Latest / HER / Bone Loss Can Be Reversible

Transcript

Bone Loss Can Be Reversible · HER

• 0:07
  Pam Peeke, MD: Hi, I'm Dr.
• 0:08
  Pam Peeke.
• 0:09
  How are you?
• 0:10
  Good grief, this is episode number 570 of the Bold and BraveHER podcast.
• 0:20
  Now, today I'm joined by my dear, dear friend, Dr.
• 0:24
  Doug, Dr.
• 0:25
  Doug Lucas.
• 0:27
  Many of you may know him already because of his incredible work and
• 0:33
  his social media following in the whole world of, well, osteoporosis,
• 0:40
  all things bone health, et cetera.
• 0:43
  He's a double board-certified orthopedic surgeon, and he's the
• 0:46
  best-selling author and host of The Dr.
• 0:50
  Doug Show on YouTube.
• 0:52
  You've got to run on over there and scope it out, become a member, you
• 0:58
  know, subscribe, get on the whole thing.
• 1:00
  He blends functional medicine, biohacking, yay, and longevity science
• 1:07
  to transform how we approach aging.
• 1:11
  Uh-oh, the A word.
• 1:12
  Doug, welcome back to the HER podcast
• 1:16
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Pam, great to be here.
• 1:18
  Always happy to talk to you
• 1:19
  Pam Peeke, MD: You and I always get into wild and crazy times
• 1:24
  playing in the same sandbox.
• 1:26
  Today, we're gonna talk about something that I just think
• 1:30
  is on so many women's mind.
• 1:34
  Now, bone health is becoming a thing, right?
• 1:39
  Would you agree?
• 1:40
  I mean, it's like headlines you know, in all of the medical journals.
• 1:45
  We're seeing more and more and more research.
• 1:47
  It's like, where were we about 20 years ago?
• 1:51
  Nowhere.
• 1:52
  But now it's, it's like a thing.
• 1:54
  Women are looking for every single option known to mankind to be able to optimize
• 2:00
  their bone health once they're aware of it, because women are mostly worried about
• 2:08
  muscles and fat, and then they forget about number three which is bone, until,
• 2:14
  oft times, they get the big shock of their life when they get their first DEXA and,
• 2:20
  and they've lost a truckload of bone, especially around the time of menopause.
• 2:25
  So now that it's kind of becoming more popular to talk about it, and
• 2:32
  that's great, you and I would agree on that many women and men, you know,
• 2:38
  because men have osteoporosis too are wondering the big question, the $60,000
• 2:43
  question: Can bone loss be reversible?
• 2:49
  And, and that's, that's so compelling, and it's-- we're gonna open up
• 2:54
  the entire discussion with that.
• 2:57
  First, Doug, why don't you go through the trajectory of peak bone and
• 3:02
  what happens in a woman's life as she courses, through her decades?
• 3:08
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yeah, absolutely.
• 3:09
  So I, I agree this is a really important topic because there's a lot
• 3:13
  of confusion here, and the messaging in the conventional system doesn't
• 3:17
  line up with what most people are hoping for, and we'll get to that.
• 3:20
  But let's talk about how bone starts off.
• 3:22
  As children, we don't have very much bone, actually.
• 3:25
  We are all cartilage, right?
• 3:26
  We're all, like, mushy and flexible and, we develop bone as we grow, and bone
• 3:32
  starts to ossify and calcify and remodel.
• 3:35
  We reach peak bone density and peach b- peak bone mass in early adult life.
• 3:39
  So could be mid-20s, early 30s, somewhere around there.
• 3:43
  And then on average, if you look at the graph, on average, women
• 3:48
  and men will lose bone about, 0.5%
• 3:52
  to 1% per year for the rest of their life.
• 3:54
  So it looks like this gradual downhill slide with an acceleration,
• 3:58
  as you mentioned, around menopause, where women can lose up to 20% of
• 4:01
  bone density within five to seven years after the onset of menopause.
• 4:04
  That's a big thing to talk about.
• 4:06
  But what I think is really important to understand about that is that that
• 4:10
  is the average of a sick population, and that doesn't have to be your story
• 4:16
  Pam Peeke, MD: So the grand majority of women that I've spoken to who are
• 4:21
  less enlightened, that's about 90% of the population out there of women,
• 4:27
  think that you should start worrying about bone first right around the
• 4:32
  time of like, you know, you're 60.
• 4:34
  And I think what's also in a lot of women's minds is the fact
• 4:39
  that Medicare, you know, won't start paying for DEXAs until 65.
• 4:44
  So that's another issue, which is you don't even know what you don't know
• 4:48
  without a DEXA, to be able to scan your bones and look at the bone mineral
• 4:55
  density and actually quantify it.
• 4:57
  So we've got a lot of things to unpack here.
• 5:00
  So again, reiterating what you said, you reach peak bone density right
• 5:05
  around the age of 30-ish, plus or minus, and you will begin to drop bone mass.
• 5:12
  Same thing happens with muscle right around that same time, by
• 5:15
  the way, as you're well aware.
• 5:18
  And I, I would say, you know, that's a great time to sit down and say, "How
• 5:24
  am I gonna optimize my bone health?"
• 5:28
  Number one.
• 5:29
  Number two, "How do I decrease the rapidity with which I
• 5:34
  drop bone mineral density?
• 5:38
  What are those interventions?"
• 5:39
  And we'll be talking about that.
• 5:41
  You know, of course, everyone knows that I'm a nutcase about strength
• 5:46
  training, so that's gonna be a big piece of the action here, too.
• 5:50
  But it's also about nutrition.
• 5:51
  It's also about sleep.
• 5:52
  It's also about inflammation.
• 5:53
  I mean, this is a, you know, more of a, a, a comprehensive integrative picture.
• 6:00
  So here you are, and then you're dropping bone mineral density.
• 6:05
  There you go.
• 6:07
  And then right around time of menopause, why is that, Doug that we have--
• 6:15
  we drop off a cliff right around the time menopause, like fifty-one,
• 6:19
  fifty-two-ish, around that time?
• 6:21
  What's going on?
• 6:22
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yeah.
• 6:22
  So it actually starts about five to seven years before true menopause.
• 6:26
  So menopause being 12 months without a cycle.
• 6:29
  If we look at what happens with the hormone fluctuation in perimenopause,
• 6:33
  one of the hormones that we see change first actually is FSH,
• 6:37
  follicle-stimulating hormone.
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  I actually just, authored a paper that was published, I think last month or
• 6:42
  two months ago, on FSH, and the, the whole first part of it was all about
• 6:46
  FSH and bone health 'cause there's a really interesting connection there.
• 6:49
  And most of your audience have probably never even heard of FSH, right?
• 6:52
  We're all talking about estradiol, progesterone, but FSH is part of that
• 6:58
  axis, and it rises because estrogen levels start to become unstable.
• 7:02
  They're not necessarily low.
• 7:03
  Sometimes they're actually high, but they start to become unstable,
• 7:07
  and FSH will start to rise.
• 7:09
  As FSH rises, we see bone loss start to accelerate.
• 7:14
  So bone metabolism, this concept of like building and breaking
• 7:18
  down bone, it's always happening.
• 7:20
  We are always replacing bone.
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  In fact, if you were to just average out the skeleton over the course of
• 7:24
  a decade, you're replacing almost the entire thing over the course of 10 years.
• 7:28
  So it's a very active organ system.
• 7:31
  So it's always breaking down, always building up, but certain inputs,
• 7:36
  and hormones are a big one, will have an impact on which of those
• 7:39
  things it's doing, and FSH rising, as it does in perimenopause, five to
• 7:44
  seven years before menopause, will result in bone loss accelerating
• 7:49
  Pam Peeke, MD: Okay.
• 7:50
  So women don't know this.
• 7:52
  I can absolutely, you know, don't bet with me, I'll make a lot of money.
• 7:56
  They, they ha- they don't know.
• 7:58
  Now, here's the other thing too, though, Doug.
• 8:00
  We're both physicians, right?
• 8:03
  I guarantee you the grand majority of physicians don't know that either
• 8:07
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Correct.
• 8:07
  Yeah
• 8:09
  Pam Peeke, MD: And, and I think that's part of the issue.
• 8:11
  How are women ever gonna know if their own providers are not getting this?
• 8:15
  You know, in med school, I got a perfunctory amount of information on
• 8:20
  bone health, and I think you did too.
• 8:24
  And that is, we medicalized it.
• 8:26
  They said, "Okay, here's, here's what osteoporosis looks like."
• 8:30
  They kind of skipped over osteopenia.
• 8:33
  And it was like, "Okay, now here are the drugs you're gonna be taking."
• 8:37
  It was just, you know, it was a pharma playbook, and that's all
• 8:41
  I ever remember from bone health.
• 8:43
  Obviously, we had to learn the physiology, the bone building, cells, osteoblasts,
• 8:51
  the bone resorbing cells, the osteoclasts, and looking for some kind of balance.
• 8:56
  But we were also given…
• 8:58
  I mean, maybe I'm inferring too much from those lectures a million years
• 9:03
  ago, dusting off cobwebs that it was kind of a hopeless situation.
• 9:07
  It's like, "You're gonna get osteoporosis, okay?"
• 9:11
  I mean, it's just, it's a thing.
• 9:13
  And, you know, "Here's the pharma book.
• 9:15
  We got your back.
• 9:16
  We got drugs."
• 9:18
  Okay, that kind of thing.
• 9:19
  That's-- Did you get that messaging or was I, like, overreading this
• 9:23
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Oh, no, totally.
• 9:24
  And it-- honestly, it just goes along with the concept of chronic disease
• 9:27
  in general that we're taught, right?
• 9:29
  Diabetes is a progressive disease.
• 9:31
  Hypertension will only continue to get worse.
• 9:34
  The solution is always pharmaceuticals.
• 9:36
  Osteoporosis is no different.
• 9:38
  The only-- Well, it's not true.
• 9:39
  It's a little bit different.
• 9:41
  The biggest difference is that bone loss is an expected consequence of aging
• 9:46
  in the conventional mindset, right?
• 9:48
  You will lose bone as you age.
• 9:50
  You won't necessarily develop diabetes.
• 9:52
  You won't necessarily develop high blood pressure, but you
• 9:55
  will lose bone as you age.
• 9:57
  That is the way that we are taught as physicians, and that's what we
• 10:00
  tell everybody in the community.
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  But from my perspective, and I know you've seen this too,
• 10:06
  that's not necessarily true.
• 10:07
  So again, on average, we see the population losing bone as they age,
• 10:12
  but that doesn't have to be our story
• 10:14
  Pam Peeke, MD: Yeah.
• 10:15
  So I think the, one of the-- when I first discovered you, I discovered you,
• 10:20
  Doug,
• 10:21
  one of the things that I loved about your approach to bone health was that you
• 10:27
  had evidence-based hopefulness, right?
• 10:31
  Instead of…
• 10:31
  You know what I mean?
• 10:32
  There's so much crap on the internet and, in social media,
• 10:37
  you don't know what to believe.
• 10:38
  You know, Doctor TikTok, probably not.
• 10:41
  I needed a way to be able to message, more of a action-oriented, being proactive,
• 10:49
  type of strategy for bone health rather than, just say, "Here, pop this
• 10:54
  pill and everything's gonna be fine."
• 10:57
  And, that's what I loved about your approach.
• 11:00
  So, and thank you for that because I think you've given so many people,
• 11:06
  male and female a lot of hope here.
• 11:09
  You know, we're not just talking about also natural, bone loss
• 11:16
  I've talked to a lot of, breast cancer, patients, prostate cancer
• 11:22
  patients who, because of the treatment they're on, are really having a
• 11:30
  decrement in, bone mineral density.
• 11:33
  And they, certainly in terms of the breast cancer patients, most of them more than
• 11:40
  likely may not be able to take estrogen.
• 11:44
  You know, the triple positives and, and back and forth.
• 11:49
  so, they need some way to be able to have a path forward.
• 11:56
  And I think that again, looking at that, when you, when you address people
• 12:02
  like that, let's go with breast cancer survivors how do you look at that?
• 12:07
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yeah.
• 12:07
  I mean, you know, we talk about hormones a lot because it is certainly
• 12:11
  an underutilized tool that a lot of women are afraid of unnecessarily.
• 12:15
  But there is also a large population of women who are reasonably not candidates
• 12:20
  for it or choose not to use it, and I, you know, support both of those.
• 12:24
  So we have to understand that there are dozens, if not hundreds of
• 12:29
  levers that we can pull that will have an impact on bone metabolism.
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  If you can't use hormones, okay, let's, you know, let's have that conversation.
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  What can you use in that range?
• 12:39
  Are you still on medication that's having a negative impact on hormone?
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  Like, let's just kind of go down that rabbit hole and figure out how
• 12:45
  to best optimize that situation, but then recognize that that is
• 12:49
  as optimized as that's gonna get.
• 12:51
  Now let's look at the other big levers.
• 12:53
  You mentioned a bunch of them earlier, right?
• 12:55
  So what are the big lifestyle levers?
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  The sleep, the nutrition, the resistance training, the impact or simulated impact
• 13:02
  devices that could potentially improve bone density or slow down bone loss.
• 13:07
  There are so many tools at our disposal, and if you can't use one
• 13:10
  of the big ones, then we just have to lean on the other ones harder.
• 13:14
  And you mentioned something earlier too that I just want to say again, which is
• 13:18
  it's not a question or it shouldn't be rather a question of natural versus drug.
• 13:23
  You and I both know that the drug approach has weaknesses, but they still
• 13:27
  are valuable in the right situation.
• 13:30
  And a woman who is a breast cancer survivor or even more
• 13:33
  importantly, on treatment for breast cancer with especially
• 13:37
  an estrogen-blocking medication, those women really should consider
• 13:41
  what's happening with their bones.
• 13:43
  Get a screening modality, DEXA or REMS or whatever before you start your treatment.
• 13:48
  As you go through your treatment, make sure you understand how much bone you're
• 13:51
  losing because you probably are, and what is the speed of that, and then potentially
• 13:55
  consider pharmaceuticals along the way.
• 13:57
  So it shouldn't be one or the other.
• 13:59
  It should be, "I want to pull all these levers for my bone health
• 14:03
  and do I need a drug today?
• 14:05
  And if not today, when will I reevaluate that decision?"
• 14:08
  Pam Peeke, MD: I completely, absolutely, I'm in violent agreement
• 14:15
  with, with all of that.
• 14:16
  And, you know, it's interesting, I hear the same thing with just the
• 14:19
  management of menopausal symptoms.
• 14:23
  You know, many women thinking, "Well, okay, I'll slap a patch on or
• 14:27
  I'll pop a pill and it's all good," without realizing it's part of an
• 14:31
  entire integrative holistic, strategy.
• 14:37
  and could you address for a moment before we hop into this bone
• 14:41
  reversal, you know, issue, can you address the issue of inflammation?
• 14:47
  I think that word is kicked around a lot.
• 14:50
  I think, what's the other word?
• 14:52
  Infla-aging or inflammaging or, you know, it's aging plus
• 14:57
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Inflammation,
• 14:58
  yeah
• 14:59
  Pam Peeke, MD: that all about?
• 15:00
  But it's kicked around a lot and I'm not sure, you know, people really understand
• 15:05
  how important it is to acknowledge its existence, what it is, and how it
• 15:13
  could actually impact on bone health.
• 15:15
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yeah.
• 15:16
  I'm gonna actually, I'm gonna hit on one thing that you mentioned
• 15:18
  just so briefly there because it's really, really important, and then
• 15:22
  we'll talk about inflammaging.
• 15:23
  I do like that word.
• 15:24
  You mentioned very briefly symptom-driven hormone care.
• 15:29
  And that is an important thing, and we should be having a conversation
• 15:32
  around symptoms of menopause during midlife, perimenopause, menopause.
• 15:36
  Yes, we can use hormones to treat that, yes, and understand that that therapy
• 15:42
  may not be adequate to prevent bone loss.
• 15:46
  And if you look at the studies, it's really, really clear.
• 15:48
  There is not a specific dose or strength or route or product that will prevent
• 15:53
  bone loss in all women, and that's why I'm a big believer in supporting
• 15:57
  the guidelines as they are and then recognizing we have to look beyond
• 16:01
  them if we're gonna use hormones as a tool to optimize our bone health.
• 16:05
  Just saying that out loud.
• 16:08
  When it comes to inflammation, this is really an undiscussed
• 16:13
  or under-discussed component of re-really all chronic disease.
• 16:17
  But bone loss, just like the development of atherosclerotic disease, heart disease,
• 16:24
  vascular disease, dementia, all of these chronic diseases share an underlying root.
• 16:32
  Now, there's a lot of potential causes of bone loss, but one of
• 16:35
  those causes is chronic inflammation.
• 16:38
  We see this so often as part of the longevity discussion,
• 16:42
  anti-aging discussion, you know, this whole weird space.
• 16:45
  But it's always a part of that conversation because inflammation is
• 16:49
  hard on our cells, it's hard on our organ systems, and our immune system can, you
• 16:55
  know, push back, but sometimes our immune system is actually part of the problem.
• 16:59
  So this is one of those things that we really have to understand, are
• 17:01
  you seeing chronic inflammation?
• 17:03
  Can we measure it on a lab?
• 17:05
  Can we, identify it in some of your symptoms, persistent joint pain?
• 17:09
  Are you actually having autoimmunity, or is it showing up as oxidative
• 17:12
  stress, which is kind of another flavor of the same thing, right?
• 17:16
  If we can measure some of those things, then really getting down to the
• 17:19
  nitty-gritty of how is this happening?
• 17:21
  Why is this happening?
• 17:22
  Is this something that I can do something about?
• 17:24
  Because it's not only gonna be good for your bones, it's gonna be good
• 17:27
  for your heart and your brain too.
• 17:29
  Pam Peeke, MD: Let's look at blood tests.
• 17:30
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yeah
• 17:31
  Pam Peeke, MD: you measure it through blood tests?
• 17:33
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: So you can measure inflammation,
• 17:35
  through certain blood tests.
• 17:36
  You know, there's some classic ones that doctors are trained to use
• 17:39
  like ESR and CRP and those are okay.
• 17:44
  They will measure inflammation, but they're not specific to anything.
• 17:47
  So we know if you have them, you are inflamed, but we don't know why.
• 17:51
  We don't know if you were just inflamed for that two minutes that you, you know,
• 17:55
  had your blood drawn or do you carry this chronic inflammation all the time.
• 17:59
  So it is a spot check, and you can use these for that.
• 18:02
  But you really have to ask the bigger question of, you
• 18:04
  know, do I need to repeat this?
• 18:05
  What else is going on?
• 18:06
  What other tests can we use?
• 18:08
  And there are some other blood tests available, and there's some functional
• 18:11
  testing out there to look at inflammation, but it's-- you start getting into
• 18:15
  like deep rabbit holes very quickly.
• 18:17
  So we do use CRP in our lab panels.
• 18:19
  You know, we use it as a spot check.
• 18:21
  We repeat it if it's high.
• 18:22
  And then if we find it consistently elevated, then we do start
• 18:25
  chasing, you know, whatever could be causing that inflammation.
• 18:29
  Pam Peeke, MD: I was extremely fortunate, to work at the NIH
• 18:36
  in my laboratory with, Dr.
• 18:39
  George Chrousos, who's probably the father of, of, cortisol and stress hormone.
• 18:46
  We actually sequenced CRH, which is the master hormone in our laboratory, and
• 18:52
  that was kind of a historic milestone.
• 18:55
  We finally, you know, looked at the whole hierarchy of those
• 19:00
  hormones before it really, hit your system as cortisol, right?
• 19:06
  And one of the things, that impressed me so much was that, people completely
• 19:14
  minimize the stress they're under.
• 19:18
  You know, it's like, "I can handle it."
• 19:19
  You know, it, it's like the Stockholm syndrome.
• 19:22
  You know, you're, you're in prison and, you know, and you
• 19:25
  get used to it after a while.
• 19:26
  You forget that your entire body is literally burning out with the fight and
• 19:33
  flight response that's out of control.
• 19:37
  and when that happens, one of the things we learned, we actually collaborated
• 19:41
  with several other institutes looking at, say, for instance, arthritis.
• 19:46
  We found out that stress hormone, receptors, as you know very well, are also
• 19:52
  located in joints, tendons, other places.
• 19:55
  So if you're stressed out, it's funny how all the, as it were, itises show up.
• 20:01
  Arthritis and other things too.
• 20:04
  it affects your brain, your lungs, every single organ system.
• 20:09
  Why shouldn't it also affect bone, which is, surprise, an organ system, a
• 20:16
  very dynamic one, just like you said.
• 20:19
  And one of the things I always really want to emphasize in any
• 20:25
  conversation I have about, any organ system optimization is that stress
• 20:31
  component, 'cause it gets blown off.
• 20:34
  Would you agree?
• 20:35
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Oh, absolutely.
• 20:36
  And you know, something I think that, most of your audience might not recognize is
• 20:40
  that women are better at this than men.
• 20:43
  W-women, especially in midlife, you know, and I've watched now
• 20:47
  however many thousands of community members and patients and, and
• 20:50
  even in my own household, right?
• 20:53
  you know, my wife, who is in midlife take on so many things.
• 20:58
  Managing the aging parents, still have children in the house,
• 21:02
  entrepreneur, career, relationships.
• 21:06
  It is a lot.
• 21:08
  And just, you know, it's amazing.
• 21:09
  I, I think, I think, not to get into a, a sex conversation.
• 21:13
  You know, when I ask men if they're stressed out, they usually say yes, right?
• 21:18
  They're like, "Yeah," like, "This is hard.
• 21:19
  I've been working my butt off."
• 21:21
  I ask women if they're stressed out, almost universally they say no.
• 21:26
  Universally they say no.
• 21:27
  And there's probably two reasons to that.
• 21:29
  One is, like you said, Stockholm syndrome, right?
• 21:31
  They're like, "Well, this is life."
• 21:32
  Like, "This is just what we do."
• 21:34
  And then I think the second piece of it is they're so tired of people telling them,
• 21:38
  especially doctors, telling them that all of their symptoms are related to stress.
• 21:42
  And they're like, "Ugh, it's not stress."
• 21:45
  Pam Peeke, MD: It's all in your head
• 21:47
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: And so I, and so I get it.
• 21:49
  And at the same time, as you mentioned, cortisol specifically, the most commonly,
• 21:53
  talked about stress hormone, we know that it impacts bone negatively.
• 21:57
  We-- If we use cortisol-like drugs, like if you use steroids, for
• 22:01
  example, you will see bone loss.
• 22:03
  It's predictable.
• 22:04
  It is one of the, the biggest red flags for bone loss on the checklist
• 22:08
  of things that are causing bone loss.
• 22:10
  we know that if you have the extreme version of elevated
• 22:13
  cortisol, Cushing syndrome, you're going to see dramatic bone loss.
• 22:17
  The only unknown is at what level of chronically elevated
• 22:21
  cortisol do we see bone loss?
• 22:23
  When is it a factor?
• 22:24
  We don't really know the answer to that.
• 22:26
  But I can tell you that if I were to put together a list of lifestyle
• 22:29
  interventions, managing stress is probably number three underneath food and movement
• 22:36
  Pam Peeke, MD: You know what we did in our laboratory, which, you know,
• 22:40
  I kind of spearheaded because I was absolutely, you know, I'm curious.
• 22:44
  I'm an investigator.
• 22:45
  I'm curious.
• 22:46
  So I said, "Hmm, let's map what happens to cortisol throughout the day."
• 22:53
  In a normal, fairly well-managed stressed person It's what we call a
• 23:01
  sinusoidal wave, which is basically, you know, it starts high in the
• 23:06
  morn-- If you think your alarm clock's getting you up, just forget it.
• 23:09
  Uh-uh.
• 23:10
  No, what happens is cortisol and its, its best friend, it, it does have
• 23:14
  a bestie, it's called, adrenaline
• 23:17
  they both wake you up.
• 23:18
  It's like, "Okay, we're awake now.
• 23:20
  Hello.
• 23:21
  You know, let's get rocking."
• 23:23
  And then off you go.
• 23:25
  And that just, you know, it keeps going until about, mm, midday
• 23:30
  and then things start changing.
• 23:32
  Then all of a sudden, you know, you're supposed to be, silly us beginning to
• 23:37
  chill, do a little bit of pre-chill before the evening, and that's why you get this
• 23:42
  sort of, backwards S wave, you know, if you can imagine what that looks like.
• 23:47
  So I was fascinated.
• 23:48
  I said, well, you know, if you take people under chronic stress, say for
• 23:52
  instance someone who has cancer and, and, you know, mentally and physically
• 23:57
  they're under ridiculous stress or, you know, postoperative and, you
• 24:02
  know, a lot of complicate-- whatever.
• 24:04
  And you know what we found out, Doug?
• 24:07
  That the sinusoidal curve disappears completely, and
• 24:11
  what we have is a flattened
• 24:12
  curve.
• 24:13
  What you have is a complete utter burnout.
• 24:17
  And so if you actually do the three-point or four-point blood
• 24:21
  testing, you'll see that it's almost the same number across the board.
• 24:26
  You're done.
• 24:27
  You know?
• 24:27
  You- that's it.
• 24:29
  And that's a terrible thing to be walking around with.
• 24:32
  I'll put money on it.
• 24:33
  Again, don't bet with me, I make money.
• 24:36
  I'll put money on it that a boatload of people are walking around like that.
• 24:40
  You know, dead-end job, rotten relationships, you know, it just goes on.
• 24:45
  Maybe even some medical issues, physical impairment, whatever,
• 24:49
  and, and there you have it.
• 24:50
  So I, I just, I just want everyone out there to never minimize your stress.
• 24:57
  I'm gonna give you a little teaser alert.
• 24:58
  Meditate.
• 25:00
  Okay?
• 25:01
  Just I, I'm like a crazy person about it could be prayer, it could be-- I don't
• 25:05
  give a damn what kind of meditation you use, all of the above, cherry-pick, put
• 25:10
  it together, I don't care, just do it.
• 25:13
  Just do some self-reflection.
• 25:15
  Walk into nature, sit down, and get the hell away from all this noise.
• 25:21
  And then you can finally have a moment to do some self-talk and,
• 25:26
  and self-calming which I think is absolutely-- I mean, again, we have
• 25:31
  great science-based evidence on this.
• 25:34
  It, it really works to be able to re-regula- re-regularize
• 25:40
  the cortisol, wave.
• 25:43
  All right.
• 25:43
  Now, when we come back, we're-- it's all about can bone loss be reversible?
• 25:51
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Dum, dum, dum.
• 26:51
  Pam Peeke, MD: And we're back.
• 26:52
  Okay, Dr.
• 26:54
  Doug, can bone loss be reversible?
• 26:59
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yes.
• 27:00
  Pam Peeke, MD: Okay, that's the end of that one.
• 27:02
  I we're done.
• 27:03
  No.
• 27:04
  Okay, now so many people have been told the opposite.
• 27:08
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Right
• 27:09
  Pam Peeke, MD: conversations going on out there.
• 27:11
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yep.
• 27:12
  Hear it every day.
• 27:13
  Yeah.
• 27:14
  Well, first, let's just talk about that whole, like, how
• 27:16
  are-- how is it that doctors are saying that it can't be reversed?
• 27:19
  And we are, and honestly, we're both right.
• 27:23
  It comes down to what we talked about in the beginning, which is
• 27:26
  the conventional doctors and system believe and are trained that on
• 27:32
  average, we will lose bone as we age.
• 27:33
  Bone loss is inevitable, period.
• 27:35
  It is genetically driven.
• 27:36
  It is driven by a lot of other things, and there's really
• 27:38
  nothing you can do about it.
• 27:40
  So as a doctor in the sy-- in that system, if someone comes to me with
• 27:44
  osteoporosis, and I'm gonna treat that like a regular doctor with a,
• 27:48
  you know, you have a chronic disease.
• 27:50
  I believe that bone loss is, inevitable.
• 27:54
  I'm gonna put you on a drug which may improve your T-score.
• 27:59
  I am going to tell you that you still have osteoporosis, and
• 28:03
  that's the way the system thinks.
• 28:05
  Meaning that if, if you were to compare it to other chronic diseases,
• 28:08
  like someone with diabetes comes in, let's say they have an elevated
• 28:11
  A1C glucose and insulin, right?
• 28:13
  You put them on insulin and a couple other drugs.
• 28:16
  Their A1C and their glucose are now normal.
• 28:18
  Do they still have diabetes?
• 28:19
  Of course, they do.
• 28:20
  Same thing with blood pressure, right?
• 28:22
  Someone comes in with high blood pressure.
• 28:23
  You put them on two or three medications.
• 28:25
  Now their blood pressure is normal.
• 28:26
  Do they still have high blood pressure?
• 28:28
  Of course they do.
• 28:29
  So with osteoporosis, that same recipe applies in the conventional system.
• 28:34
  You come in with a T-score of negative three.
• 28:35
  Your doctor puts you on Prolia.
• 28:37
  Two years later, your T-score is negative two.
• 28:39
  Do you have osteoporosis?
• 28:41
  Yes.
• 28:42
  Even though your T-score is now in the low bone density osteopenia
• 28:45
  range, you still have osteoporosis.
• 28:48
  That's how the conventional system treats chronic disease, and that's
• 28:51
  why they say treated osteoporosis is still osteoporosis, and that is true.
• 28:57
  But we're talking about something different, Pam.
• 29:00
  You and I are talking about looking for an underlying cause, this
• 29:03
  concept of root cause medicine.
• 29:05
  I don't really like the word functional medicine.
• 29:07
  I think it got dirty, but the concept of looking for why you're losing bone.
• 29:12
  What's going on?
• 29:13
  Is it a hormone thing?
• 29:14
  Is it a diet thing?
• 29:15
  Is it a gut thing?
• 29:16
  Is it an inflammation thing?
• 29:17
  Is it a whatever thing?
• 29:18
  If you can find those causes of bone loss, and you can do something about them, now
• 29:23
  we're having a different conversation.
• 29:25
  Now we can start to say, "Hey, if I can, can improve this thing,
• 29:29
  and my bone density goes from negative three to negative two,
• 29:33
  did I reverse my osteoporosis?"
• 29:35
  me, the answer is yes.
• 29:37
  How about for you?
• 29:38
  Pam Peeke, MD: I love it.
• 29:39
  So how do you explain this to a woman who's been told the opposite?
• 29:45
  Okay, h- how do you kind of un-message that, and package
• 29:52
  it up a little differently?
• 29:53
  How do you do that?
• 29:54
  So here's a woman sitting in front of you, "But I was told I still have
• 29:57
  osteoporosis and blah, blah, blah."
• 30:00
  Okay, go for it
• 30:01
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: So the first thing I do is I
• 30:02
  don't disparage their doctors.
• 30:04
  Doctors in the conventional system are doing the best that they can
• 30:07
  with the tools that they have.
• 30:07
  They want to prevent fracture just like I want to prevent fracture, just
• 30:12
  like you want to prevent fracture.
• 30:14
  We're just doing it in different ways.
• 30:16
  So I start out by saying that your doctor's right, and God bless him or
• 30:21
  her for sitting in that situation and, and doing that job, 'cause it's hard.
• 30:25
  What you're looking for, though, is an understanding of how you've heard
• 30:30
  that other people have improved bone density without drugs, reversing
• 30:34
  osteoporosis, if you wanna call it that.
• 30:36
  How is it that your doctor's right and all of these other things can be true as well?
• 30:41
  And they can both be true.
• 30:43
  And then I get into explaining how bone density or bone loss rather,
• 30:46
  is not inevitable, how we have seen thousands and thousands of cases now
• 30:51
  between our patients, our communities, and our, our social media platforms.
• 30:54
  And it can't just be this microcosm that I live in.
• 30:59
  It is the reality that bones are a responsive organ system.
• 31:03
  They respond to the stimulus that we provide them, and if you have
• 31:06
  the ability to provide the right stimulus, you can reverse osteoporosis
• 31:10
  Pam Peeke, MD: Let's look at the remedies.
• 31:12
  What are some of the strategies that you like to use to be able
• 31:16
  to best optimize bone health?
• 31:20
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yeah, we have this thing I don't
• 31:21
  have it, but I can describe it.
• 31:22
  But it's just th- this pyramid that's like every integrative doctor's pyramid
• 31:25
  of, of how we create a program, right?
• 31:27
  You start with the foundation of the pyramid.
• 31:29
  Those are the things that you and I have already mentioned multiple times:
• 31:33
  food, exercise, sleep, and mindset.
• 31:37
  Without those four things, none of the other fancy stuff can
• 31:40
  do what it's supposed to do.
• 31:41
  So we start there.
• 31:43
  What's amazing about that is all of those things are absolutely free to
• 31:48
  everybody listening to this podcast.
• 31:50
  You're gonna eat anyway.
• 31:51
  Hopefully, you're sleeping, and if you're not, we need to work on it.
• 31:54
  Your mindset is something that should always be on the front
• 31:56
  of your mind, no pun intended.
• 31:58
  And we should always be moving our bodies.
• 31:59
  I know everybody who's listening to this, who's followed you, knows that we need
• 32:04
  to be doing high-intensity resistance training to the best of our ability.
• 32:07
  That's the foundation for everything, by the way, whether it be dementia
• 32:11
  prevention, cardiovascular prevention, or osteoporosis prevention or treatment.
• 32:16
  It doesn't matter.
• 32:17
  That's the foundation, and we can go into all of those little columns if you want.
• 32:20
  But from there, we move into hormone optimization.
• 32:23
  For women that can or are willing, how do we optimize our hormones not
• 32:27
  through the lens of our-- or lens rather of our menopausal symptoms,
• 32:32
  but through the lens of our bones?
• 32:33
  And I can walk you through how we do that.
• 32:35
  And then once we optimize hormones, then we talk about supplementation.
• 32:39
  I get so aggravated at companies that market directly toward women with
• 32:44
  osteoporosis, this fear tactic marketing of saying, "I've got the supplement
• 32:48
  that's gonna reverse your osteoporosis."
• 32:50
  Of course, they don't say that.
• 32:51
  FTC would take them down.
• 32:52
  But they're really implying it, right?
• 32:55
  And I see so many women that come into our, you know, our community,
• 32:58
  our master classes or whatever, and they say, "Well, I'm taking,
• 33:01
  you know, these three products.
• 33:02
  Is this enough?"
• 33:03
  I'm like, "Well, on top of what?"
• 33:05
  Right?
• 33:05
  Are they filling in a gap?
• 33:06
  What are we doing with those things?
• 33:08
  Like, we have to ask the right questions.
• 33:09
  Why are we taking a supplement?
• 33:11
  And then from there, once you've kind of stacked all that stuff together, then
• 33:14
  asking yourself the question of, "Do I need pharmaceuticals in addition to this?"
• 33:19
  Is what is my starting point?
• 33:20
  What is my fracture risk?
• 33:22
  Pam Peeke, MD: Well, so the pharmaceutical piece, you and I both honor that.
• 33:27
  I mean, there, there are, you know, pharmaceuticals out there that most
• 33:32
  definitely impact in a b- beneficial way.
• 33:35
  I think the problem is that so many of them have side effects
• 33:41
  that women read very closely, because that's what we do as women.
• 33:46
  We read very closely.
• 33:48
  And
• 33:49
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: because we don't.
• 33:50
  Pam Peeke, MD: yeah.
• 33:51
  And then sit in front of you and say, "Well, what's up with this?
• 33:56
  What do you mean now I have an increased risk for a fragility fracture?
• 34:00
  What?
• 34:01
  I thought the whole point of taking this drug…"
• 34:03
  You know, and again, I'm not knocking drugs per se.
• 34:07
  Look, all-- most drugs, not all, but most drugs have some,
• 34:11
  you know, funky side effects.
• 34:13
  They do, right?
• 34:15
  I mean, you're putting an exogenous chemical into your body.
• 34:19
  You can't expect your body to go, "Okay, bring it on."
• 34:22
  You know?
• 34:23
  "No problem."
• 34:24
  That's not what happens.
• 34:25
  The body's like, "What the hell, and how do I manage this?"
• 34:30
  You know, to be able to get the outcome that you want, one way or the other.
• 34:34
  The other issue that comes up is the fact that some of the drugs you can
• 34:38
  only be on for, you know, a short term.
• 34:41
  I call a short term 12 months.
• 34:44
  And then you have to hop off, and then what?
• 34:47
  It's like, wait a minute.
• 34:48
  What's the strategy after that?
• 34:51
  I'm hopping onto something else.
• 34:52
  Oh, you're, you're telling me I need a drug holiday.
• 34:55
  Am I slipping backwards during that time when I can't be on a…
• 34:59
  What is going on here?
• 35:01
  I don't know.
• 35:02
  Do you-- As I look at the whole pharmacology thing, it just, when it,
• 35:08
  when, as it applies to bone, I know this happens in other conditions too,
• 35:12
  but I can see how people in general, especially women, just approach
• 35:19
  this whole thing with super caution.
• 35:21
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Oh, yeah.
• 35:22
  Well, and I mean, they don't trust it, right?
• 35:25
  Because-- So this is what we see is we see women who will go to their
• 35:28
  doctor, and their doctor, again, well-meaning, they know that this
• 35:33
  is the-- like, especially if they're gonna go down the bisphosphonates,
• 35:36
  like the Fosamax reclass pathway.
• 35:38
  If that's their recommendation, they know that that is the most, refused drug, most
• 35:46
  refused drug class in the world, right?
• 35:48
  Across the board.
• 35:49
  Women don't wanna take it, and they don't wanna take it because it has concerning
• 35:53
  risks, side effects, and intuitively, they know that it doesn't make sense
• 35:58
  because they can only be on it for three to five years, and then what?
• 36:02
  Right?
• 36:02
  A drug holiday.
• 36:03
  Well, a holiday sounds nice.
• 36:04
  It sounds like vacation, but what does that mean with a drug?
• 36:07
  There's not a good long-term plan.
• 36:09
  And one of the things we educate on in our platform is that drugs are not wrong.
• 36:14
  There is a time and a place for every drug that's on the market.
• 36:17
  The question you need to be asking your doctor is: What is
• 36:20
  my, what is my pharmaceutical plan for the rest of my life?
• 36:25
  And your doctor doesn't wanna answer that question.
• 36:27
  This is really important, though, because if you are a woman in her
• 36:30
  fifties, now that we're having this fantastic menopause conversation,
• 36:34
  people like you who are getting the word out, women are becoming more educated.
• 36:37
  They're going to their doctor.
• 36:38
  They're demanding a scan.
• 36:39
  They get a diagnosis of low bone density or osteoporosis, and their
• 36:43
  doctor, according to the guidelines, needs to put them on a drug.
• 36:46
  But if you are a woman who is fifty-one years old, you need to be
• 36:50
  asking the question of not, "What am I gonna do for the next three
• 36:53
  years, five years, or ten years?"
• 36:55
  It's actually, "What am I gonna do for the next fifty years?"
• 36:58
  Right?
• 36:59
  Maybe it's forty, but it's still a really long time.
• 37:02
  And that question is not being asked by patients, and it's
• 37:05
  not being answered by doctors.
• 37:07
  But I just-- Can I just take a step back and talk about the drugs?
• 37:10
  'Cause I, I think it's really good to put them in context.
• 37:12
  Can we go down this, this pathway?
• 37:14
  So I look at the drugs as kind of two different buckets.
• 37:18
  There are the drugs that really work with our comprehensive approach, our
• 37:23
  exercise, our nutrition, our hormones.
• 37:25
  I just released a video on this recently with the, the
• 37:27
  available data that's out there.
• 37:29
  And those are the anabolic drugs, right?
• 37:31
  So that's your Forteo, your Tymlos, Evenity to some extent.
• 37:35
  We talk about that.
• 37:36
  But these are the drugs that are ramping up bone building, right?
• 37:39
  That's why they call them anabolic drugs.
• 37:41
  Now, you can only be on them for a short period of time.
• 37:43
  You mentioned twelve months, that's Evenity.
• 37:45
  Two years, that's Forteo, Tymlos.
• 37:47
  These drugs are designed to be used for a short period of time
• 37:50
  and then followed by another drug.
• 37:52
  But what I look at when someone says, "Do I need a drug today?"
• 37:56
  We say, "Okay, how high is your fracture risk, and how comfortable
• 38:00
  are you not using a drug?"
• 38:02
  And if the answer is, "I'm not comfortable not using a drug," I
• 38:04
  have a really tough starting point.
• 38:06
  "Okay, great.
• 38:07
  Are you a candidate for one of these anabolic drugs?
• 38:09
  If so, let's do this while we're doing all the other things, and
• 38:12
  then let's see how good it can get."
• 38:14
  And I can tell you, oh my goodness, when you start stacking hormone
• 38:18
  optimization, lifestyle, sleep, reducing cortisol and stress, eating
• 38:23
  the right diet, and using an anabolic drug, I mean, it is like a rocket ship.
• 38:26
  It's, it's incredible.
• 38:28
  And so then you come out on the other side of that, and then you ask the
• 38:31
  other question, which we'll come to later, which is, "What do I do now?"
• 38:35
  But the other camp of drugs are the anti-resorptive drugs.
• 38:38
  So this would be like your bisphosphonates, that hated drug class.
• 38:41
  again, Fosamax, Reclast and then also the drug Prolia.
• 38:46
  And Prolia is a very popular drug in the medical community, but it's
• 38:49
  the one that is really well-known to increase your fracture risk above
• 38:54
  baseline if you go off of it, right?
• 38:56
  Rapidly losing bone, increase, risk of vertebral fracture and
• 38:59
  multiple vertebral fractures.
• 39:01
  So that's concerning.
• 39:03
  Not to say that we shouldn't use these drugs, though.
• 39:05
  There are times, like you mentioned earlier, with a woman who is going
• 39:08
  through treatment for breast cancer.
• 39:10
  Man, being on a bisphosphonate drug if you're rapidly losing bone is
• 39:13
  a really great combination to then become a breast cancer survivor
• 39:17
  with much better bone density.
• 39:18
  So that's a great use case for a bisphosphonate drug.
• 39:22
  But there are other circumstances too when we might want to slow down bone
• 39:26
  loss, and we don't have any other choices at the time, or maybe somebody
• 39:29
  isn't a candidate or has already used the anti-resorptives, right?
• 39:32
  Is that what's next question.
• 39:34
  And then it's okay to use these drugs, but you still have to ask
• 39:37
  yourself the question of, what's next?
• 39:40
  Am I gonna be on this drug forever?
• 39:42
  If I'm going on Fosamax, what do I do during my or after my drug holiday?
• 39:46
  If I'm gonna go on Prolia, am I ever gonna wanna come off?
• 39:50
  Because coming off Prolia is not that easy.
• 39:52
  So we just have to understand what the drugs are doing and what the
• 39:55
  long-term plan is with those drugs.
• 39:58
  Pam Peeke, MD: And you know what this requires?
• 40:00
  What's happening now in menopause care, you know, with the menopause
• 40:04
  c- care providers the certification, that's now being done by the Menopause
• 40:10
  Society, and that is you actually have to sit down with the individual
• 40:16
  in front of you and spend time.
• 40:19
  You know, instead of that, just whip out a piece of paper and
• 40:22
  everyone gets the same SOP.
• 40:25
  No.
• 40:26
  That's a no.
• 40:27
  Because a, a woman, as she courses through her hormonal milestones, starting
• 40:33
  with perimenopause, is a moving target.
• 40:36
  She's a dynamic organism, just like her bones, and things are going on.
• 40:42
  You know, out of the blue, she's doing fine.
• 40:44
  She's exercising.
• 40:45
  Man, she's got it down.
• 40:47
  She'd make you happy.
• 40:48
  And then out of the blue, she ends up being on prednisone
• 40:50
  for eight months Ruh-roh.
• 40:53
  Now what do we do?
• 40:55
  Could she be doing something knowing she's gonna be on prednisone?
• 40:59
  Is there something else she could also be adding to, you know, her strategy
• 41:04
  to be able to, mitigate some of that bone loss, which will mo- you know,
• 41:10
  most definitely be taking place.
• 41:12
  So there's all of that going on.
• 41:16
  So, I love how you framed this so well.
• 41:21
  It's customize, individualize, and honor the person sitting in
• 41:26
  front of you, and stop generalizing to everybody and his sister.
• 41:31
  Okay?
• 41:32
  All right.
• 41:33
  Now, let's look at what we can do right now.
• 41:36
  Number one, we already said some of these things.
• 41:39
  You know, honor your sleep.
• 41:41
  Just buy a damn Oura ring, for God's sake.
• 41:44
  I, I have-- I know, I got mine too, right here.
• 41:47
  Err.
• 41:48
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yep
• 41:48
  Pam Peeke, MD: what's important here, right, is that, you know, you,
• 41:52
  you don't know what you don't know.
• 41:54
  First time I put on an Oura four years ago, early adopter is I, was shocked
• 42:00
  at how much just one glass of wine at dinnertime would screw up my readings.
• 42:06
  I don't really, you know, drink alcohol much at all anymore
• 42:11
  other than celebratory, whatever.
• 42:13
  I just have read too much.
• 42:15
  I know too much.
• 42:16
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: too
• 42:17
  Pam Peeke, MD: yeah, I know too much.
• 42:18
  You know, I've got that look in my face.
• 42:19
  I know too much.
• 42:21
  the, so the sleep thing is a monster.
• 42:23
  I already, we already talked about the stress thing.
• 42:25
  You know, when it comes to nutrition, do you really need to be popping
• 42:29
  all those calcium supplements?
• 42:32
  So a lot of the, the current literature is interesting.
• 42:36
  They basically say get it all from your dietary intake because it's bioavailable.
• 42:42
  Your body goes, "Oh, I know what that is.
• 42:44
  It's called food."
• 42:46
  And it's, it's natural stuff, and it's good.
• 42:49
  And actually, I was very happy to see that 'cause it's kind of
• 42:52
  what I've been doing all along.
• 42:54
  And then at the same time, get a vitamin D level.
• 42:58
  Know what your D3 looks like here.
• 43:01
  And because, absolutely the literature shows that so many people are vitamin
• 43:07
  D deficient And for the longest period of time, which made me, you
• 43:12
  know, tear my hair out, the actual approved requirements were way too low.
• 43:18
  Oh.
• 43:19
  And now we, we have a much better understanding of what
• 43:24
  a, a really healthy range is.
• 43:28
  but you need to know what that blood level is.
• 43:30
  Ask your provider.
• 43:32
  Your provider's not gonna voluntarily do that unless they
• 43:36
  happen to be an integrative or lifestyle or functional provider.
• 43:42
  You know, that'll be the first thing out of their mouth.
• 43:44
  It's like, "What's your vitamin D3?"
• 43:46
  All right.
• 43:46
  So, that's important.
• 43:48
  Why?
• 43:48
  'Cause vitamin D helps calcium do its work, get right on in there in the,
• 43:54
  in the bones, and that's a good thing.
• 43:56
  So nu- you know, natural nutrition where you can, and then, clearly,
• 44:02
  knowing your vitamin D is important.
• 44:04
  And just have a, you know, always think about having a calcium-rich diet no matter
• 44:10
  what kind of dietary intake you're taking.
• 44:12
  I mean, you just have to learn more about food and where vitamin D is hanging
• 44:16
  out and calcium is hanging out as well.
• 44:21
  and then really exercise.
• 44:24
  you know, I'm a broken record, I understand.
• 44:27
  I'm actually standing on, my little sandbox here, okay?
• 44:30
  And, you know, resistance training, if you're 30 years old, get to it, you know?
• 44:37
  And you wanna be, banking up a, a reserve so that no matter what happens in your
• 44:44
  life, 'cause it will happen, break a leg, you know, have some kind of long-term
• 44:49
  illness kind of situation, you need it.
• 44:54
  You need your bone and your muscle, you know?
• 44:57
  And so all of that is terribly important.
• 45:00
  And, you know, why don't you, you know, anything else along that
• 45:04
  template, what do you think, Doug?
• 45:07
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yeah.
• 45:08
  I mean, I think I can just hit some points within there.
• 45:11
  From a nutrition perspective, you know, the, the one thing we talk
• 45:14
  about if, if you were to give me two minutes with an audience is
• 45:17
  the, the adequate protein thing
• 45:20
  Pam Peeke, MD: Oh, protein, of course, by definition.
• 45:23
  Yeah, absolutely
• 45:25
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: that women, you know, because so many
• 45:27
  women, especially in the, the, the two generations really that we're talking
• 45:30
  to, have sort of lived in this like, you know, skinnier is better, lighter
• 45:35
  is better, and also lived through as an adult the, the fat phobia.
• 45:41
  It puts us-- it puts that-- those two generations of women
• 45:44
  in a place where they're really not eating very much protein.
• 45:46
  They're not eating high quality protein if they're eating it, and they're
• 45:49
  probably undernourished in general.
• 45:51
  And so, you know, the two things I would say is track protein, and we're
• 45:56
  gonna aim for, in our community, we're gonna aim for around zero point eight
• 46:00
  grams per pound of ideal body weight, which is above what you may have heard.
• 46:05
  And if-- The reason why we do that is for, for two bodies of literature.
• 46:09
  One is on muscle.
• 46:10
  We know that if we wanna build muscle, we need that kind of one point three to one
• 46:14
  point six grams per kilogram, which is around zero point eight grams per pound.
• 46:18
  And if we're-- we need that threshold of protein intake multiple times a
• 46:22
  day to, Well, sorry, split up multiple times a day, not the whole thing.
• 46:27
  But to, to generate muscle protein synthesis.
• 46:29
  So we have that body of literature.
• 46:31
  And then we also have the body of literature on bone, which is really
• 46:34
  just kind of cohort based, right?
• 46:35
  We're looking at populations and asking what they eat, but more
• 46:39
  protein, higher bone density always.
• 46:42
  So that's what we have to go off of.
• 46:44
  And what I can tell you is that if you optimize for protein and you look
• 46:47
  for high quality protein, then a lot of the garbage that might be causing
• 46:51
  inflammation or having ill effect on your health falls off because you d-
• 46:55
  you just don't have any room for it.
• 46:57
  So that's the big thing with nutrition.
• 47:00
  With exercise, I think you do a great job talking about resistance and,
• 47:04
  intensity, so I won't touch any of that.
• 47:07
  The one thing I, I think is worth talking about though is the concept of impact.
• 47:12
  Now, especially that we're getting this, you know, now the, the messaging around
• 47:15
  jumping and everybody's jumping for bones, and every menopause influencer
• 47:19
  has their own jumping program.
• 47:21
  Comment jump, and I'll send it to you.
• 47:23
  That is, okay.
• 47:26
  Like it's a good stimulus.
• 47:27
  well, I should say it's an okay stimulus for bone if you can do it
• 47:31
  and if you can do it safely, and it's definitely not right for everybody.
• 47:36
  Understand that the body of literature around jumping is really focused
• 47:39
  on younger women, premenopausal,
• 47:42
  perimenopausal certainly.
• 47:44
  And anytime you do a study, and it doesn't actually matter the imp-- the, stimulus.
• 47:48
  It could be jumping, could be heel drops.
• 47:50
  Once you go past menopause in a, in a population of women not on
• 47:54
  hormones, it no longer shows benefit.
• 47:57
  So it's just really important to understand what the literature is
• 48:01
  actually showing and who the right people are for these interventions.
• 48:03
  Pam Peeke, MD: And women have physical impairments after the age of 50.
• 48:08
  If something doesn't, you know, cause you to say, "Ow," you
• 48:12
  haven't lived is my general rule.
• 48:16
  and I would honestly say that a truckload of these women are having
• 48:22
  knee issues, so the jumping thing is just exquisitely problematic.
• 48:27
  And I don't want women to ever feel guilty like, "Oh, I didn't do a jump."
• 48:32
  No.
• 48:33
  You listen to your body.
• 48:34
  There are so many workarounds.
• 48:37
  The jumping thing isn't the only way to be able to deal with the
• 48:42
  issue of stimulating your bone.
• 48:44
  And why don't we just add one last little thing?
• 48:47
  New technology.
• 48:48
  How about Mr.
• 48:49
  OsteoBoost?
• 48:50
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Right.
• 48:51
  Yeah, I mean, when I talk about, when I talk about impact, I talk
• 48:54
  about impact, and I always follow it with or simulated impact, right?
• 48:58
  And there's, there's some different ways to do that, but vibration is a
• 49:00
  really interesting stimulus, and I think you guys have created a great product.
• 49:04
  That's why, you know, we talk about it often
• 49:07
  Pam Peeke, MD: Yeah.
• 49:07
  So I would ask people to run on over to Osteoboost, O-S-T-E-O-B-O-O-S-T.com
• 49:15
  and learn about a brand new FDA cleared technology, which
• 49:20
  delivers targeted vibration.
• 49:23
  So for so many women who wanna get that extra stimulation of those bone building
• 49:28
  cells, this is a great way to do it.
• 49:30
  So just have a little look there.
• 49:32
  Just trying to cover all bases as best I can.
• 49:35
  I think what you've done here, Doug, is you've gifted women with as I said in the
• 49:41
  beginning, evidence-based hope really.
• 49:44
  And that's so important because I think women are, are just overwhelmed
• 49:49
  with just, junk noise out there, and they're, they're desperate.
• 49:54
  They're also fear-driven.
• 49:56
  "Oh my God, I don't wanna fall, break things, and end up dead."
• 49:59
  and we already know the statistics on all of that.
• 50:03
  So I, I love that.
• 50:04
  How can they learn more about, your community, joining your community and,
• 50:12
  getting your education about bone health?
• 50:15
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Yeah, absolutely.
• 50:16
  Well, the, the one page that sort of sums it all up is drdouglas.com,
• 50:21
  D-R-D-O-U-G-L-A-S.com.
• 50:23
  It's got all the things.
• 50:24
  Our YouTube channel, like you mentioned, "The Dr.
• 50:26
  Doug Show," is also a podcast or whatever platform you like to listen on.
• 50:29
  That's free content for everyone, and a really big focus for us.
• 50:33
  Our community is called the OsteoCollective, and you can go
• 50:37
  directly to that URL if you like.
• 50:38
  But the OsteoCollective is where we are educating en masse thousands of women on
• 50:43
  how to improve bone health on their own.
• 50:45
  It is not a medical practice because most women don't need one
• 50:49
  Pam Peeke, MD: Beautiful.
• 50:51
  I just absolutely love that.
• 50:53
  Doug, this has just been fantastic.
• 50:56
  Once again, just chock-full of wonderful information and really
• 51:01
  helping women open their eyes.
• 51:04
  And, you know, as we know with change, the science of change, it takes a while.
• 51:09
  You know, you start absorbing it and you're like, you're in the oh,
• 51:13
  you know, phase, and then you come back to it and you learn a little
• 51:16
  more, and then you come back to it.
• 51:17
  You know why?
• 51:18
  'Cause you're afraid.
• 51:20
  It's, it's fear-driven.
• 51:21
  You know, like, where's all this leading me?
• 51:24
  I thought that what so and so said on TikTok was different and whatever.
• 51:28
  Then you start sorting through and figuring out who your A team
• 51:32
  of evidence-based scientists are.
• 51:34
  I clearly am, and now we're absolutely honoring Dr.
• 51:40
  Doug Lucas and his beautiful work.
• 51:42
  Doug, thank you again.
• 51:43
  Doug Lucas, DO, FAAMM, AOBOS, ABAARM: Thank you, Pam.
• 51:44
  I really appreciate the
• 51:45
  Pam Peeke, MD: And I wanna take a moment to thank my sponsor, and that's SkinSafe.
• 51:52
  SkinSafe is an app developed by the Mayo Clinic.
• 51:57
  And what it does, it takes the guesswork out of shopping for
• 52:00
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• 52:03
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  Just go to Sephora and put a gun to your head.
• 52:07
  It's like, "Oh my God, where do you begin?"
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• 52:20
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• 52:22
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• 52:25
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• 52:30
  Download the app for free and use the link in our ad to get 20% off
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  a SkinSafe premium membership.
• 52:39
  You'll be spending half your life reading this stuff 'cause it's a real eye-opener.
• 52:43
  It's like, "Oh no, I'm returning this."
• 52:46
  Hey, take a moment right now and leave us a review because we just love to
• 52:52
  hear from you, because this has been a production of Podcast Health and our
• 52:57
  team is all about listening to you.
• 53:00
  And remember, oh, I love to end with a, a really cool quote that
• 53:06
  kind of, you know, grabs me.
• 53:08
  So here's a beautiful one from an award-winning author whose name is
• 53:12
  Knaust: "Life is amazing, then it's awful, then it's amazing again.
• 53:16
  And in between the amazing and the awful is ordinary and mundane and routine.
• 53:21
  Breathe in the amazing.
• 53:22
  Hold on through the awful and relax and exhale through the ordinary.
• 53:27
  That's just living, heartbreaking, soul-healing, amazing, awful, ordinary
• 53:33
  life, and it's breathtakingly beautiful."
• 53:38
  I love that, and I'm sharing that with you right now.
• 53:41
  Now get on out there.
• 53:42
  Carpe diem, seize the day, and thanks for listening.