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