in balance in as little as five sessions.

Perry Eckert: So with these standard improvements, if someone comes to an OsteoStrong centre and after six months or a year they get no improvement, we know there's something physiologically wrong with them, and we then start a different investigation. They're coming to our centres obviously to get bone density improvement, but we see our members reducing joint and back pain, improving walking gait, improving their posture — they're obviously able to stand taller, straighter. The effect of not improving their bone density is a red flag to us, because it tells us to investigate further. Normally it's something to do with the thyroid, so there's a hormone imbalance — that's the most typical — but it can be nutrition, it can be other areas of their medications or contraindications between medications. So that investigation then identifies usually a medical issue that is also serious and can be rectified, and then once that's rectified, they can continue their bone strength journey with us. But in the meantime they've got better balance and we've reduced their fall and fracture risk, and you've identified something else that needs to be looked at.

Lisa: Yeah, because this is always multiple components, and this is the thing I think with everything in functional medicine and functional health — we've got to look at the whole big picture, because the body is extremely complex. And when we go and throw in anything from a supplement to an exercise to a drug, we're pulling a hundred different things at the same time and all these genes are turning on and off, and as much as a lot of people seem to want to think that they know everything, none of us do. We're actually pulling levers on things that we don't always understand 100% of the time. So we've got to do the best with the knowledge that we have at the moment and try and come up with a good holistic sort of a programme, and OsteoStrong seems like a really good piece of the puzzle.

Lisa: I wish there was one in my hometown. I'd get Mum in there immediately, not to mention myself, because I think anyone over the age of 60 at least — I mean earlier really — but really needs to pay attention to this, because it is a major, major killer. It's a killer. It's not just, "Oh, I've got a bit of osteoporosis, it doesn't really mean anything." This is something serious. And I've seen women in their 40s that have got osteoporosis already, and very light, delicate ladies often especially, that just really need to look at this even earlier than other people.

Lisa: So how many centres in Australia do you have?

Perry Eckert: We have eight at the moment. So in New South Wales, Manly and Crows Nest. We have three in Victoria, two in Melbourne, in Hawthorn and South Melbourne, and one in regional Ballarat. One in Adelaide, in Colonel Light Gardens. Two in Tasmania, Hobart and Launceston. So that's the eight we have at the moment. There are 150 in the United States.

Lisa: Wow.

Perry Eckert: And they're in 12 other countries — Iceland, Denmark, Norway, Greece, UK, Mexico, Portugal — quite spread out. But we're growing rapidly and there's probably another two or three countries in the next 12 months. And we have in plan at the moment several more in Australia. We're talking to some people in New Zealand at the moment.

Lisa: Hopefully, yeah, hopefully that will happen. It's certainly something that I'm very passionate about.

Perry Eckert: And it is not just bones, muscles and balance, it's also a number of rejuvenative technologies. So in our centres we have red light.

Lisa: Oh, I love red light. I have a red light clinic.

Perry Eckert: We have hydromassage therapy, which is an incredible bed that you lie on with a rubber membrane and hot water jets go up and down your body, so in 10 minutes you get an equivalent to a one-hour massage. We have pulsed electromagnetic field mats.

Lisa: Also on my radar. What do you think about that? I'm investigating that at the moment for my clinic and for me.

Perry Eckert: Yeah, very good. Cellular energy, anti-inflammatory. Certainly for longevity it's something that — earthing is a critical component to cellular health, something that we don't do anymore. We walk around in rubber-soled shoes and carpets and artificial floors, we never get out on earth. And so if you're a — you're

Perry Eckert: — a Tesla fan from the late 1800s, early 1900s, then earthing is a critical component of cellular health. We also have Normatec compression boots, and that's about lymph and blood flow.

Lisa: Yep, I've got some of those.

Perry Eckert: And these are all fabulous longevity —

Lisa: You're talking my language here, so this is biohacking 101. So we talk about lymph and blood flow, cellular energy, earthing.

Perry Eckert: Meditation — something we don't do enough of. Women that come into our centre don't get "my time". They don't get a period in a day where they don't have to be somewhere or do something for someone else. So to be able to come into our centre and to relax for 10 minutes and just purely meditate and concentrate on nothing but themselves is a rarity. We're always under bad stress today, so we're always switched on, we're under stressful conditions that cause massive inflammaging, I call it.

Lisa: Yep.

Perry Eckert: And if you can go somewhere where you can relax, meditate, calm down — all of the feel-good hormones we chase you with, with our four big machines. I call them the four big dinosaurs, where we put people into a flight-or-fight response mode and then they escape from those four dinosaurs. So they come out, they've got feel-good hormones racing, their balance is improved, they're connecting at a cellular level with muscles, tendons, ligaments, their balance, proprioception at a level that they've never expected or experienced before. It's the lift-the-car-off-the-baby moment. And they do this every week, and those feel-good moments every week just load upon each other. So we get people cancelling hair appointments and cancelling other appointments, but they don't cancel their OsteoStrong appointment. They come every week. It's something quite unusual in the health and wellness business. Typically only about 25% of people that join gyms use them regularly. We get 100% attendance at our OsteoStrong clinics.

Lisa: Wow.

Perry Eckert: So there's something in what we do that triggers, at a hormonal level, the feel-good moment, and people walk out with their feet off the ground. They don't quite understand why they feel so good. When you come to an OsteoStrong centre you don't get sweaty, you come in the clothes that you're dressed in, you don't have to put on sports equipment. And we deal with people — the youngest is probably 15, the oldest is 95. Provided you're not under intense pain, provided you don't have muscular dystrophy or unmedicated hypertension or an active hernia — they're the contraindications to our science — most people that walk in walk out feeling better than when they walked in.

Perry Eckert: The component of joint and back pain is a side effect of OsteoStrong. It's not something that we advertise or talk about, apart from in shows like this. Typically when you have a joint that's in pain and you move it, you cause more pain. But there was a study — it was by Benjamin and Ralphs in 2009 — and it showed that when you compress a joint and relax it, you pump synovial fluid out of tendons and ligaments into the joint. You get hyaluronic acid and synovial fluid and blood plasma into that joint, and as you relax the joint, those fluids with metabolic wastes get absorbed back into the tendons and ligaments. So over a period of time you're getting this injection of fluid into the joint every week.

Lisa: Wow.

Perry Eckert: And you get a slight lubrication, you also get blood flow, so tendons, muscles, ligaments around the joint capsule get stronger. You feel less pain, so you start to be able to move a little bit better. The more you move, the more you can move, until the point where you get that joint mobile again. So usually within five to ten weeks people report significant reduction in joint and back pain.

Lisa: And this would be so good for people before you go to surgery, before you take the drastic step. I broke my back when I was 21 and I had two discs that were completely buggered, and now I've got four discs that are completely buggered, but I have absolutely no pain because of what you've just said. I don't have OsteoStrong around the corner, but I do a lot of loading and a lot of heavy lifting, and I keep my core really strong, and I have an anti-inflammatory diet, and I put in supplements like hyaluronic acid and glucosamine and all of those sorts of things and other things, and I don't have any pain anymore, despite the fact that those discs are not in good shape — they're bone on bone. But I used to have hellish pain, and I used to have like 10 seizures a day where I'd be like this on the floor. And I never thought that I would ever get to a pain-free state, but I am, I'm completely pain-free. And I didn't have that when I was a 12-year-old, because I was a gymnast as a kid, so I had pain from the age of at least 12 years old onwards. And now at 55 I don't have any pain and I haven't had an operation. And they said, "You need to fuse all of the discs in your back," and thank God I didn't. Instead I went the route of trying to work it out myself, and it took many years and lots of playing around and tweaking and doing. But it's just an anecdote, it's an n of one.

Lisa: I know that joints can be extremely painful. You also get a lot of people who have a lot of back pain and actually it's a gut problem. They've got SIBO or they've got a problem in the gut going on and that's pulling and causing the pain. So looking at the whole anti-inflammatory lifestyle, diet and exercise and supplements and all of that is also an important point. So I just wanted to reinforce what you said. I do a lot of yoga and things like headstands and stuff like that, which put a heck of a load on your neck, right? But actually my neck's gotten better by doing just that, because I am putting load on it. And it's a bit like compression when you use a flossing band around a muscle, work that joint out and then let it go and you let all of the blood flow back in and push all of that stuff back out of there — all the bad stuff that's there — and bring the new stuff in, so to speak. All of these little tips and tricks that you can add to your regime to sort of get you where you need to be, rather than just going, "Oh, I've got a really bad back, therefore I'll go and get a back surgery."

Perry Eckert: You're 100% correct. And people use the genetic example all the time: "It's my genetics." We know today that 85% of metabolic health is due to lifestyle and nutrition, that only 15% is actually genetic. The balance is epigenetics, and epigenetics can be altered. We have to take responsibility for our own health. We know that for older people, buying a mattress to put at the bottom of the cliff is not the answer. People spend 85% of their lifetime health budget in the last two or three years of their life, clinging to the hope that when they fall off the cliff they'll land on that mattress. And the reality is that most people miss the mattress. It's a horrible analogy, but people don't accept responsibility for their health as they age. And we know that by the time we get to age 50 or 60, half of us have three or more comorbidities to do with diabetes or one of the other conditions.

Perry Eckert: And so that's the other component of OsteoStrong that I haven't mentioned. We did a pilot study back in 2015 where we took pre-diabetic people, we put them through the programme, and we found that there was a 6% reduction in blood glucose as a result of the programme. Which doesn't sound like much, but the best medication for diabetes type 2 is metformin, and that gets a 0.3% reduction. So if you multi-stack the environmental lifestyle aspects, which is nutrition, exercise, metformin and OsteoStrong together, you can get a significant reduction in blood glucose. And we've had members report that they've been able to reverse or eliminate their diabetes type 2, which is, as I've said before, a lifestyle modifiable factor and can be cured.

Lisa: Yep. I've had so many people that have worked with diabetics, type 2 diabetics, who have reversed it, if the people were willing to do the hard yards — the diet, the change in the lifestyle, the exercise, getting there. And it takes time, but some of these people have been diabetics for 20 years and no one's ever explained to them the mechanism of what's actually happening, and they don't even understand the basics. Like, "I'm eating a healthy diet, I have fruit salad for lunch, a banana with an orange and a kiwifruit and an apple and a pear. That's healthy, isn't it?" Hell no. Not for a type 2 diabetic who's not doing much activity.

Perry Eckert: No. And look, we're not there giving advice as an OsteoStrong business, we're not diagnosing medical conditions. What we do know, though, is that if you follow our programme and you come for a set period of time — the sorts of examples that our members give... I had a lady come in, and I try and talk to the members when I'm in the centres, and she said, "Haven't really noticed the difference." And her husband said, "Well, except you don't take Panadol anymore." And she said, "What do you mean?" He said, "Well, you've had chronic back and joint pain, you take 8 to 10 Panadol a day. You haven't been taking them since Easter." And this was about September. And she said, "Oh yeah, you're probably right." And he said, "Well, not just right, but the effect of those tablets..." If you take two or three different tablets, you double and triple your fall risk, because they all affect your balance and they affect your proprioception. So older people that have multiple comorbidities, that take multiple blood pressure, diabetes, painkilling tablets, they increase their fall and fracture risk significantly.

Lisa: That's new to me, I didn't realise that. But it makes sense, because they're going to affect how onto it you are.

Perry Eckert: Logically, they all have an effect on your brain in some way, shape or form. We had some old ladies that I interviewed, and one of them said she got her dignity back, and I actually teared up when she told me this story. She said, "I've been married for 80 years." She was a really old lady, she was in Sweden. I think she'd forgotten how long she'd been married, or maybe she didn't like the husband. And she said, "When I get off the toilet, I can't stand up anymore, so he has to pull me off the toilet and my pants are down, and he's never seen me naked, and so I have no dignity." And I said, "So what's changed?" And she said, "Well, within three months of doing OsteoStrong I had enough leg strength to be able to stand up again from a sitting position." Isn't that... And so she was able to stand up, pull her pants up, she got her dignity back.

Perry Eckert: We had a 93-year-old at one of our centres. The first time she came in, she was brought by her daughter on a walking frame. Within 12 months she went from a walking frame to a walking stick, and then I remember the day she came in waving her walking stick. She no longer needed a walking aid. She still carried the walking aid as a balance security blanket, but she didn't need it for everyday life.

Perry Eckert: We had a lady who said she got her independence back. She was able to open a jar of pickles that she hadn't been able to. She had grip strength again, she was able to use her wrists. She used to go down the hallway and ask the old man to open the pickles. She said, "I still go down the hallway because I like him, but I open my own pickles now." So we get some amazing stories from quite old people in their 80s and 90s that have been able to reverse the natural loss of muscle, balance and strength, and they're now able to live better lives, a little bit more independent.

Lisa: As someone who's been dealing with a mum for eight years, caring for Mum and rehabilitating her and taking her from a wheelchair — she was in a wheelchair predominantly for two years. It took us a year to get her out, before she could take the first couple of steps in the parallel bars, and she was bent over like an L, you know, like this. And then to rebuild her, so that she's got really good posture now, and get her walking and get her back into the gym, and once we got into the gym to rebuild her strength. It's an ongoing process, because she's since had brain cancer and about two dozen concussions from falls and GI bleeds and God knows what. But she's still able to get around the house, take herself to the toilet, go and have a shower by herself, and go for little walks by herself. And that's someone who's been through the absolute ringer.

Lisa: During that period I've seen her go right down to not being able to sit on her own, just flopping over even sitting, to doing all of these things. And I've written a book about it called Relentless, which was just the first part of her journey. I haven't done one on the second and third part of her journey — we're always in the middle of the next one. I've got to write a couple more books here. But to see someone go from there to there through consistent training...

Lisa: People were often saying to me and criticising me — and I hear it all the time — "You're such a nasty daughter, you're so mean to your mum, why do you make her get up? Why don't you help her up out of the chair?" People see me out and about with her and I don't help her up very often. Sometimes I have to give her a bit of a nudge at the end or whatever, but I try to make her brain engage with her muscles so that she can learn that process. If I do that for her all the time, she's not going to learn it. And I need her to maintain, and she deconditions really quickly. We've just had a bout in hospital last week with GI bleeding, and of course she was stuck, unable to get up because she could bleed to death. So we've deconditioned, and now we're on the comeback trail again. You decondition within 24 hours when you're that old. You have to be religious. I don't let her have her birthday off, I don't let her have Christmas off. There's no day where she's not training, and if I don't, she's gone.

Perry Eckert: That's one of the key components to OsteoStrong as well. When we do the strength training, the one-and-done exercise that we do is myofibrillar hypertrophy, not sarcoplasmic hypertrophy. So if you go to a gym and you do multiple reps of lower weights, you build up sarcoplasmic fluid in your muscle. You do increase in strength, but then if you don't go to the gym for a day or a week — and as you get older, five minutes — that sarcoplasmic fluid and strength training effect rubs off very quickly.

Perry Eckert: At an OsteoStrong centre, we're exhausting muscle ATP in a 10 to 20 second exercise, maximum effort. And what happens is we don't get big and bulky like a gym, but we do increase the number of muscle myofibrils, so the density of the muscle fibre increases, and that is a long, long-term result. So typically older people come to our centres, they take four weeks off or eight weeks off, they go on a holiday, they come back and they will sit on the machine and do a record. They'll do a personal best, because they've had a rest for several months. You don't waste. Once you've built a muscle fibre, it's there and it doesn't waste away. So people typically don't lose their strength if they don't come — a holiday or a period away from the gym. And that's how the diabetes works too: as you increase the number of muscle fibres, myofibrils, you increase the muscle's ability to process blood glucose.

Lisa: Yeah, that makes a whole lot of sense. I didn't know that, so that's really good. So when you're doing that maximum full effort, you actually do a different thing than when you're doing multiples of weight. And you couldn't do this with free weights, you'd injure yourself. So that's why these specific machines are required, and guidance is required.

Perry Eckert: They emulate high impact events in a single lift or push. And the four machines cover arms, legs, spine and core. The core is important because as we age, a lot of the red blood cell production is from our collarbones and from our ribs. The bones are different — obviously hard and soft bones, and trabecular and cortical bone — and those bones have different functions, but they also have functions in blood health. So it's very important that we have healthy bone for good blood flow, because that's where all our red blood cells, white blood cells and platelets come from, is this soft, spongy bone. It's important that if you maintain that health, you also have good blood health.

Perry Eckert: A lot of the drugs like bisphosphonates switch off the cell which is the osteoclast. Now, the osteoclast-osteoblast ratio is important, but if we don't have the osteoclasts eating through the old bone, removing old brittle bone, we get an accumulation of hard, brittle bone, but we also don't get the micro blood vessels in the bone, because as these osteoclasts bore their way through, they create these micro blood vessels, which is important. If you talk to a doctor, or even a butcher, if they scrape new bone, the bone bleeds, and that's blood coming out of the bone. That's one of the main sources of blood. If you switch off with a bisphosphonate, the drug that stops you from eating old bone, this accumulation of old brittle bone — not only do we start to see a small number of spontaneous dual femur fractures, we also see necrosis of the jaw. Some of these drugs are quite nasty. But it's important that people obviously see a doctor, talk to a doctor. There's a combination of strategies for bone density.

Perry Eckert: There are a number of studies that are being done on OsteoStrong at the moment. One in Greece has been completed by one of the leading endocrinologists in Greece. The preliminary report was presented to ENDO 23 in America this year, and it showed that OsteoStrong had a significant effect on bone density and that it worked synergistically with bone drugs. So there may be advantage in some cases to doing both, drugs certainly for people with extremely low bone density. But if you want the natural approach, OsteoStrong — we're leading a revolution in natural bone health. It isn't a drug intervention.

Lisa: We know that all of these drugs are hormonally driven, as you said before. There's no such thing as a minimal hormone impact. When you take them, there's a price to pay, or a ferryman. The side effects can be quite significant.

Perry Eckert: For OsteoStrong, there are side effects to OsteoStrong: you get stronger muscles and better balance. They're pluses, not minuses.

Lisa: This has been absolutely fantastic, Perry. I really enjoyed this session. Can you tell me where can people reach out to you — your website, or where can people connect with you? And maybe you can give me a list so I can put it in the show notes with the links to the ones in Australia. And if there's anyone in New Zealand listening to this who thinks this might be a good thing to get into, please, that would be fabulous. Reach out to Perry, and let's get this further around the world so that more people have access to it. Where can they connect with you?

Perry Eckert: OsteoStrong.com.au, easy. If they log on there — if people are interested in our locations worldwide, it's osteostrong.me, and you can see the science, the studies that are there. We're doing a big study at the moment with Monash Health here in Melbourne. It's a pilot study, but it's looking at post-menopausal women. We'll have that completed hopefully by early next year. It's one of three big studies. There's a big blinded study being done in Sweden at the moment, they'll complete that in the next few months. The Greek study obviously is one that's very important. But there's been half a dozen studies prior to that looking at osteoporosis and diabetes, and the safety and efficacy of OsteoStrong for people.

Perry Eckert: We've got something like 35,000 people going through the process at the moment. We've got over six million recorded sessions. Obviously OsteoStrong is an exercise programme, and risks come with exercise, any exercise programme. I can't say that it's 100% safe, but no exercise is. Obviously we take enormous care with our people. There is a risk associated, but that risk — if you look at a gym, people hurt themselves, one in two or 300 people hurt themselves in a gym every day. We've had more than 30, 40,000 recorded sessions in Australia with no recorded injuries. People obviously will have little muscle pulls and muscle soreness from any daily activity, that's not unusual, but that's very different to an injury. That's usually something that just happens because they're deconditioned, they're very old, they pushed a bit hard today, and nothing more than an ice pack is necessary in those situations. We do have a very safe risk assessment in our process.

Lisa: Everything's got risk in it, and if you go around trying to avoid all of them, you're going to end up with the most risk, sitting on the couch and doing nothing, and then you're not going to get healthy for sure. Perry, you've been wonderful today. Thank you so much for getting up so early and being a part of the show. I really appreciate you. Absolutely fabulous, great information, and really, really thank you for your time today.

Perry Eckert: You're welcome. Thank you, Lisa. Lovely talking.