April 25, 2024 • 42 mins
Join Josh and Adam as they delve into a captivating study on the Ayurvedic remedy Shilajit, uncovering its potential in addressing osteopenia among postmenopausal women. Our discussion explores a carefully crafted 48-week trial, analyzing its design, methodology, and compelling outcomes. Navigating the intersection of evidence-based medicine and holistic practices, we uncover a promising link between Shilajit and bone mineral density. This sparks a thoughtful conversation on its integration with modern osteoporosis treatments
We invite you, our listeners, to join us in this ongoing exploration. Share your thoughts, questions, and experiences on our social media platforms—DrJournalClub on Twitter, Facebook, and LinkedIn. Together, let's nurture a dialogue that celebrates the intersection of tradition and innovation, enriching our understanding of health and healing.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Introducer (00:02):
Welcome to the Dr Journal Club podcast, the show
that goes under the hood ofevidence-based integrative
medicine.
We review recent researcharticles, interview
evidence-based medicine thoughtleaders and discuss the
challenges and opportunities ofintegrating evidence-based and
integrative medicine.
Continue your learning afterthe show at www.
(00:23):
drjournalclub.
com.
Josh (00:31):
Please bear in mind that this is for educational and
entertainment purposes only.
Talk to your doctor beforemaking any medical decisions,
changes etc.
Everything we're talking aboutthat's to teach you guys stuff
and have fun.
We are not your doctors.
Also, we would love to answeryour specific questions on
drjournalclub.
com.
You can post questions andcomments for specific videos,
(00:55):
but go ahead and email usdirectly at josh at
drjournalclub.
com.
That's josh at drjournalclub.
com.
Send us your listener questionsand we will discuss it on our
pod.
(01:28):
I had like six cups of coffeeyeah, um, I was supposed to do
my run today.
I've got a half marathon nextweek and I was supposed to do my
run and I, like I had literallya back-to-back meetings the
entire freaking day.
I thought I'd sneak it in, butit did not happen.
Adam (01:47):
Is it a half marathon.
That's like a planned race, oris this just for funsies?
Josh (01:53):
Yeah, yeah.
No, this is a rock and roll one.
They're fun.
Adam (01:59):
They're just kind of like a way to hang out with the oh,
this is in Tennessee or whatever.
Josh (02:02):
In Nashville.
Yeah, I'm excited Tennessee orwhatever.
In Nashville.
Yeah, I'm excited we're stayingin the music district.
I guess I'm not sure I've neverbeen in Nashville before.
It should be a good time, Ihear you're having a
bachelorette party there InNashville.
Is that a thing to do?
Yeah, it's interesting becausethere's the downtown, there's
(02:24):
all these interesting becauselike there's like the downtown,
there's like music, there's allthese different districts.
It seems like a really funplace to hang and it should be a
really fun place to run Like.
It sounds like like the routelooks pretty cool, but yeah.
And the rock and roll ones arejust, they're fun.
It's got like a zillion supporttables and there's music
everywhere and oh, I bet, yeah,it's like you don't even need to
bring water if you don't wantto.
(02:45):
There's like people every mile.
Adam (02:49):
If there's any rules against like no music, you'll
have the entire town, yeah yeah,seems like a good place to do a
rock and roll one, so yeahactually, the first time I did a
race that wasn't rock and rollI was, because they like have
their stuff so well together Iwas shocked.
Josh (03:04):
There was no support, there was no water.
I was like, oh my gosh, I'mgoing to start.
So I realized how much they putinto those sorts of things with
the more organized ones.
But yeah, yeah, all right,shall we jump in?
What are we going to do?
Oh wait, last thing I finallygot a trainer, because you know
how I'm going to die swimming.
I finally got a trainer becauseI you know how I'm like the die
(03:24):
swimming.
So I finally got like a trainer, but she's a virtual trainer so
she can't actually help me doanything.
So she's like trying todescribe these swim exercises.
And if you've ever had someonetry to explain a swim exercise
to you and then say, well, justgo YouTube it, it's just like
it's not going well, not goingwell.
I swim like a I don don't knowporpoise, what, what, what, what
(03:46):
, what, what are animals thatdon't swim well, I don't know,
but that's me manatees.
They just kind of float aroundwith like little fins slapping
the water.
That's kind of how I feel.
Can dogs swim?
can dogs can swim well, doggypaddle, that's a thing all right
, yeah, well, there you go yeah,I'm a dog, I'm like uh, yeah,
I'm like a puppy in the waterfor the triathlon.
Adam (04:06):
Really, all you need to do is is run to each canoe.
So hang out on the water.
Just find out how far they arefrom each other.
Swim on uh-huh.
Hang out there for a good 10minutes and then go to the next
one like the safety canoes.
Josh (04:24):
Yeah, okay, yeah, yeah.
Well, I'm hoping there'll be alot of people like there'll be
safety people there likesurfboards and and canoes and
stuff.
But yeah, I don't know.
Man, you're a much betterswimmer than I am, even though
this is, like your, your leastfavorite sport at this point.
You're doing like one and ahalf k's regularly.
Adam (04:42):
Yeah, for swimming uh, I'm doing like when I train I
typically do at least 1,000meters, and so yeah, and that's
just sort of like freestyling it.
And then if I want to add in,you know, like the paddleboard
for like leg strengthening, orif I'm using like the little
floaty for more arm stuff, thenyou can kind of crank out, you
can crank out more, so yeah thenyou can crank out more.
(05:05):
I did a 1,000-meter freestyleand then at the end did a little
paddleboard thingy.
Josh (05:11):
Those things are tough man .
I just got them now with thesenew exercises and I've got one
of those awkward things you putbetween your legs, you know like
the, the little styrofoam-likepillow yeah, I don't even know
how to.
I was like am I putting this?
Because there's a more bulbousside and a a little styrofoam
like pillow?
Yeah, I don't even know how to.
I don't even know how to.
Unlike, I was like am I puttingthis because there's like a
more bulbous side and lessbulbous side?
Adam (05:30):
I have the more bulbous side, facing like up down right
uh wait, why up?
Josh (05:38):
oh no, you're right, yeah down, because you'd want like
more buoyancy, right like that.
I had it the other way and thenI was like and then how far in
towards your crotch do you do itlike I?
First I had it like well intomy thighs and then I was like
this isn't gonna, this feelsweird.
And I tried the knees and thatfelt even stranger.
And then I tried it by myankles and I was like literally
like like um, jackknifing.
(05:59):
Every time I took like a strokeor something.
So, yeah, I'm, I'm a freakingdisaster in in the water.
So we'll, we'll see All right,just gotta be comfortable.
Adam (06:12):
What's that?
I just use it like a saddle,like you just kind of make it
this way.
Saddle Like a saddle, yes, likeyou just sit on it and it's
comfortable, and like you sit.
Josh (06:21):
And it's comfortable.
You don't sit on it, though.
I don't understand.
What do you mean?
A saddle?
Adam (06:26):
The meaning of it is as though it's a saddle.
It just needs to be comfortable.
You're overthinking it.
Josh (06:31):
First of all, saddles are not comfortable.
Second of all, I'm envisioningthat there's no way you can
mount it like a saddle.
Okay, I'll try to remember thatnext time in the water.
Adam (06:49):
Yeah, thanks a lot for that.
That's like completelyworthless.
All right, so let's talk aboutwhat are we talking about today.
Josh (06:53):
I think I think we should just keep going with this.
Yeah, I think the coffee hit,okay, um, so where are we all
right?
So we're talking about we don'teven know how to pronounce it.
We're so.
We're so excited about it.
It's a great paper.
We don't even know how topronounce it.
Adam (07:03):
How about we do a reverse podcast?
Okay, we do a trial, we'll goover the entire trial, but
people are going to be blindedto what the intervention is, and
then they have to guess thestudy.
Josh (07:16):
No, because if they haven't closed it already, with
us blabbering about saddles inthe water and awkward flailing,
they're going to do it now.
If they have to, like, wait anhour to actually know what the
intervention is.
No, that's a terrible idea,almost as bad as the idea it's
about being a suspense, josh.
This is that's what we're doingnow, dear listener, just
(07:39):
rambling on giving you suspenseabout.
Are we actually gonna talkabout medicine today?
Okay, no, we know how topronounce it because we asked
google and, according to google,it's she legit, like to legit,
she legit, she legit, she legit.
Hold on, how does this go?
She legit, she legit, right.
That's you know.
(08:00):
That's what google says.
That's what google says.
That's the way it is, and anyonethat has like deep thousands of
years tradition in Ayurveda,like you're just wrong.
If it's not like the way Googlesays, then Google's always
right.
Yeah, totally so.
But seriously, if you actuallyhave experience in Ayurveda, I
feel like we sound like totalidiots.
(08:20):
Last week we were doingacupuncture with no knowledge
whatsoever about likeacupuncture or meridians or
anything like that.
We barely knew the word chi,and now we don't even know how
to pronounce the interventionfrom an Ayurvedic.
So we beg your forgiveness,ayurvedic practitioners, but
please correct us if we're wrong.
Anyway, apparently it is thisherbal extract, almost um, from
(08:46):
the mountains in india, Ibelieve.
Right is that?
Am I totally making that up?
I think it's off the moss of,like rocks in the mountains of
india it sounds super likeromantic, like it just sounds
like a really cool thing, likeyou'd go out into the misty
mountains and like harvest thisstuff and it it was bringing me
back.
That's romantic to you.
Oh yeah.
(09:06):
Well, at least you know myearly days when I was like
herbal or little herbal kid,little herbal hippie with my
dreads.
Oh my God, trying to collectherbs in Mexico on the
mountainside, and that's whatbrought me to naturopathic
medicine, and then I lost my wayand got stuck in science as I
went.
So, yeah, I know it's like itwas a different time, anyway.
(09:31):
So, all right.
So here we are.
So we have a randomized,double-blind, placebo-controlled
trial of this substance forosteopenia, which I thought was
really interesting, and we'vehad a couple in postmenopausal
women.
In postmenopausal women.
So it seems very clinicallyrelevant, right?
So we're looking at apopulation of postmenopausal
(09:52):
women with osteopenia andosteoporosis taking this
intervention, this herbalintervention, to improve bone
strength.
So a very clinically relevantpopulation.
The only thing that was kind ofsurprising to me was there's
like two authors and it's a verywell conducted double blind
randomized control trial Likehow did you do this with two
(10:14):
people?
I don't know how that works,but I'm impressed.
Okay, so should we set up thestudy design here?
Adam (10:21):
Yeah, so it was actually a really well done study.
When you and I were kind oftexting back and forth about it,
I was actually really impressedwith this.
It was a 48 week prospectiverandomized above-line placebo
controlled trial, so essentiallyit was a year long of
supplementation.
Josh (10:40):
Which, you have to admit, is good, right, because anytime
it's like a three month, fourmonth, five month thing.
You're like, oh, it was a greattrial, but you know, anytime
it's like a three month, fourmonth, five month thing.
You're like, oh, it was a greattrial, but you know it's
short-term outcome.
So are we happy with an if it'sa year-long?
I'm impressed by it, but withthe results that they're like
looking at um longer idea wouldbe ideally better.
(11:01):
Uh, because they're looking atbone mineral density and that's
not going to change rapidly.
Yeah Well, that's just onething that we have to take into
consideration.
I am impressed, though, thatthey they kind of did take that
sort of into account, and youknow this is you know, to do it
longer is going to take a lot ofmoney.
So the fact that they gotbasically a year's worth of data
(11:23):
, I think is still important.
A year RCT with herbs like that, yeah.
And to your point like bonemineral density outcomes, yeah.
Three months wouldn't cut itRight, you'd almost need at
least a year.
Adam (11:37):
Yeah, it was a, it was registered.
It looks like in sort of likean Indian database, which is
great.
And then they followed oldconsort guidelines for their
reporting and I think, if I'mnot mistaken, they made sure
that the extract that they usewas standardized and like, did
(11:58):
contain what was in it in theexact amounts and kind of did
keep tabs on that throughout thestudy.
So the fact that they did thatfor a whole year is also very
impressive.
Josh (12:08):
Yeah, that's a good point and that's something herbal
medicine folks will always sayis.
It depends when things areharvested, how they're harvested
, et cetera, et cetera, and theymentioned that as well as being
perhaps particularly relevantwith this herbal product.
But, yeah, exactly, so theseare the things that you have to
consider, and it looks like theytook those into account.
Adam (12:27):
And then they recruited postmenopausal women, where they
define postmenopause as havingno menstruation for 12
consecutive months, correct,correct Within five years of
their last menses, between theages of 45 to 60 years old, with
a low bone mass of, basically,osteopenia.
(12:49):
So a low T-score of negativeone.
And so I think that this is avery clinically relevant cohort
of patients, because that's kindof the target audience that
you're looking for.
And then they make sure toexclude people on any sort of
anti-resorptive medication.
So making sure that peoplearen't coming in on things like,
(13:13):
you know, their bisphosphonatesand medications that we use for
osteoporosis, osteopenia.
Making sure that they were notexposed to systemic
glucocorticoids within threemonths, because glucocorticoids
such as prednisone do increasethe risk for the development of
osteopenia, osteoporosis.
They made sure that they weren'treceiving hormone replacement
(13:35):
therapy or selective estrogenreceptor modulators within six
months of study initiation.
Made sure that no one hadcancer within the last five
years had an A1C of greater than8%.
Why they used 8% as a cutoff Iam not sure, because diabetes is
6.4 or higher.
(13:57):
So why they used 8% as thecutoff I would have to look into
use of statins or othercholesterol lowering medications
.
Regular use of non-steroidalanti-inflammatory drugs so your
ibuprofens or otheranti-inflammatory drugs.
Making sure individuals did nothave a body mass of less than
(14:17):
20 or greater than 32.
So making sure that peoplearen't on either spectrum of the
BMI scale.
Josh (14:26):
And just real quick with the anti-inflammatory drugs,
like I think that probablyspeaks to their proposed
mechanism, which is they believethat this would be working
through inflammatory mechanisms.
So it would make sensetherefore, yeah.
Adam (14:40):
Yes, and they also looked at inflammatory markers like CRP
, and so if you're on somethingthat can interfere with that,
that's obviously going tointerfere with that.
Individuals who are smoking,chewing tobacco, alcohol abuse
had any sort of abnormal thyroid, liver, kidney function, which
makes sense because all three ofthose are heavily involved with
(15:02):
bone turnover, osteopenia,osteoporosis.
Josh (15:06):
And the smoking, you think , just because increased risk of
osteoporosis.
Adam (15:11):
I mean smoking just impacts literally everything.
Everything just make it cleaner.
And so I think, yeah, I think,even from both an osteopenia,
osteoporosis standpoint and froman inflammatory marker
standpoint, excluding that, itmakes sense Fair enough.
Individuals with low vitamin Dlevels defined as less than 20,
(15:32):
so insufficient but notdeficient.
And then they were recruitedfrom outpatient departments at,
essentially, the university.
Josh (15:41):
Yeah, and so, like you said, I mean it's, it's, this is
the population that comes toyou asking about you know what
are some natural things to usefor osteoporosis, osteopenia.
So it just seems super, superrelevant.
It's not like a hospital cohortor anything like that.
So, yeah, super relevant.
So far, reasonable exclusion,inclusions, etc.
Adam (16:01):
They then randomized subjects using a computer
generated block randomization,which is great.
We like to see that To one ofthree groups.
One group received placebo, onegroup received 250 milligrams
per day of Shilajit and thenanother group 500 milligrams.
So that's pretty cool thatthey're looking at.
(16:22):
Not only is it more effectivethan placebo, but if it were to
be making some sort of impact,is there a dose response
relationship there?
You would expect that a higherdose.
If it's doing what it'sproposed to do with its
mechanism of action, that youmay see a greater effect.
Josh (16:38):
Yeah, well, which is so?
Which is so cool, right?
Like I mean, technically youcould have like a threshold
effect and it's not better aftera certain dose.
But yeah, just from like acausation cause, you'd be like,
oh, it's a small study, likemaybe it's just random, but it's
just further evidence.
If you have that dose responseeffect, that yeah, this is a
real thing that we're seeing.
Adam (16:55):
Yep and the product they used, and we have no financial
compensation through this.
But I do think it's importantto understand that not all
products are created equal,especially when it comes to the
supplement industry.
They use the product calledPrima V, and it looks like it's
under some sort of a patent, andso it may not be.
Josh (17:15):
An US patent, so maybe you can get it here.
Adam (17:17):
Maybe it's available in the US, yeah and it's a purified
Shilajit extract standardizedto at least 10.3% dibenzoalpha
pyrones and greater than 50%fulvic acid.
So perhaps, if you're not usingthis product, at least look out
for 10.3% dibenzoalpha pyroneswithin the product and at least
(17:40):
50% fulvic acid yeah, it's neat,they did a really good job
describing the intervention andat least 50% fulvic acid.
Josh (17:45):
Yeah, it's neat.
They did a really good jobdescribing the intervention and
also the placebo, which was sortof standard guidelines.
That, especially with herbalapproaches like that's super,
super important to be very, veryclear about what it is and not
just say Shilajit period versusplacebo period.
So they did a great job withreporting here.
Adam (18:04):
Yeah, and then basically the placebo was just fiber.
It was microstyling cellulosein identical white opaque
capsules, and so this way no oneknows what they're getting.
You can't be like, oh, that's ablue pill and the other two are
white.
That person getting the bluepill is probably in the placebo
(18:25):
group.
That's a blue pill and theother two are white.
That person getting the bluepill is probably in the placebo
group, which is great.
And they actually did useevidence to show that dose
selection wasn't just kind ofrandom.
It was based on other studiesshowing beneficial effects on
reducing oxidative stress andinflammation at higher doses.
So that's why they used it.
They were then basically.
Then they got all their labsdrawn and got a blood sample
(18:47):
scan.
Josh (18:48):
Right and just looked at a lot of stuff, yeah, which was
also really cool because they'relooking at again.
This was a really well donestudy.
So they're like we have aproposed mechanism, we are not
only going to look at ourclinical outcomes, we're going
to look at all the blood markersthat would support our
mechanism of action, soinflammation, bone turnover
(19:09):
markers, all of these as well ashaving a dose-dependent effect.
So if they saw an effect whichI'm not going to spoil the
results yet you'd be able to seeit across the board, both from
molecular or chemical levels,showing the proposed mechanism
here as well as the clinicallyrelevant outcomes.
Well, I guess you can arguesemi-clinically relevant, bone
(19:32):
mineral density.
Probably the most importantoutcome, of course, would be
fractures, but you would needmassive cohorts of decades to
really show that.
Look, the thing is we don't dothis for money.
This is pro bono and, quitehonestly, the mothership kind of
ekes it out every month or so,right?
So we do this because we careabout this, we think it's
(19:54):
important, we think thatintegrating evidence-based
medicine and integrativemedicine is essential and there
just aren't other resources outthere.
The moment we find somethingthat does it better, we'll
probably drop it.
We're busy folks, but right nowthis is what's out there.
Unfortunately that's it, and sowe're going to keep on fighting
that good fight.
And if you believe in that, ifyou believe in intellectual
(20:16):
honesty in the profession andintegrative medicine and being
an integrative provider andbringing that into the
integrative space, please helpus, and you can help us by
becoming a member on Dr JournalClub.
If you're in need of continuingeducation credits, take our
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We have ethics courses,pharmacy courses, general
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Interact with us on socialmedia, listen to the podcast,
(20:37):
rate our podcast, tell yourfriends.
These are all ways that you cansort of help support the cause.
Adam (20:46):
And then, in order to have an 80% power to detect a
clinically significantdifference between the two
groups, they needed at least 20participants in each group, for
a total of 60.
And they ended up with,actually, they screened 68,
which I thought was actuallykind of low.
I don't know why they onlyscreened 68.
And out of that 68, 60 wereeligible.
Josh (21:09):
Nice.
Yeah, usually you do double,you do like 20% extra right to
deal with dropouts and stuff.
But yeah, so that was good.
They had so basicallyapproximately 20 people in each
group and the population theyhad to at least be osteopenic,
but they were also a bit ofosteoporosis as well.
So it's a mixed population ofosteopenia and osteoporosis,
(21:30):
which again would make anyapparent effect even more
impressive, because the folkswith osteoporosis obviously have
much more significant disease,and so if it impacts that,
that's a good thing.
Adam (21:41):
Yep.
Overall, 19 were in the placeboand then 20 were in each of the
Shilajit groups, and it seemedlike the adherence rate was
really impressive.
Josh (21:53):
Especially over a year right, really really good.
Adam (21:56):
Yeah, over 48 weeks, yeah, and then the average baseline
T-score at the lumbar spine wasminus two, which was consistent
with osteopenia, and then at thefemoral neck, which is usually
the one that I actually pay alittle bit more attention to,
was between minus one and minus2.5.
So they really range fromosteopenic to basically
(22:17):
borderline osteoporosis.
If I saw a minus 2.5, I wouldjust say that that person's
osteoporotic.
But that's just me.
But yeah, so these are peoplewho are, at you know, at risk or
at higher risk for bonefractures.
Josh (22:32):
Yeah, important, clinically relevant population.
You give them basicallyShilajit for a year.
Good response.
And then let's look at the.
Should we look at the effectsAnything else for methods, or
should we jump into thatbeautiful figure one?
Adam (22:47):
Well, I just want to make sure that we do address what the
primary outcome was.
I'm just trying to find itright now.
Sorry, I don't actually thinkthey outright said what the
primary outcome was.
Was it just a pre-post bonemineral density from start of
trial?
Josh (23:07):
Yes, that was my understanding.
Yeah, I don't think Ispecifically highlighted them
saying that, but I probably justmissed it because they did look
at 24 weeks, so at the halfwaymark they also looked at it
reasonable, yeah, veryreasonable, uh, yeah, so the
primary outcomes here are DEXAscan and bone mineral density at
(23:29):
one year right, yeah, and Iactually didn't like how they
reported the results.
Adam (23:35):
They used figures, and figures can be kind of
misleading if you're not payingattention to the scale, so it
could look like there's a hugedifference when really it's not
much.
I prefer tables, and so you hadto kind of go back and forth
with the figures and the text tokind of make sense of the data.
Josh (23:53):
Yeah, I had the same experience and I got lost in the
text as well.
There was just so manydifferent outcomes that they
were reporting on.
There were so many outcomes.
Adam (24:02):
Yeah, yeah.
So I just tried to payattention to the bone mineral
density and then I looked at,really, the week 48 results,
because that's really what wecare about.
Yeah, the secondary outcomeswhich were all the other markers
and those are a little biteasier to make sense of.
But when we looked at the bonemineral density, the placebo
(24:24):
group continued to havebasically have a decrease in
their bone mineral density.
The placebo group continued tobasically have a decrease in
their bone mineral density overtime, which would make sense,
yep, whereas those with theShilajit compared to placebo,
actually had improved bonemineral density.
Josh (24:39):
Yeah, and in a very nice dose dependent manner.
So one of the things I likeabout.
So I agree with you usuallywith tables, but when you have a
nice dose response like this,it's like really it's so
visually easy to see in a figureand so I just love that.
So if you're following alongand we'll include the paper link
in the show notes, but there'son figure one, there's just this
(25:03):
really beautiful section Bwhich just really shows this
perfect like dose responserelationship.
You see the placebo grouphaving worsening bone mineral
density in the lumbar spine.
You see a slight improvementfor the 250 milligram and then a
better improvement for the 500.
And it's just this really nicestatistically significant effect
(25:25):
.
It's hard to say like well, Imean, maybe you're more familiar
with the literature like onmeds for this, like what would
be considered a clinicallyrelevant bone mineral density
change as opposed to fracturechange.
But at least as far as likeyeah, this is a real thing, you
know, it really does seem quiteconvincing to me.
Adam (25:44):
Yeah, and we also, you know, we did see a dose
dependent improvement as well,which I think is really
important to highlight.
Josh (25:51):
Both femoral, neck and lumbar spine.
Yes, dose dependent responseYep, yeah.
Adam (25:58):
So I mean we're seeing just consistency of 250 is
better than placebo, 500 isbetter than 250 and placebo.
And we're seeing, at both thespine and the neck, the femoral.
Josh (26:18):
And similar situations, less obvious, less visually
appealing, but similar storywith all the biomarkers of
inflammation and bone turnover.
So again the proposed mechanismhere of being sort of an
inflammatory-induced boneturnover.
So again the proposed mechanismhere of being sort of an
inflammatory induced boneturnover issue, sort of mediated
by menopause, I guess, is theargument that seems to bear out
right, which is just really it'svery convincing when you see
(26:38):
the whole story kind of line upwith the data.
Adam (26:41):
Yeah, and all the inflammatory markers went in the
right direction.
So the ones that would beassociated with, you know,
increased bone turnover wentdown at the higher doses but
went up with the placebo.
And those that are associatedwith improved bone making went
(27:04):
up with the intervention andthen down with the placebo.
So if we look at the markerCTX1, which is C-terminal
telopeptide type 1 collagen,that is, an inflammatory marker
associated with bone turnover,that went up by week 48, that
went up by week 48.
(27:25):
When you looked at thedifference, it went up 11% in
the placebo group but it wentdown 22% in the 500 milligram
group and down 18% in the 250milligram group.
When we look at the biomarkerrank L, which is actually an
(27:45):
important one because there arenewer medications that target
the rank L, ligand, which isjust a receptor activator of
nuclear factor, kappa beta, andthat went up with the placebo by
12% and went down by 10% withthe 500 milligram dose.
And then osteoprotegerin, whichis basically doing what it
(28:11):
sounds like it's pro-osteo, it'smaking bone growth, it's
generating new bone, the placebowent down 4%, whereas with the
500 milligram it went up 57%.
Josh (28:25):
That's pretty cool, yeah.
And again, these very nice doseresponses were 250 milligrams.
So across all of those, I thinkfor yeah, for all of them, you
have a dose response effect.
You have a relative improvementwith a 250 milligram and then
even more of an improvement withthe 500 milligram.
So all the bone turnovermarkers follow that same story
and are statisticallysignificant.
(28:46):
And then it's a similar storywith the inflammatory markers,
right?
So we're looking at highsensitivity, crp, mda,
glutathione and nitric oxide,nitric oxide and it's a similar,
similar story throughout.
So you see worsening in theplacebo group over a year, which
you would expect in thispopulation.
You see improvements at 250milligrams and you see even more
(29:09):
improvements at at 500.
I mean, it's just, you know theonly thing that I would you
know.
So I'm I'm of all of these markI don't know which ones you you
use a lot.
I mean CRP I'm much morecomfortable with as like a
regular marker that I look at.
So you know, 30%, uh, decreasein.
You know CRP sounds reallyimpressive, but if you look at
the actual numbers, it's justit's not super huge Like you
(29:31):
know they they're at, you knowit's not, it's not a massive
shift in absolute numbersbecause they're starting out at
around, you know, point seven,eight or two or something like
that.
Adam (29:41):
Honestly, the only thing I cared about in this entire
paper was the bone mineraldensity.
Josh (29:45):
Yeah, fair enough.
Yeah, totally yeah.
So these, these are.
It's just kind of cool to seesuch a consistent story.
Adam (29:52):
Yeah I think it's important that we're seeing
consistency and the the proposedmechanism of his action, is
also holding up, which onlyhelps to provide more evidence
to um.
You know the causality argument, um.
So you know, we're seeing, andwe're seeing it consistently
with every single marker.
It's not sort of random, it's,it's everything's going in the
(30:14):
right direction.
There's a magnitude, uh to thatwhere we're getting a dose
response, um, and we're seeing,you know, anti-inflammatory
markers quote unquote go up andthen the pro-inflammatory
markers go down, go down more athigher doses and they're
statistically significant.
When we're looking at bonemineral density change, you're
(30:38):
seeing a 4% improvement at the500 milligram dose.
So whether or not that'sclinically relevant, I don't
know versus a minus 4% worsening.
Josh (30:52):
But even to stop bone loss , I mean that's just huge right.
You've got this osteoporoticpopulation and it's not only
stopping it, like bones growingback.
That's crazy.
Adam (30:59):
Well, I think you know, even though it's, it's cool
clinically, is that?
Is that an important amount?
If it went, if it improved by4%%?
Yes, I get what you're sayingPer this study it's better than
nothing.
Doing nothing, you'll continueto have loss.
So, yes, we could do betterthan that, right?
However, is it worthwhile totell all of my osteopenic
(31:25):
post-menopausal individuals whohave a uterus to say, or that
were born with uterus to say,you should go out and supplement
with this on a daily basisuntil you know for life,
essentially Fair.
And then, by improving yourbone mineral density, are we
(31:47):
also preventing fracture?
So there's two things that wekind of have to answer Are we
getting clinical benefit in theamount of improvement in bone
mineral density and are we alsoachieving what we want to do in
the sense of will thissupplement actually prevent a
fracture?
So really, what we should bedoing next for future trials is
(32:10):
one compare this to standard ofcare.
Josh (32:13):
That was going to be my question.
Like, what do we?
I don't, I don't know thisspace enough Like, what are the
improvements that we see on themeds that are out there, right,
what's the comparison to thestandard of care?
Adam (32:24):
Right, and I think I think that that's something that we
would have to do is then compareShilajit to something like a
bisphosphonate, because that'stypically the starting place,
and then you would need anothertrial and, okay, in those who
are bisphosphonate intolerant orpeople who have failed
bisphosphonate therapy, how doesit compare to something else?
And then also we will need aclinical outcomes trial.
(32:47):
Looking at Shilajit extractsupplementation.
Does supplementing with thisprevent fracture?
Josh (32:55):
Yes, and that you need a massive cohort for that.
But, yes, 100% agree.
And I think we're reallystruggling because this isn't
our field and so just looking atthese numbers, like we can see
the story, but, to your point,like we just don't know how
clinically relevant this is.
So if you're, if you do a lotof this kind of work and you're
a listener, you know, let usknow is this, is this as
impressive an outcome as maybe Isuspect that it is?
(33:18):
Clinically, how does thatcompare?
And I think that was somethingmissing from the discussion.
You know that would be a greatplace to compare it to, or not
even to directly compare, butbasically to say, like the drugs
on the market, the standard ofcare, do X, Y, Z right, Just so
you have some yardstick aboutwhat we're dealing with here.
So I would have liked to seethat.
(33:39):
But otherwise it's good andexcellent points right.
It's like it looks like a solidstudy, it looks like it's real.
The question is, of course isit clinically relevant?
The other thing I wanted topoint out it almost looked too
good, the story was almost toogood, and then it was like
there's only two authors and itwas a pretty involved study.
(34:03):
And then they're harping onthis very specific product.
So my little red flaggy earswent up.
And but you know, according towhat they're saying, there's no
funding or financial conflictsof interest.
It's not funded by the company.
That makes that they don't haveany competing interests.
So you know, I guess we takethem at their word.
It's just like it almost lookedtoo good or something.
(34:25):
I don't know, Maybe I'm just.
I've gotten so cynical over theyears with with these trials.
Adam (34:31):
No, I mean, I think you know when it, if it sounds too
good to be true, that's thatreally is when, like, your
spidey senses should go up andbe like, okay, well, what gives?
I think one thing that gives is, you know, we're not comparing
it to the standard of care,we're only comparing it to
placebo.
Not to belittle, you know, theamazing work the authors did.
We don't have hard clinicaloutcome data, but I do think
(34:53):
it's important because you'regoing to have patients who are
medically hesitant or resistant,and if you're out of options
and they're absolutely refusingcare, I would say, okay, well,
maybe we consider this, ifyou're, if you're up for it,
just because doing nothing perthis trial seems to be worse,
(35:16):
and so if you're trying to doless harm, it seems like this
would be at least something toconsider.
This is not medical advice.
Josh (35:23):
Yeah, no, that's fair.
I have a family member in mind.
It's exactly the situation.
It's like, well, I don't wantto consider these meds, and
basically they're telling methen there's nothing to do but
just like wait for things tocontinue.
So this might be somethingwhere we can say at least
there's, but they're a littlebit more open minded to natural
approaches.
So yeah, I think it's.
(35:43):
It's a clinical context, ofcourse, comparison, etc.
So you know.
Another interesting thing is andI just don't know this space
well enough and you're moreclinically active than I am With
the bisphosphonates.
It's just a couple years.
You do treatment for right,like it's not a forever thing,
right.
So it could be an interestingfuture study here too, where
you're doing instead of insteadof you're doing like an additive
(36:08):
right, like you're doing thistherapy for a few years, which
is your limit anyway, and thenyou try something else, or maybe
you add them together orsomething.
So there could be someinteresting things.
To be fair, what we'redescribing are much more
advanced level studies whichwould not come yet until the
preliminary studies like thishave been conducted right.
So no, but a study like thisreally paves the pathway for fun
(36:30):
for that yes, yes, very clearmechanism, very clear data,
totally okay, excellent, um, Idon't know that I have anything
else to add.
My spidey sense went off enoughthat I was even googling that
that hospital, the hospitalclinic or the clinic, the
university.
Um, I was like there's got tobe some connection here, but I
couldn't find it with a littlebit of google sleuthing I have
(36:53):
an idea what I have an idea whatthat Heather Zwickey know that
listens, okay, uh, yep andZwickey.
Adam (37:01):
Dr.
Zwickey is awesome, agreed, andshe's still affiliated with
health guard and and we knowthat she listens to this very
astutely every day because whowouldn't?
Josh (37:14):
What smart person wouldn't right?
Correct, correct.
It's a syllogism, basicallyyeah exactly.
Adam (37:21):
She would probably listen to this episode and be like, wow
, these guys are great.
They talked about an awesomestudy.
I'm going to see if one of mystudents at health got would
like to see if one of mystudents at HealthCott would
like to conduct a randomizedcontrolled trial.
Looking at something like this,there you go, excellent
connection with OHSU and I'msure they get plenty of data.
Josh (37:40):
So we just set it up, just like that Piece of cake.
That's how trials get done,people, I'm just saying
Excellent, excellent, excellent.
Adam (37:51):
If you want to ask questions, you can put me in as
third author.
Josh (37:54):
There you go.
There's all these rules aboutauthorless right.
It's like you know, if you werein the hallway or you attended
a meeting where the authors met,you're like author number seven
.
So if you suggested a similaridea on a podcast, you're going
to be positioned, you know,between what's that Intellectual
property?
There you go.
(38:14):
I don't think that's a thing,but we'll.
We'll take it.
It's timestamped now.
So, heather, don't even try tosteal this idea.
We gave it to you essentially,or exactly.
There we go.
There you go, until next time.
Oh, we have a bunch.
So thank you, listeners.
So much, we've gotten like awhole flood of recommendations.
Adam (38:37):
I'm really digging the involvement from the community.
We're just like we cannot keepup.
Josh (38:41):
Community's stepping up.
Yeah, it's good.
It's good we have our work cutout for us.
We've got some really coolstudies listed.
We owe uh, mark davis, dr davis, a bunch.
We got a great recommendationfor the new d mano study, which
I think we're just going to bumpto front of the line for next
week because it's time relevantand there's also a new uh april
(39:02):
doctor journal club videolooking at a lavender for
anxiety oh, yeah, that was areally good one.
Lavender for depression.
Excuse me, yeah, Depression fordepression, which is
interesting because all thestudies that I've seen before
just been on anxiety.
So, yeah, Adam's been superbusy.
There's like some reallyawesome new content on the
website and, yeah, keep therecommendations coming in
(39:24):
community.
This is awesome we're havingback and forth.
I just heard back from EricYarnell Dr Urnell, I love the
podcast feedback on Ginger.
He was like I knew there wassomething up.
He said as he was listening tothe podcast he was screaming out
loud, being like how do theypublish this garbage?
So I think he's as passionateas we are about this stuff,
(39:44):
Loving the feedback from thecommunity but if you could
please share these episodes,Spread the love.
Adam (39:52):
The more that the integrative community can hear
about us, the more that we canhave these awesome discussions
and kind of just spread moreknowledge about evidence-based
integrative therapies that areout there, because we're looking
to stuff that I otherwisewouldn't come across.
And so if more people canlisten and more people are
sharing and more people haveideas and want to comment and
(40:12):
write us an email whether it's agood review or an issue that
you have, all feedback iswelcome please, beautiful Mic
drop.
Josh (40:20):
That perfectly said.
All right, everybody.
We'll see you next time.
If you enjoy this podcast,chances are that one of your
colleagues and friends probablywould as well.
Please do us a favor and letthem know about the podcast and,
if you have a little bit ofextra time, even just a few
seconds, if you could rate usand review us on Apple Podcast
or any other distributor, itwould be greatly appreciated.
(40:43):
It would mean a lot to us andhelp get the word out to other
people that would really enjoyour content.
Thank you, hey y'all.
This is Josh.
We talked about some reallyinteresting stuff today.
I think one of the things we'regoing to do that's relevant.
There is a course we have on DrJournal Club called the EBM
Boot Camp.
That's really meant forclinicians to sort of help them
understand how to criticallyevaluate the literature, etc,
(41:05):
etc.
Some of the things that we'vebeen talking about today.
Go ahead and check out the shownotes link.
We're going to link to itdirectly.
I think it might be of interest.
Don't forget to follow us onsocial and interact with us on
social media at DrJournalClub,drjournalclub on Twitter.
We're on Facebook, we're onLinkedIn, etc.
Etc.
So please reach out to us.
We always love to talk to ourfans and our listeners.
(41:27):
If you have any specificquestions you'd like to ask us
about research, evidence, beinga clinician, et cetera, don't
hesitate to ask.
And then, of course, if youhave any topics that you'd like
us to cover on the pod, pleaselet us know as well.
Introducer (41:42):
Thank you for listening to the Doctor Journal
Club podcast, the show that goesunder the hood of
evidence-based integrativemedicine.
We review recent researcharticles, interview
evidence-based medicine thoughtleaders and discuss the
challenges and opportunities ofintegrating evidence-based and
(42:02):
integrative medicine.
Be sure to visit www.
dr rjournalclub.
com to learn more.
Welcome to the Dr Journal Club podcast, the show
that goes under the hood ofevidence-based integrative
medicine.
We review recent researcharticles, interview
evidence-based medicine thoughtleaders and discuss the
challenges and opportunities ofintegrating evidence-based and
integrative medicine.
Continue your learning afterthe show at www.
(00:23):
drjournalclub.
com.
Josh (00:31):
Please bear in mind that this is for educational and
entertainment purposes only.
Talk to your doctor beforemaking any medical decisions,
changes etc.
Everything we're talking aboutthat's to teach you guys stuff
and have fun.
We are not your doctors.
Also, we would love to answeryour specific questions on
drjournalclub.
com.
You can post questions andcomments for specific videos,
(00:55):
but go ahead and email usdirectly at josh at
drjournalclub.
com.
That's josh at drjournalclub.
com.
Send us your listener questionsand we will discuss it on our
pod.
(01:28):
I had like six cups of coffeeyeah, um, I was supposed to do
my run today.
I've got a half marathon nextweek and I was supposed to do my
run and I, like I had literallya back-to-back meetings the
entire freaking day.
I thought I'd sneak it in, butit did not happen.
Adam (01:47):
Is it a half marathon.
That's like a planned race, oris this just for funsies?
Josh (01:53):
Yeah, yeah.
No, this is a rock and roll one.
They're fun.
Adam (01:59):
They're just kind of like a way to hang out with the oh,
this is in Tennessee or whatever.
Josh (02:02):
In Nashville.
Yeah, I'm excited Tennessee orwhatever.
In Nashville.
Yeah, I'm excited we're stayingin the music district.
I guess I'm not sure I've neverbeen in Nashville before.
It should be a good time, Ihear you're having a
bachelorette party there InNashville.
Is that a thing to do?
Yeah, it's interesting becausethere's the downtown, there's
(02:24):
all these interesting becauselike there's like the downtown,
there's like music, there's allthese different districts.
It seems like a really funplace to hang and it should be a
really fun place to run Like.
It sounds like like the routelooks pretty cool, but yeah.
And the rock and roll ones arejust, they're fun.
It's got like a zillion supporttables and there's music
everywhere and oh, I bet, yeah,it's like you don't even need to
bring water if you don't wantto.
(02:45):
There's like people every mile.
Adam (02:49):
If there's any rules against like no music, you'll
have the entire town, yeah yeah,seems like a good place to do a
rock and roll one, so yeahactually, the first time I did a
race that wasn't rock and rollI was, because they like have
their stuff so well together Iwas shocked.
Josh (03:04):
There was no support, there was no water.
I was like, oh my gosh, I'mgoing to start.
So I realized how much they putinto those sorts of things with
the more organized ones.
But yeah, yeah, all right,shall we jump in?
What are we going to do?
Oh wait, last thing I finallygot a trainer, because you know
how I'm going to die swimming.
I finally got a trainer becauseI you know how I'm like the die
(03:24):
swimming.
So I finally got like a trainer, but she's a virtual trainer so
she can't actually help me doanything.
So she's like trying todescribe these swim exercises.
And if you've ever had someonetry to explain a swim exercise
to you and then say, well, justgo YouTube it, it's just like
it's not going well, not goingwell.
I swim like a I don don't knowporpoise, what, what, what, what
(03:46):
, what, what are animals thatdon't swim well, I don't know,
but that's me manatees.
They just kind of float aroundwith like little fins slapping
the water.
That's kind of how I feel.
Can dogs swim?
can dogs can swim well, doggypaddle, that's a thing all right
, yeah, well, there you go yeah,I'm a dog, I'm like uh, yeah,
I'm like a puppy in the waterfor the triathlon.
Adam (04:06):
Really, all you need to do is is run to each canoe.
So hang out on the water.
Just find out how far they arefrom each other.
Swim on uh-huh.
Hang out there for a good 10minutes and then go to the next
one like the safety canoes.
Josh (04:24):
Yeah, okay, yeah, yeah.
Well, I'm hoping there'll be alot of people like there'll be
safety people there likesurfboards and and canoes and
stuff.
But yeah, I don't know.
Man, you're a much betterswimmer than I am, even though
this is, like your, your leastfavorite sport at this point.
You're doing like one and ahalf k's regularly.
Adam (04:42):
Yeah, for swimming uh, I'm doing like when I train I
typically do at least 1,000meters, and so yeah, and that's
just sort of like freestyling it.
And then if I want to add in,you know, like the paddleboard
for like leg strengthening, orif I'm using like the little
floaty for more arm stuff, thenyou can kind of crank out, you
can crank out more, so yeah thenyou can crank out more.
(05:05):
I did a 1,000-meter freestyleand then at the end did a little
paddleboard thingy.
Josh (05:11):
Those things are tough man .
I just got them now with thesenew exercises and I've got one
of those awkward things you putbetween your legs, you know like
the, the little styrofoam-likepillow yeah, I don't even know
how to.
I was like am I putting this?
Because there's a more bulbousside and a a little styrofoam
like pillow?
Yeah, I don't even know how to.
I don't even know how to.
Unlike, I was like am I puttingthis because there's like a
more bulbous side and lessbulbous side?
Adam (05:30):
I have the more bulbous side, facing like up down right
uh wait, why up?
Josh (05:38):
oh no, you're right, yeah down, because you'd want like
more buoyancy, right like that.
I had it the other way and thenI was like and then how far in
towards your crotch do you do itlike I?
First I had it like well intomy thighs and then I was like
this isn't gonna, this feelsweird.
And I tried the knees and thatfelt even stranger.
And then I tried it by myankles and I was like literally
like like um, jackknifing.
(05:59):
Every time I took like a strokeor something.
So, yeah, I'm, I'm a freakingdisaster in in the water.
So we'll, we'll see All right,just gotta be comfortable.
Adam (06:12):
What's that?
I just use it like a saddle,like you just kind of make it
this way.
Saddle Like a saddle, yes, likeyou just sit on it and it's
comfortable, and like you sit.
Josh (06:21):
And it's comfortable.
You don't sit on it, though.
I don't understand.
What do you mean?
A saddle?
Adam (06:26):
The meaning of it is as though it's a saddle.
It just needs to be comfortable.
You're overthinking it.
Josh (06:31):
First of all, saddles are not comfortable.
Second of all, I'm envisioningthat there's no way you can
mount it like a saddle.
Okay, I'll try to remember thatnext time in the water.
Adam (06:49):
Yeah, thanks a lot for that.
That's like completelyworthless.
All right, so let's talk aboutwhat are we talking about today.
Josh (06:53):
I think I think we should just keep going with this.
Yeah, I think the coffee hit,okay, um, so where are we all
right?
So we're talking about we don'teven know how to pronounce it.
We're so.
We're so excited about it.
It's a great paper.
We don't even know how topronounce it.
Adam (07:03):
How about we do a reverse podcast?
Okay, we do a trial, we'll goover the entire trial, but
people are going to be blindedto what the intervention is, and
then they have to guess thestudy.
Josh (07:16):
No, because if they haven't closed it already, with
us blabbering about saddles inthe water and awkward flailing,
they're going to do it now.
If they have to, like, wait anhour to actually know what the
intervention is.
No, that's a terrible idea,almost as bad as the idea it's
about being a suspense, josh.
This is that's what we're doingnow, dear listener, just
(07:39):
rambling on giving you suspenseabout.
Are we actually gonna talkabout medicine today?
Okay, no, we know how topronounce it because we asked
google and, according to google,it's she legit, like to legit,
she legit, she legit, she legit.
Hold on, how does this go?
She legit, she legit, right.
That's you know.
(08:00):
That's what google says.
That's what google says.
That's the way it is, and anyonethat has like deep thousands of
years tradition in Ayurveda,like you're just wrong.
If it's not like the way Googlesays, then Google's always
right.
Yeah, totally so.
But seriously, if you actuallyhave experience in Ayurveda, I
feel like we sound like totalidiots.
(08:20):
Last week we were doingacupuncture with no knowledge
whatsoever about likeacupuncture or meridians or
anything like that.
We barely knew the word chi,and now we don't even know how
to pronounce the interventionfrom an Ayurvedic.
So we beg your forgiveness,ayurvedic practitioners, but
please correct us if we're wrong.
Anyway, apparently it is thisherbal extract, almost um, from
(08:46):
the mountains in india, Ibelieve.
Right is that?
Am I totally making that up?
I think it's off the moss of,like rocks in the mountains of
india it sounds super likeromantic, like it just sounds
like a really cool thing, likeyou'd go out into the misty
mountains and like harvest thisstuff and it it was bringing me
back.
That's romantic to you.
Oh yeah.
(09:06):
Well, at least you know myearly days when I was like
herbal or little herbal kid,little herbal hippie with my
dreads.
Oh my God, trying to collectherbs in Mexico on the
mountainside, and that's whatbrought me to naturopathic
medicine, and then I lost my wayand got stuck in science as I
went.
So, yeah, I know it's like itwas a different time, anyway.
(09:31):
So, all right.
So here we are.
So we have a randomized,double-blind, placebo-controlled
trial of this substance forosteopenia, which I thought was
really interesting, and we'vehad a couple in postmenopausal
women.
In postmenopausal women.
So it seems very clinicallyrelevant, right?
So we're looking at apopulation of postmenopausal
(09:52):
women with osteopenia andosteoporosis taking this
intervention, this herbalintervention, to improve bone
strength.
So a very clinically relevantpopulation.
The only thing that was kind ofsurprising to me was there's
like two authors and it's a verywell conducted double blind
randomized control trial Likehow did you do this with two
(10:14):
people?
I don't know how that works,but I'm impressed.
Okay, so should we set up thestudy design here?
Adam (10:21):
Yeah, so it was actually a really well done study.
When you and I were kind oftexting back and forth about it,
I was actually really impressedwith this.
It was a 48 week prospectiverandomized above-line placebo
controlled trial, so essentiallyit was a year long of
supplementation.
Josh (10:40):
Which, you have to admit, is good, right, because anytime
it's like a three month, fourmonth, five month thing.
You're like, oh, it was a greattrial, but you know, anytime
it's like a three month, fourmonth, five month thing.
You're like, oh, it was a greattrial, but you know it's
short-term outcome.
So are we happy with an if it'sa year-long?
I'm impressed by it, but withthe results that they're like
looking at um longer idea wouldbe ideally better.
(11:01):
Uh, because they're looking atbone mineral density and that's
not going to change rapidly.
Yeah Well, that's just onething that we have to take into
consideration.
I am impressed, though, thatthey they kind of did take that
sort of into account, and youknow this is you know, to do it
longer is going to take a lot ofmoney.
So the fact that they gotbasically a year's worth of data
(11:23):
, I think is still important.
A year RCT with herbs like that, yeah.
And to your point like bonemineral density outcomes, yeah.
Three months wouldn't cut itRight, you'd almost need at
least a year.
Adam (11:37):
Yeah, it was a, it was registered.
It looks like in sort of likean Indian database, which is
great.
And then they followed oldconsort guidelines for their
reporting and I think, if I'mnot mistaken, they made sure
that the extract that they usewas standardized and like, did
(11:58):
contain what was in it in theexact amounts and kind of did
keep tabs on that throughout thestudy.
So the fact that they did thatfor a whole year is also very
impressive.
Josh (12:08):
Yeah, that's a good point and that's something herbal
medicine folks will always sayis.
It depends when things areharvested, how they're harvested
, et cetera, et cetera, and theymentioned that as well as being
perhaps particularly relevantwith this herbal product.
But, yeah, exactly, so theseare the things that you have to
consider, and it looks like theytook those into account.
Adam (12:27):
And then they recruited postmenopausal women, where they
define postmenopause as havingno menstruation for 12
consecutive months, correct,correct Within five years of
their last menses, between theages of 45 to 60 years old, with
a low bone mass of, basically,osteopenia.
(12:49):
So a low T-score of negativeone.
And so I think that this is avery clinically relevant cohort
of patients, because that's kindof the target audience that
you're looking for.
And then they make sure toexclude people on any sort of
anti-resorptive medication.
So making sure that peoplearen't coming in on things like,
(13:13):
you know, their bisphosphonatesand medications that we use for
osteoporosis, osteopenia.
Making sure that they were notexposed to systemic
glucocorticoids within threemonths, because glucocorticoids
such as prednisone do increasethe risk for the development of
osteopenia, osteoporosis.
They made sure that they weren'treceiving hormone replacement
(13:35):
therapy or selective estrogenreceptor modulators within six
months of study initiation.
Made sure that no one hadcancer within the last five
years had an A1C of greater than8%.
Why they used 8% as a cutoff Iam not sure, because diabetes is
6.4 or higher.
(13:57):
So why they used 8% as thecutoff I would have to look into
use of statins or othercholesterol lowering medications
.
Regular use of non-steroidalanti-inflammatory drugs so your
ibuprofens or otheranti-inflammatory drugs.
Making sure individuals did nothave a body mass of less than
(14:17):
20 or greater than 32.
So making sure that peoplearen't on either spectrum of the
BMI scale.
Josh (14:26):
And just real quick with the anti-inflammatory drugs,
like I think that probablyspeaks to their proposed
mechanism, which is they believethat this would be working
through inflammatory mechanisms.
So it would make sensetherefore, yeah.
Adam (14:40):
Yes, and they also looked at inflammatory markers like CRP
, and so if you're on somethingthat can interfere with that,
that's obviously going tointerfere with that.
Individuals who are smoking,chewing tobacco, alcohol abuse
had any sort of abnormal thyroid, liver, kidney function, which
makes sense because all three ofthose are heavily involved with
(15:02):
bone turnover, osteopenia,osteoporosis.
Josh (15:06):
And the smoking, you think , just because increased risk of
osteoporosis.
Adam (15:11):
I mean smoking just impacts literally everything.
Everything just make it cleaner.
And so I think, yeah, I think,even from both an osteopenia,
osteoporosis standpoint and froman inflammatory marker
standpoint, excluding that, itmakes sense Fair enough.
Individuals with low vitamin Dlevels defined as less than 20,
(15:32):
so insufficient but notdeficient.
And then they were recruitedfrom outpatient departments at,
essentially, the university.
Josh (15:41):
Yeah, and so, like you said, I mean it's, it's, this is
the population that comes toyou asking about you know what
are some natural things to usefor osteoporosis, osteopenia.
So it just seems super, superrelevant.
It's not like a hospital cohortor anything like that.
So, yeah, super relevant.
So far, reasonable exclusion,inclusions, etc.
Adam (16:01):
They then randomized subjects using a computer
generated block randomization,which is great.
We like to see that To one ofthree groups.
One group received placebo, onegroup received 250 milligrams
per day of Shilajit and thenanother group 500 milligrams.
So that's pretty cool thatthey're looking at.
(16:22):
Not only is it more effectivethan placebo, but if it were to
be making some sort of impact,is there a dose response
relationship there?
You would expect that a higherdose.
If it's doing what it'sproposed to do with its
mechanism of action, that youmay see a greater effect.
Josh (16:38):
Yeah, well, which is so?
Which is so cool, right?
Like I mean, technically youcould have like a threshold
effect and it's not better aftera certain dose.
But yeah, just from like acausation cause, you'd be like,
oh, it's a small study, likemaybe it's just random, but it's
just further evidence.
If you have that dose responseeffect, that yeah, this is a
real thing that we're seeing.
Adam (16:55):
Yep and the product they used, and we have no financial
compensation through this.
But I do think it's importantto understand that not all
products are created equal,especially when it comes to the
supplement industry.
They use the product calledPrima V, and it looks like it's
under some sort of a patent, andso it may not be.
Josh (17:15):
An US patent, so maybe you can get it here.
Adam (17:17):
Maybe it's available in the US, yeah and it's a purified
Shilajit extract standardizedto at least 10.3% dibenzoalpha
pyrones and greater than 50%fulvic acid.
So perhaps, if you're not usingthis product, at least look out
for 10.3% dibenzoalpha pyroneswithin the product and at least
(17:40):
50% fulvic acid yeah, it's neat,they did a really good job
describing the intervention andat least 50% fulvic acid.
Josh (17:45):
Yeah, it's neat.
They did a really good jobdescribing the intervention and
also the placebo, which was sortof standard guidelines.
That, especially with herbalapproaches like that's super,
super important to be very, veryclear about what it is and not
just say Shilajit period versusplacebo period.
So they did a great job withreporting here.
Adam (18:04):
Yeah, and then basically the placebo was just fiber.
It was microstyling cellulosein identical white opaque
capsules, and so this way no oneknows what they're getting.
You can't be like, oh, that's ablue pill and the other two are
white.
That person getting the bluepill is probably in the placebo
(18:25):
group.
That's a blue pill and theother two are white.
That person getting the bluepill is probably in the placebo
group, which is great.
And they actually did useevidence to show that dose
selection wasn't just kind ofrandom.
It was based on other studiesshowing beneficial effects on
reducing oxidative stress andinflammation at higher doses.
So that's why they used it.
They were then basically.
Then they got all their labsdrawn and got a blood sample
(18:47):
scan.
Josh (18:48):
Right and just looked at a lot of stuff, yeah, which was
also really cool because they'relooking at again.
This was a really well donestudy.
So they're like we have aproposed mechanism, we are not
only going to look at ourclinical outcomes, we're going
to look at all the blood markersthat would support our
mechanism of action, soinflammation, bone turnover
(19:09):
markers, all of these as well ashaving a dose-dependent effect.
So if they saw an effect whichI'm not going to spoil the
results yet you'd be able to seeit across the board, both from
molecular or chemical levels,showing the proposed mechanism
here as well as the clinicallyrelevant outcomes.
Well, I guess you can arguesemi-clinically relevant, bone
(19:32):
mineral density.
Probably the most importantoutcome, of course, would be
fractures, but you would needmassive cohorts of decades to
really show that.
Look, the thing is we don't dothis for money.
This is pro bono and, quitehonestly, the mothership kind of
ekes it out every month or so,right?
So we do this because we careabout this, we think it's
(19:54):
important, we think thatintegrating evidence-based
medicine and integrativemedicine is essential and there
just aren't other resources outthere.
The moment we find somethingthat does it better, we'll
probably drop it.
We're busy folks, but right nowthis is what's out there.
Unfortunately that's it, and sowe're going to keep on fighting
that good fight.
And if you believe in that, ifyou believe in intellectual
(20:16):
honesty in the profession andintegrative medicine and being
an integrative provider andbringing that into the
integrative space, please helpus, and you can help us by
becoming a member on Dr JournalClub.
If you're in need of continuingeducation credits, take our
NANSEAC-approved courses.
We have ethics courses,pharmacy courses, general
courses.
Interact with us on socialmedia, listen to the podcast,
(20:37):
rate our podcast, tell yourfriends.
These are all ways that you cansort of help support the cause.
Adam (20:46):
And then, in order to have an 80% power to detect a
clinically significantdifference between the two
groups, they needed at least 20participants in each group, for
a total of 60.
And they ended up with,actually, they screened 68,
which I thought was actuallykind of low.
I don't know why they onlyscreened 68.
And out of that 68, 60 wereeligible.
Josh (21:09):
Nice.
Yeah, usually you do double,you do like 20% extra right to
deal with dropouts and stuff.
But yeah, so that was good.
They had so basicallyapproximately 20 people in each
group and the population theyhad to at least be osteopenic,
but they were also a bit ofosteoporosis as well.
So it's a mixed population ofosteopenia and osteoporosis,
(21:30):
which again would make anyapparent effect even more
impressive, because the folkswith osteoporosis obviously have
much more significant disease,and so if it impacts that,
that's a good thing.
Adam (21:41):
Yep.
Overall, 19 were in the placeboand then 20 were in each of the
Shilajit groups, and it seemedlike the adherence rate was
really impressive.
Josh (21:53):
Especially over a year right, really really good.
Adam (21:56):
Yeah, over 48 weeks, yeah, and then the average baseline
T-score at the lumbar spine wasminus two, which was consistent
with osteopenia, and then at thefemoral neck, which is usually
the one that I actually pay alittle bit more attention to,
was between minus one and minus2.5.
So they really range fromosteopenic to basically
(22:17):
borderline osteoporosis.
If I saw a minus 2.5, I wouldjust say that that person's
osteoporotic.
But that's just me.
But yeah, so these are peoplewho are, at you know, at risk or
at higher risk for bonefractures.
Josh (22:32):
Yeah, important, clinically relevant population.
You give them basicallyShilajit for a year.
Good response.
And then let's look at the.
Should we look at the effectsAnything else for methods, or
should we jump into thatbeautiful figure one?
Adam (22:47):
Well, I just want to make sure that we do address what the
primary outcome was.
I'm just trying to find itright now.
Sorry, I don't actually thinkthey outright said what the
primary outcome was.
Was it just a pre-post bonemineral density from start of
trial?
Josh (23:07):
Yes, that was my understanding.
Yeah, I don't think Ispecifically highlighted them
saying that, but I probably justmissed it because they did look
at 24 weeks, so at the halfwaymark they also looked at it
reasonable, yeah, veryreasonable, uh, yeah, so the
primary outcomes here are DEXAscan and bone mineral density at
(23:29):
one year right, yeah, and Iactually didn't like how they
reported the results.
Adam (23:35):
They used figures, and figures can be kind of
misleading if you're not payingattention to the scale, so it
could look like there's a hugedifference when really it's not
much.
I prefer tables, and so you hadto kind of go back and forth
with the figures and the text tokind of make sense of the data.
Josh (23:53):
Yeah, I had the same experience and I got lost in the
text as well.
There was just so manydifferent outcomes that they
were reporting on.
There were so many outcomes.
Adam (24:02):
Yeah, yeah.
So I just tried to payattention to the bone mineral
density and then I looked at,really, the week 48 results,
because that's really what wecare about.
Yeah, the secondary outcomeswhich were all the other markers
and those are a little biteasier to make sense of.
But when we looked at the bonemineral density, the placebo
(24:24):
group continued to havebasically have a decrease in
their bone mineral density.
The placebo group continued tobasically have a decrease in
their bone mineral density overtime, which would make sense,
yep, whereas those with theShilajit compared to placebo,
actually had improved bonemineral density.
Josh (24:39):
Yeah, and in a very nice dose dependent manner.
So one of the things I likeabout.
So I agree with you usuallywith tables, but when you have a
nice dose response like this,it's like really it's so
visually easy to see in a figureand so I just love that.
So if you're following alongand we'll include the paper link
in the show notes, but there'son figure one, there's just this
(25:03):
really beautiful section Bwhich just really shows this
perfect like dose responserelationship.
You see the placebo grouphaving worsening bone mineral
density in the lumbar spine.
You see a slight improvementfor the 250 milligram and then a
better improvement for the 500.
And it's just this really nicestatistically significant effect
(25:25):
.
It's hard to say like well, Imean, maybe you're more familiar
with the literature like onmeds for this, like what would
be considered a clinicallyrelevant bone mineral density
change as opposed to fracturechange.
But at least as far as likeyeah, this is a real thing, you
know, it really does seem quiteconvincing to me.
Adam (25:44):
Yeah, and we also, you know, we did see a dose
dependent improvement as well,which I think is really
important to highlight.
Josh (25:51):
Both femoral, neck and lumbar spine.
Yes, dose dependent responseYep, yeah.
Adam (25:58):
So I mean we're seeing just consistency of 250 is
better than placebo, 500 isbetter than 250 and placebo.
And we're seeing, at both thespine and the neck, the femoral.
Josh (26:18):
And similar situations, less obvious, less visually
appealing, but similar storywith all the biomarkers of
inflammation and bone turnover.
So again the proposed mechanismhere of being sort of an
inflammatory-induced boneturnover.
So again the proposed mechanismhere of being sort of an
inflammatory induced boneturnover issue, sort of mediated
by menopause, I guess, is theargument that seems to bear out
right, which is just really it'svery convincing when you see
(26:38):
the whole story kind of line upwith the data.
Adam (26:41):
Yeah, and all the inflammatory markers went in the
right direction.
So the ones that would beassociated with, you know,
increased bone turnover wentdown at the higher doses but
went up with the placebo.
And those that are associatedwith improved bone making went
(27:04):
up with the intervention andthen down with the placebo.
So if we look at the markerCTX1, which is C-terminal
telopeptide type 1 collagen,that is, an inflammatory marker
associated with bone turnover,that went up by week 48, that
went up by week 48.
(27:25):
When you looked at thedifference, it went up 11% in
the placebo group but it wentdown 22% in the 500 milligram
group and down 18% in the 250milligram group.
When we look at the biomarkerrank L, which is actually an
(27:45):
important one because there arenewer medications that target
the rank L, ligand, which isjust a receptor activator of
nuclear factor, kappa beta, andthat went up with the placebo by
12% and went down by 10% withthe 500 milligram dose.
And then osteoprotegerin, whichis basically doing what it
(28:11):
sounds like it's pro-osteo, it'smaking bone growth, it's
generating new bone, the placebowent down 4%, whereas with the
500 milligram it went up 57%.
Josh (28:25):
That's pretty cool, yeah.
And again, these very nice doseresponses were 250 milligrams.
So across all of those, I thinkfor yeah, for all of them, you
have a dose response effect.
You have a relative improvementwith a 250 milligram and then
even more of an improvement withthe 500 milligram.
So all the bone turnovermarkers follow that same story
and are statisticallysignificant.
(28:46):
And then it's a similar storywith the inflammatory markers,
right?
So we're looking at highsensitivity, crp, mda,
glutathione and nitric oxide,nitric oxide and it's a similar,
similar story throughout.
So you see worsening in theplacebo group over a year, which
you would expect in thispopulation.
You see improvements at 250milligrams and you see even more
(29:09):
improvements at at 500.
I mean, it's just, you know theonly thing that I would you
know.
So I'm I'm of all of these markI don't know which ones you you
use a lot.
I mean CRP I'm much morecomfortable with as like a
regular marker that I look at.
So you know, 30%, uh, decreasein.
You know CRP sounds reallyimpressive, but if you look at
the actual numbers, it's justit's not super huge Like you
(29:31):
know they they're at, you knowit's not, it's not a massive
shift in absolute numbersbecause they're starting out at
around, you know, point seven,eight or two or something like
that.
Adam (29:41):
Honestly, the only thing I cared about in this entire
paper was the bone mineraldensity.
Josh (29:45):
Yeah, fair enough.
Yeah, totally yeah.
So these, these are.
It's just kind of cool to seesuch a consistent story.
Adam (29:52):
Yeah I think it's important that we're seeing
consistency and the the proposedmechanism of his action, is
also holding up, which onlyhelps to provide more evidence
to um.
You know the causality argument, um.
So you know, we're seeing, andwe're seeing it consistently
with every single marker.
It's not sort of random, it's,it's everything's going in the
(30:14):
right direction.
There's a magnitude, uh to thatwhere we're getting a dose
response, um, and we're seeing,you know, anti-inflammatory
markers quote unquote go up andthen the pro-inflammatory
markers go down, go down more athigher doses and they're
statistically significant.
When we're looking at bonemineral density change, you're
(30:38):
seeing a 4% improvement at the500 milligram dose.
So whether or not that'sclinically relevant, I don't
know versus a minus 4% worsening.
Josh (30:52):
But even to stop bone loss , I mean that's just huge right.
You've got this osteoporoticpopulation and it's not only
stopping it, like bones growingback.
That's crazy.
Adam (30:59):
Well, I think you know, even though it's, it's cool
clinically, is that?
Is that an important amount?
If it went, if it improved by4%%?
Yes, I get what you're sayingPer this study it's better than
nothing.
Doing nothing, you'll continueto have loss.
So, yes, we could do betterthan that, right?
However, is it worthwhile totell all of my osteopenic
(31:25):
post-menopausal individuals whohave a uterus to say, or that
were born with uterus to say,you should go out and supplement
with this on a daily basisuntil you know for life,
essentially Fair.
And then, by improving yourbone mineral density, are we
(31:47):
also preventing fracture?
So there's two things that wekind of have to answer Are we
getting clinical benefit in theamount of improvement in bone
mineral density and are we alsoachieving what we want to do in
the sense of will thissupplement actually prevent a
fracture?
So really, what we should bedoing next for future trials is
(32:10):
one compare this to standard ofcare.
Josh (32:13):
That was going to be my question.
Like, what do we?
I don't, I don't know thisspace enough Like, what are the
improvements that we see on themeds that are out there, right,
what's the comparison to thestandard of care?
Adam (32:24):
Right, and I think I think that that's something that we
would have to do is then compareShilajit to something like a
bisphosphonate, because that'stypically the starting place,
and then you would need anothertrial and, okay, in those who
are bisphosphonate intolerant orpeople who have failed
bisphosphonate therapy, how doesit compare to something else?
And then also we will need aclinical outcomes trial.
(32:47):
Looking at Shilajit extractsupplementation.
Does supplementing with thisprevent fracture?
Josh (32:55):
Yes, and that you need a massive cohort for that.
But, yes, 100% agree.
And I think we're reallystruggling because this isn't
our field and so just looking atthese numbers, like we can see
the story, but, to your point,like we just don't know how
clinically relevant this is.
So if you're, if you do a lotof this kind of work and you're
a listener, you know, let usknow is this, is this as
impressive an outcome as maybe Isuspect that it is?
(33:18):
Clinically, how does thatcompare?
And I think that was somethingmissing from the discussion.
You know that would be a greatplace to compare it to, or not
even to directly compare, butbasically to say, like the drugs
on the market, the standard ofcare, do X, Y, Z right, Just so
you have some yardstick aboutwhat we're dealing with here.
So I would have liked to seethat.
(33:39):
But otherwise it's good andexcellent points right.
It's like it looks like a solidstudy, it looks like it's real.
The question is, of course isit clinically relevant?
The other thing I wanted topoint out it almost looked too
good, the story was almost toogood, and then it was like
there's only two authors and itwas a pretty involved study.
(34:03):
And then they're harping onthis very specific product.
So my little red flaggy earswent up.
And but you know, according towhat they're saying, there's no
funding or financial conflictsof interest.
It's not funded by the company.
That makes that they don't haveany competing interests.
So you know, I guess we takethem at their word.
It's just like it almost lookedtoo good or something.
(34:25):
I don't know, Maybe I'm just.
I've gotten so cynical over theyears with with these trials.
Adam (34:31):
No, I mean, I think you know when it, if it sounds too
good to be true, that's thatreally is when, like, your
spidey senses should go up andbe like, okay, well, what gives?
I think one thing that gives is, you know, we're not comparing
it to the standard of care,we're only comparing it to
placebo.
Not to belittle, you know, theamazing work the authors did.
We don't have hard clinicaloutcome data, but I do think
(34:53):
it's important because you'regoing to have patients who are
medically hesitant or resistant,and if you're out of options
and they're absolutely refusingcare, I would say, okay, well,
maybe we consider this, ifyou're, if you're up for it,
just because doing nothing perthis trial seems to be worse,
(35:16):
and so if you're trying to doless harm, it seems like this
would be at least something toconsider.
This is not medical advice.
Josh (35:23):
Yeah, no, that's fair.
I have a family member in mind.
It's exactly the situation.
It's like, well, I don't wantto consider these meds, and
basically they're telling methen there's nothing to do but
just like wait for things tocontinue.
So this might be somethingwhere we can say at least
there's, but they're a littlebit more open minded to natural
approaches.
So yeah, I think it's.
(35:43):
It's a clinical context, ofcourse, comparison, etc.
So you know.
Another interesting thing is andI just don't know this space
well enough and you're moreclinically active than I am With
the bisphosphonates.
It's just a couple years.
You do treatment for right,like it's not a forever thing,
right.
So it could be an interestingfuture study here too, where
you're doing instead of insteadof you're doing like an additive
(36:08):
right, like you're doing thistherapy for a few years, which
is your limit anyway, and thenyou try something else, or maybe
you add them together orsomething.
So there could be someinteresting things.
To be fair, what we'redescribing are much more
advanced level studies whichwould not come yet until the
preliminary studies like thishave been conducted right.
So no, but a study like thisreally paves the pathway for fun
(36:30):
for that yes, yes, very clearmechanism, very clear data,
totally okay, excellent, um, Idon't know that I have anything
else to add.
My spidey sense went off enoughthat I was even googling that
that hospital, the hospitalclinic or the clinic, the
university.
Um, I was like there's got tobe some connection here, but I
couldn't find it with a littlebit of google sleuthing I have
(36:53):
an idea what I have an idea whatthat Heather Zwickey know that
listens, okay, uh, yep andZwickey.
Adam (37:01):
Dr.
Zwickey is awesome, agreed, andshe's still affiliated with
health guard and and we knowthat she listens to this very
astutely every day because whowouldn't?
Josh (37:14):
What smart person wouldn't right?
Correct, correct.
It's a syllogism, basicallyyeah exactly.
Adam (37:21):
She would probably listen to this episode and be like, wow
, these guys are great.
They talked about an awesomestudy.
I'm going to see if one of mystudents at health got would
like to see if one of mystudents at HealthCott would
like to conduct a randomizedcontrolled trial.
Looking at something like this,there you go, excellent
connection with OHSU and I'msure they get plenty of data.
Josh (37:40):
So we just set it up, just like that Piece of cake.
That's how trials get done,people, I'm just saying
Excellent, excellent, excellent.
Adam (37:51):
If you want to ask questions, you can put me in as
third author.
Josh (37:54):
There you go.
There's all these rules aboutauthorless right.
It's like you know, if you werein the hallway or you attended
a meeting where the authors met,you're like author number seven
.
So if you suggested a similaridea on a podcast, you're going
to be positioned, you know,between what's that Intellectual
property?
There you go.
(38:14):
I don't think that's a thing,but we'll.
We'll take it.
It's timestamped now.
So, heather, don't even try tosteal this idea.
We gave it to you essentially,or exactly.
There we go.
There you go, until next time.
Oh, we have a bunch.
So thank you, listeners.
So much, we've gotten like awhole flood of recommendations.
Adam (38:37):
I'm really digging the involvement from the community.
We're just like we cannot keepup.
Josh (38:41):
Community's stepping up.
Yeah, it's good.
It's good we have our work cutout for us.
We've got some really coolstudies listed.
We owe uh, mark davis, dr davis, a bunch.
We got a great recommendationfor the new d mano study, which
I think we're just going to bumpto front of the line for next
week because it's time relevantand there's also a new uh april
(39:02):
doctor journal club videolooking at a lavender for
anxiety oh, yeah, that was areally good one.
Lavender for depression.
Excuse me, yeah, Depression fordepression, which is
interesting because all thestudies that I've seen before
just been on anxiety.
So, yeah, Adam's been superbusy.
There's like some reallyawesome new content on the
website and, yeah, keep therecommendations coming in
(39:24):
community.
This is awesome we're havingback and forth.
I just heard back from EricYarnell Dr Urnell, I love the
podcast feedback on Ginger.
He was like I knew there wassomething up.
He said as he was listening tothe podcast he was screaming out
loud, being like how do theypublish this garbage?
So I think he's as passionateas we are about this stuff,
(39:44):
Loving the feedback from thecommunity but if you could
please share these episodes,Spread the love.
Adam (39:52):
The more that the integrative community can hear
about us, the more that we canhave these awesome discussions
and kind of just spread moreknowledge about evidence-based
integrative therapies that areout there, because we're looking
to stuff that I otherwisewouldn't come across.
And so if more people canlisten and more people are
sharing and more people haveideas and want to comment and
(40:12):
write us an email whether it's agood review or an issue that
you have, all feedback iswelcome please, beautiful Mic
drop.
Josh (40:20):
That perfectly said.
All right, everybody.
We'll see you next time.
If you enjoy this podcast,chances are that one of your
colleagues and friends probablywould as well.
Please do us a favor and letthem know about the podcast and,
if you have a little bit ofextra time, even just a few
seconds, if you could rate usand review us on Apple Podcast
or any other distributor, itwould be greatly appreciated.
(40:43):
It would mean a lot to us andhelp get the word out to other
people that would really enjoyour content.
Thank you, hey y'all.
This is Josh.
We talked about some reallyinteresting stuff today.
I think one of the things we'regoing to do that's relevant.
There is a course we have on DrJournal Club called the EBM
Boot Camp.
That's really meant forclinicians to sort of help them
understand how to criticallyevaluate the literature, etc,
(41:05):
etc.
Some of the things that we'vebeen talking about today.
Go ahead and check out the shownotes link.
We're going to link to itdirectly.
I think it might be of interest.
Don't forget to follow us onsocial and interact with us on
social media at DrJournalClub,drjournalclub on Twitter.
We're on Facebook, we're onLinkedIn, etc.
Etc.
So please reach out to us.
We always love to talk to ourfans and our listeners.
(41:27):
If you have any specificquestions you'd like to ask us
about research, evidence, beinga clinician, et cetera, don't
hesitate to ask.
And then, of course, if youhave any topics that you'd like
us to cover on the pod, pleaselet us know as well.
Introducer (41:42):
Thank you for listening to the Doctor Journal
Club podcast, the show that goesunder the hood of
evidence-based integrativemedicine.
We review recent researcharticles, interview
evidence-based medicine thoughtleaders and discuss the
challenges and opportunities ofintegrating evidence-based and
(42:02):
integrative medicine.
Be sure to visit www.
dr rjournalclub.
com to learn more.
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