Latest / Wits & Weights | Strength & Fat Loss Over 40 / Why Lifters Over 40 Should Focus on Bone Health, Not Just Muscle (Dr. Doug Lucas) | Ep 409

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Why Lifters Over 40 Should Focus on Bone Health, Not Just Muscle (Dr. Doug Lucas) | Ep 409 · Wits & Weights | Strength & Fat Loss Over 40

• 0:01
  Philip Pape: If you're someone who takes your health seriously and wants to build muscle and strength that lasts decades, but you've never thought about what's supporting all that muscle tissue or whether your skeleton can actually handle the load you're putting on it, this episode is for you.
• 0:15
  Philip Pape: My guest today is an orthopedic surgeon who left his surgical practice to focus on bone health.
• 0:20
  Philip Pape: He's going to explain why your skeleton isn't just scaffolding, it's the limiting factor for how much muscle you can build, how hard you can train, and how long you can keep lifting.
• 0:31
  Philip Pape: You'll learn how to optimize bone density without drugs, what hormone optimization has to do with skeletal strength, and why bones aren't passive structures, but active organs that respond to training stress.
• 0:44
  Philip Pape: If your goal is to build a physique that's strong on the outside but resilient on the inside, you're gonna enjoy this one.
• 0:50
  Philip Pape: Welcome to Wit and Weight, the show that helps you build a strong, healthy physique using evidence, engineering, and efficiency.
• 1:01
  Philip Pape: I'm your host, Philip Fape, and today we're gonna talk about something that doesn't come up as often as I'd like to see it in physique and strength training discussions, but could be the most important foundation for long-term performance, and that is bone health.
• 1:14
  Philip Pape: My guest is Dr.
• 1:16
  Philip Pape: Doug Lucas, a double board certified orthopedic surgeon and osteoporosis specialist who stepped away from the surgical practice to focus on a mission that he's passionate about, and that is proving that osteoporosis is not only preventable, but often reversible.
• 1:31
  Philip Pape: He's the founder of the Osteocollective, an online community supporting bone health education and lifestyle change.
• 1:38
  Philip Pape: He's the author of two best-selling books on osteoporosis and hormone optimization and host of the Dr.
• 1:43
  Philip Pape: Doug Show podcast.
• 1:44
  Philip Pape: I invited Dr.
• 1:46
  Philip Pape: Doug on the show because of his perspective on how bone density, hormone health, and strength training intersect.
• 1:53
  Philip Pape: For those of us who lift weights and care about building muscle, that lasts, that gives us longevity, aka everyone who listens to this podcast, understanding the role of skeletal integrity is at least as essential as, say, getting jacked.
• 2:06
  Philip Pape: So we're going to discuss why your bones should be a priority, how strength training builds bone density, you know, mechanistically, what our over 40 lifters need to know about hormones and skeletal health and steps you can start taking today.
• 2:19
  Philip Pape: Dr.
• 2:19
  Philip Pape: Doug, welcome to the show.
• 2:21
  Dr. Doug Lucas: Oh man, that was such a good intro.
• 2:23
  Dr. Doug Lucas: That just like so many things to talk about in there.
• 2:25
  Dr. Doug Lucas: Happy to be here.
• 2:26
  Philip Pape: Good, good, good.
• 2:27
  Philip Pape: Hopefully we can remember them all.
• 2:28
  Philip Pape: Because I know you're an expert in bone health, but you also have these other angles that relate to our listeners.
• 2:34
  Philip Pape: And before we get into those, I like to define some things.
• 2:37
  Philip Pape: I want to nerd out with you on the anatomy, the physiology, the system-level interconnectedness.
• 2:44
  Philip Pape: Because I know we're talking more about, you know, there's buzzwords like osteosarcopenia, the kind of portmanteau of two different things, so that we have that foundation for the rest of the discussion.
• 2:53
  Philip Pape: So let's just start with defining bone health.
• 2:56
  Dr. Doug Lucas: Yeah, man.
• 2:56
  Dr. Doug Lucas: Well, so I wish it were just that simple.
• 2:58
  Dr. Doug Lucas: You know, when most people think bone health, they think osteoporosis, they think old people, hip fracture.
• 3:04
  Dr. Doug Lucas: And that is true that all that's exists.
• 3:07
  Dr. Doug Lucas: And I love talking to that population too.
• 3:09
  Dr. Doug Lucas: But bone health really, for me, has taken a turn over the last five years as we've been creating, you know, clinical programs, community resources, and I'm on stages across the, you know, right now, the globe, talking about bone health.
• 3:21
  Dr. Doug Lucas: And what's happened to me is that I think that we really need to just redefine bone health.
• 3:26
  Dr. Doug Lucas: Bones in general are such a great organ to look at because they're telling us a story, not loudly, quietly, but through imaging, through blood markers.
• 3:36
  Dr. Doug Lucas: And we know that on average, people will lose bone as they age.
• 3:39
  Dr. Doug Lucas: But I think we've got it backwards where we say, oh, if you lose enough bone, you have a disease.
• 3:43
  Dr. Doug Lucas: But actually, I think we need to be looking at bone health as a biomarker of longevity.
• 3:47
  Dr. Doug Lucas: If you're losing bone, something's wrong.
• 3:50
  Dr. Doug Lucas: And that's how we need to change this perspective of bone health.
• 3:52
  Dr. Doug Lucas: Because bone health is really just imbalanced bone metabolism when it's wrong, and it's balanced bone metabolism when it's right.
• 3:59
  Philip Pape: No, I love that term, bone metabolism, because that I haven't heard.
• 4:02
  Philip Pape: Let's let's dig into that.
• 4:03
  Philip Pape: I like that bone can be a biomarker.
• 4:05
  Philip Pape: It's it's a changing thing, right?
• 4:06
  Philip Pape: I think people maybe think of it as this fixed structure and it's super dynamic like everything in the body.
• 4:11
  Philip Pape: So, what do you mean by bone metabolism?
• 4:13
  Dr. Doug Lucas: Yeah.
• 4:14
  Dr. Doug Lucas: So imagine this.
• 4:15
  Dr. Doug Lucas: Every 10 years, especially as younger adults, we are replacing our entire skeleton.
• 4:20
  Dr. Doug Lucas: So, you know, go back 10 years ago.
• 4:22
  Dr. Doug Lucas: The skeleton you had then is completely different than the skeleton that you have now.
• 4:26
  Dr. Doug Lucas: Bones are not just static, you know, framework for our body that our muscles attach to.
• 4:30
  Dr. Doug Lucas: They are, as you said, dynamic.
• 4:32
  Dr. Doug Lucas: They are living, they're making cells.
• 4:34
  Dr. Doug Lucas: They actually are full of stem cells.
• 4:36
  Dr. Doug Lucas: They are really, really cool organs that are communicating to the rest of your body through hormones, just like everything else.
• 4:43
  Dr. Doug Lucas: And so when I say bone metabolism, what I mean is how much bone are you breaking down at any one time?
• 4:48
  Dr. Doug Lucas: How much bone are you building at any one time?
• 4:50
  Dr. Doug Lucas: And then what is that balance?
• 4:52
  Dr. Doug Lucas: So you mentioned, you know, cells earlier.
• 4:54
  Dr. Doug Lucas: So osteoblasts are building, osteoclasts are breaking down.
• 4:58
  Dr. Doug Lucas: There's always a balance between the two.
• 5:00
  Dr. Doug Lucas: And if you break down more than you build up, you'll lose bone.
• 5:03
  Dr. Doug Lucas: And if you're building up more than you break down, you're gonna build bone.
• 5:06
  Dr. Doug Lucas: And that bone metabolism is what we need to be looking at when we start talking about bone health.
• 5:11
  Philip Pape: So is there a proxy or I should say an equivalent for muscle protein synthesis then in the bone world?
• 5:16
  Dr. Doug Lucas: Yeah, that's interesting.
• 5:17
  Dr. Doug Lucas: Um, I don't know how you measure it with muscle, but yes, the idea is that you want to stimulate bone.
• 5:23
  Dr. Doug Lucas: There's not a cool process like bone protein synthesis that I'm aware of.
• 5:27
  Dr. Doug Lucas: Um, you know, maybe there is.
• 5:28
  Dr. Doug Lucas: I'd love to learn about it.
• 5:29
  Dr. Doug Lucas: But we can measure it in bone, which is different than in muscle.
• 5:32
  Philip Pape: Got it.
• 5:33
  Philip Pape: And I know for some context for the listener, right?
• 5:36
  Philip Pape: You were an orthopedic surgeon.
• 5:38
  Philip Pape: Uh, I've dealt with several of those.
• 5:39
  Philip Pape: I had back surgery and rotator cuff surgery, and some are awesome and some, you know, I wouldn't see again.
• 5:45
  Philip Pape: And, you know, just like anyone else in the healthcare industry.
• 5:47
  Philip Pape: Right.
• 5:47
  Philip Pape: But you then pivoted into more functional medicine focused on bone health.
• 5:51
  Philip Pape: So, what's the context behind that transition as it relates to your passion for this today?
• 5:56
  Dr. Doug Lucas: Yeah, man, I love the OR.
• 5:57
  Dr. Doug Lucas: You know, when I went into medical school, I didn't know, I didn't know what I wanted to do.
• 6:00
  Dr. Doug Lucas: I think like a lot of medical students, and I was just fascinated by the operating room.
• 6:05
  Dr. Doug Lucas: I loved the, you know, the power of the literally power tools, but the power of what we could do in the operating room, we could make something that is so broken, so much better quickly, you know, and just it was so clear, so black and white.
• 6:17
  Dr. Doug Lucas: Loved operating, did that for, you know, a decade or more.
• 6:20
  Dr. Doug Lucas: But what I realized too is that when I got into practice, yes, we could do great things in the operating room, but really the most powerful thing is preventing what we were operating on in the first place.
• 6:30
  Dr. Doug Lucas: So I got very interested in a lot of the stuff that you talk about.
• 6:33
  Dr. Doug Lucas: We talk about the right nutrition that's right for you, the right type of movement, resistance training, you know, what kind of supplements based off of what biomarkers.
• 6:40
  Dr. Doug Lucas: I just went down all these rabbit holes and I realized that I wasn't as excited about seeing patients anymore because I realized that they were, it was already too late.
• 6:48
  Dr. Doug Lucas: You know, they'd already gone down the, you know, this path based on either their own bad decisions or somebody told them, likely their doctor told them to go down.
• 6:55
  Dr. Doug Lucas: And I was really just cleaning up the mess of metabolic disease, especially as a foot and ankle surgeon.
• 6:59
  Dr. Doug Lucas: And so I was very fortunate.
• 7:01
  Dr. Doug Lucas: My wife uh is also an entrepreneur and runs a company.
• 7:04
  Dr. Doug Lucas: So we were able to tolerate me stepping away from a relatively high-paying W-2 job, getting additional training, hormone fellowship, you know, anti-aging, you know, functional medicine fellowship, and then starting my own telehealth practice and getting to where we are today.
• 7:19
  Philip Pape: Okay, that makes a lot of sense.
• 7:20
  Philip Pape: And um, there's more of that in this industry, especially as a podcaster, getting to interact with cardiac surgeon, urologists, uh, all sorts of doctors who have done a similar thing as you, I think, because they almost feel frustrated that they have come so late in the process.
• 7:34
  Philip Pape: Yeah.
• 7:34
  Philip Pape: Right.
• 7:35
  Philip Pape: Just as well, GPs, um, you know, you've got the Dr.
• 7:37
  Philip Pape: Spencers of the world who are trying to integrate as much preventative stuff into their practice as possible.
• 7:43
  Philip Pape: Okay, so that that's really important, right?
• 7:44
  Philip Pape: Because that's what we're focused on on this show.
• 7:46
  Philip Pape: So when someone hears osteoporosis or bone density, and I know there are a lot of different terms.
• 7:51
  Philip Pape: In fact, I heard you on Karen Martell talking about some that are a bit maybe archaic now.
• 7:55
  Philip Pape: I think osteopenia is used less now.
• 7:57
  Philip Pape: Yeah.
• 7:58
  Philip Pape: And they think either you think, okay, this is an old person's problem, right?
• 8:02
  Philip Pape: Like this is something to worry about years and years from now.
• 8:04
  Philip Pape: I know are are much more cognizant of it now, especially those that listen to these types of shows.
• 8:10
  Philip Pape: But you work with people from across the age range.
• 8:12
  Philip Pape: So one important question, speaking of preventative, is when do we start doing something?
• 8:18
  Philip Pape: And I know the question's obviously like you should lift weights, guys, as soon as you're able to, like, you know, you're 14, start lifting weights.
• 8:23
  Philip Pape: That's fine.
• 8:24
  Philip Pape: But, you know, what does the spectrum and the timeline look like where the risk just starts to accumulate in that timeline?
• 8:30
  Philip Pape: Yeah.
• 8:30
  Dr. Doug Lucas: You know, this is this is one of the things I talk about most, actually, because I I try to get in front of younger audiences.
• 8:36
  Dr. Doug Lucas: The part of my mission, which is educating about how to reverse osteoporosis, I love that part.
• 8:40
  Dr. Doug Lucas: And it's really important because there's a lot of there's a lot of anxiety and fear, and unnecessarily so in those that have the diagnosis of osteoporosis.
• 8:48
  Dr. Doug Lucas: But I think the bigger part of this is who needs to be screened, when, why, with what, and what does it mean?
• 8:55
  Dr. Doug Lucas: And so if you think about bone density, the bone density increases as you go through childhood into early adulthood.
• 9:03
  Dr. Doug Lucas: Bone density will peak, your peak bone mass will occur in your late 20s, early 30s, both men and women.
• 9:08
  Dr. Doug Lucas: Arguably because we are no longer that physically active as young children, as adolescents, more screen time, more games, more school, you know, less running around, jumping off of stuff, banging our bones around.
• 9:21
  Dr. Doug Lucas: We are seeing young adults with lower bone mass to start with.
• 9:25
  Dr. Doug Lucas: This is a big problem because on average, all women and men will lose bone density as they age.
• 9:32
  Dr. Doug Lucas: I don't think it has to be that way, but that's the average.
• 9:34
  Dr. Doug Lucas: And especially women as they get into perimenopause and menopause are going to see a rapid drop.
• 9:39
  Dr. Doug Lucas: If you don't know what your starting point is, you don't know what you should be doing.
• 9:44
  Dr. Doug Lucas: So, right now, I'm telling every young adult with any risk factor whatsoever for bone health, and I'm happy to go through them, but I can just shorten it by saying that you all have them.
• 9:52
  Dr. Doug Lucas: Everyone should be screened to see what their bone density and hopefully quality are, depending on the screening modality, to know what your starting point is, especially certain populations at risk.
• 10:03
  Dr. Doug Lucas: So, just a couple of things there.
• 10:05
  Dr. Doug Lucas: Young women who are involved in endurance sports, all should be screened.
• 10:10
  Dr. Doug Lucas: I've had so many patients, young women in their 20s and 30s, that have not even low bone density osteopenia, outright osteoporosis.
• 10:18
  Dr. Doug Lucas: It's frightening.
• 10:19
  Dr. Doug Lucas: And I think it's rampant in that age group, that subgroup of athletes, and they don't know it.
• 10:24
  Dr. Doug Lucas: Nobody's talking about it.
• 10:25
  Philip Pape: And real quickly, why is that?
• 10:27
  Dr. Doug Lucas: Yeah, well, I think it has to do a little bit with uh, you know, how much stress they're putting their body through.
• 10:30
  Dr. Doug Lucas: I think there's some, you know, there's body dysmorphia in there, there's eating disorders in there, and then there's hormonal disruption in there.
• 10:37
  Dr. Doug Lucas: So a lot of women who are in, you know, endurance sports, especially as young women, either will never develop a normal menstrual cycle or will lose it and then not worry about it because they're told that, oh, that's okay.
• 10:48
  Dr. Doug Lucas: Totally common for you know long distance runners to not cycle, but it is a big deal and it is not normal.
• 10:54
  Dr. Doug Lucas: So if you're not cycling as a woman, you are losing bone by definition.
• 10:59
  Philip Pape: Okay.
• 10:59
  Philip Pape: So that's one, that's one at-risk population.
• 11:01
  Philip Pape: Young women endurance sports.
• 11:02
  Dr. Doug Lucas: Yeah.
• 11:02
  Dr. Doug Lucas: So and then the other group that I think is, I mean, nobody ever talks about this, but I think, you know, young men, the more and more we see young men either with low testosterone and then subsequently low estrogen, either naturally or they're on testosterone replacement, but they're using an aromatase inhibitor like anastrazole, and they're bottoming out their estrogen just because that's what they're trying to do to increase their testosterone.
• 11:23
  Dr. Doug Lucas: If you don't have estrogen, as a man, even a young man lifting heavy weights, you're still losing bone.
• 11:29
  Dr. Doug Lucas: And so I've seen, you know, this, I don't know how common this is, but I've seen men, 20s, 30s, on TRT, but on too high a dose of AI that are losing bone and they have osteoporosis and they look, they're jacked, right?
• 11:40
  Dr. Doug Lucas: They're lean and they jacked, they look amazing.
• 11:42
  Dr. Doug Lucas: They look like Superman, but they have osteoporosis.
• 11:46
  Philip Pape: Are they on TRT for physiologic replacement or or to get performance enhancing, you know, up into the thousands of testosterone?
• 11:54
  Dr. Doug Lucas: Yes, yeah, yeah, yeah, yeah.
• 11:55
  Dr. Doug Lucas: Yeah, but both, right?
• 11:57
  Dr. Doug Lucas: I'm not prescribing it at the the super physiologic levels, but you know, but either way, even if you have a testosterone, it's you know, 3,000 total T, but you're on a you know, a large dose of AI and your estrogen is zero, it doesn't matter.
• 12:09
  Dr. Doug Lucas: You're still losing bone.
• 12:10
  Philip Pape: Okay.
• 12:11
  Philip Pape: So then that raises the question that for people who are training for strength of physique, let's say beyond these at-risk populations, which right there, we're going to include them in the list of absolutely get checked and baselined early and monitor this.
• 12:24
  Philip Pape: You know, what do we take out of when we talk about bone density, bone quality, whatever the metrics are, and prioritizing them in and of themselves, right?
• 12:32
  Philip Pape: So I guess we can talk about the metrics that need to be screened.
• 12:35
  Philip Pape: And is there anything you're doing specifically that you're not already doing for muscle and health anyway?
• 12:41
  Philip Pape: Because I love the fact that we get two for ones when we talk about this stuff.
• 12:44
  Philip Pape: If you're lifting weights, you're gonna solve a lot of issues.
• 12:46
  Philip Pape: So you're good.
• 12:48
  Philip Pape: But in some cases, like is it the at-grist populations or maybe a need to pay attention to bones specifically for one reason or another?
• 12:54
  Philip Pape: So help me understand that.
• 12:56
  Dr. Doug Lucas: Yeah.
• 12:56
  Dr. Doug Lucas: So I think it changes the way you train and it might change the way you eat.
• 12:59
  Dr. Doug Lucas: You know, so I mean, let's go back to that, like the young athletic, you know, endurance athlete woman.
• 13:05
  Dr. Doug Lucas: I'm not saying that she has to stop running, but she should pay attention to how many calories are you getting, what is your total body fat?
• 13:11
  Dr. Doug Lucas: You know, if you need to be super lean for competition, can you get less lean in your offseason?
• 13:16
  Dr. Doug Lucas: You know, let's figure out can we create a way where you're not losing bone?
• 13:19
  Dr. Doug Lucas: Because again, if you're losing bone, something's wrong.
• 13:21
  Dr. Doug Lucas: And then if you're truly osteoporotic in your 20s as a woman, I mean, this is this is, you know, red flags, warning signals, like we got to build bone.
• 13:31
  Dr. Doug Lucas: And then if that's the case, then maybe you're gonna have to back off of your long distance training, add more resistance, build more muscle, and do some kind of impact training as well.
• 13:40
  Philip Pape: And speaking of building muscle, this is another thing that comes up strength versus muscle.
• 13:45
  Philip Pape: And I say versus loosely, because right, there's a lot of overlap, obviously.
• 13:48
  Philip Pape: But the idea that lifting heavy and heavy is another subjective term, because do we mean training close to failure for muscular tension, or do we literally mean low reps up in a high percentage of your max?
• 13:58
  Philip Pape: So just let's resolve that real quick.
• 14:00
  Philip Pape: And then I do want to dive into some of the how do you scan for this and and other stuff.
• 14:05
  Philip Pape: Lifting heavy, like what are your thoughts on that?
• 14:07
  Dr. Doug Lucas: Yeah.
• 14:07
  Dr. Doug Lucas: So I mean, when I say it, I say we need to lift heavy.
• 14:10
  Dr. Doug Lucas: But what but what do I mean by that?
• 14:12
  Dr. Doug Lucas: And I and I get I have some some interesting exercise physiology people out there in like the longevity space that will give me negative comments to say, like, you don't have to lift heavy or, you know, I mean all these different like subjective terms, right?
• 14:23
  Dr. Doug Lucas: But what I mean is when you look at the literature, there are studies looking at what's called high intensity resistance.
• 14:29
  Dr. Doug Lucas: So they're talking, you know, 80 to 90 percent of one rep max.
• 14:33
  Dr. Doug Lucas: That's heavy, regardless of what your starting point is, you know.
• 14:36
  Dr. Doug Lucas: So that's what I mean by high intensity, heavy.
• 14:39
  Dr. Doug Lucas: We know that those studies, those protocols are going to have a better response to either slowing down bone loss or potentially even building bone if they are mixed with impact.
• 14:48
  Dr. Doug Lucas: So when I say heavy, I don't mean go out there and try to deadlift 225 pounds if you've never done it.
• 14:53
  Dr. Doug Lucas: Like, please don't do that.
• 14:54
  Dr. Doug Lucas: But if your starting point is, you know, a band and your wanderet max is like, you know, whatever this color band is, then you know, go 80% of that.
• 15:01
  Dr. Doug Lucas: Like that's heavy.
• 15:02
  Dr. Doug Lucas: So you could do that with pink dumbbells if you needed to.
• 15:05
  Dr. Doug Lucas: It just depends on your starting point.
• 15:07
  Philip Pape: 100%.
• 15:07
  Philip Pape: Uh, my mother-in-law, we we were getting her for Christmas a set of you know, arthritis-friendly dumbbells and a wrist wrap, because for her, that's super heavy, and I'm excited for what she's gonna get out of it, right?
• 15:18
  Philip Pape: Um, yeah, no, that's a that's a good qualification because I'm going forward, you know, some of these recent talks I've had, and now you're only reinforcing that, is I think there's these different regimes of percent max that kind of have different goals, right?
• 15:30
  Philip Pape: There's the hypertrophy regime, which is extremely wide, and there's the strength, which is a little bit higher up, like 60%.
• 15:35
  Philip Pape: And then maybe we say, okay, the the super necessary bone health population is 80%, right?
• 15:41
  Philip Pape: And that is what, five, five uh reps-ish, I think.
• 15:45
  Philip Pape: Right.
• 15:45
  Philip Pape: I forgot my.
• 15:46
  Dr. Doug Lucas: I mean it's five by five-ish, right?
• 15:47
  Dr. Doug Lucas: Yeah.
• 15:47
  Dr. Doug Lucas: Five reps.
• 15:48
  Philip Pape: Yeah, exactly.
• 15:49
  Philip Pape: Which is a beginner program like starting strength or something, is gonna be in that range.
• 15:52
  Philip Pape: So that's perfect.
• 15:53
  Philip Pape: Um, okay, so then before we get into the scan discussion terms here, bone density, that's pretty self-explanatory, but we can describe what we mean by that, you know, uh physiologically.
• 16:04
  Philip Pape: Bone quality, like what are the different metrics of how we measure bone health?
• 16:08
  Dr. Doug Lucas: Yeah, so we talk a lot about bone density because the definition of osteoporosis is based off of density from the imaging modality of DEXA, which is not a great imaging modality, to be honest.
• 16:18
  Dr. Doug Lucas: You know, we can use DEXA for a lot of things, body composition, bone density.
• 16:22
  Dr. Doug Lucas: It's okay, but it's just a two-dimensional x-ray.
• 16:26
  Dr. Doug Lucas: So your output is only as good as your input.
• 16:29
  Dr. Doug Lucas: Uh we're not gonna get away from DEXA anytime soon, though, because it is the gold standard, even though it's not, there's nothing gold about it, but it's the standard and it's widely available.
• 16:38
  Dr. Doug Lucas: It's covered by insurance under many circumstances.
• 16:40
  Dr. Doug Lucas: So with DEXA, you know, you're gonna get this thing called a T-score.
• 16:44
  Dr. Doug Lucas: It measures, well, for older individuals, T-score is gonna measure your bone density compared to a younger version of your sex and ethnicity.
• 16:53
  Dr. Doug Lucas: And that's what we use as a definition of osteoporosis.
• 16:56
  Dr. Doug Lucas: Now, for younger individuals, there's a thing called a Z-score.
• 16:58
  Dr. Doug Lucas: You also get from DEXA, it compares you to your age-matched peers.
• 17:01
  Dr. Doug Lucas: That's valuable for individuals younger than the age of 50.
• 17:04
  Dr. Doug Lucas: And that's just comparing you to somebody who's like you, but maybe has different bone density.
• 17:08
  Dr. Doug Lucas: So we can use bone density from that perspective.
• 17:11
  Dr. Doug Lucas: But what we really want to know is what's your fracture risk.
• 17:14
  Dr. Doug Lucas: Now, maybe not in a 20-year-old athlete do we want to know your fracture risk, although if you have low bone density, I want to know your fracture risk.
• 17:20
  Dr. Doug Lucas: But as we get further along, we want to know what your fracture risk is.
• 17:24
  Dr. Doug Lucas: And then that question is really a combination of bone density and bone quality.
• 17:29
  Dr. Doug Lucas: Because we see a lot of issues with bone density when you start predicting fracture risk.
• 17:33
  Dr. Doug Lucas: In fact, most fragility fractures, and there's clear definitions there, but most fragility fractures occur in those without osteoporosis.
• 17:41
  Dr. Doug Lucas: They have low bone density, not osteoporosis, partially because there's just more of them.
• 17:45
  Dr. Doug Lucas: But it's not necessarily just a density problem, it's a quality problem.
• 17:49
  Dr. Doug Lucas: So then how do you measure quality?
• 17:50
  Dr. Doug Lucas: Well, this is not super clear.
• 17:53
  Dr. Doug Lucas: There are modalities out there that are not DEXA.
• 17:56
  Dr. Doug Lucas: So ultrasound device called RAMS from the company Echolite out of Italy, that device has a fragility score.
• 18:02
  Dr. Doug Lucas: It's measuring quality and comparing it to a database of people who have or have not fractured.
• 18:06
  Dr. Doug Lucas: So that's kind of cool.
• 18:08
  Dr. Doug Lucas: Um, CT studies, quantitative CT can do it as well.
• 18:11
  Dr. Doug Lucas: So, quantitative CT, you can look at different ways that the computer can calculate strength.
• 18:18
  Dr. Doug Lucas: It's usually calculated as strength.
• 18:19
  Dr. Doug Lucas: Um, and so there's a quality metric there, but CT is not a great thing to use because you can't use it continuously over time.
• 18:26
  Dr. Doug Lucas: Like you don't want to go CT your body every six months or 12 months to look at your bone density and quality.
• 18:30
  Dr. Doug Lucas: It's just too much radiation.
• 18:32
  Dr. Doug Lucas: So you're kind of stuck between the ultrasound device, the RAMs, or what else you can do on DEXA.
• 18:38
  Dr. Doug Lucas: There's a couple other things you can do on DEXA.
• 18:39
  Dr. Doug Lucas: One's called TBS or tubecular bone score, one's called 3D Shaper that just got FDA approved.
• 18:44
  Dr. Doug Lucas: But neither of those are are adding any additional inputs to DEXA.
• 18:48
  Dr. Doug Lucas: It's just different ways to calculate on the output side.
• 18:50
  Dr. Doug Lucas: And again, DEXA is an old school two-dimensional x-ray.
• 18:53
  Dr. Doug Lucas: So how good could it be?
• 18:54
  Dr. Doug Lucas: So this is one of the challenges with imaging and bone is that there really isn't a great tool to say that you can accurately say what your bone density is, what your bone quality is, and then ultimately what your fracture risk is.
• 19:06
  Philip Pape: Well, that's discouraging, but but you made me my you made my brain go to AI when you mentioned obviously the uh ultrasound and having the comparative, the correlational analysis and where is that all going?
• 19:17
  Philip Pape: Like I imagine they're looking at taking the imaging and like you said, correlational machine learning uh comparisons.
• 19:24
  Philip Pape: Are we on the cusp of something there?
• 19:26
  Philip Pape: Are there any breakthroughs about to happen?
• 19:27
  Philip Pape: What's going on?
• 19:28
  Dr. Doug Lucas: So the company Echolite and I have not worked together, but I just imagine, I mean, I know so many business owners that have these devices.
• 19:36
  Dr. Doug Lucas: The scanned data, after you get a scan, all of that data is owned by Echo Lite, by the parent company.
• 19:42
  Dr. Doug Lucas: So they'll download from these machines, you know, these thousands and thousands of scans.
• 19:47
  Dr. Doug Lucas: Their database is massive.
• 19:49
  Dr. Doug Lucas: So, yes, could you use AI to come up with a better calculation based off of these inputs that are coming in from Ultrasound?
• 19:56
  Dr. Doug Lucas: Absolutely.
• 19:57
  Dr. Doug Lucas: I hope they're doing that.
• 19:58
  Dr. Doug Lucas: I don't know for sure that they are, but yes, you could certainly use AI learning to better predict this.
• 20:03
  Dr. Doug Lucas: And I think that is where we're going.
• 20:04
  Philip Pape: Yeah, that's pretty cool.
• 20:05
  Philip Pape: Um, yeah, I have an app coming out just to show that that's based on AI.
• 20:09
  Philip Pape: And I'm surprised myself at what it can do because we almost don't have full control of some of the things these this AI can do.
• 20:16
  Philip Pape: Uh, it's insane.
• 20:17
  Philip Pape: All right.
• 20:18
  Philip Pape: So if so let's say someone is uh assessing their density and quality with one of these measures or a combination of these measures over time, maybe they're at risk, maybe they're not, but they want to know what to do on a daily basis.
• 20:29
  Philip Pape: And of course, we love to start with lifestyle uh first here.
• 20:32
  Philip Pape: And I think a lot of people assume that if they're lifting weights, fairly active, not doing anything overly stressful, like the at-risk populations and not under-eating.
• 20:41
  Philip Pape: Like, so we're saying all the things that they, a lot of things they should be doing that maybe they're not doing.
• 20:45
  Philip Pape: What would you say are the big hitters besides lifting weights?
• 20:49
  Philip Pape: Or are you like, hey, lifting weights is 80% of it?
• 20:52
  Philip Pape: And then here are the other ones.
• 20:53
  Dr. Doug Lucas: Yeah, I mean, I think um, not to pander to your audience or anything, but I mean, yeah, like the resistance training part is huge.
• 21:00
  Dr. Doug Lucas: But we we kind of build it like this.
• 21:02
  Dr. Doug Lucas: Like we have a pyramid, the foundation of our pyramid is just like every other functional integrative practitioner out there.
• 21:07
  Dr. Doug Lucas: Nothing special about it, right?
• 21:09
  Dr. Doug Lucas: It's exercise, nutrition, mindset, and sleep.
• 21:12
  Dr. Doug Lucas: There's nothing special about those categories, except that when it comes to nutrition and bone health, just like with muscle health, you have to eat enough calories.
• 21:21
  Dr. Doug Lucas: And there's just no way around that.
• 21:22
  Dr. Doug Lucas: You have to get enough of the basics, you have to get enough protein.
• 21:26
  Dr. Doug Lucas: And for those that have osteoporosis, it is a sign that they have had inadequate protein, either consumption or absorption, one of the two.
• 21:33
  Dr. Doug Lucas: But either consumption or absorption, they've had inadequate protein for a long time.
• 21:37
  Dr. Doug Lucas: You know, and I used to get on stages and I used to, you know, preach about my beliefs about food.
• 21:42
  Dr. Doug Lucas: And then I realized like nobody cares what I think about food outside of the things I can prove in research, which is more protein in population studies, better bone density.
• 21:52
  Dr. Doug Lucas: It is hands down clear.
• 21:53
  Dr. Doug Lucas: Same thing with muscle mass, right?
• 21:55
  Dr. Doug Lucas: Like you have to reach this muscle protein synthesis threshold.
• 21:57
  Dr. Doug Lucas: We don't know what that threshold is for bone, but it's somewhere around the same thing because it just gets you anabolic.
• 22:02
  Dr. Doug Lucas: It's just that simple.
• 22:03
  Dr. Doug Lucas: Yeah.
• 22:04
  Dr. Doug Lucas: And then exercise perspective, we we kind of talked about it, hit on it.
• 22:07
  Dr. Doug Lucas: The resistance training, high intensity, fantastic.
• 22:10
  Dr. Doug Lucas: The difference is impact training because most of your listeners are probably not doing intentional impact.
• 22:15
  Dr. Doug Lucas: It hurts, it might not be good for your joints if you're doing it wrong, but it does provide a good stimulus for bone.
• 22:21
  Dr. Doug Lucas: Resistance training has not consistently shown benefit for bone health in the literature.
• 22:25
  Dr. Doug Lucas: In fact, usually it's it just slows down bone loss.
• 22:28
  Dr. Doug Lucas: It does not build bone.
• 22:29
  Dr. Doug Lucas: If you want to build bone, you need to add additional impact, either through something like a box jump, some kind of plyometric thing, heel drop, or some kind of simulated impact like whole body vibration or osteogenic loading as a device that's there's some devices that are out there as well that could potentially do it.
• 22:45
  Dr. Doug Lucas: But something that adds more than just resistance to that exercise piece.
• 22:49
  Philip Pape: I want to hit on that.
• 22:50
  Philip Pape: That's interesting because you said um lifting at best preserves your bone density, which of course itself is important.
• 22:58
  Philip Pape: For those listening who want an excuse not to do impact training, then I want to talk about doing impact training.
• 23:03
  Philip Pape: Okay.
• 23:04
  Dr. Doug Lucas: Yeah.
• 23:04
  Philip Pape: If they've been living a healthy lifestyle since, say, their 30s, is it a big concern that they're not doing impact training or is it kind of like you're okay?
• 23:11
  Philip Pape: Or is this a non-negotiable almost?
• 23:14
  Dr. Doug Lucas: Well, and this is where you screen, right?
• 23:15
  Dr. Doug Lucas: Like you screen, and if you're if your bone entity is great, cool.
• 23:18
  Dr. Doug Lucas: Like you're probably fine to not do it.
• 23:19
  Dr. Doug Lucas: But if you have osteoporosis, you need to start figuring out how to do it in a way that your body can handle it.
• 23:24
  Philip Pape: Okay.
• 23:24
  Philip Pape: And that's not unlike some messaging I've had from some other good coaches in the space I respect.
• 23:29
  Philip Pape: Like Megan Dahlman is really big into bone health, and she's she talks about impact training, but she's like, not everyone has to do it.
• 23:34
  Philip Pape: But yeah, if you're trying to recover bone, so that's really good.
• 23:37
  Philip Pape: So box jumps, you mentioned whole body vibrations.
• 23:40
  Philip Pape: So are we talking about things that some of us make fun of because some people use it as like their only form of exercise, thinking it's gonna, you know what I'm talking about?
• 23:47
  Philip Pape: It's the vibrates your whole body.
• 23:48
  Philip Pape: Yeah, yeah, yeah.
• 23:49
  Philip Pape: The plates and everything.
• 23:50
  Philip Pape: Yeah.
• 23:51
  Dr. Doug Lucas: Yeah.
• 23:51
  Philip Pape: Okay, okay, interesting.
• 23:52
  Philip Pape: So there's a good use for that then.
• 23:54
  Dr. Doug Lucas: Yeah.
• 23:55
  Dr. Doug Lucas: So I so I'm a big fan because I have a lot of a lot of my, you know, community members, they have such a low starting point that their resistance is, their resistance training is very, very minimal, right?
• 24:04
  Dr. Doug Lucas: Or they have significant arthritis.
• 24:06
  Dr. Doug Lucas: I mean, there's we have all cumbers from different health perspectives.
• 24:09
  Dr. Doug Lucas: So we have some very sick people.
• 24:10
  Dr. Doug Lucas: Something that is passive could be absolutely beneficial if it works, right?
• 24:15
  Dr. Doug Lucas: So it's got to work.
• 24:16
  Dr. Doug Lucas: The evidence behind whole body vibration, if done correctly, meaning on the right device.
• 24:21
  Dr. Doug Lucas: So the the company we utilize is power plate because their devices are very, you know, they're powerful, hence the name.
• 24:26
  Dr. Doug Lucas: Um, they're powerful and they are predictable and they're commercial grade or even healthcare grade.
• 24:31
  Dr. Doug Lucas: So they have home devices and it moves up and down the certain amount.
• 24:35
  Dr. Doug Lucas: So that's hertz, 30 to 40 hertz.
• 24:37
  Dr. Doug Lucas: And then it's up and down, not like side to side, like you know, the pivot one side to side that just make your sacrum looks like it hurts.
• 24:44
  Dr. Doug Lucas: Um, so the up and down version is what you need, and it has to go up and down enough to actually create enough gravitational force.
• 24:50
  Dr. Doug Lucas: And that's you want that three to five Gs, and or that's two to four millimeters.
• 24:54
  Dr. Doug Lucas: And so if you have the right device, stand on it for 10 minutes, you can actually see bone mineral density increase and multiple studies demonstrating that.
• 25:02
  Philip Pape: That's incredible.
• 25:03
  Philip Pape: Okay.
• 25:04
  Philip Pape: Yeah, I'm learning something here for sure.
• 25:06
  Philip Pape: I didn't I didn't know that.
• 25:07
  Philip Pape: I'm gonna, this is gonna be pinned in my notes for personal reasons for people that I know in my life, but also to share this.
• 25:12
  Philip Pape: So I thank you.
• 25:13
  Philip Pape: Thank you.
• 25:13
  Philip Pape: Always always looking to learn something.
• 25:15
  Dr. Doug Lucas: Yeah.
• 25:16
  Philip Pape: So, okay, so we've got lifting weights, we've got impact training, we've got not undereating, eating enough protein, huge.
• 25:21
  Philip Pape: I'm a big fan of that messaging in general.
• 25:24
  Philip Pape: Even people who want to lose fat, we talk about the importance of the majority of the year being spent at maintenance or potentially in a surplus building muscle, and you're gonna be much more healthier, you're gonna feel great.
• 25:33
  Philip Pape: What about vitamins, minerals, and fiber and their correlation?
• 25:37
  Philip Pape: Because there's a lot of confusion about calcium over the years and vitamin D, et cetera.
• 25:41
  Dr. Doug Lucas: Yeah, so um so minerals are super important.
• 25:45
  Dr. Doug Lucas: So uh we talk about, we hear about calcium all the time.
• 25:48
  Dr. Doug Lucas: Oh, you have osteoporosis, you need to take calcium and vitamin D.
• 25:51
  Dr. Doug Lucas: Hopefully they say vitamin D.
• 25:53
  Dr. Doug Lucas: The thing about minerals, though, is that like they don't exist in a vacuum.
• 25:56
  Dr. Doug Lucas: So your bones, yes, the most prominent mineral is calcium by volume and by weight, but it's so much more than that.
• 26:04
  Dr. Doug Lucas: And if you're gonna lay down calcium, you need magnesium.
• 26:07
  Dr. Doug Lucas: In fact, you need more magnesium than you need calcium.
• 26:09
  Dr. Doug Lucas: You also need potassium, you also need boron.
• 26:11
  Dr. Doug Lucas: You like you need it all.
• 26:13
  Dr. Doug Lucas: And so when I see people taking just big doses of calcium, essentially chalk, right?
• 26:18
  Dr. Doug Lucas: Calcium carbonate is chalk.
• 26:20
  Dr. Doug Lucas: If you take a big dose of calcium carbonate, first of all, your body's not gonna absorb very much.
• 26:24
  Dr. Doug Lucas: But secondly, osteoporosis is not a calcium deficiency problem.
• 26:28
  Dr. Doug Lucas: Osteoporosis is a you know multi-factorial thing.
• 26:31
  Dr. Doug Lucas: And so if you're gonna consume calcium or other minerals, it has to be done in a way where uh you're consuming them all together.
• 26:39
  Dr. Doug Lucas: That could be through supplementation, preferably through diet, but you need them all together.
• 26:44
  Dr. Doug Lucas: It's not just a calcium vitamin D deficiency.
• 26:46
  Dr. Doug Lucas: And then from a vitamin perspective, yes, vitamin D does help with the absorption of calcium, it does help with utilization, but you can almost get yourself in trouble.
• 26:53
  Dr. Doug Lucas: And this is where the research is actually pretty clear.
• 26:55
  Dr. Doug Lucas: If you take a huge chunk of calcium and you add vitamin D to it, you will absorb it.
• 27:00
  Dr. Doug Lucas: But then what?
• 27:01
  Dr. Doug Lucas: And so then you see these spikes of blood serum calcium.
• 27:05
  Dr. Doug Lucas: And when you do that, so you also need vitamin K to help to put it where you want it to go.
• 27:09
  Dr. Doug Lucas: So it's again, it's like we try in in medicine to simplify things because we need to do it at scale, right?
• 27:14
  Dr. Doug Lucas: We need to do this for 280 million Americans.
• 27:16
  Dr. Doug Lucas: Great.
• 27:17
  Dr. Doug Lucas: But we need to be realistic too.
• 27:18
  Dr. Doug Lucas: Taking a thousand milligrams of calcium plus 400 IU of vitamin D seems to not be dangerous, but is it really helpful?
• 27:27
  Dr. Doug Lucas: The research doesn't really support that.
• 27:29
  Dr. Doug Lucas: Even go back to the women's health initiative from 2002.
• 27:31
  Dr. Doug Lucas: What was the benefit of those things?
• 27:33
  Dr. Doug Lucas: It was pretty minimal.
• 27:34
  Dr. Doug Lucas: If you start stacking them, so you get multi-mineral, right?
• 27:37
  Dr. Doug Lucas: So you get calcium, you get the magnesium, you get all the things together.
• 27:41
  Dr. Doug Lucas: And then you start adding vitamin D, vitamin K.
• 27:44
  Dr. Doug Lucas: You also need A to make the D work in the cell.
• 27:46
  Dr. Doug Lucas: Like you have to start putting a list together, then you start coming up with a comprehensive stack that can help you to build bone.
• 27:52
  Philip Pape: Got it.
• 27:53
  Philip Pape: And is this comprehensive stack currently sold that way in in different markets?
• 27:57
  Philip Pape: Or like is it readily available at Walmart or Amazon, like the osteoporosis stack?
• 28:02
  Dr. Doug Lucas: Yeah, so it is.
• 28:03
  Dr. Doug Lucas: Like if you were to go on um, you know, if you're going to Amazon and shop, you know, whatever, whatever product you're looking for, right?
• 28:10
  Dr. Doug Lucas: You'll find a bajillion supplements.
• 28:12
  Dr. Doug Lucas: The challenge is how do you put it together?
• 28:14
  Dr. Doug Lucas: Because there's not a single product.
• 28:16
  Dr. Doug Lucas: And even in companies like there's companies I work with that are very specific to osteoporosis.
• 28:21
  Dr. Doug Lucas: So even in those companies, uh, you have to stack multiple products depending on your starting point.
• 28:27
  Dr. Doug Lucas: And this is what I always say about supplements is to say, look, depending on where you are, your genetics, what your biomarkers show or your deficiencies are, and maybe even functional testing, you're going to have a different stack than the person next to you.
• 28:38
  Dr. Doug Lucas: So there really isn't a one-size-fits-all approach.
• 28:41
  Philip Pape: Yeah, that makes a lot of sense.
• 28:42
  Philip Pape: All right.
• 28:43
  Philip Pape: So in addition to that, um, what about medications?
• 28:47
  Philip Pape: And oh, I actually want to start with is there anything people should be avoiding?
• 28:50
  Philip Pape: Because, again, some like Boniva has been around years and I've heard horror stories about that.
• 28:56
  Philip Pape: I mean, what's the latest state of things that are, you know, ancient and to be avoided, still around that should be avoided and things that are sometimes recommended?
• 29:04
  Dr. Doug Lucas: Yeah.
• 29:04
  Dr. Doug Lucas: So the pharmaceuticals and bone health are tough because in the conventional system, you know, we have this, we have this system that is really good at some things, right?
• 29:13
  Dr. Doug Lucas: It was designed to treat infections and to, you know, treat trauma and do surgeries as all that developed.
• 29:20
  Dr. Doug Lucas: But what it's terrible at is treating chronic disease.
• 29:24
  Dr. Doug Lucas: So whenever you're talking about making a drug, a specific pharmaceutical for something like osteoporosis or dementia or even heart disease, you know, like cholesterol, different story, but even like the chronic heart disease thing.
• 29:35
  Dr. Doug Lucas: Like it doesn't do a great job of that.
• 29:37
  Dr. Doug Lucas: And bone health is certainly no exception here.
• 29:39
  Dr. Doug Lucas: So the drugs that are designed for bone health are designed to be a single solution that will reduce fracture risk.
• 29:46
  Dr. Doug Lucas: To do that, there's kind of two different ways to do it.
• 29:49
  Dr. Doug Lucas: And they they all work off the same bone metabolism thing that I was just talking about, right?
• 29:53
  Dr. Doug Lucas: So if you want to reduce fracture risk, you can either slow down bone loss or you can build up bone.
• 29:59
  Dr. Doug Lucas: Which is the same thing I do.
• 30:01
  Dr. Doug Lucas: I just use different tools.
• 30:02
  Dr. Doug Lucas: The drugs that slow down bone loss, you mentioned Boneva.
• 30:05
  Dr. Doug Lucas: So there's kind of two main classes here: there's bisphosphonate drugs.
• 30:08
  Dr. Doug Lucas: So that's phosmax, boneva, reclast, all of these drugs that are bisphosphonates and work by essentially poisoning osteoclasts, those cells that break down bone.
• 30:18
  Dr. Doug Lucas: Prolia is a similar drug.
• 30:21
  Dr. Doug Lucas: That one also works by shutting down the osteoclast different mechanism, but you're still slowing down bone loss.
• 30:26
  Dr. Doug Lucas: The challenge with that is when you slow down bone loss, you also slow down bone building.
• 30:32
  Dr. Doug Lucas: Bone metabolism, neither side works in a vacuum.
• 30:35
  Dr. Doug Lucas: And so if you shut down one side, you shut down the other.
• 30:38
  Dr. Doug Lucas: And we can measure these things in blood.
• 30:40
  Dr. Doug Lucas: So there's bone turnover markers.
• 30:41
  Dr. Doug Lucas: This is what I meant.
• 30:42
  Dr. Doug Lucas: Like you can't measure this in muscle, or at least not well.
• 30:44
  Dr. Doug Lucas: In bones, you can actually measure it in blood.
• 30:46
  Dr. Doug Lucas: So we see the marker for bone loss drop.
• 30:48
  Dr. Doug Lucas: We see the marker for bone building drop as well.
• 30:50
  Dr. Doug Lucas: That's okay in the short term, especially if you are at high risk of fracture.
• 30:56
  Dr. Doug Lucas: And uh if you're at high risk of fracture, you might have to take one of these drugs.
• 31:00
  Dr. Doug Lucas: There's a time and a place for these drugs.
• 31:02
  Dr. Doug Lucas: So I'll come back to that.
• 31:03
  Dr. Doug Lucas: Um again, perlea, same thing.
• 31:05
  Dr. Doug Lucas: Slows down bone loss, slows down bone building.
• 31:07
  Dr. Doug Lucas: You can't do that forever.
• 31:09
  Dr. Doug Lucas: Now, the other side of that equation is drugs that increase bone building.
• 31:13
  Dr. Doug Lucas: Those drugs are called anabolic drugs.
• 31:15
  Dr. Doug Lucas: They push bone building up.
• 31:16
  Dr. Doug Lucas: So you're push pushing up that side of the equation.
• 31:18
  Dr. Doug Lucas: And the other side of the equation rises too.
• 31:21
  Dr. Doug Lucas: So now both sides are doing more.
• 31:23
  Dr. Doug Lucas: And those are actually my preferred drugs if you're going to use a drug.
• 31:26
  Dr. Doug Lucas: The challenge is none of these drugs you can take long term.
• 31:28
  Dr. Doug Lucas: So the bisphosphonate, the recommendation is three to five years, depending on your risk.
• 31:32
  Dr. Doug Lucas: The anabolic drugs, it's one to two years, depending on your starting point and your risk.
• 31:38
  Dr. Doug Lucas: None of those things make sense if you're 50 years old or even 60 or even 70, right?
• 31:43
  Dr. Doug Lucas: Pro Lee is a little bit different.
• 31:44
  Dr. Doug Lucas: That one is there's safety data out to 10 years, recommendations to continue on kind of mixing up drugs after that, but we don't have a long-term plan here.
• 31:53
  Dr. Doug Lucas: Unlike the other things that we talk about, resistance training, the right diet, the sleep, the mindset, potentially hormone replacement, which I know we'll get to, those things you can do for the rest of your life, or at least hopefully.
• 32:04
  Philip Pape: Perfect segue.
• 32:05
  Philip Pape: Um, hormone replacement, which I was gonna talk about next, because you're right.
• 32:10
  Philip Pape: Let's put that into contrast of the things that are that are there for the long term, that are uh positive practices that we can do and fully control without medication.
• 32:18
  Philip Pape: So hormone, both optimization, I'll call it, hormone balance via your lifestyle, but also hormone replacement are big topics for our population.
• 32:27
  Philip Pape: So where do we start in the context of bone health here?
• 32:29
  Dr. Doug Lucas: Well, I guess let's start at do you want to start at the end or the beginning?
• 32:32
  Dr. Doug Lucas: You want to start at the, you know, the as hormones start to get wonky in midlife, honestly, both for women and men?
• 32:38
  Philip Pape: Let's start there.
• 32:39
  Dr. Doug Lucas: Yeah.
• 32:39
  Dr. Doug Lucas: Yeah.
• 32:39
  Dr. Doug Lucas: So um one of the things you didn't mention that I do professionally is that one, my clinical practice got acquired by a larger company, LifeMD.
• 32:47
  Dr. Doug Lucas: I now work as their VP of health and hormone optimization.
• 32:50
  Dr. Doug Lucas: So my job is to build programs, both for women, mostly women right now, but for women and for men that are set up to help optimize hormones.
• 32:59
  Dr. Doug Lucas: Again, through potentially lifestyle, but also through replacement.
• 33:03
  Dr. Doug Lucas: So very deep at these topics.
• 33:05
  Dr. Doug Lucas: Like you said, one of my books is about hormones.
• 33:07
  Dr. Doug Lucas: Huge advocate for hormone use, replacement, optimization.
• 33:11
  Dr. Doug Lucas: For women, as they start to get into this perimenopause midlife phase, it is the wild, wild west.
• 33:18
  Dr. Doug Lucas: We'll talk about postmenopause and you know how challenging that space is, some things that have changed recently, actually, as of you know, this week, that we can talk about.
• 33:27
  Dr. Doug Lucas: But perimenopause, there's very little data, very little research, very few guidelines, and yet wildly symptomatic population who's searching for an answer.
• 33:37
  Dr. Doug Lucas: So it's a it's a really tough space.
• 33:38
  Dr. Doug Lucas: But the good news is there is hope for all the women who are looking for answers because there is a lot of research going on right now.
• 33:45
  Philip Pape: And you know, real quick on that, it's a very vulnerable population because of that.
• 33:48
  Philip Pape: And I don't say that's a fearmonger, but I've seen that in the industry, it's it's rife for taking advantage of.
• 33:53
  Philip Pape: And this is why we have to be all of us, including those of us giving the information, super nuanced and respectful of truth.
• 34:02
  Philip Pape: Is it not even a word you can use today uh and have any meaning.
• 34:06
  Philip Pape: But uh, you know, what what's best supported by our our latest information and the scientific evidence?
• 34:12
  Philip Pape: Yeah.
• 34:12
  Dr. Doug Lucas: So I mean, I think this is this is where I see this challenge, especially in social media, between, you know, doctors talking about perimenopause versus coaches talking about perimenopause.
• 34:22
  Dr. Doug Lucas: And you have coaches saying it's not your hormones, work on your lifestyle.
• 34:24
  Dr. Doug Lucas: And you have doctors saying it's not your lifestyle, work on your hormones.
• 34:27
  Dr. Doug Lucas: You have women in the middle pulling their hair out uh or losing their hair, depending on the situation, right?
• 34:32
  Dr. Doug Lucas: And it is, it's it's tough, and it's really hard to figure this out, even as a provider who understands that both sides are actually true.
• 34:39
  Dr. Doug Lucas: Where do we start?
• 34:40
  Dr. Doug Lucas: And so I'm a huge advocate for testing, especially in perimenopause.
• 34:44
  Dr. Doug Lucas: There's different ways that you can do that, and we can get into some of those details, but ultimately we need data.
• 34:48
  Dr. Doug Lucas: We need data to understand what's happening with your hormones.
• 34:51
  Dr. Doug Lucas: Is this more of a lifestyle thing?
• 34:52
  Dr. Doug Lucas: Is this actually a hormone dysfunction?
• 34:54
  Dr. Doug Lucas: You know, and it gets, it can be challenging because you have to get into some of the things that our our society and our culture are not comfortable talking about.
• 35:02
  Dr. Doug Lucas: We have to talk about cycles, menstruation, symptoms.
• 35:05
  Dr. Doug Lucas: We have to talk about sexual dysfunction.
• 35:07
  Dr. Doug Lucas: Like we have to get into these things in order to understand what's happening with your hormones and your symptoms.
• 35:11
  Dr. Doug Lucas: Only once you uncover all these things can you actually create a plan to move forward, potentially with hormone replacement, maybe optimization, maybe supplementation, you know, maybe all through lifestyle.
• 35:21
  Dr. Doug Lucas: Yeah.
• 35:21
  Philip Pape: So it's lifestyle and hormones is kind of what you're saying.
• 35:24
  Philip Pape: And it's it's some somewhere along that spectrum for each individual.
• 35:28
  Philip Pape: So then still talking about this population, and we can include men in there too with testosterone, because you briefly mentioned TRT before, as it relates specifically to bone health.
• 35:38
  Philip Pape: Are there any concerns?
• 35:39
  Philip Pape: Are there, you know, is it just a matter of if you need replacement, that will also happen to help with your bone health?
• 35:46
  Dr. Doug Lucas: Yeah.
• 35:46
  Dr. Doug Lucas: So TRT is a really interesting topic.
• 35:48
  Dr. Doug Lucas: I love talking to men about hormones and testosterone replacement.
• 35:52
  Dr. Doug Lucas: It's, I think it's been, you know, fortunately, like we're not in the same, we're not in the same problem with men as we are in women, but it's still not good where we are with men.
• 36:00
  Dr. Doug Lucas: With women, I mean, there is no, there is no testosterone product to even talk about commercially, which is just wild because it's such a huge market.
• 36:07
  Dr. Doug Lucas: But for men, you know, at least we have products.
• 36:10
  Dr. Doug Lucas: The question is, how do we do it and who do we do it in?
• 36:12
  Dr. Doug Lucas: Um, I just redid the testosterone protocols for Lyph MD.
• 36:17
  Dr. Doug Lucas: When they were done originally, they were very strict, treating only the strict diagnosis of hypogonadism, as some of the guidelines would recommend.
• 36:25
  Dr. Doug Lucas: But more and more research is coming out showing that it's not just total testosterone that matters if your doctor is even checking it.
• 36:31
  Dr. Doug Lucas: It's total testosterone, it's free testosterone, and it's symptoms.
• 36:35
  Dr. Doug Lucas: Now, both for men and women, we kind of get trapped having to talk about sexual function, dysfunction, libido, et cetera, which is fine.
• 36:41
  Dr. Doug Lucas: We can talk about that.
• 36:42
  Dr. Doug Lucas: But I also find for men that low testosterone is associated with all of these other potential symptoms too, like depressed mood, fatigue, less vitality, vigor, inability to maintain muscle mass.
• 36:55
  Dr. Doug Lucas: Like a lot of these things have other causes too.
• 36:58
  Dr. Doug Lucas: And this is why the research is difficult here.
• 37:00
  Dr. Doug Lucas: But when you find a man who is symptomatic, the biomarkers fit, and you put him on TRT, nine-day difference.
• 37:08
  Dr. Doug Lucas: And it's it's awesome.
• 37:10
  Dr. Doug Lucas: But it still has to be done correctly.
• 37:12
  Dr. Doug Lucas: There's still this, you know, this recommendation generally from especially the physique world of like using AI to block estrogen so you have more testosterone.
• 37:21
  Dr. Doug Lucas: And I think that's a mistake for your bones.
• 37:23
  Dr. Doug Lucas: I used to use aromatase inhibitors and uh not at big doses, just to try to kind of balance things out.
• 37:29
  Dr. Doug Lucas: But as I got more mature in my practice, I realized I don't have a single patient that I have them on now at all.
• 37:35
  Dr. Doug Lucas: Like not one.
• 37:36
  Dr. Doug Lucas: Because there isn't, there hasn't been a patient that I couldn't just adjust their dose or adjust something else with their metabolism, their detox of the hormones to help balance out their hormones.
• 37:44
  Dr. Doug Lucas: So I think it just has to be done right, but it is massively powerful for men.
• 37:49
  Philip Pape: Okay.
• 37:49
  Philip Pape: So that's really clear.
• 37:50
  Philip Pape: I mean, and it's consistent with when, you know, men have these numbers total, free, uh low in general, and have other issues related to strength training, for example, where again, we say it's not just the lifestyle.
• 38:01
  Philip Pape: I know I've seen men who, you know, tick up their testosterone, maybe 50, 100 points through that, but then they're still 300 or 400 shy on the total.
• 38:09
  Philip Pape: Right.
• 38:09
  Philip Pape: Moving kind of up the chain to the younger population, then, because we started there.
• 38:13
  Philip Pape: What what do we want to talk about with hormones?
• 38:15
  Philip Pape: Is there something preventative that people need to be doing?
• 38:19
  Dr. Doug Lucas: As you go younger, you mean?
• 38:20
  Philip Pape: Yeah.
• 38:20
  Dr. Doug Lucas: Yeah.
• 38:21
  Philip Pape: Benjamin Button style.
• 38:22
  Philip Pape: Let's do it.
• 38:22
  Dr. Doug Lucas: Yeah, yeah, yeah.
• 38:23
  Dr. Doug Lucas: Okay.
• 38:23
  Dr. Doug Lucas: So then uh yeah, I mean, as we go younger, I mean, I see low testosterone in men, well, and women, but if we just talk men, you know, into their 30s and 20s.
• 38:32
  Dr. Doug Lucas: I think there's a really challenging problem happening with our, you know, in our modern culture, the environment that we all live in is so toxic.
• 38:41
  Dr. Doug Lucas: Too much stress is rampant, poor sleep is rampant, we're all exposed to toxins all day long.
• 38:46
  Dr. Doug Lucas: A lot of these are hormone disrupting.
• 38:49
  Dr. Doug Lucas: And so I, again, I see men, you know, in their 20s with low testosterone.
• 38:53
  Dr. Doug Lucas: I mean, it's insane.
• 38:54
  Dr. Doug Lucas: So we know that on average this is happening in the population.
• 38:57
  Dr. Doug Lucas: I'm probably in a biased space because I'm a, you know, I'm a hormone specialist.
• 39:01
  Dr. Doug Lucas: So I see people who have are symptomatic with low hormones, but there's too many of them.
• 39:05
  Dr. Doug Lucas: So I think I would encourage testing.
• 39:07
  Dr. Doug Lucas: If you have symptoms of low testosterone as a guy, or if your hormones feel off, you're not cycling regularly as a woman, let's get some data, right?
• 39:15
  Dr. Doug Lucas: We need to know what's going on.
• 39:16
  Dr. Doug Lucas: And then what do you do about it?
• 39:18
  Dr. Doug Lucas: Well, I wouldn't at that age prefer to start replacing testosterone.
• 39:22
  Dr. Doug Lucas: There's so many things we can do when it comes to lifestyle, you know, optimizing all these things that we've talked about already, and potentially some other treatments, you know, things like clomophene that it's off label, like things where we can help to sort of hijack the system, get it going, and then hopefully not need a pharmacologic therapy as you get into midlife.
• 39:40
  Philip Pape: Yeah, that those are good guidelines in general, right?
• 39:42
  Philip Pape: The younger you are, hopefully there's more you can intervene with naturally.
• 39:45
  Philip Pape: Right.
• 39:45
  Philip Pape: If that word can be used, uh lifestyle.
• 39:48
  Philip Pape: So you have a framework, because I do like frameworks and helping people understand timelines here.
• 39:53
  Philip Pape: And you know, when you go from scanning to intervention, and I understand this changes by age.
• 39:58
  Philip Pape: I know you have a framework here for our method, right?
• 40:00
  Philip Pape: Recognize, reverse, retest, revive.
• 40:03
  Philip Pape: Maybe we can tie that into a process.
• 40:05
  Philip Pape: Yeah.
• 40:06
  Philip Pape: Um, folks listening here, they like to collect data, figure out things, experiment.
• 40:10
  Philip Pape: Um, how does that fit into this?
• 40:11
  Philip Pape: And what do timelines look like, maybe for a I'll say typical person listening to this show in their 40s?
• 40:17
  Dr. Doug Lucas: Yeah, absolutely.
• 40:18
  Dr. Doug Lucas: So this framework was really developed for people that have, you know, some low bone density, osteopenia, osteoporosis.
• 40:24
  Dr. Doug Lucas: They want to figure out what's going on.
• 40:25
  Dr. Doug Lucas: One of the biggest challenges in the conventional system with osteoporosis as a diagnosis is that once you have it, there's really no specialist in osteoporosis in the conventional system.
• 40:36
  Dr. Doug Lucas: Thinking about orthopedic surgeons before, like, they're not specialists in bone health, really.
• 40:40
  Dr. Doug Lucas: They're specialists in putting implants in bones, you know, endocrinologists, rheumatologists, internal medicine, like nobody wants it.
• 40:48
  Dr. Doug Lucas: And there are specialists in bone drugs, but they're not really specialists in bone health.
• 40:53
  Dr. Doug Lucas: And so it's a really interesting space.
• 40:55
  Dr. Doug Lucas: And so, you know, what happens is when you start talking about, you know, okay, I have low bone density, I have osteoporosis.
• 41:02
  Dr. Doug Lucas: What do I do about it?
• 41:03
  Dr. Doug Lucas: Your doctor says, well, you either are or are not a candidate for a drug, and that's it.
• 41:07
  Dr. Doug Lucas: They might do some additional tests to make sure that you don't have something like a parathyroid tumor that would result in bone loss.
• 41:13
  Dr. Doug Lucas: You know, some of these clear things like celiac disease, you know, do you have symptoms of that?
• 41:17
  Dr. Doug Lucas: Should we test for that?
• 41:18
  Dr. Doug Lucas: Because that causes osteoporosis.
• 41:20
  Dr. Doug Lucas: But once you get those things off the table, then they just say, Well, I don't know why you have bone loss.
• 41:24
  Dr. Doug Lucas: This is part of aging, and you either are or are not a candidate for a drug.
• 41:28
  Dr. Doug Lucas: I think that's a huge mistake.
• 41:30
  Dr. Doug Lucas: And I don't blame the doctors.
• 41:31
  Dr. Doug Lucas: This is how they're trained.
• 41:32
  Dr. Doug Lucas: And, you know, they're again, they have drugs and surgery to use.
• 41:36
  Dr. Doug Lucas: But if you want to do this naturally, if you want to do this from a comprehensive perspective, you need to sort of take a different angle.
• 41:42
  Dr. Doug Lucas: So this is where we created this four-hour method.
• 41:44
  Dr. Doug Lucas: And the first R, as you said, is to recognize why you're losing bone.
• 41:48
  Dr. Doug Lucas: Why are you losing bone?
• 41:50
  Dr. Doug Lucas: Go back to the longevity conversation we had at the beginning of this talk.
• 41:53
  Dr. Doug Lucas: If you're losing bone, something's wrong.
• 41:55
  Dr. Doug Lucas: What is it?
• 41:56
  Dr. Doug Lucas: Is it a dietary thing?
• 41:57
  Dr. Doug Lucas: Is it an absorption thing?
• 41:58
  Dr. Doug Lucas: Is it a gut health thing?
• 41:59
  Dr. Doug Lucas: Is it a hormone thing?
• 42:00
  Dr. Doug Lucas: It could be a lot of things.
• 42:01
  Dr. Doug Lucas: And the way you figure that out is by asking the right questions and getting the right data.
• 42:05
  Dr. Doug Lucas: And then once you do that, then we oh gosh, what's the second R?
• 42:10
  Dr. Doug Lucas: Recognize reverse.
• 42:12
  Dr. Doug Lucas: Thank you.
• 42:12
  Dr. Doug Lucas: Goodness.
• 42:12
  Dr. Doug Lucas: I usually have it in front of me when I talk about it.
• 42:14
  unknown: Oh, good.
• 42:15
  Dr. Doug Lucas: Uh the second R is to reverse.
• 42:16
  Dr. Doug Lucas: So then you want to reverse those causes of bone loss.
• 42:18
  Dr. Doug Lucas: And this is actually what I talk about when I'm talking about reversing osteoporosis is reversing the causes of bone loss.
• 42:24
  Dr. Doug Lucas: Eventually your T-score will get above negative 2.5.
• 42:27
  Dr. Doug Lucas: That's the threshold that the WHO set as the diagnosis.
• 42:31
  Dr. Doug Lucas: But that's actually, I'm not that worried about that.
• 42:33
  Dr. Doug Lucas: Right.
• 42:33
  Dr. Doug Lucas: If your T-score is negative five and you go from negative five to negative three, you are reversing your osteoporosis.
• 42:39
  Dr. Doug Lucas: And I'm excited for you about that.
• 42:41
  Dr. Doug Lucas: So then you have to make that plan.
• 42:42
  Dr. Doug Lucas: And that plan is going to be like we just talked about.
• 42:44
  Dr. Doug Lucas: I have that pyramid, it's lifestyle, it's hormone optimization, it's supplementation.
• 42:48
  Dr. Doug Lucas: And then and only then, once you've done those things, potentially move on to like a peptide or a drug.
• 42:53
  Dr. Doug Lucas: Right.
• 42:53
  Dr. Doug Lucas: So that's the second R.
• 42:54
  Dr. Doug Lucas: And then the third R is to retest.
• 42:56
  Dr. Doug Lucas: I can't tell you how many times I've seen women and men who get a diagnosis, they decide to do something.
• 43:03
  Dr. Doug Lucas: Maybe it's a supplement, maybe it's an exercise program or whatever.
• 43:06
  Dr. Doug Lucas: And then they just stick their head in the sand and they don't retest.
• 43:08
  Dr. Doug Lucas: That is such a mistake because they're going to get a DEXA again in two years or maybe more, maybe like four or five years, and realize that their plan didn't work.
• 43:16
  Dr. Doug Lucas: There's so many things that we can measure, right?
• 43:18
  Dr. Doug Lucas: So if you identify that a vitamin deficiency, like your vitamin D deficient, okay, that's an easy fix.
• 43:25
  Dr. Doug Lucas: But then you need to retest that and make sure that you're headed the right direction.
• 43:28
  Dr. Doug Lucas: Same thing with hormone dysfunction, hormone deficiency, postmenopausal woman.
• 43:33
  Dr. Doug Lucas: Let's get you on HRT if you're a good candidate for that.
• 43:35
  Dr. Doug Lucas: But do you have enough estradiol in your system?
• 43:37
  Dr. Doug Lucas: Are you absorbing it well enough through that gel or that patch in order to actually have the impact on bone that you want to have?
• 43:43
  Dr. Doug Lucas: We can measure these things.
• 43:44
  Dr. Doug Lucas: So let's test it.
• 43:45
  Philip Pape: I'm sure it depends on the intervention, but what test cycles are we talking about?
• 43:49
  Philip Pape: Three, six months, a year?
• 43:51
  Dr. Doug Lucas: Yeah, it does depend.
• 43:52
  Dr. Doug Lucas: So something like, you know, a hormone, if you were to start estradiol as a, let's say a woman who starts an estradiol patch in an oral micronized progesterone capsule, I can check her hormone levels next week, you know, and they're going to be different.
• 44:03
  Dr. Doug Lucas: I wouldn't, that's too soon, but just give you an example.
• 44:06
  Dr. Doug Lucas: But if you're talking about bone turnover markers, you're going to want to give it a couple of months.
• 44:09
  Dr. Doug Lucas: If you're talking about, you know, some of the things are going to take longer, like how long does it take for magnesium to come up?
• 44:14
  Dr. Doug Lucas: How long does it take for homocysteine to go?
• 44:15
  Dr. Doug Lucas: Like it just depends on what you're looking for.
• 44:18
  Philip Pape: Okay, great.
• 44:18
  Philip Pape: Yeah.
• 44:18
  Philip Pape: Just wanted to clarify it's and it's not like four years, you know.
• 44:22
  Dr. Doug Lucas: Right.
• 44:22
  Dr. Doug Lucas: Well, that and that's the thing, is that's too long because that's DEXA, right?
• 44:24
  Dr. Doug Lucas: So DEXA is recommended every one or two years.
• 44:27
  Dr. Doug Lucas: And two years is way too long, in my opinion, to A, do any intervention without knowing it's working, and B, just like that's a long time.
• 44:34
  Dr. Doug Lucas: So for sure.
• 44:36
  Dr. Doug Lucas: All right.
• 44:36
  Dr. Doug Lucas: Yeah.
• 44:37
  Dr. Doug Lucas: Yeah.
• 44:37
  Philip Pape: So go on to the last R and revive.
• 44:39
  Dr. Doug Lucas: So the fourth R is to revive your life.
• 44:41
  Dr. Doug Lucas: And I just I love this one because even as an orthopedic surgeon, watching my patients have a hip fracture go through the process of recovery.
• 44:50
  Dr. Doug Lucas: And remember that not all of them survived, right?
• 44:52
  Dr. Doug Lucas: A third of those patients on average are going to die.
• 44:55
  Dr. Doug Lucas: Two-thirds of them are going to lose their independence.
• 44:57
  Dr. Doug Lucas: This is a big deal.
• 44:58
  Dr. Doug Lucas: So watching them recover is difficult from a surgical perspective.
• 45:03
  Dr. Doug Lucas: But watching them recover from their fear and anxiety if they didn't fracture, that's much more rewarding, honestly.
• 45:09
  Dr. Doug Lucas: But it's also much easier to do because you still have your body intact.
• 45:13
  Dr. Doug Lucas: And so this is the this revive your life so you can live without the fear of fracture.
• 45:17
  Dr. Doug Lucas: Get away from that fear, that anxiety that you're going to sit down in your car and break your back, that you're going to pick up your grandchild and you're going to break your spine or your hip, right?
• 45:24
  Dr. Doug Lucas: You're going to be out hiking on your own, you're going to fall, break your hip, and you're going to die out there overnight.
• 45:29
  Dr. Doug Lucas: I hear these things every day.
• 45:31
  Dr. Doug Lucas: So that fear and anxiety is real.
• 45:33
  Dr. Doug Lucas: So that's what we want to get you to is to get back to the things that you love to do to create the memories that you're here to create.
• 45:38
  Philip Pape: That's the message here, man.
• 45:40
  Philip Pape: That's awesome.
• 45:40
  Philip Pape: I mean, I think osteoporosis puts fear in some people's heart as this binary precipice that you fall off of, and now you're you're ruined for the rest of your life.
• 45:49
  Philip Pape: Your bones are beyond repair.
• 45:51
  Philip Pape: And this message that you can reverse it and not only reverse it, but do it fairly quickly if you do the interventions and start to see that is a very empowering and very, you know, uh optimistic.
• 46:00
  Philip Pape: And so I guess maybe to wrap up here, because this is a great message to end on.
• 46:04
  Philip Pape: Is there a story or an avatar that you could share with the audience?
• 46:08
  Philip Pape: You know, I you work with people all the time, but just so they can kind of viscerally feel what that looks like.
• 46:13
  Dr. Doug Lucas: Yeah, sure.
• 46:14
  Dr. Doug Lucas: Yeah, one of my favorite stories, uh, I talk about her a lot.
• 46:16
  Dr. Doug Lucas: She was actually on stage at my uh last live event in February.
• 46:19
  Dr. Doug Lucas: Her name's Robin.
• 46:20
  Dr. Doug Lucas: And so she was one of our, one of our earlier patients.
• 46:23
  Dr. Doug Lucas: So she came in right at the age of 51, had gone through menopause.
• 46:27
  Dr. Doug Lucas: I believe she had a family history of breast cancer.
• 46:30
  Dr. Doug Lucas: So she was decided she was not going to start on HRT.
• 46:33
  Dr. Doug Lucas: I forget why she got screened for osteoporosis, but she got adexa and she had pretty significant osteoporosis of her spine.
• 46:39
  Dr. Doug Lucas: Hips, low bone density, not terrible, but still she was blown away.
• 46:43
  Dr. Doug Lucas: I mean, just changed her life, right?
• 46:45
  Dr. Doug Lucas: Young, active, I mean, very young at heart.
• 46:48
  Dr. Doug Lucas: I mean, you've if you look at her, you would think that she's probably 30 years old.
• 46:52
  Dr. Doug Lucas: Entrepreneur, great family, you know, two young daughters.
• 46:56
  Dr. Doug Lucas: And this totally changed her life.
• 46:57
  Dr. Doug Lucas: Fear, she didn't know, you know, could she do all the things that she wanted to do?
• 47:01
  Dr. Doug Lucas: So she came and worked with us.
• 47:03
  Dr. Doug Lucas: This was clinically as a patient, and we did all the lifestyle stuff that you and I've talked about.
• 47:07
  Dr. Doug Lucas: And she did a great job, improved her stress.
• 47:10
  Dr. Doug Lucas: Again, entrepreneur, how do you do that?
• 47:12
  Dr. Doug Lucas: It's difficult.
• 47:12
  Dr. Doug Lucas: Um, improved her sleep, stopped drinking, really changed things around, worked on her gut health.
• 47:18
  Dr. Doug Lucas: We did start her on HRT because I reassured her that a history of breast cancer in an immediate family member is not a contraindication to starting on HRT.
• 47:26
  Dr. Doug Lucas: And so we started her on HRT.
• 47:27
  Dr. Doug Lucas: It took us a while to get that optimized.
• 47:29
  Dr. Doug Lucas: But in the first 12 months, with just those interventions, we saw her hips improve, I believe 6% and 7% left, right, which is a lot on ADEXA.
• 47:39
  Dr. Doug Lucas: That's a ton on ADEXA in 12 months.
• 47:41
  Dr. Doug Lucas: It was amazing.
• 47:41
  Dr. Doug Lucas: And I love the story because her spine actually got worse.
• 47:44
  Dr. Doug Lucas: So her spine actually went down by about 4%.
• 47:46
  Dr. Doug Lucas: And I share the story, not to show my failures, but to say that we said, okay, well, my goodness, you seem to be doing all the things.
• 47:53
  Dr. Doug Lucas: What are we missing?
• 47:54
  Dr. Doug Lucas: And this is great for your audience because what we were missing was she didn't tell us that she had back pain.
• 47:59
  Dr. Doug Lucas: She had an old back injury.
• 48:01
  Dr. Doug Lucas: She was afraid to load her spine.
• 48:02
  Dr. Doug Lucas: So we were talking about loading her spine, you know, talking about putting a barbell on her shoulders, but she wasn't doing it.
• 48:08
  Dr. Doug Lucas: So she she worked with our exercise physiologist and like, okay, let's figure out how to load your spine without hurting it.
• 48:14
  Dr. Doug Lucas: So she was able to do that.
• 48:15
  Dr. Doug Lucas: And then the next year she went from a negative, she was at negative three, two at that point.
• 48:19
  Dr. Doug Lucas: I think she went from negative three, two, it was something like negative two, four.
• 48:23
  Dr. Doug Lucas: I mean, some massive leap.
• 48:24
  Dr. Doug Lucas: It was almost 20% on inner bone mineral density.
• 48:28
  Dr. Doug Lucas: And it was just amazing.
• 48:28
  Dr. Doug Lucas: Because we clearly had all of the pieces in place, right?
• 48:31
  Dr. Doug Lucas: She called me when she left the imaging center.
• 48:34
  Dr. Doug Lucas: This is back when I used to give my phone number to all my patients.
• 48:37
  Dr. Doug Lucas: She called me when she left the imaging center.
• 48:39
  Dr. Doug Lucas: I mean, just bawling because she felt that all of that fear, all of that anxiety was gone.
• 48:44
  Dr. Doug Lucas: It's gone.
• 48:45
  Dr. Doug Lucas: And then what's cool is that now, so we have now another year of data, and her DEXA continues to get better, right?
• 48:51
  Dr. Doug Lucas: So now she's definitely no longer osteoproduct.
• 48:54
  Dr. Doug Lucas: She has reversed her osteoporosis.
• 48:56
  Dr. Doug Lucas: She's barely even osteopenic at this point.
• 48:58
  Dr. Doug Lucas: She will, if she'll continue on this trajectory, she will have normal bone density in the next couple of years.
• 49:02
  Dr. Doug Lucas: So she has taken this thing, this precipice, like you said, she was on the other side.
• 49:06
  Dr. Doug Lucas: She was falling into the crater and just climbed right back out of her own will.
• 49:11
  Dr. Doug Lucas: She just needed the right information.
• 49:13
  Dr. Doug Lucas: And she climbed right back out and she has recovered.
• 49:16
  Dr. Doug Lucas: She has lost that fear, that anxiety, and is back to living her life.
• 49:20
  Philip Pape: That's awesome.
• 49:21
  Philip Pape: Yeah.
• 49:21
  Philip Pape: And it sounds like, you know, the information was great.
• 49:24
  Philip Pape: And obviously the support you guys gave her and kind of recognizing that she was afraid of part of that, which is a very, very common fear we talk about all the time, which is you have pain, back pain, especially, um, is one of the most common.
• 49:38
  Philip Pape: And there's a fear that doing anything with your back is going to make it worse.
• 49:41
  Philip Pape: So I love that you guys were able to support her through that and say, okay, this the data is telling us something isn't working.
• 49:46
  Philip Pape: We know this stuff does work.
• 49:47
  Philip Pape: So what's missing?
• 49:48
  Philip Pape: And then go ahead and do it.
• 49:49
  Philip Pape: Right.
• 49:49
  Philip Pape: Really love that.
• 49:50
  Philip Pape: Everybody listening, I'm sure, is hopeful, especially the women who, you know, write in with concerns about uh bone health.
• 49:57
  Philip Pape: And I'm I'm always telling them, hey, just go lift weights.
• 49:59
  Philip Pape: Like I have no problem.
• 50:00
  Philip Pape: I don't feel like I'm taking a risk doing that because I know how valuable it is.
• 50:03
  Philip Pape: It's just doing it right and having right form and building into it.
• 50:06
  Philip Pape: So is there anything I didn't ask you in this whole context that's super important that you want to?
• 50:11
  Dr. Doug Lucas: So I think this is a really important one because we probably have some audience members who have osteoporosis that are afraid to lift weights.
• 50:17
  Dr. Doug Lucas: And so I I'd love to talk about this.
• 50:19
  Dr. Doug Lucas: It it kind of gets me in trouble.
• 50:21
  Dr. Doug Lucas: But I just had a community member today.
• 50:24
  Dr. Doug Lucas: She was uh talking about another uh another provider who's actually talking about pelvic floor health.
• 50:28
  Dr. Doug Lucas: And this pelvic floor provider was talking about doing, you know, like cat cow exercises of the spine and then how that relates to the pelvic floor.
• 50:37
  Dr. Doug Lucas: But she said, Oh, well, I was told with osteoporosis I can't do cat-cow.
• 50:41
  Dr. Doug Lucas: Right?
• 50:42
  Dr. Doug Lucas: And I'm like, wait, like you can't bend your spine.
• 50:46
  Dr. Doug Lucas: I mean, I understand you don't want to load in a flex position.
• 50:49
  Dr. Doug Lucas: There are some things that would not be wise that could potentially put you at risk.
• 50:53
  Dr. Doug Lucas: But cat cow is just a that's a I mean, this is a normal range of motion thing of your spine.
• 50:58
  Dr. Doug Lucas: Like if you are that fragile, then you would fracture just standing up.
• 51:02
  unknown: Right.
• 51:03
  Dr. Doug Lucas: And so it this is really hard because doctors will scare people once they get the diagnosis to say, don't lift more than whatever their arbitrary number is, five pounds, 15 pounds, don't lift more than 15 pounds, you know, take calcium and vitamin D and take this drug.
• 51:17
  Dr. Doug Lucas: And that's what they tell them.
• 51:18
  Dr. Doug Lucas: And then they're afraid to do anything.
• 51:19
  Dr. Doug Lucas: But what we know so clearly is that if you're gonna build bone, you have to load it.
• 51:24
  Dr. Doug Lucas: Then how do you do that safely?
• 51:26
  Dr. Doug Lucas: And we actually used to back away from exercise in our program because it's all virtual.
• 51:31
  Dr. Doug Lucas: And you know, I was hesitant, like somebody's gonna fracture, you know.
• 51:35
  Dr. Doug Lucas: But what we realize is that we can't back away from it.
• 51:37
  Dr. Doug Lucas: We just need to, you know, face it head on.
• 51:39
  Dr. Doug Lucas: And so we have a program that is very fundamental, very rudimentary, because we have so many of our community members who have never lifted a weight ever in their life.
• 51:47
  Dr. Doug Lucas: So they can come in, but there's so many things that you can do safely, right?
• 51:51
  Dr. Doug Lucas: Watch a video, you can lay down, you can lift something, you can do it in a way where your spine is neutral and you start somewhere.
• 51:57
  Dr. Doug Lucas: Pick that point carefully.
• 51:59
  Dr. Doug Lucas: But once you start there, then it's just all about progressive overload, just like everything else, right?
• 52:03
  Dr. Doug Lucas: And so, have I ever seen a fracture?
• 52:06
  Dr. Doug Lucas: I had one person recently who did have a fracture, and it wasn't because she was following and just fractured um accidentally.
• 52:15
  Dr. Doug Lucas: What she did, she was doing a barbell back squats.
• 52:17
  Dr. Doug Lucas: You can imagine she was already pretty advanced, right?
• 52:19
  Dr. Doug Lucas: She was training with her husband.
• 52:21
  Dr. Doug Lucas: She didn't take her husband's weight off.
• 52:23
  Dr. Doug Lucas: Well, she said he didn't take his weight off.
• 52:25
  Dr. Doug Lucas: So I'll let them figure that one out.
• 52:26
  Dr. Doug Lucas: But she she unracked it and then didn't rack it back.
• 52:31
  Dr. Doug Lucas: She just said, well, well, you know, I guess I'll try it.
• 52:33
  Dr. Doug Lucas: And then it was clearly way too heavy for her.
• 52:36
  Dr. Doug Lucas: Uh, and so she did actually end up with a fracture of her uh somewhere on her spine as a result of that.
• 52:40
  Dr. Doug Lucas: But that was just bad decision making.
• 52:42
  Dr. Doug Lucas: That wasn't because of exercise, right?
• 52:44
  Dr. Doug Lucas: And so, you know, I have watched women who have never lifted a weight, work their way up to doing barbell deadlifts, barbell, you know, overhead press with severe osteoporosis.
• 52:55
  Dr. Doug Lucas: Like that's the only way that you're gonna get better.
• 52:57
  Dr. Doug Lucas: But I know that somebody's gonna listen to this and go do something and have a fracture.
• 53:01
  Dr. Doug Lucas: So, you know, doctors need to say what they need to say to protect themselves.
• 53:04
  Dr. Doug Lucas: But uh, if you are trying to improve your bone, you need to understand that you have to pick a safe starting point and progressively overload.
• 53:10
  Dr. Doug Lucas: It's the only way you're gonna do this naturally if you're trying to do it naturally.
• 53:14
  Philip Pape: Exactly it.
• 53:14
  Philip Pape: You have to ladder your way up, listen to what Dr.
• 53:16
  Philip Pape: Doug is saying.
• 53:17
  Philip Pape: Go check out our episode with Dr.
• 53:19
  Philip Pape: John Russin as well that we did a few weeks back.
• 53:21
  Philip Pape: Same concept.
• 53:22
  Philip Pape: We talk about it here.
• 53:23
  Philip Pape: It's like heavy isn't heavy in absolute terms.
• 53:26
  Philip Pape: It's heavy for you, which could be, you know, a dowel, right?
• 53:29
  Philip Pape: It could be a body weight.
• 53:31
  Philip Pape: So start where you're at and build from there.
• 53:32
  Philip Pape: Okay, awesome.
• 53:33
  Philip Pape: Uh, this has been a great conversation, Dr.
• 53:35
  Philip Pape: Doug.
• 53:36
  Philip Pape: Tell us where folks can reach out to you.
• 53:38
  Philip Pape: I know there's like 10 different things that you you've got going on.
• 53:41
  Philip Pape: So, what's maybe one or two of the best places to take our listeners?
• 53:44
  Dr. Doug Lucas: Yeah, I think uh two things.
• 53:46
  Dr. Doug Lucas: So if you want information about osteoporosis, I would just check out the YouTube channel.
• 53:50
  Dr. Doug Lucas: So the Dr.
• 53:50
  Dr. Doug Lucas: Doug show, Bones, Hormones, and Healthspan, this is all about bone health and hormones.
• 53:55
  Dr. Doug Lucas: And we're really trying to double down on that content.
• 53:57
  Dr. Doug Lucas: So this is the place to go if you want to learn about anything specifically through the lens of osteoporosis.
• 54:03
  Dr. Doug Lucas: If you're looking for support, we're still building out our bone health programs at LifeMD.
• 54:07
  Dr. Doug Lucas: So clinically, I don't have anything to offer you right now, but our community is all that probably most of you need if you have the problem.
• 54:14
  Dr. Doug Lucas: You just need the right information and the right resources.
• 54:17
  Dr. Doug Lucas: That's the osteocollective.
• 54:19
  Dr. Doug Lucas: And you can just go to osteocollective.com, check it out there.
• 54:22
  Dr. Doug Lucas: You can join our free masterclass.
• 54:24
  Dr. Doug Lucas: You could do, you know, all the stuff that we have out there available.
• 54:27
  Dr. Doug Lucas: Would love to see you in our community if you have osteoporosis or concerns around it.
• 54:31
  Philip Pape: Awesome.
• 54:31
  Philip Pape: So the YouTube channel, which I think is at dr underscore Doug Lucas, which we will include in the show notes.
• 54:37
  Philip Pape: So you can just tap it.
• 54:37
  Philip Pape: If you're listening to the show, just tap it.
• 54:39
  Philip Pape: And then Osteocollective will also include that as well.
• 54:41
  Philip Pape: You can Google it or go to the website that Dr.
• 54:43
  Philip Pape: Doug said.
• 54:44
  Philip Pape: All right.
• 54:44
  Philip Pape: So that was a fantastic conversation.
• 54:46
  Philip Pape: Great guest.
• 54:47
  Philip Pape: I really appreciate your time, Doug.
• 54:48
  Philip Pape: Um, I learned a lot, which is selfishly one of the goals when I have a guest on, and uh then I can spread it to everyone else in future episodes.
• 54:56
  Philip Pape: So thank you so much for coming on the show, my man.
• 54:58
  Dr. Doug Lucas: Awesome.
• 54:58
  Dr. Doug Lucas: Thank you, Philip.
• 54:59
  Dr. Doug Lucas: Appreciate it.