Why BONE Strength Is As Important as Muscle for Longevity (Dr. Doug Lucas) | Ep 409 - Wits & Weights | Fat Loss, Nutrition, & Strength Training for Lifters

Episode Transcript
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Philip Pape (00:01):
If you're someone who takes your health seriously
and wants to build muscle andstrength that lasts decades, but
you've never thought aboutwhat's supporting all that
muscle tissue or whether yourskeleton can actually handle the
load you're putting on it, thisepisode is for you.
My guest today is an orthopedicsurgeon who left his surgical
practice to focus on bonehealth.
He's going to explain why yourskeleton isn't just scaffolding,

(00:24):
it's the limiting factor forhow much muscle you can build,
how hard you can train, and howlong you can keep lifting.
You'll learn how to optimizebone density without drugs, what
hormone optimization has to dowith skeletal strength, and why
bones aren't passive structures,but active organs that respond
to training stress.
If your goal is to build aphysique that's strong on the

(00:46):
outside but resilient on theinside, you're gonna enjoy this
one.
Welcome to Wit and Weight, theshow that helps you build a
strong, healthy physique usingevidence, engineering, and
efficiency.
I'm your host, Philip Fape, andtoday we're gonna talk about
something that doesn't come upas often as I'd like to see it

(01:07):
in physique and strengthtraining discussions, but could
be the most important foundationfor long-term performance, and
that is bone health.
My guest is Dr.
Doug Lucas, a double boardcertified orthopedic surgeon and
osteoporosis specialist whostepped away from the surgical
practice to focus on a missionthat he's passionate about, and
that is proving thatosteoporosis is not only

(01:28):
preventable, but oftenreversible.
He's the founder of theOsteocollective, an online
community supporting bone healtheducation and lifestyle change.
He's the author of twobest-selling books on
osteoporosis and hormoneoptimization and host of the Dr.
Doug Show podcast.
I invited Dr.
Doug on the show because of hisperspective on how bone

(01:50):
density, hormone health, andstrength training intersect.
For those of us who liftweights and care about building
muscle, that lasts, that givesus longevity, aka everyone who
listens to this podcast,understanding the role of
skeletal integrity is at leastas essential as, say, getting
jacked.
So we're going to discuss whyyour bones should be a priority,
how strength training buildsbone density, you know,

(02:12):
mechanistically, what our over40 lifters need to know about
hormones and skeletal health andsteps you can start taking
today.
Dr.
Doug, welcome to the show.

Dr. Doug Lucas (02:21):
Oh man, that was such a good intro.
That just like so many thingsto talk about in there.
Happy to be here.

Good, good, good.
Hopefully we can remember themall.
Because I know you're an expertin bone health, but you also
have these other angles thatrelate to our listeners.
And before we get into those, Ilike to define some things.
I want to nerd out with you onthe anatomy, the physiology, the
system-levelinterconnectedness.
Because I know we're talkingmore about, you know, there's
buzzwords like osteosarcopenia,the kind of portmanteau of two

(02:49):
different things, so that wehave that foundation for the
rest of the discussion.
So let's just start withdefining bone health.

Yeah, man.
Well, so I wish it were justthat simple.
You know, when most peoplethink bone health, they think
osteoporosis, they think oldpeople, hip fracture.
And that is true that allthat's exists.
And I love talking to thatpopulation too.
But bone health really, for me,has taken a turn over the last
five years as we've beencreating, you know, clinical
programs, community resources,and I'm on stages across the,

(03:18):
you know, right now, the globe,talking about bone health.
And what's happened to me isthat I think that we really need
to just redefine bone health.
Bones in general are such agreat organ to look at because
they're telling us a story, notloudly, quietly, but through
imaging, through blood markers.
And we know that on average,people will lose bone as they

(03:39):
age.
But I think we've got itbackwards where we say, oh, if
you lose enough bone, you have adisease.
But actually, I think we needto be looking at bone health as
a biomarker of longevity.
If you're losing bone,something's wrong.
And that's how we need tochange this perspective of bone
health.
Because bone health is reallyjust imbalanced bone metabolism
when it's wrong, and it'sbalanced bone metabolism when
it's right.

No, I love that term, bone metabolism, because
that I haven't heard.
Let's let's dig into that.
I like that bone can be abiomarker.
It's it's a changing thing,right?
I think people maybe think ofit as this fixed structure and
it's super dynamic likeeverything in the body.
So, what do you mean by bonemetabolism?

Yeah.
So imagine this.
Every 10 years, especially asyounger adults, we are replacing
our entire skeleton.
So, you know, go back 10 yearsago.
The skeleton you had then iscompletely different than the
skeleton that you have now.
Bones are not just static, youknow, framework for our body
that our muscles attach to.
They are, as you said, dynamic.
They are living, they're makingcells.

(04:34):
They actually are full of stemcells.
They are really, really coolorgans that are communicating to
the rest of your body throughhormones, just like everything
else.
And so when I say bonemetabolism, what I mean is how
much bone are you breaking downat any one time?
How much bone are you buildingat any one time?
And then what is that balance?
So you mentioned, you know,cells earlier.
So osteoblasts are building,osteoclasts are breaking down.

(04:58):
There's always a balancebetween the two.
And if you break down more thanyou build up, you'll lose bone.
And if you're building up morethan you break down, you're
gonna build bone.
And that bone metabolism iswhat we need to be looking at
when we start talking about bonehealth.

So is there a proxy or I should say an equivalent
for muscle protein synthesisthen in the bone world?

Yeah, that's interesting.
Um, I don't know how youmeasure it with muscle, but yes,
the idea is that you want tostimulate bone.
There's not a cool process likebone protein synthesis that I'm
aware of.
Um, you know, maybe there is.
I'd love to learn about it.
But we can measure it in bone,which is different than in
muscle.

Got it.
And I know for some context forthe listener, right?
You were an orthopedic surgeon.
Uh, I've dealt with several ofthose.
I had back surgery and rotatorcuff surgery, and some are
awesome and some, you know, Iwouldn't see again.
And, you know, just like anyoneelse in the healthcare
industry.
Right.
But you then pivoted into morefunctional medicine focused on
bone health.
So, what's the context behindthat transition as it relates to

(05:54):
your passion for this today?

Yeah, man, I love the OR.
You know, when I went intomedical school, I didn't know, I
didn't know what I wanted todo.
I think like a lot of medicalstudents, and I was just
fascinated by the operatingroom.
I loved the, you know, thepower of the literally power
tools, but the power of what wecould do in the operating room,
we could make something that isso broken, so much better
quickly, you know, and just itwas so clear, so black and

(06:16):
white.
Loved operating, did that for,you know, a decade or more.
But what I realized too is thatwhen I got into practice, yes,
we could do great things in theoperating room, but really the
most powerful thing ispreventing what we were
operating on in the first place.
So I got very interested in alot of the stuff that you talk
about.
We talk about the rightnutrition that's right for you,
the right type of movement,resistance training, you know,

(06:38):
what kind of supplements basedoff of what biomarkers.
I just went down all theserabbit holes and I realized that
I wasn't as excited aboutseeing patients anymore because
I realized that they were, itwas already too late.
You know, they'd already gonedown the, you know, this path
based on either their own baddecisions or somebody told them,
likely their doctor told themto go down.
And I was really just cleaningup the mess of metabolic
disease, especially as a footand ankle surgeon.

(06:59):
And so I was very fortunate.
My wife uh is also anentrepreneur and runs a company.
So we were able to tolerate mestepping away from a relatively
high-paying W-2 job, gettingadditional training, hormone
fellowship, you know,anti-aging, you know, functional
medicine fellowship, and thenstarting my own telehealth
practice and getting to where weare today.

Okay, that makes a lot of sense.
And um, there's more of that inthis industry, especially as a
podcaster, getting to interactwith cardiac surgeon,
urologists, uh, all sorts ofdoctors who have done a similar
thing as you, I think, becausethey almost feel frustrated that
they have come so late in theprocess.
Yeah.
Right.
Just as well, GPs, um, youknow, you've got the Dr.
Spencers of the world who aretrying to integrate as much

(07:40):
preventative stuff into theirpractice as possible.
Okay, so that that's reallyimportant, right?
Because that's what we'refocused on on this show.
So when someone hearsosteoporosis or bone density,
and I know there are a lot ofdifferent terms.
In fact, I heard you on KarenMartell talking about some that
are a bit maybe archaic now.
I think osteopenia is used lessnow.
Yeah.
And they think either youthink, okay, this is an old

(08:01):
person's problem, right?
Like this is something to worryabout years and years from now.
I know are are much morecognizant of it now, especially
those that listen to these typesof shows.
But you work with people fromacross the age range.
So one important question,speaking of preventative, is
when do we start doingsomething?
And I know the question'sobviously like you should lift
weights, guys, as soon as you'reable to, like, you know, you're

(08:22):
14, start lifting weights.
That's fine.
But, you know, what does thespectrum and the timeline look
like where the risk just startsto accumulate in that timeline?
Yeah.

You know, this is this is one of the things I
talk about most, actually,because I I try to get in front
of younger audiences.
The part of my mission, whichis educating about how to
reverse osteoporosis, I lovethat part.
And it's really importantbecause there's a lot of there's
a lot of anxiety and fear, andunnecessarily so in those that
have the diagnosis ofosteoporosis.
But I think the bigger part ofthis is who needs to be

(08:51):
screened, when, why, with what,and what does it mean?
And so if you think about bonedensity, the bone density
increases as you go throughchildhood into early adulthood.
Bone density will peak, yourpeak bone mass will occur in
your late 20s, early 30s, bothmen and women.
Arguably because we are nolonger that physically active as

(09:13):
young children, as adolescents,more screen time, more games,
more school, you know, lessrunning around, jumping off of
stuff, banging our bones around.
We are seeing young adults withlower bone mass to start with.
This is a big problem becauseon average, all women and men
will lose bone density as theyage.
I don't think it has to be thatway, but that's the average.

(09:34):
And especially women as theyget into perimenopause and
menopause are going to see arapid drop.
If you don't know what yourstarting point is, you don't
know what you should be doing.
So, right now, I'm tellingevery young adult with any risk
factor whatsoever for bonehealth, and I'm happy to go
through them, but I can justshorten it by saying that you
all have them.
Everyone should be screened tosee what their bone density and

(09:56):
hopefully quality are, dependingon the screening modality, to
know what your starting pointis, especially certain
populations at risk.
So, just a couple of thingsthere.
Young women who are involved inendurance sports, all should be
screened.
I've had so many patients,young women in their 20s and
30s, that have not even low bonedensity osteopenia, outright

(10:17):
osteoporosis.
It's frightening.
And I think it's rampant inthat age group, that subgroup of
athletes, and they don't knowit.
Nobody's talking about it.

And real quickly, why is that?

Yeah, well, I think it has to do a little bit
with uh, you know, how muchstress they're putting their
body through.
I think there's some, you know,there's body dysmorphia in
there, there's eating disordersin there, and then there's
hormonal disruption in there.
So a lot of women who are in,you know, endurance sports,
especially as young women,either will never develop a
normal menstrual cycle or willlose it and then not worry about
it because they're told that,oh, that's okay.

(10:48):
Totally common for you knowlong distance runners to not
cycle, but it is a big deal andit is not normal.
So if you're not cycling as awoman, you are losing bone by
definition.

Okay.
So that's one, that's oneat-risk population.
Young women endurance sports.

Yeah.
So and then the other groupthat I think is, I mean, nobody
ever talks about this, but Ithink, you know, young men, the
more and more we see young meneither with low testosterone and
then subsequently low estrogen,either naturally or they're on
testosterone replacement, butthey're using an aromatase
inhibitor like anastrazole, andthey're bottoming out their
estrogen just because that'swhat they're trying to do to
increase their testosterone.

(11:23):
If you don't have estrogen, asa man, even a young man lifting
heavy weights, you're stilllosing bone.
And so I've seen, you know,this, I don't know how common
this is, but I've seen men, 20s,30s, on TRT, but on too high a
dose of AI that are losing boneand they have osteoporosis and
they look, they're jacked,right?
They're lean and they jacked,they look amazing.
They look like Superman, butthey have osteoporosis.

Are they on TRT for physiologic replacement or or
to get performance enhancing,you know, up into the thousands
of testosterone?

Yes, yeah, yeah, yeah, yeah.
Yeah, but both, right?
I'm not prescribing it at thethe super physiologic levels,
but you know, but either way,even if you have a testosterone,
it's you know, 3,000 total T,but you're on a you know, a
large dose of AI and yourestrogen is zero, it doesn't
matter.
You're still losing bone.

Okay.
So then that raises thequestion that for people who are
training for strength ofphysique, let's say beyond these
at-risk populations, whichright there, we're going to
include them in the list ofabsolutely get checked and
baselined early and monitorthis.
You know, what do we take outof when we talk about bone
density, bone quality, whateverthe metrics are, and
prioritizing them in and ofthemselves, right?

(12:32):
So I guess we can talk aboutthe metrics that need to be
screened.
And is there anything you'redoing specifically that you're
not already doing for muscle andhealth anyway?
Because I love the fact that weget two for ones when we talk
about this stuff.
If you're lifting weights,you're gonna solve a lot of
issues.
So you're good.
But in some cases, like is itthe at-grist populations or
maybe a need to pay attention tobones specifically for one

(12:54):
reason or another?
So help me understand that.

Yeah.
So I think it changes the wayyou train and it might change
the way you eat.
You know, so I mean, let's goback to that, like the young
athletic, you know, enduranceathlete woman.
I'm not saying that she has tostop running, but she should pay
attention to how many caloriesare you getting, what is your
total body fat?
You know, if you need to besuper lean for competition, can
you get less lean in youroffseason?

(13:16):
You know, let's figure out canwe create a way where you're not
losing bone?
Because again, if you're losingbone, something's wrong.
And then if you're trulyosteoporotic in your 20s as a
woman, I mean, this is this is,you know, red flags, warning
signals, like we got to buildbone.
And then if that's the case,then maybe you're gonna have to
back off of your long distancetraining, add more resistance,

(13:37):
build more muscle, and do somekind of impact training as well.

And speaking of building muscle, this is another
thing that comes up strengthversus muscle.
And I say versus loosely,because right, there's a lot of
overlap, obviously.
But the idea that lifting heavyand heavy is another subjective
term, because do we meantraining close to failure for
muscular tension, or do weliterally mean low reps up in a
high percentage of your max?
So just let's resolve that realquick.
And then I do want to dive intosome of the how do you scan for

(14:03):
this and and other stuff.
Lifting heavy, like what areyour thoughts on that?

Yeah.
So I mean, when I say it, I saywe need to lift heavy.
But what but what do I mean bythat?
And I and I get I have somesome interesting exercise
physiology people out there inlike the longevity space that
will give me negative commentsto say, like, you don't have to
lift heavy or, you know, I meanall these different like
subjective terms, right?
But what I mean is when youlook at the literature, there
are studies looking at what'scalled high intensity

(14:29):
resistance.
So they're talking, you know,80 to 90 percent of one rep max.
That's heavy, regardless ofwhat your starting point is, you
know.
So that's what I mean by highintensity, heavy.
We know that those studies,those protocols are going to
have a better response to eitherslowing down bone loss or
potentially even building boneif they are mixed with impact.
So when I say heavy, I don'tmean go out there and try to

(14:50):
deadlift 225 pounds if you'venever done it.
Like, please don't do that.
But if your starting point is,you know, a band and your
wanderet max is like, you know,whatever this color band is,
then you know, go 80% of that.
Like that's heavy.
So you could do that with pinkdumbbells if you needed to.
It just depends on yourstarting point.

100%.
Uh, my mother-in-law, we wewere getting her for Christmas a
set of you know,arthritis-friendly dumbbells and
a wrist wrap, because for her,that's super heavy, and I'm
excited for what she's gonna getout of it, right?
Um, yeah, no, that's a that's agood qualification because I'm
going forward, you know, some ofthese recent talks I've had,
and now you're only reinforcingthat, is I think there's these
different regimes of percent maxthat kind of have different

(15:29):
goals, right?
There's the hypertrophy regime,which is extremely wide, and
there's the strength, which is alittle bit higher up, like 60%.
And then maybe we say, okay,the the super necessary bone
health population is 80%, right?
And that is what, five, five uhreps-ish, I think.
Right.
I forgot my.

I mean it's five by five-ish, right?
Yeah.
Five reps.

Yeah, exactly.
Which is a beginner programlike starting strength or
something, is gonna be in thatrange.
So that's perfect.
Um, okay, so then before we getinto the scan discussion terms
here, bone density, that'spretty self-explanatory, but we
can describe what we mean bythat, you know, uh
physiologically.
Bone quality, like what are thedifferent metrics of how we
measure bone health?

Yeah, so we talk a lot about bone density
because the definition ofosteoporosis is based off of
density from the imagingmodality of DEXA, which is not a
great imaging modality, to behonest.
You know, we can use DEXA for alot of things, body
composition, bone density.
It's okay, but it's just atwo-dimensional x-ray.
So your output is only as goodas your input.

(16:29):
Uh we're not gonna get awayfrom DEXA anytime soon, though,
because it is the gold standard,even though it's not, there's
nothing gold about it, but it'sthe standard and it's widely
available.
It's covered by insurance undermany circumstances.
So with DEXA, you know, you'regonna get this thing called a
T-score.
It measures, well, for olderindividuals, T-score is gonna
measure your bone densitycompared to a younger version of

(16:51):
your sex and ethnicity.
And that's what we use as adefinition of osteoporosis.
Now, for younger individuals,there's a thing called a
Z-score.
You also get from DEXA, itcompares you to your age-matched
peers.
That's valuable for individualsyounger than the age of 50.
And that's just comparing youto somebody who's like you, but
maybe has different bonedensity.
So we can use bone density fromthat perspective.
But what we really want to knowis what's your fracture risk.

(17:14):
Now, maybe not in a 20-year-oldathlete do we want to know your
fracture risk, although if youhave low bone density, I want to
know your fracture risk.
But as we get further along, wewant to know what your fracture
risk is.
And then that question isreally a combination of bone
density and bone quality.
Because we see a lot of issueswith bone density when you start
predicting fracture risk.
In fact, most fragilityfractures, and there's clear

(17:36):
definitions there, but mostfragility fractures occur in
those without osteoporosis.
They have low bone density, notosteoporosis, partially because
there's just more of them.
But it's not necessarily just adensity problem, it's a quality
problem.
So then how do you measurequality?
Well, this is not super clear.
There are modalities out therethat are not DEXA.
So ultrasound device calledRAMS from the company Echolite

(17:59):
out of Italy, that device has afragility score.
It's measuring quality andcomparing it to a database of
people who have or have notfractured.
So that's kind of cool.
Um, CT studies, quantitative CTcan do it as well.
So, quantitative CT, you canlook at different ways that the
computer can calculate strength.
It's usually calculated asstrength.

(18:19):
Um, and so there's a qualitymetric there, but CT is not a
great thing to use because youcan't use it continuously over
time.
Like you don't want to go CTyour body every six months or 12
months to look at your bonedensity and quality.
It's just too much radiation.
So you're kind of stuck betweenthe ultrasound device, the
RAMs, or what else you can do onDEXA.
There's a couple other thingsyou can do on DEXA.
One's called TBS or tubecularbone score, one's called 3D

(18:43):
Shaper that just got FDAapproved.
But neither of those are areadding any additional inputs to
DEXA.
It's just different ways tocalculate on the output side.
And again, DEXA is an oldschool two-dimensional x-ray.
So how good could it be?
So this is one of thechallenges with imaging and bone
is that there really isn't agreat tool to say that you can
accurately say what your bonedensity is, what your bone

(19:03):
quality is, and then ultimatelywhat your fracture risk is.

Well, that's discouraging, but but you made
me my you made my brain go to AIwhen you mentioned obviously
the uh ultrasound and having thecomparative, the correlational
analysis and where is that allgoing?
Like I imagine they're lookingat taking the imaging and like
you said, correlational machinelearning uh comparisons.
Are we on the cusp of somethingthere?
Are there any breakthroughsabout to happen?

(19:27):
What's going on?

So the company Echolite and I have not worked
together, but I just imagine, Imean, I know so many business
owners that have these devices.
The scanned data, after you geta scan, all of that data is
owned by Echo Lite, by theparent company.
So they'll download from thesemachines, you know, these
thousands and thousands ofscans.
Their database is massive.

(19:49):
So, yes, could you use AI tocome up with a better
calculation based off of theseinputs that are coming in from
Ultrasound?
Absolutely.
I hope they're doing that.
I don't know for sure that theyare, but yes, you could
certainly use AI learning tobetter predict this.
And I think that is where we'regoing.

Yeah, that's pretty cool.
Um, yeah, I have an app comingout just to show that that's
based on AI.
And I'm surprised myself atwhat it can do because we almost
don't have full control of someof the things these this AI can
do.
Uh, it's insane.
All right.
So if so let's say someone isuh assessing their density and
quality with one of thesemeasures or a combination of
these measures over time, maybethey're at risk, maybe they're

(20:27):
not, but they want to know whatto do on a daily basis.
And of course, we love to startwith lifestyle uh first here.
And I think a lot of peopleassume that if they're lifting
weights, fairly active, notdoing anything overly stressful,
like the at-risk populationsand not under-eating.
Like, so we're saying all thethings that they, a lot of
things they should be doing thatmaybe they're not doing.
What would you say are the bighitters besides lifting weights?

(20:49):
Or are you like, hey, liftingweights is 80% of it?
And then here are the otherones.

Yeah, I mean, I think um, not to pander to your
audience or anything, but Imean, yeah, like the resistance
training part is huge.
But we we kind of build it likethis.
Like we have a pyramid, thefoundation of our pyramid is
just like every other functionalintegrative practitioner out
there.
Nothing special about it,right?
It's exercise, nutrition,mindset, and sleep.
There's nothing special aboutthose categories, except that

(21:16):
when it comes to nutrition andbone health, just like with
muscle health, you have to eatenough calories.
And there's just no way aroundthat.
You have to get enough of thebasics, you have to get enough
protein.
And for those that haveosteoporosis, it is a sign that
they have had inadequateprotein, either consumption or
absorption, one of the two.
But either consumption orabsorption, they've had
inadequate protein for a longtime.

(21:37):
You know, and I used to get onstages and I used to, you know,
preach about my beliefs aboutfood.
And then I realized like nobodycares what I think about food
outside of the things I canprove in research, which is more
protein in population studies,better bone density.
It is hands down clear.
Same thing with muscle mass,right?
Like you have to reach thismuscle protein synthesis
threshold.
We don't know what thatthreshold is for bone, but it's

(22:00):
somewhere around the same thingbecause it just gets you
anabolic.
It's just that simple.
Yeah.
And then exercise perspective,we we kind of talked about it,
hit on it.
The resistance training, highintensity, fantastic.
The difference is impacttraining because most of your
listeners are probably not doingintentional impact.
It hurts, it might not be goodfor your joints if you're doing
it wrong, but it does provide agood stimulus for bone.

(22:21):
Resistance training has notconsistently shown benefit for
bone health in the literature.
In fact, usually it's it justslows down bone loss.
It does not build bone.
If you want to build bone, youneed to add additional impact,
either through something like abox jump, some kind of
plyometric thing, heel drop, orsome kind of simulated impact
like whole body vibration orosteogenic loading as a device

(22:42):
that's there's some devices thatare out there as well that
could potentially do it.
But something that adds morethan just resistance to that
exercise piece.

I want to hit on that.
That's interesting because yousaid um lifting at best
preserves your bone density,which of course itself is
important.
For those listening who want anexcuse not to do impact
training, then I want to talkabout doing impact training.
Okay.

Yeah.

If they've been living a healthy lifestyle
since, say, their 30s, is it abig concern that they're not
doing impact training or is itkind of like you're okay?
Or is this a non-negotiablealmost?

Well, and this is where you screen, right?
Like you screen, and if you'reif your bone entity is great,
cool.
Like you're probably fine tonot do it.
But if you have osteoporosis,you need to start figuring out
how to do it in a way that yourbody can handle it.

Okay.
And that's not unlike somemessaging I've had from some
other good coaches in the spaceI respect.
Like Megan Dahlman is reallybig into bone health, and she's
she talks about impact training,but she's like, not everyone
has to do it.
But yeah, if you're trying torecover bone, so that's really
good.
So box jumps, you mentionedwhole body vibrations.
So are we talking about thingsthat some of us make fun of
because some people use it aslike their only form of

(23:45):
exercise, thinking it's gonna,you know what I'm talking about?
It's the vibrates your wholebody.
Yeah, yeah, yeah.
The plates and everything.
Yeah.

Yeah.

Okay, okay, interesting.
So there's a good use for thatthen.

Yeah.
So I so I'm a big fan because Ihave a lot of a lot of my, you
know, community members, theyhave such a low starting point
that their resistance is, theirresistance training is very,
very minimal, right?
Or they have significantarthritis.
I mean, there's we have allcumbers from different health
perspectives.
So we have some very sickpeople.
Something that is passive couldbe absolutely beneficial if it
works, right?

(24:15):
So it's got to work.
The evidence behind whole bodyvibration, if done correctly,
meaning on the right device.
So the the company we utilizeis power plate because their
devices are very, you know,they're powerful, hence the
name.
Um, they're powerful and theyare predictable and they're
commercial grade or evenhealthcare grade.
So they have home devices andit moves up and down the certain
amount.
So that's hertz, 30 to 40hertz.

(24:37):
And then it's up and down, notlike side to side, like you
know, the pivot one side to sidethat just make your sacrum
looks like it hurts.
Um, so the up and down versionis what you need, and it has to
go up and down enough toactually create enough
gravitational force.
And that's you want that threeto five Gs, and or that's two to
four millimeters.
And so if you have the rightdevice, stand on it for 10

(24:57):
minutes, you can actually seebone mineral density increase
and multiple studiesdemonstrating that.

That's incredible.
Okay.
Yeah, I'm learning somethinghere for sure.
I didn't I didn't know that.
I'm gonna, this is gonna bepinned in my notes for personal
reasons for people that I knowin my life, but also to share
this.
So I thank you.
Thank you.
Always always looking to learnsomething.

Yeah.

So, okay, so we've got lifting weights, we've got
impact training, we've got notundereating, eating enough
protein, huge.
I'm a big fan of that messagingin general.
Even people who want to losefat, we talk about the
importance of the majority ofthe year being spent at
maintenance or potentially in asurplus building muscle, and
you're gonna be much morehealthier, you're gonna feel
great.
What about vitamins, minerals,and fiber and their correlation?

(25:37):
Because there's a lot ofconfusion about calcium over the
years and vitamin D, et cetera.

Yeah, so um so minerals are super important.
So uh we talk about, we hearabout calcium all the time.
Oh, you have osteoporosis, youneed to take calcium and vitamin
D.
Hopefully they say vitamin D.
The thing about minerals,though, is that like they don't
exist in a vacuum.
So your bones, yes, the mostprominent mineral is calcium by

(26:02):
volume and by weight, but it'sso much more than that.
And if you're gonna lay downcalcium, you need magnesium.
In fact, you need moremagnesium than you need calcium.
You also need potassium, youalso need boron.
You like you need it all.
And so when I see people takingjust big doses of calcium,
essentially chalk, right?
Calcium carbonate is chalk.
If you take a big dose ofcalcium carbonate, first of all,

(26:22):
your body's not gonna absorbvery much.
But secondly, osteoporosis isnot a calcium deficiency
problem.
Osteoporosis is a you knowmulti-factorial thing.
And so if you're gonna consumecalcium or other minerals, it
has to be done in a way where uhyou're consuming them all
together.
That could be throughsupplementation, preferably
through diet, but you need themall together.

(26:44):
It's not just a calcium vitaminD deficiency.
And then from a vitaminperspective, yes, vitamin D does
help with the absorption ofcalcium, it does help with
utilization, but you can almostget yourself in trouble.
And this is where the researchis actually pretty clear.
If you take a huge chunk ofcalcium and you add vitamin D to
it, you will absorb it.
But then what?
And so then you see thesespikes of blood serum calcium.

(27:05):
And when you do that, so youalso need vitamin K to help to
put it where you want it to go.
So it's again, it's like we tryin in medicine to simplify
things because we need to do itat scale, right?
We need to do this for 280million Americans.
Great.
But we need to be realistictoo.
Taking a thousand milligrams ofcalcium plus 400 IU of vitamin
D seems to not be dangerous, butis it really helpful?

(27:27):
The research doesn't reallysupport that.
Even go back to the women'shealth initiative from 2002.
What was the benefit of thosethings?
It was pretty minimal.
If you start stacking them, soyou get multi-mineral, right?
So you get calcium, you get themagnesium, you get all the
things together.
And then you start addingvitamin D, vitamin K.
You also need A to make the Dwork in the cell.
Like you have to start puttinga list together, then you start

(27:49):
coming up with a comprehensivestack that can help you to build
bone.

Got it.
And is this comprehensive stackcurrently sold that way in in
different markets?
Or like is it readily availableat Walmart or Amazon, like the
osteoporosis stack?

Yeah, so it is.
Like if you were to go on um,you know, if you're going to
Amazon and shop, you know,whatever, whatever product
you're looking for, right?
You'll find a bajillionsupplements.
The challenge is how do you putit together?
Because there's not a singleproduct.
And even in companies likethere's companies I work with
that are very specific toosteoporosis.
So even in those companies, uh,you have to stack multiple

(28:25):
products depending on yourstarting point.
And this is what I always sayabout supplements is to say,
look, depending on where youare, your genetics, what your
biomarkers show or yourdeficiencies are, and maybe even
functional testing, you'regoing to have a different stack
than the person next to you.
So there really isn't aone-size-fits-all approach.

Yeah, that makes a lot of sense.
All right.
So in addition to that, um,what about medications?
And oh, I actually want tostart with is there anything
people should be avoiding?
Because, again, some likeBoniva has been around years and
I've heard horror stories aboutthat.
I mean, what's the latest stateof things that are, you know,
ancient and to be avoided, stillaround that should be avoided

(29:02):
and things that are sometimesrecommended?

Yeah.
So the pharmaceuticals and bonehealth are tough because in the
conventional system, you know,we have this, we have this
system that is really good atsome things, right?
It was designed to treatinfections and to, you know,
treat trauma and do surgeries asall that developed.
But what it's terrible at istreating chronic disease.
So whenever you're talkingabout making a drug, a specific

(29:26):
pharmaceutical for somethinglike osteoporosis or dementia or
even heart disease, you know,like cholesterol, different
story, but even like the chronicheart disease thing.
Like it doesn't do a great jobof that.
And bone health is certainly noexception here.
So the drugs that are designedfor bone health are designed to
be a single solution that willreduce fracture risk.
To do that, there's kind of twodifferent ways to do it.

(29:49):
And they they all work off thesame bone metabolism thing that
I was just talking about, right?
So if you want to reducefracture risk, you can either
slow down bone loss or you canbuild up bone.
Which is the same thing I do.
I just use different tools.
The drugs that slow down boneloss, you mentioned Boneva.
So there's kind of two mainclasses here: there's
bisphosphonate drugs.
So that's phosmax, boneva,reclast, all of these drugs that

(30:12):
are bisphosphonates and work byessentially poisoning
osteoclasts, those cells thatbreak down bone.
Prolia is a similar drug.
That one also works by shuttingdown the osteoclast different
mechanism, but you're stillslowing down bone loss.
The challenge with that is whenyou slow down bone loss, you
also slow down bone building.
Bone metabolism, neither sideworks in a vacuum.

(30:35):
And so if you shut down oneside, you shut down the other.
And we can measure these thingsin blood.
So there's bone turnovermarkers.
This is what I meant.
Like you can't measure this inmuscle, or at least not well.
In bones, you can actuallymeasure it in blood.
So we see the marker for boneloss drop.
We see the marker for bonebuilding drop as well.
That's okay in the short term,especially if you are at high
risk of fracture.

(30:56):
And uh if you're at high riskof fracture, you might have to
take one of these drugs.
There's a time and a place forthese drugs.
So I'll come back to that.
Um again, perlea, same thing.
Slows down bone loss, slowsdown bone building.
You can't do that forever.
Now, the other side of thatequation is drugs that increase
bone building.
Those drugs are called anabolicdrugs.
They push bone building up.

(31:16):
So you're push pushing up thatside of the equation.
And the other side of theequation rises too.
So now both sides are doingmore.
And those are actually mypreferred drugs if you're going
to use a drug.
The challenge is none of thesedrugs you can take long term.
So the bisphosphonate, therecommendation is three to five
years, depending on your risk.
The anabolic drugs, it's one totwo years, depending on your

(31:37):
starting point and your risk.
None of those things make senseif you're 50 years old or even
60 or even 70, right?
Pro Lee is a little bitdifferent.
That one is there's safety dataout to 10 years,
recommendations to continue onkind of mixing up drugs after
that, but we don't have along-term plan here.
Unlike the other things that wetalk about, resistance
training, the right diet, thesleep, the mindset, potentially

(31:59):
hormone replacement, which Iknow we'll get to, those things
you can do for the rest of yourlife, or at least hopefully.

Perfect segue.
Um, hormone replacement, whichI was gonna talk about next,
because you're right.
Let's put that into contrast ofthe things that are that are
there for the long term, thatare uh positive practices that
we can do and fully controlwithout medication.
So hormone, both optimization,I'll call it, hormone balance
via your lifestyle, but alsohormone replacement are big

(32:25):
topics for our population.
So where do we start in thecontext of bone health here?

Well, I guess let's start at do you want to
start at the end or thebeginning?
You want to start at the, youknow, the as hormones start to
get wonky in midlife, honestly,both for women and men?

Let's start there.

Yeah.
Yeah.
So um one of the things youdidn't mention that I do
professionally is that one, myclinical practice got acquired
by a larger company, LifeMD.
I now work as their VP ofhealth and hormone optimization.
So my job is to build programs,both for women, mostly women
right now, but for women and formen that are set up to help
optimize hormones.

(32:59):
Again, through potentiallylifestyle, but also through
replacement.
So very deep at these topics.
Like you said, one of my booksis about hormones.
Huge advocate for hormone use,replacement, optimization.
For women, as they start to getinto this perimenopause midlife
phase, it is the wild, wildwest.
We'll talk about postmenopauseand you know how challenging

(33:22):
that space is, some things thathave changed recently, actually,
as of you know, this week, thatwe can talk about.
But perimenopause, there's verylittle data, very little
research, very few guidelines,and yet wildly symptomatic
population who's searching foran answer.
So it's a it's a really toughspace.
But the good news is there ishope for all the women who are

(33:42):
looking for answers becausethere is a lot of research going
on right now.

And you know, real quick on that, it's a very
vulnerable population because ofthat.
And I don't say that's afearmonger, but I've seen that
in the industry, it's it's rifefor taking advantage of.
And this is why we have to beall of us, including those of us
giving the information, supernuanced and respectful of truth.
Is it not even a word you canuse today uh and have any

(34:06):
meaning.
But uh, you know, what what'sbest supported by our our latest
information and the scientificevidence?
Yeah.

So I mean, I think this is this is where I
see this challenge, especiallyin social media, between, you
know, doctors talking aboutperimenopause versus coaches
talking about perimenopause.
And you have coaches sayingit's not your hormones, work on
your lifestyle.
And you have doctors sayingit's not your lifestyle, work on
your hormones.
You have women in the middlepulling their hair out uh or
losing their hair, depending onthe situation, right?
And it is, it's it's tough, andit's really hard to figure this

(34:35):
out, even as a provider whounderstands that both sides are
actually true.
Where do we start?
And so I'm a huge advocate fortesting, especially in
perimenopause.
There's different ways that youcan do that, and we can get
into some of those details, butultimately we need data.
We need data to understandwhat's happening with your
hormones.
Is this more of a lifestylething?
Is this actually a hormonedysfunction?
You know, and it gets, it canbe challenging because you have

(34:57):
to get into some of the thingsthat our our society and our
culture are not comfortabletalking about.
We have to talk about cycles,menstruation, symptoms.
We have to talk about sexualdysfunction.
Like we have to get into thesethings in order to understand
what's happening with yourhormones and your symptoms.
Only once you uncover all thesethings can you actually create
a plan to move forward,potentially with hormone
replacement, maybe optimization,maybe supplementation, you

(35:20):
know, maybe all throughlifestyle.
Yeah.

So it's lifestyle and hormones is kind of what
you're saying.
And it's it's some somewherealong that spectrum for each
individual.
So then still talking aboutthis population, and we can
include men in there too withtestosterone, because you
briefly mentioned TRT before, asit relates specifically to bone
health.
Are there any concerns?
Are there, you know, is it justa matter of if you need

(35:42):
replacement, that will alsohappen to help with your bone
health?

Yeah.
So TRT is a really interestingtopic.
I love talking to men abouthormones and testosterone
replacement.
It's, I think it's been, youknow, fortunately, like we're
not in the same, we're not inthe same problem with men as we
are in women, but it's still notgood where we are with men.
With women, I mean, there isno, there is no testosterone
product to even talk aboutcommercially, which is just wild

(36:06):
because it's such a hugemarket.
But for men, you know, at leastwe have products.
The question is, how do we doit and who do we do it in?
Um, I just redid thetestosterone protocols for Lyph
MD.
When they were done originally,they were very strict, treating
only the strict diagnosis ofhypogonadism, as some of the
guidelines would recommend.
But more and more research iscoming out showing that it's not

(36:28):
just total testosterone thatmatters if your doctor is even
checking it.
It's total testosterone, it'sfree testosterone, and it's
symptoms.
Now, both for men and women, wekind of get trapped having to
talk about sexual function,dysfunction, libido, et cetera,
which is fine.
We can talk about that.
But I also find for men thatlow testosterone is associated
with all of these otherpotential symptoms too, like

(36:49):
depressed mood, fatigue, lessvitality, vigor, inability to
maintain muscle mass.
Like a lot of these things haveother causes too.
And this is why the research isdifficult here.
But when you find a man who issymptomatic, the biomarkers fit,
and you put him on TRT,nine-day difference.
And it's it's awesome.

(37:10):
But it still has to be donecorrectly.
There's still this, you know,this recommendation generally
from especially the physiqueworld of like using AI to block
estrogen so you have moretestosterone.
And I think that's a mistakefor your bones.
I used to use aromataseinhibitors and uh not at big
doses, just to try to kind ofbalance things out.
But as I got more mature in mypractice, I realized I don't

(37:33):
have a single patient that Ihave them on now at all.
Like not one.
Because there isn't, therehasn't been a patient that I
couldn't just adjust their doseor adjust something else with
their metabolism, their detox ofthe hormones to help balance
out their hormones.
So I think it just has to bedone right, but it is massively
powerful for men.

Okay.
So that's really clear.
I mean, and it's consistentwith when, you know, men have
these numbers total, free, uhlow in general, and have other
issues related to strengthtraining, for example, where
again, we say it's not just thelifestyle.
I know I've seen men who, youknow, tick up their
testosterone, maybe 50, 100points through that, but then
they're still 300 or 400 shy onthe total.

(38:09):
Right.
Moving kind of up the chain tothe younger population, then,
because we started there.
What what do we want to talkabout with hormones?
Is there something preventativethat people need to be doing?

As you go younger, you mean?

Yeah.

Yeah.

Benjamin Button style.
Let's do it.

Yeah, yeah, yeah.
Okay.
So then uh yeah, I mean, as wego younger, I mean, I see low
testosterone in men, well, andwomen, but if we just talk men,
you know, into their 30s and20s.
I think there's a reallychallenging problem happening
with our, you know, in ourmodern culture, the environment
that we all live in is so toxic.
Too much stress is rampant,poor sleep is rampant, we're all

(38:44):
exposed to toxins all day long.
A lot of these are hormonedisrupting.
And so I, again, I see men, youknow, in their 20s with low
testosterone.
I mean, it's insane.
So we know that on average thisis happening in the population.
I'm probably in a biased spacebecause I'm a, you know, I'm a
hormone specialist.
So I see people who have aresymptomatic with low hormones,
but there's too many of them.

(39:05):
So I think I would encouragetesting.
If you have symptoms of lowtestosterone as a guy, or if
your hormones feel off, you'renot cycling regularly as a
woman, let's get some data,right?
We need to know what's goingon.
And then what do you do aboutit?
Well, I wouldn't at that ageprefer to start replacing
testosterone.
There's so many things we cando when it comes to lifestyle,

(39:26):
you know, optimizing all thesethings that we've talked about
already, and potentially someother treatments, you know,
things like clomophene that it'soff label, like things where we
can help to sort of hijack thesystem, get it going, and then
hopefully not need apharmacologic therapy as you get
into midlife.

Yeah, that those are good guidelines in general,
right?
The younger you are, hopefullythere's more you can intervene
with naturally.
Right.
If that word can be used, uhlifestyle.
So you have a framework,because I do like frameworks and
helping people understandtimelines here.
And you know, when you go fromscanning to intervention, and I
understand this changes by age.
I know you have a frameworkhere for our method, right?
Recognize, reverse, retest,revive.

(40:03):
Maybe we can tie that into aprocess.
Yeah.
Um, folks listening here, theylike to collect data, figure out
things, experiment.
Um, how does that fit intothis?
And what do timelines looklike, maybe for a I'll say
typical person listening to thisshow in their 40s?

Yeah, absolutely.
So this framework was reallydeveloped for people that have,
you know, some low bone density,osteopenia, osteoporosis.
They want to figure out what'sgoing on.
One of the biggest challengesin the conventional system with
osteoporosis as a diagnosis isthat once you have it, there's
really no specialist inosteoporosis in the conventional
system.
Thinking about orthopedicsurgeons before, like, they're

(40:39):
not specialists in bone health,really.
They're specialists in puttingimplants in bones, you know,
endocrinologists,rheumatologists, internal
medicine, like nobody wants it.
And there are specialists inbone drugs, but they're not
really specialists in bonehealth.
And so it's a reallyinteresting space.
And so, you know, what happensis when you start talking about,

(40:59):
you know, okay, I have low bonedensity, I have osteoporosis.
What do I do about it?
Your doctor says, well, youeither are or are not a
candidate for a drug, and that'sit.
They might do some additionaltests to make sure that you
don't have something like aparathyroid tumor that would
result in bone loss.
You know, some of these clearthings like celiac disease, you
know, do you have symptoms ofthat?
Should we test for that?
Because that causesosteoporosis.

(41:20):
But once you get those thingsoff the table, then they just
say, Well, I don't know why youhave bone loss.
This is part of aging, and youeither are or are not a
candidate for a drug.
I think that's a huge mistake.
And I don't blame the doctors.
This is how they're trained.
And, you know, they're again,they have drugs and surgery to
use.
But if you want to do thisnaturally, if you want to do
this from a comprehensiveperspective, you need to sort of

(41:41):
take a different angle.
So this is where we createdthis four-hour method.
And the first R, as you said,is to recognize why you're
losing bone.
Why are you losing bone?
Go back to the longevityconversation we had at the
beginning of this talk.
If you're losing bone,something's wrong.
What is it?
Is it a dietary thing?
Is it an absorption thing?
Is it a gut health thing?
Is it a hormone thing?
It could be a lot of things.

(42:01):
And the way you figure that outis by asking the right
questions and getting the rightdata.
And then once you do that, thenwe oh gosh, what's the second
R?
Recognize reverse.
Thank you.
Goodness.
I usually have it in front ofme when I talk about it.

unknown (42:14):
Oh, good.

Uh the second R is to reverse.
So then you want to reversethose causes of bone loss.
And this is actually what Italk about when I'm talking
about reversing osteoporosis isreversing the causes of bone
loss.
Eventually your T-score willget above negative 2.5.
That's the threshold that theWHO set as the diagnosis.
But that's actually, I'm notthat worried about that.
Right.
If your T-score is negativefive and you go from negative

(42:36):
five to negative three, you arereversing your osteoporosis.
And I'm excited for you aboutthat.
So then you have to make thatplan.
And that plan is going to belike we just talked about.
I have that pyramid, it'slifestyle, it's hormone
optimization, it'ssupplementation.
And then and only then, onceyou've done those things,
potentially move on to like apeptide or a drug.
Right.
So that's the second R.
And then the third R is toretest.

(42:56):
I can't tell you how many timesI've seen women and men who get
a diagnosis, they decide to dosomething.
Maybe it's a supplement, maybeit's an exercise program or
whatever.
And then they just stick theirhead in the sand and they don't
retest.
That is such a mistake becausethey're going to get a DEXA
again in two years or maybemore, maybe like four or five
years, and realize that theirplan didn't work.
There's so many things that wecan measure, right?

(43:18):
So if you identify that avitamin deficiency, like your
vitamin D deficient, okay,that's an easy fix.
But then you need to retestthat and make sure that you're
headed the right direction.
Same thing with hormonedysfunction, hormone deficiency,
postmenopausal woman.
Let's get you on HRT if you'rea good candidate for that.
But do you have enoughestradiol in your system?
Are you absorbing it wellenough through that gel or that

(43:40):
patch in order to actually havethe impact on bone that you want
to have?
We can measure these things.
So let's test it.

I'm sure it depends on the intervention, but what
test cycles are we talkingabout?
Three, six months, a year?

Yeah, it does depend.
So something like, you know, ahormone, if you were to start
estradiol as a, let's say awoman who starts an estradiol
patch in an oral micronizedprogesterone capsule, I can
check her hormone levels nextweek, you know, and they're
going to be different.
I wouldn't, that's too soon,but just give you an example.
But if you're talking aboutbone turnover markers, you're
going to want to give it acouple of months.
If you're talking about, youknow, some of the things are

(44:11):
going to take longer, like howlong does it take for magnesium
to come up?
How long does it take forhomocysteine to go?
Like it just depends on whatyou're looking for.

Okay, great.
Yeah.
Just wanted to clarify it's andit's not like four years, you
know.

Right.
Well, that and that's thething, is that's too long
because that's DEXA, right?
So DEXA is recommended everyone or two years.
And two years is way too long,in my opinion, to A, do any
intervention without knowingit's working, and B, just like
that's a long time.
So for sure.
All right.
Yeah.
Yeah.

So go on to the last R and revive.

So the fourth R is to revive your life.
And I just I love this onebecause even as an orthopedic
surgeon, watching my patientshave a hip fracture go through
the process of recovery.
And remember that not all ofthem survived, right?
A third of those patients onaverage are going to die.
Two-thirds of them are going tolose their independence.
This is a big deal.
So watching them recover isdifficult from a surgical

(45:03):
perspective.
But watching them recover fromtheir fear and anxiety if they
didn't fracture, that's muchmore rewarding, honestly.
But it's also much easier to dobecause you still have your
body intact.
And so this is the this reviveyour life so you can live
without the fear of fracture.
Get away from that fear, thatanxiety that you're going to sit
down in your car and break yourback, that you're going to pick
up your grandchild and you'regoing to break your spine or

(45:24):
your hip, right?
You're going to be out hikingon your own, you're going to
fall, break your hip, and you'regoing to die out there
overnight.
I hear these things every day.
So that fear and anxiety isreal.
So that's what we want to getyou to is to get back to the
things that you love to do tocreate the memories that you're
here to create.

That's the message here, man.
That's awesome.
I mean, I think osteoporosisputs fear in some people's heart
as this binary precipice thatyou fall off of, and now you're
you're ruined for the rest ofyour life.
Your bones are beyond repair.
And this message that you canreverse it and not only reverse
it, but do it fairly quickly ifyou do the interventions and
start to see that is a veryempowering and very, you know,

(45:59):
uh optimistic.
And so I guess maybe to wrap uphere, because this is a great
message to end on.
Is there a story or an avatarthat you could share with the
audience?
You know, I you work withpeople all the time, but just so
they can kind of viscerallyfeel what that looks like.

Yeah, sure.
Yeah, one of my favoritestories, uh, I talk about her a
lot.
She was actually on stage at myuh last live event in February.
Her name's Robin.
And so she was one of our, oneof our earlier patients.
So she came in right at the ageof 51, had gone through
menopause.
I believe she had a familyhistory of breast cancer.
So she was decided she was notgoing to start on HRT.
I forget why she got screenedfor osteoporosis, but she got

(46:36):
adexa and she had prettysignificant osteoporosis of her
spine.
Hips, low bone density, notterrible, but still she was
blown away.
I mean, just changed her life,right?
Young, active, I mean, veryyoung at heart.
I mean, you've if you look ather, you would think that she's
probably 30 years old.
Entrepreneur, great family, youknow, two young daughters.
And this totally changed herlife.

(46:57):
Fear, she didn't know, youknow, could she do all the
things that she wanted to do?
So she came and worked with us.
This was clinically as apatient, and we did all the
lifestyle stuff that you andI've talked about.
And she did a great job,improved her stress.
Again, entrepreneur, how do youdo that?
It's difficult.
Um, improved her sleep, stoppeddrinking, really changed things
around, worked on her guthealth.

(47:18):
We did start her on HRT becauseI reassured her that a history
of breast cancer in an immediatefamily member is not a
contraindication to starting onHRT.
And so we started her on HRT.
It took us a while to get thatoptimized.
But in the first 12 months,with just those interventions,
we saw her hips improve, Ibelieve 6% and 7% left, right,
which is a lot on ADEXA.

(47:39):
That's a ton on ADEXA in 12months.
It was amazing.
And I love the story becauseher spine actually got worse.
So her spine actually went downby about 4%.
And I share the story, not toshow my failures, but to say
that we said, okay, well, mygoodness, you seem to be doing
all the things.
What are we missing?
And this is great for youraudience because what we were
missing was she didn't tell usthat she had back pain.

(47:59):
She had an old back injury.
She was afraid to load herspine.
So we were talking aboutloading her spine, you know,
talking about putting a barbellon her shoulders, but she wasn't
doing it.
So she she worked with ourexercise physiologist and like,
okay, let's figure out how toload your spine without hurting
it.
So she was able to do that.
And then the next year she wentfrom a negative, she was at
negative three, two at thatpoint.
I think she went from negativethree, two, it was something

(48:21):
like negative two, four.
I mean, some massive leap.
It was almost 20% on inner bonemineral density.
And it was just amazing.
Because we clearly had all ofthe pieces in place, right?
She called me when she left theimaging center.
This is back when I used togive my phone number to all my
patients.
She called me when she left theimaging center.
I mean, just bawling becauseshe felt that all of that fear,

(48:42):
all of that anxiety was gone.
It's gone.
And then what's cool is thatnow, so we have now another year
of data, and her DEXA continuesto get better, right?
So now she's definitely nolonger osteoproduct.
She has reversed herosteoporosis.
She's barely even osteopenic atthis point.
She will, if she'll continue onthis trajectory, she will have
normal bone density in the nextcouple of years.

(49:02):
So she has taken this thing,this precipice, like you said,
she was on the other side.
She was falling into the craterand just climbed right back out
of her own will.
She just needed the rightinformation.
And she climbed right back outand she has recovered.
She has lost that fear, thatanxiety, and is back to living
her life.

That's awesome.
Yeah.
And it sounds like, you know,the information was great.
And obviously the support youguys gave her and kind of
recognizing that she was afraidof part of that, which is a
very, very common fear we talkabout all the time, which is you
have pain, back pain,especially, um, is one of the
most common.
And there's a fear that doinganything with your back is going

(49:40):
to make it worse.
So I love that you guys wereable to support her through that
and say, okay, this the data istelling us something isn't
working.
We know this stuff does work.
So what's missing?
And then go ahead and do it.
Right.
Really love that.
Everybody listening, I'm sure,is hopeful, especially the women
who, you know, write in withconcerns about uh bone health.
And I'm I'm always tellingthem, hey, just go lift weights.
Like I have no problem.
I don't feel like I'm taking arisk doing that because I know

(50:02):
how valuable it is.
It's just doing it right andhaving right form and building
into it.
So is there anything I didn'task you in this whole context
that's super important that youwant to?

So I think this is a really important one
because we probably have someaudience members who have
osteoporosis that are afraid tolift weights.
And so I I'd love to talk aboutthis.
It it kind of gets me introuble.
But I just had a communitymember today.
She was uh talking aboutanother uh another provider
who's actually talking aboutpelvic floor health.
And this pelvic floor providerwas talking about doing, you

(50:31):
know, like cat cow exercises ofthe spine and then how that
relates to the pelvic floor.
But she said, Oh, well, I wastold with osteoporosis I can't
do cat-cow.
Right?
And I'm like, wait, like youcan't bend your spine.
I mean, I understand you don'twant to load in a flex position.
There are some things thatwould not be wise that could

(50:52):
potentially put you at risk.
But cat cow is just a that's aI mean, this is a normal range
of motion thing of your spine.
Like if you are that fragile,then you would fracture just
standing up.

unknown (51:02):
Right.

And so it this is really hard because doctors
will scare people once they getthe diagnosis to say, don't lift
more than whatever theirarbitrary number is, five
pounds, 15 pounds, don't liftmore than 15 pounds, you know,
take calcium and vitamin D andtake this drug.
And that's what they tell them.
And then they're afraid to doanything.
But what we know so clearly isthat if you're gonna build bone,
you have to load it.

(51:24):
Then how do you do that safely?
And we actually used to backaway from exercise in our
program because it's allvirtual.
And you know, I was hesitant,like somebody's gonna fracture,
you know.
But what we realize is that wecan't back away from it.
We just need to, you know, faceit head on.
And so we have a program thatis very fundamental, very
rudimentary, because we have somany of our community members

(51:45):
who have never lifted a weightever in their life.
So they can come in, butthere's so many things that you
can do safely, right?
Watch a video, you can laydown, you can lift something,
you can do it in a way whereyour spine is neutral and you
start somewhere.
Pick that point carefully.
But once you start there, thenit's just all about progressive
overload, just like everythingelse, right?
And so, have I ever seen afracture?

(52:06):
I had one person recently whodid have a fracture, and it
wasn't because she was followingand just fractured um
accidentally.
What she did, she was doing abarbell back squats.
You can imagine she was alreadypretty advanced, right?
She was training with herhusband.
She didn't take her husband'sweight off.
Well, she said he didn't takehis weight off.
So I'll let them figure thatone out.

(52:26):
But she she unracked it andthen didn't rack it back.
She just said, well, well, youknow, I guess I'll try it.
And then it was clearly way tooheavy for her.
Uh, and so she did actually endup with a fracture of her uh
somewhere on her spine as aresult of that.
But that was just bad decisionmaking.
That wasn't because ofexercise, right?
And so, you know, I havewatched women who have never

(52:48):
lifted a weight, work their wayup to doing barbell deadlifts,
barbell, you know, overheadpress with severe osteoporosis.
Like that's the only way thatyou're gonna get better.
But I know that somebody'sgonna listen to this and go do
something and have a fracture.
So, you know, doctors need tosay what they need to say to
protect themselves.
But uh, if you are trying toimprove your bone, you need to
understand that you have to picka safe starting point and

(53:09):
progressively overload.
It's the only way you're gonnado this naturally if you're
trying to do it naturally.

Exactly it.
You have to ladder your way up,listen to what Dr.
Doug is saying.
Go check out our episode withDr.
John Russin as well that we dida few weeks back.
Same concept.
We talk about it here.
It's like heavy isn't heavy inabsolute terms.
It's heavy for you, which couldbe, you know, a dowel, right?
It could be a body weight.
So start where you're at andbuild from there.
Okay, awesome.
Uh, this has been a greatconversation, Dr.

(53:35):
Doug.
Tell us where folks can reachout to you.
I know there's like 10different things that you you've
got going on.
So, what's maybe one or two ofthe best places to take our
listeners?

Yeah, I think uh two things.
So if you want informationabout osteoporosis, I would just
check out the YouTube channel.
So the Dr.
Doug show, Bones, Hormones, andHealthspan, this is all about
bone health and hormones.
And we're really trying todouble down on that content.
So this is the place to go ifyou want to learn about anything
specifically through the lensof osteoporosis.
If you're looking for support,we're still building out our

(54:05):
bone health programs at LifeMD.
So clinically, I don't haveanything to offer you right now,
but our community is all thatprobably most of you need if you
have the problem.
You just need the rightinformation and the right
resources.
That's the osteocollective.
And you can just go toosteocollective.com, check it
out there.
You can join our freemasterclass.
You could do, you know, all thestuff that we have out there

(54:26):
available.
Would love to see you in ourcommunity if you have
osteoporosis or concerns aroundit.

Awesome.
So the YouTube channel, which Ithink is at dr underscore Doug
Lucas, which we will include inthe show notes.
So you can just tap it.
If you're listening to theshow, just tap it.
And then Osteocollective willalso include that as well.
You can Google it or go to thewebsite that Dr.
Doug said.
All right.
So that was a fantasticconversation.
Great guest.
I really appreciate your time,Doug.
Um, I learned a lot, which isselfishly one of the goals when

(54:52):
I have a guest on, and uh then Ican spread it to everyone else
in future episodes.
So thank you so much for comingon the show, my man.

Awesome.
Thank you, Philip.
Appreciate it.

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Why BONE Strength Is As Important as Muscle for Longevity (Dr. Doug Lucas) | Ep 409

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Why BONE Strength Is As Important as Muscle for Longevity (Dr. Doug Lucas) | Ep 409