The Gut Health Podcast
The Gut Health Podcast explores the scientific connection between the gut, food, mood, microbes and well-being. Kate Scarlata is a world-renowned GI dietitian and Dr. Megan Riehl is a prominent GI psychologist at the University of Michigan and both are the co-authors of Mind Your Gut: The Science-based, Whole-body Guide to Living Well with IBS. Their unique lens with which they approach holistic conversations with leading experts in the field of gastroenterology will appeal to the millions of individuals impacted by gut health.
As leaders in their field, Kate and Megan dynamically plow through the common myths surrounding gut health and share evidence-backed information on navigating medical management, nutrition, behavioral interventions and more for those living with or without a GI condition.
The Gut Health Podcast is where science, expertise, and two enthusiastic advocates for wellness come together to help you live your best life.
Learn more about Kate and Megan at www.katescarlata.com and www.drriehl.com
Instagram: @Theguthealthpodcast
The Gut Health Podcast
The Gut–Bone Axis: How Gut Health Impacts Bone Health, Calcium Absorption & Osteoporosis (with guest Dr. Laura McCabe)
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Your bones aren’t stones, and osteoporosis isn’t just a calcium problem. Bone is living tissue that continuously remodels, and the signals that guide that process may start in an unexpected place: your gut. We dig into the gut–bone axis and the emerging field of osteomicrobiology with Dr. Laura McCabe.
We discuss:
• How bones are living tissue that continuously remodels
• Osteoporosis as a common silent disease—and why fractures are often the first sign.
• Osteomicrobiology and how the gut–bone axis may influence inflammation, immune signaling, and hormones
• Fiber fermentation and short-chain fatty acids that may support calcium absorption and gut barrier health
• The gut microbiome, vitamin K, and its role in bone mineralization
• Prunes as a whole-food intervention and the evidence behind six prunes per day
• Fermented foods like yogurt and kefir, plus the importance of protein for muscle and bone health
• Menopause, estrogen loss, changes in the gut barrier, and inflammation linked to accelerated bone loss
• Calcium from food first, caution with high-dose supplements, and practical dairy options including lactose-free choices
• Weight-bearing exercise, strength training, and yoga as bone-loading signals and how exercise may also affect the microbiome
• Why people respond differently based on genetics, lifestyle, medications, and steroid exposure
• Where the science is heading, from metabolomics to more personalized nutrition approaches
We hope you’ll share this episode and help spread the word about bone health!
This episode was sponsored by Activia.
References:
Learn more about our guest, Laura McCabe, PhD
Don’t forget to subscribe, rate, and leave us a comment.
You can also follow us on social media @TheGutHealthPodcast, where we’d love for you to share your thoughts, questions, and experiences.
Learn more about Kate and Dr. Riehl:
Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast
Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.
The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.
Welcome To The Gut Health Podcast
Kate Scarlata, MPH, RDNThis podcast has been sponsored by Activia.
Kate Scarlata, MPH, RDNMaintaining a healthy gut is key for overall physical and mental well-being. Whether you're a health-conscious advocate, an individual navigating the complexities of living with GI issues, or a healthcare provider, you are in the right place. The Gut Health Podcast will empower you with a fascinating scientific connection between your brain, food, and the gut. Come join us. We welcome you. Hello, friends, and welcome to the Gut Health Podcast. We are your hosts. I'm Kate Scarlata, a GI dietitian,
Dr. Megan Riehland I'm Dr. Megan Riehl, a GI psychologist. When you think about keeping your bones healthy, you might think about drinking milk or taking calcium supplements and maybe lifting weights. But what if we told you that one of the biggest influences on your bone health might actually be living inside your gut?
Kate Scarlata, MPH, RDNThat's right. It may sound surprising, but the trillions of microbes that make up your gut microbiome don't just help digest food. They're actually incredibly active, communicating with your immune system, influencing hormones, helping you absorb nutrients. Yes, those minerals like calcium. And believe it or not, they do play a key role in keeping your skeleton strong.
Dr. Megan RiehlYeah, this has been a fascinating episode to prepare for because, you know, when I think about bones, they aren't just hard, lifeless structures. They are living tissue that constantly are remodeling themselves. Every single day, specialized cells are breaking down old bones while others build new bone. Interestingly, 5 to 10% of the adult human skeleton is replaced each year. I loved sharing that fact with my kids. Yeah. That delicate balance helps determine whether we maintain strong, healthy bones or gradually lose bone density over time. And osteoporosis is one of those things. It's far more common than people realize. About one in two women and up to one in four men over the age of 50 will experience a bone fracture due to osteoporosis during their lifetime. And so today, an estimated 54 million Americans have either osteoporosis or low bone mass. That's a huge number.
Kate Scarlata, MPH, RDNI know. And you know, we're all living longer, right? So, you know, we got to keep those bones healthy.
Why Bones Constantly Remodel
Kate Scarlata, MPH, RDNSo, osteoporosis is an escalating global health challenge. It leads to compromised skeletal integrity, as Dr. Riehl mentioned, but in over 200 million people worldwide. So it is a problem around the globe. Yep. And it leads to socioeconomic burden and can really significantly diminish quality of life. So the tricky part is that it's a silent disease. Bone loss can happen without obvious symptoms, and many people don't know they have it until they experience a fracture, or maybe get a DEXA scan because they may be at higher risk, or they're postmenopausal women, and their doctor orders that. New concept osteomicrobiology. That's a mouthful. Tell us what it is, Kate. I'm gonna tell you. It's the study of how the gut microbiome influences bone health. It's like this gut bone access. Research suggests our gut bacteria may affect everything from calcium absorption and vitamin metabolism to inflammation, immune signaling, and even hormones that regulate that bone remodeling.
Dr. Megan RiehlYes. So we are going to be exploring the concept of the gut bone access and the science, animal studies, human clinical trials, and really what the emerging science could mean for preventing osteoporosis and maintaining bone health throughout our lives, as well as our gut health.
Kate Scarlata, MPH, RDNExactly. So we have a great guide who is really an expert in this intersection between the gut microbiome and our bone health. And her name is Dr. Laura McCabe. She serves as Associate Vice President for Research Regulatory Support in the Office of Research and Innovation and is at Michigan State University. She is the Foundation Distinguished
Osteoporosis Risk And Silent Bone Loss
Kate Scarlata, MPH, RDNProfessor of Physiology.
Dr. Megan RiehlGo green, Kate. Now you say go white. You go what? Go what? Okay.
Kate Scarlata, MPH, RDNThere we go. Go green. Okay. Her research focuses on gut bone signaling pathways as strategies for prevention of osteoporosis. She has authored more than 115 scholarly articles, holds multiple patents, and has received research funding from many major agencies, including NIH, NSF, NASA, and the American Diabetes Association.
Dr. Megan RiehlSo we are excited to welcome you. And, you know, we hope that all of our listeners followed our women's health series earlier this year. And you'll remember that we talked about menopause and declining estrogen that can accelerate bone loss. So really today with our guest, we're building on this conversation by exploring another important piece of the puzzle, which is the gut.
Kate Scarlata, MPH, RDNOh, yeah, baby. We love the gut. Yep. Whether you're thinking about bone health long term, you know, we are living longer, living with a GI disorder that may make you at greater risk for osteoporosis, such as untreated celiac disease. We're going to get into inflammatory bowel disease as a potential risk. This episode is packed with practical, science-based insights. So let's start this episode with a mythbuster. What's one myth about bones that you wish everyone would stop believing?
Dr. Laura McCabeWell, the one that I've gotten from colleagues and muscle and other areas of the body, they just talk about bone as
Osteomicrobiology And The Gut Bone Axis
Dr. Laura McCabebeing a stone. It's just the structure of mineral, and it's so much more. That is so incorrect. You have all sorts of cells in your bone. You've got immune cells, blood cells, you've got nerves, you've got cells that are responsive to what you do, your activities, and they resorb bone and build bone, and there's so much activity going on. It is not static there at all. It's a very active organ.
Kate Scarlata, MPH, RDNI think that's a common myth. I think people do think of them as just these hard rocks that develop as we, you know, grow, and then that's it.
Dr. Megan RiehlAnd like they break and then, you know, we try to put them back together. But like, yeah, my mind is now so much more appreciative to the nuances of the bone. Well, let's start big picture. What is gut bone access? And how can the gut microbiome influence these not stony bones?
Dr. Laura McCabeWell, first I have to say I love talking about the gut bone access because it's a passion to me. With my training starting in gut, gut physiology as a grad student. And then as a postdoc, I studied bone molecular biology. And you'd think, oh my gosh, these two organs are so different, they're so far apart. And it really was this call from the Crohn's and Colitis Foundation for grants looking at how people with colitis lose bone and why. And so I really thought, oh my gosh, this is the calling for me. And I've got these, I know these two organs. And that really started off our research and showing that inflammation in the gut was linked to bone loss. So there's these ideas of links, and we and other labs were studying that, and there's some immune cells as they get activated when the gut's not as healthy. They can move from the gut to the bone and in that bone marrow area where all the other cells are, and they can bring that inflammation signal to the bone. But at the time, so I got really good at finding ways to cause gut inflammation and induce bone loss. And then I thought, oh my goodness, I don't want to be known for this. You know, how to, you know, there should be something more that I could do. And then I thought, okay, what do we know from this? We know if inflammation causes bone loss, is it possible that if we reduce gut inflammation, that it might benefit bone? And people sort of thought, oh, I don't know, Laura, I don't know. And it turns out that indeed, when we can reduce that inflammation or promote gut health, that it has benefits to bone health. And so we've been so excited. And that's just the story, and that is the link of the gut-bone axis. And of course, other labs are working on this and showing all sorts of detailed signaling pathways and things. But I think it's really beautiful. And honestly, I think that the gut is the outside going through our body, the GI tract. So we're eating and we're kind of sampling the environment, and it goes into our gut. We have these microbiota bacteria in there that are also feeding off of what we give them, and then they make products that can enter the bloodstream and can regulate inflammation, and then that leads to all the organs. So it's like this beautiful signaling symphony and is really, you know, I think the wave of the future and the importance. It shows the importance of the gut.
Kate Scarlata, MPH, RDNYou know, as the gut health podcast, we're with you. Yeah, we definitely are following this science on, you know, multiple different levels. And this is an area certainly that's so important, especially as we're all living longer and we work with a lot of people with GI conditions and realize this connection. So it is beautiful. It's a beautiful connection. Yes. So I think it's interesting too how the gut microbiota or microbiome play a role in just mineral absorption. And we think about calcium as just one of these big building blocks of bone. But what is the connection with the gut microbiome
Fiber Short Chain Fatty Acids Calcium
Kate Scarlata, MPH, RDNand calcium absorption and maybe other minerals and helping us maintain healthy bones? What's the gut connection there?
Dr. Laura McCabeSure. So there are studies in humans and experimental models showing that as the microbiota digest fiber, that calcium absorption is enhanced. And the thinking is that one part of this is the production of short-chain fatty acids that help with the absorption of calcium. Some other thoughts, too, though, are just the microbiome is helping break down the food more, maybe releasing the calcium for better absorption. And then the microbiome produces vitamins like vitamin K, which is also important for bone and helps with mineralization in the bone by modifying some proteins. And so, really, it's a multi-step process that the microbiota works for calcium absorption. But I do think that the bone health is more than just the calcium. It's these other products that the microbiota make that are also interesting. So as they're breaking down the food products, they metabolize it and then they put out things into the gut that can also benefit gut health and bone health.
Kate Scarlata, MPH, RDNYeah, it's so so interesting. Like you think of just butyrate, for instance, that really is essential for that gut barrier, you know, function. And, you know, reading a little bit about propionate and that short chain fatty acid being really important for bone health. And so getting down to some of these things. And I also think when we think of things like IBD, for instance, and they have you know somewhat of a dysbiotic or imbalanced microbiome, and how that can, you know, it's that big role. It's inflammation is present with often with dysbiosis, but then just who's there? And do they even have the capacity? I know in some IBD studies, which is really interesting, a subset of IBD patients cannot break down fructans, which are a fiber that's fermentable and increases short chain fatty acids. But if you don't have the capacity because you don't have those microbes, it's just, you know, like how do we, you know, there's all these different areas where we can kind of look at and say, how can we make their microbiota digest fructans more? Or do we need to change the diet a little bit more slowly so we enhance those microbes? And a lot of these are getting worked in different labs around the country, which is interesting. We had Heather Armstrong on from Canada, with she's doing some interesting research in this area and really adjusting or trying to adjust the microbiota through diet slowly. I'm in these patients that can't break down fructans properly. So it is so complicated, but I feel like we're just starting to really open up these connections with all the work that you're doing in others in this space. So I'm glad you brought up the vitamin K thing too, because I think, you know, that's where we get most of our vitamin K is from our microbiota, and we know that it's important in bone health. Certainly you can take a supplement, but probably a healthy microbiome helps with that. So you kind of touched upon fiber, and I certainly did too. But really the role of fiber in this bone health scenario, anything else that you'd want to talk more about? Absolutely. I love fiber. So we love fiber too.
Dr. Laura McCabeYay, fiber. And it's really at the kind of the top. It's the food, right, that for the bacteria. And we know that if there's fiber, it promotes the development of the good bacteria, some like that could be considered probiotic, even. So it feeds the good bacteria so they can grow in the gut. And why are they good? Often because they're making good things for the body. And so that fiber becomes critical. And, you know, the research on that's sort of interesting because people are trying to find ways to make different kinds of fibers to promote the growth of certain bacteria versus other bacteria. So the complexity of the potential therapeutics down the road is really vast. But the fiber is nice because it's, like I said, it does everything versus if you take a single probiotic or something, you're only getting one bacteria and you're not giving it the food that it needs. So, really, that's why I think of the fiber as the top of the whole pyramid of gut health.
Kate Scarlata, MPH, RDNWe agree. Yeah, we certainly agree. And, you know, I think it's just really learning what people can tolerate. Were they overdoing fiber? Can we titrate back and go up slowly, you know, but really working on getting a
Prunes As A Whole Food Strategy
Kate Scarlata, MPH, RDNdiversity of different types of fibers and getting that number up. You know, that's what the microbes want, right?
Dr. Laura McCabeYeah. And it might be too. We've been looking at just whole foods. So, you know, you take a whole food like a prune, and we've been doing studies with prune. So they have fiber, but they also have polyphenols, they have a variety of things. We give mice or humans a prune, it completely changes their microbiota, like night and day, and it happens really rapidly. And the metabolites that are in the bloodstream are quite different. The bacteria that are changing the microbiota change, so they can really make these things from the prunes. And we find that it benefits bone health, actually, in experimental models and humans.
Kate Scarlata, MPH, RDNYeah, you know, I'm glad you brought up the prune thing because I have a lot of colleagues always, you know, prunes for gut health and I mean for bone health. So do you know how many prunes? I should know this. Is it like six a day? You are correct.
Dr. Laura McCabeSix a day is enough. And they're quite tasty. I I, you know, I take them as snacks during the day. And yes, they're very healthy. We've just found really good results for them. I mean, in addition to other things, I mean, I like to think of yes, you know, vary the diet and have, you know, you have your prunes, have your fiber, have a little yogurt, a little kimchi or some fermented food. And, you know, I think all of that is a good thing.
Dr. Megan RiehlWell, you're hitting on, you know, I think all those foods you just listed are things we're so entrenched in the GI space. Yes. But now we're adding this additional motivation for your bone health, you know, that we're talking to our families about, hey, let's eat a diverse type of diet because not only are we helping our gut, but it's trickling out that symphony of empowering our bones across the lifespan too, because I want my kids starting with this stuff. But I want to eat it as a perimenopausal woman. And I want my mom and my grandparents thinking about this too for their bone health longevity. So hopefully we're planting seeds of motivation for people as we move through.
Kate Scarlata, MPH, RDNExactly. And I just want to comment because I really am grateful that you mentioned sort of that whole food complex, because, you know, I attend a lot of the gut microbiome conferences and they're really talking about the food matrix and how important that is because you're not just getting fiber, you're getting it with the polyphenols, which also can have some prebiotic effects and enhance those probiotic microbes in the gut, but also everything else together in there, you know, that can also enhance the gut health. So not just getting isolated fiber or chicory root extract added just simply to something. I mean, that's fine for filling the fiber gap, but you know, getting it in a whole food is really important as well.
Dr. Laura McCabeYeah. And the varied types help to keep your microbiota diverse. You know, so diversity is very good. It tends to track with health, as you know. And I'd also want to add it with regard to bone health, it is important early in life because that's when we're building our bone density to its maximum level. So about in your 30s or so is when you've reached your max bone density. So that's a critical time during your youth where it's so important to maximize bone health. And then, of course, after that, we want to maintain that bone health and keep that going, and especially during the time when we lose estrogen, of course, for women. Yes. Yeah.
Kate Scarlata, MPH, RDNGeez, I feel like I'm just like a mess over here. The ship has sailed. No, I'm still gonna know. No, no, Kate. You're maintaining. You're maintaining. I'm maintaining. Yes.
Dr. Laura McCabeWe got you covered. Okay, yeah, good, good.
Kate Scarlata, MPH, RDNSo we've kind of touched upon this a little bit, but are there other things that people can do to improve their gut microbiome, to improve gut health? Like, are there any probiotics that we know out there that are particularly helpful or certain types of fermented foods or different microbiome
Kefir Yogurt Fermented Foods Protein
Kate Scarlata, MPH, RDNsort of focused approaches to managing our bones' health?
Dr. Laura McCabeOne of my favorites as well is the microbiota that tends to be associated with milk products. And so that's like lactobacilli, and of course, there are others, but what I find particularly interesting is when you're born, is when your bone grows the most dramatically. And what is the diet of a baby? It's milk. And so milk has its own fiber actually in it, and it also promotes certain bacterial growth like the lactobacilli, and those tend to be very beneficial for bone health. And so I recommend kefir, yogurt, those sorts of foods that tend to have those broad milk-associated bacteria.
Kate Scarlata, MPH, RDNYeah.
Dr. Laura McCabeI'd also add though that so while all these things are really good in the fermented foods and everything, it's important to also have protein on board. And so protein's important. And what we're finding is that it helps with some of the Gut microbiota metabolites, but it also is important for muscle and bone, and it's part of the story of the I think the diet and the that kind of diet for bone health and gut health.
Dr. Megan RiehlI guess I'm gonna revisit my relationship with kefir. You're inspiring me. I gotta get back into some dairy. And those are some fantastic suggestions.
Kate Scarlata, MPH, RDNYou know, I love the kefir with the frozen fruit and just blend it. Like if you don't like it plain, you can make like a fun smoothie, throw a couple prunes in there, strawberries, and make like a just a yummy yummy, or do like even a smoothie bowl with a little bit of granola or nuts or seeds. But we do that a lot. So I'll get you. I'll get you some recipes, Dr. Riehl.
Dr. Megan RiehlAnd lots of parents are listening. And I think Kate, to your point is how do we make these foods palatable, enjoyable? I think the more we introduce them earlier in life for our kids, you know, they don't know the difference. So I think that, you know, having some of those recipes, demonstrating it for the family, having it in the refrigerator, and trying different things is really critical. And again, I'm really motivated to have my kids have strong bones. And I'm in the maintenance phase. So, you know, we're maintenancing.
Kate Scarlata, MPH, RDNExactly. I just have to put a quick little story. I had my 19-month-old granddaughter over yesterday, and we did a Greek yogurt smoothie with kiwi fruit and cherries and almonds, and she could not get enough of that. And it just made, you know, more gamma, more. I'm like, okay.
Dr. Megan RiehlThat baby's lucky. She's gonna have the best darn microbiome one could ask for. It's just so cute. We love that cramping.
Kate Scarlata, MPH, RDNShe helped make it in the blender. So that was fun too. She's learning a little cooking skills. That's right. That's right.
Sponsor Break Activia And Gut Comfort
Kate Scarlata, MPH, RDNBacked by over 20 years of research, Activia knows that overall well-being starts from within. The brand was ahead of gut health trends and offers a broad range of products to help address the growing interest in this space. Activia offers a variety of probiotic yogurts and drinks that deliciously support gut health. Enjoying Activia twice a day for two weeks as part of a balanced diet and healthy lifestyle may help reduce the frequency of minor digestive discomfort, which includes gas, bloating, rumbling, and abdominal discomfort. Based on a 2025 national survey of doctors, including primary care, OBGYN, and gastroenterologist, Activia is the number one doctor recommended probiotic brand. Activia is a modern gut health innovator and is passionate about helping consumers feel their best. Check out Activia's client resources at Activia Gut Health Toolkit.com.
Dr. Megan RiehlWell, on the other side of
Menopause Estrogen Gut Barrier Inflammation
Dr. Megan Riehlthe life stage, menopause. Let's let's take a hard right turn here. It's a major turning point, as you mentioned, in terms of age and bone health. So tell us about changes in the gut microbiome around menopause. Does it play a role in accelerated bone loss? I think I know the answer, but I'd love to hear it from the way you describe it. Yes.
Dr. Laura McCabeSo I think with the loss of estrogen, there are gut changes. And those changes are associated with that microbiota as well as the gut barrier. And so just to kind of review that, the gut is the outside going in you. And really the lining of the gut is what I'm referring to when I talk about the barrier. So it has your intestinal cells are there and they're really close together, tight, so that nothing from the outside can pass inside you unless the cells say it's okay and they have little channels and things that things can go through. But in certain disease conditions, with inflammation, but also with menopause, the barrier can weaken a little bit. And so some of the bacterial products can kind of cross over the ones that we don't want. And they're going between the epithelial cells in the barrier, and that promotes some of that inflammation that's in the gut, which then we think goes to the bone. And when there's inflammation, that calls on and activates the cells that resorb or eat your bone. And so that can lead to bone loss. And so it is linked to estrogen deficiency. It's just another wonderful thing that estrogen does for our bodies. And then it's just sad when we go through menopause and then have to adjust to not having it. Yes. The joys. The joys.
Kate Scarlata, MPH, RDNYes, seems a little unfair, I have to say. So I wanted to talk a little bit about calcium. A lot
Calcium From Food Versus Supplements
Kate Scarlata, MPH, RDNof people are for years they were downing most of their calcium with supplements. And then it seems like, oh, that might not be a good idea for heart disease risk. And can you elaborate on that science a little bit? Where should we be getting our calcium from? Sure.
Dr. Laura McCabeI think the diet, of course, is the natural thing. It's the best way to go. Anything you can get from your diet. In the standard American diet, people typically get a good amount of calcium if you're eating the right foods, a well-balanced diet. But for those who can't have milk products or calcium-related foods, you know, sometimes then they're taking supplements. And that can be okay, but it's really the high dose, like taking a lot of calcium in a pill, it's just not natural. And your body has this huge calcium load that it has to deal with. So it may be possible that that's not so beneficial for the body. And there is thoughts out there for that, especially the higher dose. I think if you're 500 and under, maybe that might be okay because that's more of standard of what you might get in your diet. But it's really the super high doses. And then if you're, this is the case with supplements. They're just way more, they call it pharmacologic, you know, just not physiologic or normal dose. And that's where you can run into trouble. And then you have that calcium. There's some thoughts that that can contribute to those calcifications in your blood vessels, perhaps. There's varying data, but I think definitely you don't want to be dosing all your calcium at one dose in a day.
Kate Scarlata, MPH, RDNAbsolutely. I think your body really can only absorb about 500 milligrams at a time, anyways. And I really try to get my patients to do it primarily with food and fill in the gap. But there is this sort of notion that dairy is bad for us. It's like gluten is bad for everyone, dairy is bad, especially in the GI space. You know, it's something that we're constantly having to myth bust because it's just it's so dense in nutrients. And so it's hard because we'll have, you know, people just downing a lot of just oat milk and coconut yogurt, and there's no added calcium in any, you know, sometimes there is, but most products there isn't. And again, it's in a supplement kind of form. It's not like it's natural matrix. So again, you know, if you can do dairy, it's a great way to get your calcium. Um, certainly there's other foods with calcium in them, but dairy really gives you that biggest bang for your buck, right?
Dr. Megan RiehlGoes back to what we've talked. No fiber- maxxing, no calcium -maxxing. It's you know, thinking about moderation here. And, you know, I guess in the GI space, you might have to kind of moderate your way up with dairy reintroduction. So don't sit down and have, you know, a whole huge glass of milk if you haven't been drinking milk for a while. You're likely going to have some gas and bloating or some tummy response if you're reintroducing, but you can go slow and reintroduce it back in for some reason.
Kate Scarlata, MPH, RDNAnd there's most of it's the gas and bloating is the lactose, the milk sugar. And there's so many lactose-free dairy options. All hard cheeses is very, very low in lactose. And then there's lactose-free Greek yogurt, there's lactose-free milk. And so there's so many products out there that you can abort having gas and bloating and still get your calcium and protein and all the goodness, riboflavin and all the goodness in milk.
Dr. Laura McCabeAnd I love both of those things because it's also true, right? With your fiber or kefir. I mean, I recommended my son drink kefir and he drank a whole, you know, the whole gallon thing of kefir or whatever. And so it's like, no, no, no, don't do that at first. You know, you need to start off and build to drink more, but you do have to do that in moderation at first so that your gut can adapt to that new diet.
Dr. Megan RiehlRight. Yeah. It's an ecosystem. Love is excitement. Love the excitement, but maybe we gotta slow it down a little bit.
Dr. Laura McCabeAnd you know, that's something gut-wise, actually, as you get older, you're less adaptive to changes in the diet. And so as you get older, it's even more important to titrate, slowly adapt to these dietary changes as well.
Kate Scarlata, MPH, RDNYep. Yeah, we like that. Go low, slow, advance. That's right.
Dr. Megan RiehlThat's right. You've mentioned protein.
Exercise Loading Muscle Signals Microbiome
Dr. Megan RiehlIs there anything else when we think about healthy aging? And you just hit on kind of going slow as we age, but what's the evidence actually show about protein and bone health? And as you said, maintaining that muscle as we age. What do we need to be thinking about here?
Dr. Laura McCabeAnother great question. And it's great for bone because it does get into it's not a stone, it's adaptive, and really exercise and loading of bone really helps to stimulate it to remodel itself. It's sort of like a house, you know, and you get a crack in the wall, you don't like leave it there, you go and you fix it and you repair it. Well, your bone's doing that all the time. And every 10 years, every part of your bone has been remodeled totally. So you keep redoing it and so that that mineral in your bone is so strong and new and healthy so that it can support you. And when you load, when you're walking, you're stimulating that bone production. And how do we know that? One way is to look at the racket arm of a tennis player. So you look at the racket arm of a tennis player, and it's got way more bone density than the opposite arm. And so that's the best, you know, the easiest way to see how that force has stimulated bone to be formed there. And you'd go through the same thing as you're walking or running, that also stimulates that bone because bone, Wolf's law, it's called, he was an investigator, but there's a law after him, and that's is where bone is made where it's needed, and it's removed where it's not. So if you're not active, then there's no signal. Why are you wasting energy supporting that bone? So it doesn't need to be as strong. So your body is very adaptive and bone is as well. So that exercise is critical. Movement, weights, even yoga puts some stress on the bones and has been shown to benefit bone density. So all those things help to support bone health. And with the muscle, we're now knowing it's not just the load directly on the bone, but we're building that muscle and that the muscles send signals to the bone. So it's so beautiful. All the organs are always signaling around with each other. And again, it's the connection that's very nice.
Kate Scarlata, MPH, RDNIt's like just treat all your organs like with the highest degree of attention because they're all going to be talking. It's like best friends, right?
Dr. Laura McCabeExactly.
Dr. Megan RiehlWell, and I'm thinking, you know, Kate, you on Instagram inspire me. And it just kind of I get more of like an endorphin boost in watching your morning walks and getting out in nature and moving your body. Never underestimate the power of just getting out. If it's a five-minute walk, if it's a 20-minute walk, if it's playing with your kids, if it's, you know, you're somebody that's living in a nursing home and they are doing some chair yoga or movement. Any movement at any age, I'm hearing you say, is a benefit to your bones and your health. And so if you're listening to us and you're like, I'm not eating calcium, my protein sucks, I don't move, my pore bones ache. Start with something small and know that this beautiful orchestra that allows you to move your body is benefiting there. And then you'll move your way up.
Dr. Laura McCabeAnd we can bring this back to the gut because there have also been studies in runners, and the activity alters the gut microbiota. And there's some thinking that when you're exercising, you make lactic acid, and the lactic acid goes into the gut. So things go out of the gut, but it also flows in, and that promotes those like lactobacilli. They love lactic acid, and so they're very happy. And there can be shifts in the microbiota. It's thought from exercise itself, so it's also two-way communication.
Kate Scarlata, MPH, RDNI love that. Well, I definitely am a nature queen and I have a two-year-old chocolate lab. So by default, I am out walking all the time with her to keep her busy. I did want to ask, I know there's a lot of bone coaches, there's a lot of people out
Vibration Plates Responders Stress Steroids
Kate Scarlata, MPH, RDNthere in the wellness influencer space and vibration plates, and I know FDA approved, I think, the osteo boost, but like how do those play a role in bone health? Anything?
Dr. Laura McCabeYou know, for the vibration, I mean, I think there's mixed findings on that. So it's not a hundred percent, but I do know that the theory is that the specific vibration of the early vibration plate was that it's about a horse standing in a field and that movement of the legs in the wind. And so it's sort of that standing signals up and down the bones that stimulate the muscle and also send signals into the bone that lead to promoting the bone health. But I think you know, I've stood on some, I don't know, I sometimes I don't feel like a horse in the wheel. You know, each one is different, there are different kinds of vibrations. And so I haven't followed up with how that's moved with the kinds of patterns, but I also know that there have been some studies that say, yes, it might work, and then other studies that maybe aren't as good findings. Okay. I will, as an extension of this though, I want to go back to the bone because we can say that there are great things like probiotics or prunes, and there are positive findings, but I also want to make note that sometimes there are responders that really respond and it's like, wow, this is great. And then sometimes there are non-responders. And so we have to keep that in mind and think about why that is. And that's why I like a varied approach so that if you're not responding one way, you'll respond to the other. So that breadth of your diet is important, you know, and exercise, you can hit it through all ways. Different types. But, you know, there's some thought that it's we have a genetic background that tells our gut, you know, what kind of microbiota might be happy in there, or how strong our barrier is. There's some likely genetic component. Then there's a lifestyle component. So you're walking or running and you're eating well. Well, already you've got a certain microbiota. You might have the best microbiota so that when you're eating prunes, you won't have a better response in a study, right? And so there's like a variety of factors. You could be on medications, and that could change your response.
Dr. Megan RiehlHow about mood? Mood or anxiety, stress.
Dr. Laura McCabeYeah, let's go. Sure. I think mood can play a role. We've worked with glucocorticoids or steroids, and we've found that steroids alter the gut microbiota. So we can give them like under the skin, and it changes the gut microbiota. So it's not even oral, which is really crazy. It's crazy. And so again, it's a response to the gut microbiota, and they are linked with some bone loss. And we have shown that we can in experimental models that we can prevent that with feeding of prunes or probiotics. So really targeting the gut to support the bone health in those kind of conditions. So, yes, I do think that would support the potential of stress to impact the gut. Yeah.
Kate Scarlata, MPH, RDNIs there a particular probiotic that has science for bone health that you like would recommend? Is there, or like, do we have a specific?
Dr. Laura McCabeI always come back to the yogurt or kefir or something, like the variety of them microbes rather than focusing on a single one. But there are, there are some really good ones. There are some good ones out there with you know science, and you can look them up. But I think you can also get that in your diet too.
Kate Scarlata, MPH, RDNYeah. Yeah. So more like live
Probiotics Limits And Personalized Future Science
Kate Scarlata, MPH, RDNmicrobes, not necessarily like fitting the definition of a probiotic, which has to be a studied down to the strain level. Yes. That just having those fermented foods that are making lactic acid, maybe have some lactobacillus like you'd find in yogurt. That in itself is what you're like leaning towards.
Dr. Laura McCabeYes, but I'll tell you too, we're thinking about when you look at responders and non-responders, then you can go in and type them. And so you can say, okay, how did their gut microbiota change in response to the treatment? The change in the responders must be a clue as to who do you need on board to get that response. And then we're looking at what are the products made by the microbiota, because maybe those responders have the microbiota making some really good things. Metabolite. That's why it's hard. I hate to say one bacteria is good, you know. So, because it could be that there's another one that can do just the same thing and could be good, and it's not getting the attention that it should. So I like to be, you know, I think broad is best. And so I think that we may end up where I see us going in the future is maybe something more personalized, where we get an idea what's the microbiota or what products are in the bloodstream, and you know, who are you? Who is the individual patient, and how can we manage that?
Kate Scarlata, MPH, RDNDefinitely. I definitely see that. I've been watching this and studying this area since 2000 and going to any conference that I can. And it in the beginning, it was all about what microbes were in the gut, what sequencing, and now they're looking totally much more like what are they doing, what are they making. And those metabolites are really important. So, and those are easier to kind of test, I think.
Dr. Laura McCabeSo well, yes and no. So we're studying some, and there's this whole new area of dark matter, you know. So you think of the dark matter in space, but this is. Actually, the dark matter of the metabolomics within your blood or what's produced, and it's that we can run these samples on mass spec and we can identify okay, there's these compounds, but there's so many more that we can't identify the peak. We don't know what kind of compound it is. And so we're finding unique things that we haven't really thought about before and looking for ways to determine, you know, are they beneficial? Are they driving the beneficial response that we're seeing? And so I'm guessing there'll be new novel compounds or products down the road as we better understand this.
Kate Scarlata, MPH, RDNIt just shows how complex this is. And how we want to be like, oh, good bacteria, bad bacteria. And it's like, oh, yeah, no. This is really like we're just touching the surface of this science. It's exploding, but still there's so much more to know.
Dr. Megan RiehlVery cool research happening at my alma mater there. So MSU, it's very exciting. I'm just so interested in the work that you and your lab are doing, as well as others around the world. So very cool, very cool. Lots to come in this space. Kate, I think you have a question for her.
Kate Scarlata, MPH, RDNI do. So I really just wanted, you know, all this research. You've been in this space for a while. I'm imagining you're a leader in this field. What are you doing individually for your own health, knowing what you know to protect your bones?
Dr. Laura McCabeSo I do all the things I've just told you. You know, I'm I'm loading my bones, so I'm out there walking or running. I drink kefir like a little glass every day. I love yogurt, I eat fiber, you know, I've fermented foods. They're all over my house. So yeah. In fact, I have, you know, sometimes when you open fermented foods, it will off the thing, and my sons will be like, oh mom, you know. Yeah. I love it. And what about your prunes? Are you a pruner? Yeah, I'm eating prunes too, yes. And like you say, you know, like you know, five to six a day, and they're just a great snack.
Dr. Megan RiehlAbsolutely. Yeah. Well, I'm gonna be looking up some prune recipes. I've seen them like filled, I don't know, like we add the butter on the inside or the peanut butters, or sprinkling with uh sea salt, and I've seen them dipped in chocolate. So I don't know, I might juzge up my prune uh life here in in the coming weeks. Check in. Stay tuned.
Kate Scarlata, MPH, RDNStay tuned. I've seen them kind of pressed and rolled, and so they become like a layer, and then they put little dark chocolate on top with some seeds and maybe a little bit of sea salt. And that sounds pretty good to me.
Dr. Megan RiehlIt sounds delicious, right? All right, we like to wrap up with a speed round. Are you in, Dr. McCabe? All right,
What Dr McCabe Does Daily
Dr. Megan Riehllet's go. What's your favorite way to wind down after a long day at work?
Dr. Laura McCabeProbably yoga. I love yoga, Iyengar yoga, and just that moment of space and pause and de-stressing.
Kate Scarlata, MPH, RDNYes. Oh, yeah, love that. So is it tea or coffee or both? Oh, both.
Dr. Megan RiehlI'm with you. Um, a coffee girl over here, but that's okay, you know? A little caffeine is not a bad thing. What's one book or podcast you recommend to every healthcare professional?
Dr. Laura McCabeYeah, that's a tough one. I'd say that I really love science. And so I get the science podcasts, the science articles, because I love seeing all the science going on. And I'm a AAAS member, and it's my favorite thing. So not as classical, I guess, but it's my area, and I just thrills me. Every day I read something that's been discovered, and it's exciting.
Kate Scarlata, MPH, RDNI love that. What's one piece of health advice you follow yourself? And I think we kind of got this, but is there anything we didn't cover?
Dr. Laura McCabeNo, I think it it really is keeping your gut healthy and doing all that you can to support, you know, exercise, diet, you know, the standard thing. Oh, and calmness yoga.
Dr. Megan RiehlYes, yes.
Dr. Laura McCabeTreat wrong.
Dr. Megan RiehlYes. Calm is good. And what's the most surprising thing you've learned during your career thus far?
Dr. Laura McCabeYes. So I'd say it's treating an organ, uh like a diseased organ by targeting another organ. Because we're targeting the gut to benefit bone health. I mean, that is when you think about it, that's like pretty cool. It's like pretty futuristic because we always think the drug has
Speed Round Takeaways And Closing
Dr. Laura McCabeto go to the tissue that you want to change. You know, your treatment goes there. But that's not necessarily the case. We could think now differently, like treating the gut to improve the whole body or to improve bone health is just like too cool. I think that's revolutionary. And so I'm really glad to be a part of that movement and the future of that.
Dr. Megan RiehlIt's huge. You're singing my song, you know. I treat the brain to help the gut. So you're you're doing it with the bones. Yes. This has been a fascinating conversation. We could talk to you all day long. You are our people now, and we'll likely be contacting you in the future to hear what's happening over in your lab. So we thank you and thank you to all of our listeners out there. We hope that you will share this episode and help spread the good bone health. That's right.
Kate Scarlata, MPH, RDNThanks for coming on, Dr. McCabe.
Dr. Laura McCabeAnd thanks for having me. Amazing.
Dr. Megan RiehlThank you for joining us as we grow this gut health community. We hope you enjoyed this episode, and don't forget to subscribe, rate, and leave us a comment. You can also follow us on social media @TheGutHealth Podcast, where we'd love for you to share your thoughts, questions, and experiences. Thanks for tuning in, friends.
