April 24 Nutrition from Food vs Supplementation

April 24, 2024


Session Notes

Nutritional Supplements and Bone Health

Supplement Decision Process  

*   Dr. Doug discussed the evolution of supplement recommendations in their practice, moving from high supplementation to a more strategic approach using biomarkers and functional testing.


*   The goal is to target supplementation based on true deficiencies, functional testing, or mechanisms that make sense even without a biomarker.


*   The practice creates a comprehensive document listing potential supplements, which is then refined by removing less critical ones based on biomarkers and patient preferences.


Importance of Tracking Nutrient Intake  

*   Breta emphasized the importance of tracking nutrient intake to ensure patients are getting the necessary nutrients and to help in making informed decisions about supplementation.


*   They use tools like Chronometer to track food and nutrient intake, which can be helpful for understanding overall calories, macros, and to some extent, micronutrients.



Supplements and Nutrient Absorption  

*   Dr. Doug mentioned that even with a good diet, most people are deficient in certain nutrients due to lifestyle demands.


*   They prefer targeted supplementation over multivitamins, as multivitamins often contain suboptimal forms and amounts of nutrients.


Specific Nutrients and Supplementation  

*   **Calcium**: The practice has shifted to recommending whole food sources of calcium, like Algaecal, which includes other beneficial minerals.


*   **Vitamin D**: Discussed the importance of vitamin D and its role in calcium absorption and bone health.


*   **B Vitamins**: B vitamins are commonly supplemented due to widespread deficiencies. They are moving away from serum B12 as a marker and towards methylmalonic acid (MMA) for a more accurate assessment.


*   **Magnesium**: Magnesium is supplemented across the board, with a preference for forms like magnesium bisglycinate over oxide due to better absorption.


*   **Omega-3s**: Omega-3 supplementation is common unless someone consumes a lot of fish and is monitored for heavy metals.


Protein and Collagen Supplementation  

*   Dr. Doug prefers natural food sources for protein but acknowledges the convenience of protein powders.


*   Whey protein is well-studied and beneficial if tolerated. Beef protein is an alternative, and plant-based proteins are considered less optimal due to absorption and amino acid profile concerns.


*   Collagen can be counted as a protein source, as it is nearly complete except for tryptophan, which is not commonly deficient in diets.


Other Discussions

*   **Caffeine and Bone Health**: Dr. Doug will look into the effects of caffeine on bone health due to patient interest.


*   **Vitamin A Toxicity**: Dr. Doug clarified misconceptions about vitamin A toxicity, explaining that most people are deficient in retinol, the active form of vitamin A, and toxicity concerns are overblown unless consuming large amounts of liver.

Q&A Highlights

*   **Supplements on an Empty Stomach**: Most supplements do not need to be taken on an empty stomach, except for thyroid medication.


*   **Boron Supplementation**: A liquid boron supplement from Trace Minerals was recommended for those who need it.


*   **Supplement Timing**: It was suggested to spread out supplement intake throughout the day if taking them all at once causes issues.


00:00:22.475 --> 00:00:31.964

Breta Alstrom: the nature of the topic here. But we'll get a good perspective. And hopefully, that helps all of you make some good choices around what you're eating and when you're supplementing.


00:00:32.035 --> 00:00:33.485

Breta Alstrom: So


00:00:35.665 --> 00:00:44.115

Breta Alstrom: I think we'll start out with kind of the overarching question for Dr. Doug. But what's the process of deciding what supplements people get. In the first place.


00:00:44.735 --> 00:00:45.095

Dr Doug: Yeah.


00:00:45.255 --> 00:00:48.015

Dr Doug: yeah, this is something. I think we've really


00:00:48.705 --> 00:01:01.975

Dr Doug: we. We've changed and kinda gone full circle. And now we're, I think we're like full circle plus a half circle on how we do this in the practice so early on I was such a big advocate for supplementation, because I saw so many deficiencies.


00:01:02.005 --> 00:01:28.144

Dr Doug: and with my training and orthopedics. I joke with this to my team. But it, we have this joke in the orthopedic world that if something doesn't fit, just get a bigger hammer, you know, you just hit it harder, and it'll go in so when I started in this in the functional space, talking about nutrition, talking about training, talking about supplementation, we were. People were resistant to making changes. So I thought, well, let's just use the tools we have, and we'll just hit it with a bigger hammer.


00:01:28.255 --> 00:01:42.954

Dr Doug: But, as everybody here probably knows, you run into ceilings as far as how many supplements somebody potentially can take. And then, of course, there are side effects of supplements. And you start running into all these issues when you're adding, you know dozens and dozens of capsules.


00:01:42.995 --> 00:01:45.595

Dr Doug: So we backed away from that pretty quickly.


00:01:45.765 --> 00:02:09.305

Dr Doug: We started getting much more strategic. We started using our biomarkers differently. We started using functional testing differently. And so now, we're really trying to be as targeted as possible, based off of either a biomarker of true like seeing true deficiency, functional testing, suggesting deficiency, or potentially even using something where we don't have a bio marker. But the mechanism makes sense. And I can explain all those things.


00:02:09.315 --> 00:02:11.935

Dr Doug: And I think we've kind of gone


00:02:12.065 --> 00:02:29.195

Dr Doug: to one extreme of trying to use as as few supplements as possible in really focusing on lifestyle. But then, also finding a barrier there with the amount of change that somebody can make from a lifestyle perspective with all the limitations that potentially you can have with lifestyle. So then. Now we're kind of back


00:02:29.865 --> 00:02:50.094

Dr Doug: not to where we were. But we're using more now than we were, you know, whatever, 6 months ago, and still just trying to find that sweet spot. But for us it's really just a. It's a customized thing, you know, everybody's gonna have different capacity to to take supplements our approach when we create the document as the the patients here can attest is like


00:02:51.075 --> 00:03:14.014

Dr Doug: you, you see the document of all the potential things. And it's huge. Yeah, you have, you know, there's dozens and dozens of things on there. But then we go through it, and we start peeling stuff away. And we say, well, this doesn't have a bio marker. This isn't low hanging, for this is probably too many, you know, this isn't as important, and we we try to. We try to decide which ones are most important, and then we let the patient ultimately choose how many things they're willing to take, and unfortunately


00:03:14.205 --> 00:03:29.194

Dr Doug: cost also will then play a role when some of these things are not cheap. So all that. Yeah, thanks, Angela. It says exactly what I was. Gonna say so, Angela said, not to mention draining my wallet. Exactly. Yeah, it does. It drains a wallet. And you know, people have different tolerance levels for that, for sure.


00:03:29.665 --> 00:03:54.655

Breta Alstrom: Yeah. And that's, I think one of the core components of our program, too, is, we do have people track their intake. So you know there's some degree to which we can say, Okay, if you're, you know, not symptomatic. Are you getting the things that you need? But I do think that's a question we'll kind of circle back to, because it will walk down that line a little bit. But there is a difference, too, between you know what you need to take in versus what you might have symptomatic


00:03:54.655 --> 00:04:00.984

Breta Alstrom: terms of, and there is some power to the pure dose of supplements as well. So


00:04:00.985 --> 00:04:09.625

Breta Alstrom: making sure that we can manage all of that in the big picture is really helpful. And a lot of that stuff, too, is like what your dieticians are looking at as well, or


00:04:09.965 --> 00:04:23.924

Breta Alstrom: when you're having your reports put together by your provider, or like how we're assessing labs right? Like you're looking for some of those common threads, like, if you see XY and Z, that are all treated by magnesium. Well, hey, maybe you need more magnesium. So


00:04:24.135 --> 00:04:25.054

Breta Alstrom: just yeah, yeah.


00:04:25.055 --> 00:04:33.254

Dr Doug: And, Brett, I'm going to interrupt real quick. I saw some comments in the chat. So, Aranga, you mentioned that supplements are upsetting your gut, so it's pretty common.


00:04:33.255 --> 00:04:57.554

Dr Doug: And so, especially when we have, you know, however many we started all at one time, you know, layering them in one at a time. And then, if they're still bothering you working with the team because we've been doing this for years, our our dieticians are well trained to look at kind of what supplements are likely to be causing stomach discomfort, which ones need more food, which ones you can take on an empty stomach, etc. So make sure you're reaching out to the team, and they can definitely walk you through that.


00:04:58.275 --> 00:04:58.955

Breta Alstrom: Yeah.


00:04:59.815 --> 00:05:17.874

Breta Alstrom: So on the side, we did have a really good question, too, about chronometer, which I think we'll probably need to dedicate like an entire talk sometime to chronometer. But they did want to know if you feel like that's a sufficient tool for the supplements that they take, and if you use chronometer.


00:05:18.565 --> 00:05:20.765

Dr Doug: Yeah, boy.


00:05:20.915 --> 00:05:24.691

Dr Doug: talk about something that is has a double edge to it.


00:05:25.315 --> 00:05:40.084

Dr Doug: so I use. I do use chronometer. I think it is sufficient, but not necessary. If that makes sense, it is a great tool, and depending on where you are in the journey. If you're new to tracking food at all. Oh, my gosh! You'll learn so much!


00:05:40.094 --> 00:05:41.505

Dr Doug: Number one.


00:05:42.025 --> 00:05:47.925

Dr Doug: You'll learn how frustrating it is to enter food into chronometer, and that's not just chronometer. It's everything. My fitness. Palette doesn't matter what it is.


00:05:48.771 --> 00:06:12.424

Dr Doug: All of them are similar, but once you get over that hump of learning how to put food into a a tracker like that. Then you really start to get a sense of, you know, total calories, total nutrition. I think it's really good for overall calories. It's really good for Macros. It can be okay for micro nutrients. But I I don't think. And, Brett, you can help me here, cause I don't actually look at this with with patients. But


00:06:12.425 --> 00:06:19.144

Dr Doug: looking at the micronutrient composition of a diet through chronometer, I don't really know how that works, but from a macros perspective.


00:06:19.595 --> 00:06:23.565

Dr Doug: Over and over and over again we see people that will start to track for the first time


00:06:23.725 --> 00:06:33.854

Dr Doug: and be like, oh, I thought I was getting adequate protein, but I'm getting 60 grams a day, you know, or I thought I was eating enough enough food, and I'm getting 800 calories a day. My gosh! How did I ever get this low?


00:06:33.855 --> 00:07:00.104

Dr Doug: And so you can see these big, glaring things with chronometer now using it forever is there's a whole behavior side to that. I'm someone who's used it off and on for years. I still find it helpful to track food whenever I have a specific goal in mind. But some people are just not willing to drag, or you could actually get really unhealthy with it from a mental space. So there's definitely 2 edges to this thing. But it is a tool for sure. You wanna talk about micronutrients and chronometer.


00:07:00.105 --> 00:07:02.586

Breta Alstrom: Yeah, can you actually make screen sharing? An option.


00:07:02.835 --> 00:07:05.555

Dr Doug: Sure. Can I wonder if we can change that in the settings?


00:07:07.215 --> 00:07:08.424

Dr Doug: But you got it now?


00:07:08.535 --> 00:07:09.225

Dr Doug: Well.


00:07:09.425 --> 00:07:26.891

Breta Alstrom: So I did prepare a couple of days of what our Ostia process meal plan looks like the I only did days one through 3 and hold on. You'll see my screen in just a second just as an example. So you guys can kinda see what we are looking at here.


00:07:27.825 --> 00:07:30.314

Breta Alstrom: but in chronometer


00:07:30.615 --> 00:07:32.625

Breta Alstrom: you can see that


00:07:32.855 --> 00:07:48.774

Breta Alstrom: this is day one. Now keep in mind if there's anything that you have to cook, none of the fats and oils for things that you had to cook were incorporated into this plan. So just it might be like a little bit light on things like fat and this is also like the lowest protein day that isn't on the meal plan.


00:07:48.785 --> 00:08:04.255

Breta Alstrom: But when we come down here you can see all these micronutrient targets. And so, you know, we're doing pretty well here, and you can review to kind of see like where we might need to fill in like vitamin d is pretty low, but we know vitamin D is really challenging to get through food, anyway.


00:08:04.507 --> 00:08:27.974

Breta Alstrom: And then we have all of our minerals. So we're definitely meeting our calcium needs. But depending on how much iron you need, which, you know, is a little bit of a controversial topic. You know those kinds of things we can play around with, and same thing like we're almost there on the magnesium. But I do think these are nice to just kind of see like, am I closing the little circles here? Am I doing that? And then when we're looking at the bone health, we're at 89%


00:08:28.223 --> 00:08:32.454

Breta Alstrom: cause. We're a little low on the magnesium, and we're very low on the vitamin D, so


00:08:32.785 --> 00:08:44.464

Breta Alstrom: those things might be things you're considering supplementing, anyway. But you can definitely use this as a tool like that. If your I recommend looking at the individual days.


00:08:44.625 --> 00:09:13.084

Breta Alstrom: unless you have like, been very diligent about tracking an entire week and every single thing for the week, and then you can run like reports and get your averages. Which again, is a conversation for another day. But I do think Spot checking days is just a lot more efficient to kind of see how you're doing. You can see it's a little bit different. On the second day we are getting more nutrition overall. A couple of 100 extra calories more protein here. But then we're just missing out on a little bit of full late.


00:09:13.085 --> 00:09:24.205

Breta Alstrom: So fully, it's really easy to. Well, we would actually opt for yeah. Well, Fo, fully probably a methylated fully. But that's a really easy one to get in through supplementation. You're probably gonna get that, anyway.


00:09:24.715 --> 00:09:29.424

Breta Alstrom: And if we look at the third day we're a little shorter in some different things, so


00:09:29.585 --> 00:09:43.855

Breta Alstrom: just based on how comprehensive your nutrition is. And I will also say this meal plan in particular, like I've said in the nutrition chat on slack is lowering carbohydrate. So the lower you are in carbohydrate.


00:09:44.395 --> 00:10:02.504

Breta Alstrom: depending on your protein intake, and from what sources you're getting your protein. You might need to supplement a little bit more. If you have a higher carbohydrate intake, you're probably gonna fill in a lot more of these gaps, too. So just keep that in mind. But it's just a good picture on all the different ways, like you can kind of see how the nutrients stack up.


00:10:04.475 --> 00:10:11.584

Dr Doug: Yeah, and a couple of pointers that I've I've learned even just recently, because I've been using this off and on for years. But even recently, I've


00:10:11.675 --> 00:10:37.865

Dr Doug: I'm working with a coach who has encouraged me to to really take a different look at it. And so we played with some of the different settings, things that we aren't necessarily using in the practice cause. We're a little bit of a different focus with me. But the biggest thing I've learned recently is is just. If you want to track over time, the more days, the better the more consistency the better. And even if you're eating a meal that feels absolutely impossible to track like. Oftentimes I'll go out to dinner with my wife, and we'll get like.


00:10:37.865 --> 00:11:00.534

Dr Doug: you know, just a bunch of little things. I'm like, you go out to Topus, and it's like I just had 15 different little plates in front of me, and there's absolutely no way I can track this just ballpark it just like pick the most nutrient dense things. Put it on there, don't, as my coach says, don't don't air, Macro. It just put something down so that you can at least get an idea of what you're consuming, and then move on. You don't have to be perfect, but consistency is better than missing.


00:11:00.965 --> 00:11:10.005

Breta Alstrom: Yeah, 100%. And that's yeah. That's the the thing that makes pulling that overarching data. The hardest is the inconsistency and tracking so


00:11:10.391 --> 00:11:18.945

Breta Alstrom: and then, like, I said, you can definitely like if I hold on, let me. Just. I can break down these meals a little bit differently.


00:11:19.945 --> 00:11:45.514

Dr Doug: Yeah. And that's something she can do like when when you put in meals like this, especially if you're okay with eating the same thing over and over again. You can make great meals and then make them the same over and over again. And then that's part of that learning curve. I tend to make really simple meals, so I don't need to do that. But people that like to actually cook. I'm sort of like a one ingredient kind of guy. But for people that like to actually cook and make meals, then you can plug them in here one time and then keep using it over and over again.


00:11:46.115 --> 00:11:52.265

Breta Alstrom: Yes, yeah, which I think is the most helpful thing. And I so to see, like


00:11:52.425 --> 00:12:10.544

Breta Alstrom: you can see what your sources are if you just hover over these, you can see, like your higher source of B 6, you know, is potentially this, like tuna salad, like. So you can get all of that information. So you can say like, Well, actually, you know, maybe if I were to increase my intake, of which I find this is more helpful, for like


00:12:10.836 --> 00:12:36.745

Breta Alstrom: generally or fat, but, like, you know, you can say, Okay, well, I actually had a half of a cup. Could I have 3 quarters of a cup. And then I'd actually meet my needs. Or for people that do need like a saturated fat restriction. A lot of times. It's just looking at. Okay, where is my saturated fat coming from? And then could I actually cut that source in half? And then, or like it, could be like super super small change. And then you're meeting.


00:12:36.745 --> 00:12:39.355

Dr Doug: Yeah, that's cool. I've never done that.


00:12:39.655 --> 00:12:58.721

Breta Alstrom: Oh, yeah, this is like the most helpful thing. This is the, I think one of the best values of chronometer is looking at the micro. So instead of getting like these big overarching recommendations like, eat less of this food, eat more of this like, eat more vegetables, eat less ready, or whatever.


00:12:59.075 --> 00:13:00.484

Dr Doug: Just not that, Brett. It's an Instagram.


00:13:00.485 --> 00:13:30.095

Breta Alstrom: Yeah, you can literally go into your diet and say, Okay, this is the one thing that's putting me over. Like I've had patients before who they did need like a saturated fat restriction based on their genetics. And so the only time they ever went over their genetics was when they had chick-fil-a. So it was like super clear to just be like, if you just wouldn't have had chick-fil-a today, you would have been totally within your saturated fat limits. So it really helps make strategic and very specific and clear goals, which is what I like.


00:13:30.527 --> 00:13:33.915

Breta Alstrom: And it makes it nicer when you're trying to make choices, too.


00:13:35.145 --> 00:13:41.935

Breta Alstrom: there's I mean, a ton of other value to chronometer. The other thing that you can do is use it to like. Often. Oftentimes we


00:13:42.055 --> 00:14:01.095

Breta Alstrom: track retrospectively, but we can also plug things in prospectively, so you could come in here. You can see I've tracked these into the future and then you would already have that stuff in there. You could know what you wanted. Your data look like you could tweak it already and then make your food based on what's hitting all your goals? If that's something that you're interested.


00:14:01.095 --> 00:14:08.285

Dr Doug: Can you also use? I know my fitness, PAL does this. But can you use the pre-enter data to create a shopping list?


00:14:09.101 --> 00:14:15.685

Breta Alstrom: I would have to double check. I don't normally do that but I don't see why you couldn't.


00:14:15.905 --> 00:14:34.344

Dr Doug: Yeah, I worked with a group. And they were huge advocates of basically like putting everything in your tracker on Sunday. So you know what you're eating at every meal. That's a little too controlling for me. But they saw a lot of success with people that are willing to do it. So if you're struggling to get in the right food, that is a tool that you could potentially use.


00:14:34.590 --> 00:14:52.724

Breta Alstrom: Yeah, even just to help you with planning instead of being like you know, I think most people get to the end of the day, and they're like, Oh, no, I'm 50 grams short on protein versus like. If you just would have like outlined things a little bit, you could have like hit your goal really easily without have been like trying to shove in, you know, 2 chicken breasts at dinner. So


00:14:53.295 --> 00:15:05.701

Breta Alstrom: yeah, so just a little overview of chronometer, since that was a a big question. But we'll we can do a deep dive on chronometer some other day, cause there are like a ton of features in here. But just as like a tiny little overview.


00:15:05.965 --> 00:15:25.855

Dr Doug: And I think we actually have that scheduled at some point for you to do like a full on chronometer full hour. Another quick announcement. I just got confirmation, too, that Nick Truby is gonna do Dr. Nick Druby is gonna do an Hsn session on exercise. So that'll be a fun one for you guys, too. We'll let you know when that's scheduled. It's sometime in May, I think.


00:15:26.815 --> 00:15:27.645

Dr Doug: yeah.


00:15:27.645 --> 00:15:40.845

Breta Alstrom: Yup, that will be in May. That'll be a great a great talk so excited for that one. You can also individually add supplements in there, and there are time saving tips


00:15:41.318 --> 00:15:52.124

Breta Alstrom: as well. But I feel like we're gonna save that this is just part of the question that we had. We'll save that for like a full, deep dive, because we could literally spend all day today talking about chronometer.


00:15:52.165 --> 00:16:03.165

Breta Alstrom: So outside of chronometer how can you know if you're getting enough nutrients through food other than lab data, of course, which we know we don't always get


00:16:03.765 --> 00:16:08.454

Breta Alstrom: all the nutrients from our lab data, anyway. So any thoughts on that.


00:16:08.995 --> 00:16:25.964

Dr Doug: Yeah. So we we do do a couple of we do. Do we use biomarkers in serum and blood for a couple of things? But oftentimes what you're really seeing is just what's happening in the blood at that moment. So one of the ones actually, that we're changing is is serum B, 12.


00:16:25.965 --> 00:16:33.715

Dr Doug: So all the patients that are here, you've had a Sermb 12 marker and a Sermb 12 marker basically just tells you what you just ate, or the supplement that you just took.


00:16:34.005 --> 00:16:58.705

Dr Doug: So it's not a good marker of B 12 over time. So we're switching to another marker called mma, or methylmalonic acid, which is the B. 12. I won't get into the details, but basically, if you don't have enough B 12, your mma will go up or down whichever way. So the you can use markers that are sort of the byproduct of the presence of the thing, and some of those are, gonna be more available and more accurate. But there aren't that


00:16:58.705 --> 00:17:21.385

Dr Doug: that many biomarkers that we can use in blood. So that's when we kind of get into functional testing and doing things like a nutri evol. There's a couple of other tests that will look at either breakdown markers will look at urine output of certain vitamin breakdown markers. And then there's organic acid testing, which is another functional testing. What am I missing there? Probably. Oh, well, here.


00:17:21.385 --> 00:17:40.594

Dr Doug: Htma, hair tissue mineral analysis is another one that we've played with, that we don't quite know what to do with yet. So there's some interesting ways to look at deficiencies. But I think the easiest thing is just to look at using chromimeter. Look at what you're getting and just make sure you're optimizing. What we're really looking for is


00:17:41.585 --> 00:17:52.814

Dr Doug: what you're doing moving forward. And then, if we can identify any obvious deficiencies, or if people are still missing something, either they're not getting better for some reason, then, looking deeper and seeing like, Okay, what can we uncover.


00:17:53.855 --> 00:17:54.235

Breta Alstrom: Yeah.


00:17:54.365 --> 00:18:14.004

Breta Alstrom: there's also you know, like clear symptoms, you can look for as well. And so if you like, just Google, nutrition focus, physical exam, like micronutrient findings, it'll give you like a good like signs possible related causes. And then you could, you know, cross reference, that with like your intake and see if you're getting enough.


00:18:14.369 --> 00:18:33.695

Breta Alstrom: But also, you know, if you're struggling with absorption and different things like that, then you could be getting enough. But your body's not able to utilize it. And then you have, you know, confounding factors, which is why we like the functional testing make sure you're actually processing and utilizing all the nutrients you're giving to your body. So just some other things to look at.


00:18:36.411 --> 00:18:41.145

Breta Alstrom: Okay. So from there, I


00:18:41.445 --> 00:18:43.924

Breta Alstrom: I feel like we have a couple of like


00:18:44.395 --> 00:19:01.604

Breta Alstrom: a couple of nutrients that just kind of chronically come up on like. Can I get them from food? Does my supplement have too much like what is that? And the first one is calcium. And I know we've talked about this before. But if somebody's getting 500 to 700 milligrams of calcium from food? Do they need a calcium supplement.


00:19:02.135 --> 00:19:18.325

Dr Doug: Yeah. And this has been a switch that we've made recently. So early on, I was concerned about the data that most of you have probably read into, which is, if you're consuming a lot of calcium through supplements that there's a concern for increased risk of calcification, of arteries potentially increased risk of heart attack and stroke.


00:19:18.325 --> 00:19:32.364

Dr Doug: So my initial run through of I don't know how many studies I read, but a lot I kind of came to the conclusion that, okay, if we're truly calcium deficient, we should use calcium supplementation. But if we can get enough through diet, let's just avoid it to potentially avoid that risk.


00:19:32.485 --> 00:19:57.204

Dr Doug: It wasn't till I started sitting down with the folks at Al Jakal and going through their research and then talking to their research team. So this is such a great example for me. We're like using a team of researchers who have looked at instead of me looking at dozens of studies. Whatever I have time to actually get through. But looking at a team that has built a company around this and looked at hundreds or thousands of studies, what we were able to come to together is that when you


00:19:57.205 --> 00:20:17.214

Dr Doug: look at the calcium supplements like calcium carbonate calcium, citrate those things that are synthetic are going to result in a higher spike of serum calcium. So when you're consuming it in calcium carbonate is a natural form, but not a natural form, that we usually consume in high quantities. So when you're consuming it in those forms, you're going to get this spike


00:20:17.215 --> 00:20:32.594

Dr Doug: of calcium. But when you consume it in a whole food form. You don't, and it's because natural things are natural. Your body knows what to do with it. Right? So then, that led me down to the next spot, which is well, if we're using the milled up bone products, the Mchc products.


00:20:32.923 --> 00:20:58.534

Dr Doug: then we're probably not gonna get that same spike. And there is actually one study from one patented product that shows that where calcium citrate carbonated spikes the Mchc. Product, it doesn't. And then with algae cow, it is also a whole food product. And so they don't have the serum studies like that. So we're sort of taking a little bit of a leap here. But anytime where you're getting calcium from whole foods, the relationship with


00:20:58.695 --> 00:21:01.765

Dr Doug: calcification and cardiovascular disease actually flips.


00:21:01.925 --> 00:21:27.554

Dr Doug: So there was a study that I put in the video on Al Jakal if you actually made it through that 40 min video. But in that study they were looking at calcium intake through food, through whole food sources. And again, that relationship was flipped. So of people that had a 0 coroner, artery, calcium score. At the beginning of the study, the people that were consuming the most calcium, had the least progression to a positive coroner calcium score at the end of the study.


00:21:27.615 --> 00:21:46.875

Dr Doug: So that was enough for me to say, Okay, well, if it's coming through whole food, and we know we need to get adequate calcium, we're probably avoiding the risk of using a synthetic calcium, because we know that even that risk goes away with just adding vitamin d. So if we're adding from a whole food source, with vitamin d with vitamin K, with all the other things


00:21:46.875 --> 00:22:03.874

Dr Doug: likely we're safe in doing this. And then the reason why we made that switch to Algaile is that you're getting a plant food, a whole food source of calcium. But you're also getting the 3 milligrams of Boron. You're getting a little bit of magnesium. You're getting all the other trace minerals that we know are going to be helpful for bone


00:22:04.055 --> 00:22:09.285

Dr Doug: and other things, so getting it all in 2 capsules twice a day makes it really really simple?


00:22:09.365 --> 00:22:10.524

Dr Doug: If that makes sense.


00:22:11.815 --> 00:22:22.434

Breta Alstrom: Yeah, I have had some people like, you know, who would maybe track their calcium intake during the day and decide if they needed to take like one capsule or 2 capsules if you


00:22:22.435 --> 00:22:47.334

Breta Alstrom: time for that, by all means, like, you know, like whatever effort like you wanna put in. But you also don't have to make your life harder, either. So you know, if you pick a good supplement stack that works for you, you don't have to get everything through whole foods. You don't ha like, you know, you can use supplements, and it's not the end of the world. And there's definitely like some benefit there to just like the ease of access.


00:22:47.335 --> 00:23:07.924

Dr Doug: Yeah. And one thing on that, too, Brad. So if you're using a product like Algecow, and you're relying on the product to get your Boron and your other trace minerals, and then you cut it in half because of the calcium. Just remember that now you have to backfill all the other things. So then you need to have, like another trace mineral product, and probably another boron product. So it does just make it. It makes it more challenging.


00:23:07.925 --> 00:23:13.314

Breta Alstrom: Yeah. And I remember, too, we were trying to figure out like on a few of the products.


00:23:13.365 --> 00:23:29.524

Breta Alstrom: whether you know or even when we would rework people supplement stacks because they would have 12 different supplements. And they were like, well, you know, I just wanna get this and this, and we can choose these like cheaper products. But then you need to have XY, and Z. And by the time you add, in all those extra products you're not saving.


00:23:29.525 --> 00:23:30.924

Dr Doug: Not cheaper. Yeah.


00:23:30.925 --> 00:23:32.775

Breta Alstrom: So there's.


00:23:32.825 --> 00:23:55.995

Breta Alstrom: you know, like definitely weigh all of that stuff, and, like your time is also valuable. And as somebody who spent time doing that for you, let me say save you the time, and you're probably not gonna save very much so then I you know, we've gotten this question also, like a few times, there's a lot of I think it's I don't know. I wouldn't say it's like Trendy, but there's a lot of talk about ground egg shells as a natural form of calcium.


00:23:56.085 --> 00:23:57.754

Breta Alstrom: How do we feel about that?


00:23:58.065 --> 00:24:15.315

Dr Doug: Yeah, I made a video on this a while back. So I think it's it's fun. And I love using like, if you're gonna eat animals like eating. The whole animal, I think, is great. If you're gonna use the animal, use all the parts of the animal. I think that's just respectful. If you're gonna eat eggs, can you use the shell for calcium? The answer is, you can.


00:24:15.435 --> 00:24:41.675

Dr Doug: But it's primarily calcium carbonate. And so my question would be. Is this the same as taking a big chunk of calcium carbonate in a capsule? We don't really know the answer to that, you know, it is a whole food form. So arguably, it might be different. But it's a hundred percent calcium carbonate. So I don't know that it's gonna be different. And then the other issue, too, is, I hear, people that will say, Well, I just. I just eat some eggs, and then I crush up all the shells, and I consume all the shells.


00:24:41.895 --> 00:25:08.254

Dr Doug: There's 2 grams, 2,000 milligrams of calcium in a medium sized egg. So that's a lot of calcium, especially as calcium carbonate. So I think it's possible. I'm also a little bit concerned about potentially contamination. You're eating the part that potentially could carry bacteria. So I don't know. I wash my hands after I I make eggs, so I don't know. I I think there are better ways to do it. I I think it's cool, but I don't. I wouldn't recommend it.


00:25:10.135 --> 00:25:29.505

Breta Alstrom: Yeah. And also again, go back to your time. There's also, you know. So to our next question is, can you? Is it okay? If you get all of your calcium from milk, which you know there's several other options for whole food sources of calcium as well. So I do think you have quite a few options. And


00:25:29.805 --> 00:25:31.285

Breta Alstrom: yeah.


00:25:31.285 --> 00:25:44.375

Dr Doug: Yeah, I would imagine in that study where they were looking at calcium and consumption through whole foods, the people that were at the upper end of that were likely consuming it through dairy. I mean, you have to be, because it's the highest density of calcium in most people's diets.


00:25:44.495 --> 00:25:51.305

Dr Doug: So could you get all your calcium through? You could. But you better tolerate dairy, so not everybody tolerates dairy.


00:25:51.655 --> 00:26:03.925

Breta Alstrom: Yeah, and that the other thing, too, I think on the so the dash diet study is like a big landmark nutrition study. That's dairy intake is, I think, one of the the primary


00:26:03.965 --> 00:26:08.574

Breta Alstrom: components of that that sets it apart from some others on like that healthy metabolic


00:26:08.735 --> 00:26:23.135

Breta Alstrom: health. So the calcium component there from that real food source. And being com, you know, protective of heart health as well. Can be beneficial. So oh, good question in the chat, though I don't mind through almond milk.


00:26:23.135 --> 00:26:49.624

Dr Doug: Yeah, great, great question. Yeah, I love that. So I think I talked about this last time, too, and I was talking trash about oat milk. So this is something I get a little I get a little heated over, but so all of the I would call them synthetic milks or nut juices, or whatever you wanna call them. So almond milk, any of the milks are, gonna have any of those synthetic things are gonna have basically calcium added to them. There is probably trace amount of calcium actually in almonds, right?


00:26:49.625 --> 00:27:08.555

Dr Doug: So it's gonna have some kind of calcium added to it. So I look at that as a supplement. So I would not look at that as a whole food source of calcium. It's just another form of supplementation, so is it wrong to do it? No, just consider it for what it is. I would add that as a supplement, and then also, so if we look at. So that's almond milk.


00:27:08.882 --> 00:27:31.445

Dr Doug: Soy milked up other potential benefits of soy. I've got a video where we're drafting and scripting on the phytoestrogens and soy would certainly be included in that. So some potential benefit for the phytoestrogens, and soy especially for those women that are not on estrogen replacement. But that's also fortified, and then, of course, oat milk is all fortified, since oaks, oats don't actually make milk


00:27:33.285 --> 00:28:00.584

Dr Doug: And then yeah, Dan said, almond milk is also high in oxalates which could potentially impede calcium absorption. Yeah. So you just imagine that you're consuming this. You know this milky liquid that's all bound up with calcium and oxalates in other binders and gums and other unnatural things. So I do consume almond milk for smoothies. If I need a Smoothie, and I don't have any raw milk around, so we do have it. And the nice thing about it is it stays good in the fridge for like months.


00:28:00.705 --> 00:28:03.065

Dr Doug: which is a bad sign.


00:28:03.535 --> 00:28:31.835

Breta Alstrom: Yeah. And I would say, too. So in the one, if you're looking for a natural, the most natural form of almond milk you can. There's a product called Malk Mak, and they have pretty low additive like nut milks. They are a little bit priceier, because they do go bad but that is an option. And then, if you guys do see like the osteopress meal plan that I post in the nutrition channel, that typically


00:28:31.835 --> 00:28:59.134

Breta Alstrom: if you don't use regular dairy, which you can totally use regular dairy. I've put in the recommendation for, like silk, protein, almond milk, so at least you're getting the protein component, because that's really what you know boosts up. The protein shakes that we're getting so most of the protein powders which we have a whole, we'll talk about protein powders today, but they're gonna give you around 20 grams of scoop. So if you can add in that extra boost from either a regular milk or something that actually has extra protein in it. I would totally recommend that. Instead.


00:28:59.785 --> 00:29:00.984

Breta Alstrom: if you're going to choose.


00:29:01.734 --> 00:29:05.126

Breta Alstrom: you're gonna choose a processed almond milk. I would choose.


00:29:05.805 --> 00:29:13.915

Dawn Aragón, PhD: If anyone wants to know how to make almond milk, I know how to make almond milk and that only lasts in the fridge for 4 days. So.


00:29:13.995 --> 00:29:15.275

Breta Alstrom: There you go!


00:29:15.505 --> 00:29:22.885

Dr Doug: So that tells you all the things that are added to it to make it last for processing, shipping being in the grocery store. All that.


00:29:23.265 --> 00:29:24.875

Breta Alstrom: Yeah.


00:29:24.975 --> 00:29:31.844

Breta Alstrom: and outside of that, though, like, you're not really getting the same. Nu, nutrients, like almond, milk.


00:29:32.245 --> 00:29:47.155

Breta Alstrom: any form is not going to be like a one to one for a cow's milk. You're just not gonna get the same nutrients there. So, and I don't drink dairy. So you know we're in the same boat. But you're just gonna you're gonna miss out on that. So keep that in mind. It's not necessarily like a one to one swap


00:29:47.335 --> 00:29:50.025

Breta Alstrom: we're using it for like flavor and texture. So


00:29:51.150 --> 00:29:52.255

Breta Alstrom: the


00:29:52.485 --> 00:30:05.574

Breta Alstrom: the nutrition meal plan you need to be on slack. And then you should see the Nutrition channel on the left hand side, and then it's pinned in there, I believe, so. There's no way to like share the link to it, cause they're Pdfs.


00:30:06.615 --> 00:30:24.075

Breta Alstrom: So yes. Okay, awesome. Let's talk about B. Vitamins, because I feel like this is another pretty like hot button topic as far as like, am I getting too much? Am I getting enough? Let's start, maybe with like B. 12 and Folate, why are we recommending those supplements.


00:30:24.535 --> 00:30:31.445

Dr Doug: Yeah. And, Lauren, I will get to your question about B vitamins and neuropathy. So that's a really interesting topic. So


00:30:31.845 --> 00:30:41.275

Dr Doug: we measure like I mentioned earlier. We've been measuring serum B 12 and serum folate. We're switching to Mma and Rbc. Folate


00:30:42.015 --> 00:30:52.765

Dr Doug: when you measure them in blood. You're just getting like, did somebody take their supplements or not? So we don't. It's hard to know. But the reason why we started with that, and we've stuck with that is that we know. For the most part


00:30:52.785 --> 00:31:02.535

Dr Doug: everybody's woefully B vitamin deficient. It doesn't matter if you're mainlining ribeye steak. You're still going to be b vitamin deficient because we use our B vitamins specifically B, 12 full, 8


00:31:02.795 --> 00:31:09.554

Dr Doug: b, 6, all of them, probably, but those specifically in the process of making our catecholamines, our stress hormones


00:31:09.905 --> 00:31:20.044

Dr Doug: and so and magnesium. So that's probably another topic. But all of these things we're using at super physiologic rates and doses


00:31:20.265 --> 00:31:39.945

Dr Doug: with our current lifestyle like if you live in our society. And you're, you know, waking up early, and you're pushing through your day. You're doing all the things that we do, and you're taking care of other people, and you're not taking the time to rest and get the sunlight and do all the things your demand for B vitamins is above what we were made or designed for, whichever you believe.


00:31:40.045 --> 00:31:55.325

Dr Doug: So we don't really need to know what your levels are. We just need to probably find a way for you to get more, and that could be through supplementation that could be through really optimizing diet. But I don't think I've ever found anybody that had optimal levels of B vitamins just through diet. If they're living a conventional lifestyle.


00:31:55.826 --> 00:32:07.404

Dr Doug: So that's one that we almost always end up replacing and then there's some different ways to do it which Brett you'll probably bring up. But those are the ones that we're replacing pretty much all the time, because we know that almost everybody's efficient.


00:32:08.168 --> 00:32:09.355

Breta Alstrom: And so


00:32:09.495 --> 00:32:26.804

Breta Alstrom: I think there gets to be like some complications, too. And maybe we just talk about this here. But you know a lot of the multi vitamins that people have are going to be super high. And b vitamins, which I think, compared to like what we're actually giving people is really not that high. But let's just talk about multi vitamins. And


00:32:27.425 --> 00:32:29.685

Breta Alstrom: what are we? What are we thinking about? Multi vitamins?


00:32:29.685 --> 00:32:54.434

Dr Doug: Yeah, the challenge with multivitamins is that they're trying to put a lot of a lot of things. So you look at the list of what's in a multi vitamin, you're like. Oh, my gosh! It has 5,000 ingredients. It must be great. But to get 5,000 things in 3 capsules. You have to use a very, very small amounts. Some things are bulkier than others, and so they're going to make. They're gonna compensate for the bulkier things by using less bulky versions which are usually not better versions.


00:32:54.435 --> 00:33:04.925

Dr Doug: And so you see that with magnesium, that's why a lot of times in Maltese, you'll see like mag oxide, because there's more mag per oxide rather than magbous glycinate, because the glycinate part's big.


00:33:04.935 --> 00:33:31.265

Dr Doug: Also they tend to use cheaper forms. So even the best multi vitamins still uses forms of like B, 6, for example, non methylated folate. So they're using folic acid, for example, so forms that are not as well tolerated. So we pretty much get most people off of B vitamins. There's a few exceptions to that, but I'm sorry of multivitamins. There's a few exceptions to that. But for the most part we're aiming for specific nutrients rather than just using a shotgun. Multivitamin approach.


00:33:31.645 --> 00:33:44.064

Breta Alstrom: Yeah, cause definitely some nutrients that you don't need in your multi, especially if you're, you know, tracking your data. And you're like, Hey, I'm good like here here and here. But I like, yeah. B. Vitamins, I definitely think, are one of those things that you just like.


00:33:44.195 --> 00:34:06.724

Breta Alstrom: The dose makes the benefit for a lot of people. And you're just not gonna get that through food, or you're gonna have issues with absorption. Especially as you age. One of the things that happens is you have naturally lower stomach acid, and that stomach acid for things like B 12 is incredibly important for activating the entire sequence of absorption. So you know, if there's any confounding factors like that.


00:34:06.725 --> 00:34:15.475

Breta Alstrom: you're definitely gonna have decreased absorption. And sometimes the solution to decreased absorption is just more of the thing, so that way you can glean as much from it as you can.


00:34:15.475 --> 00:34:16.295

Breta Alstrom: So


00:34:18.285 --> 00:34:22.105

Breta Alstrom: with you mentioned Mag Oxide being a little bit lower. I


00:34:22.355 --> 00:34:38.905

Breta Alstrom: there are. There have been questions in both slack and in the chat here on alcohol, using mag oxide and I'm guessing that's the reason why is because it's smaller, and calcium is already a big capsule. Calcium is big, nutrient. And yeah, so is that.


00:34:39.045 --> 00:35:04.594

Dr Doug: That that's totally why. So I talked to Dean about that the CEO, and in the formulation they would have loved to use a glycinate. But when you use that that molecule they would end up with like 5 milligrams of magnesium, right? So they're they're aiming to get as much magnesium as possible, but avoiding the potential side effects of Magoxide, which is loose stools. And so that's why there's I forget what the amount is, but it's not that much, but it's a lot more than if they were to use like a glycinate.


00:35:05.975 --> 00:35:06.715

Breta Alstrom: cool.


00:35:07.635 --> 00:35:08.885

Breta Alstrom: So


00:35:08.895 --> 00:35:10.954

Breta Alstrom: just. Like a baseline.


00:35:11.245 --> 00:35:19.104

Breta Alstrom: We've talked about our b vitamins, what micronutrients are we probably looking at supplementing regardless of dietary. Intake.


00:35:20.435 --> 00:35:26.254

Dr Doug: Yeah. I mean, I think the things that hit just about everybody's list. They might not stay there, but they start. There


00:35:26.325 --> 00:35:32.034

Dr Doug: would be either methylated or non methylated B. Vitamins based off of genetics. If we have them.


00:35:32.195 --> 00:35:37.374

Dr Doug: magnesium across the board. Omega 3 is across the board, unless somebody eats a


00:35:37.405 --> 00:35:39.875

Dr Doug: tonne of fish, and then we're testing them for heavy metals.


00:35:42.125 --> 00:35:43.165

Dr Doug: What else?


00:35:43.995 --> 00:35:45.245

Dr Doug: True, nutrient.


00:35:45.795 --> 00:35:47.215

Dr Doug: not intervention.


00:35:49.385 --> 00:35:50.965

Breta Alstrom: I feel like that. I mean.


00:35:50.965 --> 00:35:52.074

Dr Doug: That's kind of the big ones.


00:35:53.365 --> 00:35:56.535

Dr Doug: Oh, it's fat, soluble vitamins! DA. And K.


00:35:56.535 --> 00:35:57.265

Breta Alstrom: Yeah.


00:35:57.675 --> 00:36:20.195

Breta Alstrom: And somebody has asked, what is the minimum amount of fat needed? I looked this up. But to to so basically, the more, not maybe not exponentially more fat. You're getting the better absorption you're gonna get. But it was suggested as a minimum of 11 grams of fat, and you would get 20% better absorption with


00:36:20.235 --> 00:36:31.155

Breta Alstrom: 35 grams of fat, so that you don't have to calculate that that's mostly just have a meal and have your supplements with a meal. You don't have to get super specific. And in the weeds on that. So.


00:36:31.355 --> 00:36:31.685

Dr Doug: That's.


00:36:32.985 --> 00:36:37.655

Breta Alstrom: So then, when it comes to magnesium and calcium, zinc and calcium


00:36:38.045 --> 00:36:44.018

Breta Alstrom: people taking them together versus how we're getting them through food and the competition.


00:36:44.925 --> 00:36:47.365

Breta Alstrom: What should people be thinking about when it comes.


00:36:47.365 --> 00:37:14.205

Dr Doug: Yeah, that that one I don't worry about. So there are some interactions that I do worry about like zinc and copper, for example. But magnesium and calcium come together frequently and naturally. So I feel the same way about vitamin d and vitamin K. You'll hear people say, well, they're gonna compete. You have to separate them same thing with DNA. Right? They're gonna compete. You have to separate them. But they're found naturally in food. So you know dairy is gonna have DA and K


00:37:14.205 --> 00:37:28.245

Dr Doug: in it. So your body knows how to separate those things naturally. So why would we have to do that through supplementation. So I don't think magnesium and calcium. We really need to worry about that. But the ratio does matter, and so we are. We try to push this, but we're not quite


00:37:28.513 --> 00:37:50.804

Dr Doug: because we're we have a special population of osteoporosis. We are higher in calcium than I would be for people that don't have bone health challenges. So I think in general, you want to at least double or triple the amount of magnesium as calcium that you're consuming through supplementation. We don't do that because everybody would have diarrhea if we did that. So we're not gonna do that to our patients. But in general, you wanna have more magnesium than calcium.


00:37:53.005 --> 00:37:56.034

Breta Alstrom: yeah, and then, how about the zinc component?


00:37:56.765 --> 00:37:59.595

Dr Doug: Zinc and copper, specifically, or zinc and other nutrients.


00:37:59.595 --> 00:38:01.185

Breta Alstrom: Thinking calcium.


00:38:01.415 --> 00:38:03.545

Dr Doug: Yeah, we don't.


00:38:03.565 --> 00:38:28.115

Dr Doug: Yeah, we don't. Really. We don't actually supplement zinc that often cause we are testing. I didn't mention this earlier. We are testing red blood cell zinc, and rbc, zinc is a reasonable. It's a reasonable biomarker to tell you if you're deficient in zinc zinc is much easier to get through diet than say, as copper and some other nutrients. And so with Rbc. Zinc, I almost stopped testing it, because we found that nobody was deficient in zinc.


00:38:28.115 --> 00:38:48.254

Dr Doug: And maybe it's because through the pandemic everybody started taking vitamin D and zinc. I don't know but we find that I think I can. I can think of maybe one person who is actually deficient in zinc, and I think they were taking a whole bunch of copper which will bind zinc. So I I don't really worry about zinc, because we're not really supplementing zinc for the most part.


00:38:48.517 --> 00:38:54.034

Breta Alstrom: So this brings us to a good point like, what are you looking at for? The ratio of iron to copper.


00:38:55.175 --> 00:39:07.634

Dr Doug: Yeah. So the ratio is tough. So the ratios that we look at are really related to iron specifically. And then we're looking at copper in a couple of different pathways. So I'll walk you through this.


00:39:07.645 --> 00:39:32.685

Dr Doug: So when we look at iron, we're looking at iron and blood, so it would be listed just as a a serum iron. And then we're looking at binding capacity of iron. So that's gonna be listed as total iron binding capacity. Tibc, and what we're looking at is how much of the binding capacity of your blood is bound up with iron, and if the answer is more than about a quarter or a third, then you are technically iron heavy.


00:39:32.775 --> 00:39:47.335

Dr Doug: but there's nuance to this. And so then you also want to look at something like Ferritin. So Ferritin is the theoretical storage form of iron that's debatable. I was actually just texting with Morley Robins this morning


00:39:47.335 --> 00:40:00.824

Dr Doug: podcast on vitamin D, but he was reminding me about a couple of these things, and so Ferritin is probably not supposed to be in blood at all, or, if it's there supposed to be very, very low, but yet we use it as an instrument to say, Oh.


00:40:00.825 --> 00:40:25.004

Dr Doug: your you know your iron is low. If your Ferritin's low, that might actually not be a bad thing, but we do know certainly that if it's high, then you have an iron storage problem because your your tissues are kicking out Ferritin when they probably shouldn't. So if your ratio is high, meaning that you have a lot of iron and you have deficient storage capacity on the Tibc and your Ferritin's high. Then we start getting concerned about, you know, do you have a storage problem? Are you iron overloaded? What's going on here?


00:40:25.025 --> 00:40:40.354

Dr Doug: And we see this pretty frequently, especially in post menopausal women, because when you were cycling, you were getting ironed out on a regular basis. When you lose that capacity, then you become more like men where we just build up iron over the course of our lifetime, and we have no, we have no exit route.


00:40:40.425 --> 00:40:44.345

Dr Doug: The only way you get ironed out is through blood. And so this happens


00:40:44.495 --> 00:41:03.905

Dr Doug: mostly in post menopausal women and in men. So you can get iron overload really easily. We see it all the time. One of the things that we look at then is copper, so copper is obviously it's a mineral, but it is used to make the proteins that bind iron, so without copper you will end up with iron overload, probably some other things, too.


00:41:03.905 --> 00:41:16.414

Dr Doug: but you can measure that in 2 ways you can measure serum copper, and we have a range that we're looking for there and then you can also measure this biomarker called Cyrilloplasmoplasm is sort of like the iron


00:41:16.415 --> 00:41:35.604

Dr Doug: commander sort of tells iron where to go. So Cyrilaplasm is made out of copper. It's literally just a whole bunch of coppers on a protein structure. So if you don't have adequate copper, you don't have adequate cerilloplasm. So we're measuring those now and we're seeing pretty frequently that correlation between what looks like iron overload and deficient copper. So we're looking at all those things.


00:41:36.045 --> 00:41:52.285

Breta Alstrom: Yeah, and just circling back to magnesium before we switch gears here. If somebody's blood levels of magnesium are like above normal, or really, I guess you know any nutrient. Would you recommend somebody not supplement? Feel like it's a little more nutrient.


00:41:52.285 --> 00:42:16.375

Dr Doug: Yeah, it depends. So one of the things we hear, too. And this is a great example of this question. Is my blood level of magnesium is high. And so then you have to ask, Well, which test are you doing so? Is it serum magnesium? Meaning that it's just your blood, magnesium or magnesium and blood? Or is it red blood cell magnesium? So that'd be listed as Rvc. Mag, Rbc. Mag is, gonna be the amount of magnesium that's inside the red blood cells


00:42:16.375 --> 00:42:31.365

Dr Doug: versus the magnesium that's free in your blood. This is true with calcium, too. So most of the minerals that are in blood are very tightly regulated. And so that's why, when I worked with a company called Lifeforce, and I consider them like health, optimization, light.


00:42:31.535 --> 00:42:48.114

Dr Doug: great company. But they use an inexpensive blood panel, and so they use serum magnesium, and they're diagnosing people with magnesium deficiency. And then, what was really funny, as I told them this would happen. So when people follow up, they're like, Well, my serum, Mag, isn't different. But I'm on all this magnesium supplementation.


00:42:48.145 --> 00:43:06.315

Dr Doug: I know it's because it's not the right biomarker. And like it happened like quarter after quarter after quarter, like, why is it not different? Because it doesn't change, because it's tightly regulated. Same thing with serum calcium is tightly regulated, and if it is high or low, that indicates that something is out of whack.


00:43:06.315 --> 00:43:22.935

Dr Doug: right? This is not just. I'm not getting enough in in my food that something is wrong in high Mag, low, mag high, calcium, low calcium, same with potassium like your heart will stop the the channels that move energy back and forth will stop. So serum is not a good way to to measure any of those things.


00:43:23.305 --> 00:43:24.045

Breta Alstrom: Yeah.


00:43:24.965 --> 00:43:37.525

Dr Doug: I didn't actually answer your question, though, to answer your question. If your Rbc. Mag. Is high, which is hard to do. But if your Rbc. Mag was actually high. Then. Yeah, I would back down. But I don't think I've ever seen that


00:43:37.635 --> 00:43:39.075

Dr Doug: I don't think not once.


00:43:39.075 --> 00:43:40.147

Breta Alstrom: No, it's hard.


00:43:40.505 --> 00:43:41.045

Dr Doug: We're so.


00:43:41.420 --> 00:43:41.795

Breta Alstrom: Hard.


00:43:42.055 --> 00:44:02.614

Dr Doug: It's in that Omega 3. I have seen people actually get over 12 on an omega, 3 or an omega check. So that means that they have a pretty high omega. 3 to 6 ratio. Is it actually dangerous? I mean, in theory, you could have a sort of thinner blood? Maybe. So then I would have them back down. But that's a lot of fish oil to do that.


00:44:02.825 --> 00:44:22.144

Breta Alstrom: Yeah. And you know, when it comes to upper limits of stuff, there, there is the upper limit. If you guys are looking at this it is only indicative of an adverse effect. The adverse effects range dramatically so like the adverse effect, for the upper limit of magnesium is diarrhea, which


00:44:22.145 --> 00:44:48.880

Breta Alstrom: might be okay like that's not, you know, life threatening for most people. Whereas there's like other nutrients that maybe there would be like some different complications. So if you just Google that or look at the nih fact sheets. And then the nutrient that you're looking for, you can find all of that information. If you're looking about like on how much is too much to supplement. And for most nutrients it doesn't matter and or it's like a really high amount.


00:44:49.413 --> 00:44:54.215

Dr Doug: Yeah, I find it's it's not usually that we're getting too much. It's usually that we would be getting the wrong form.


00:44:54.215 --> 00:44:55.645

Breta Alstrom: Right? Right?


00:44:56.025 --> 00:45:09.404

Breta Alstrom: Alright. Let's switch gears into protein and collagen and all things amino acids here. So I do think we would consider extra protein a supplement. So do you have some go to protein.


00:45:09.485 --> 00:45:13.065

Breta Alstrom: supplement protein powder options for people.


00:45:14.265 --> 00:45:28.694

Dr Doug: Yeah, so protein for me, obviously, it's really important. And I would prefer people to get it through natural food if possible. So for people that are exclusively relying on whey, protein powders and bars.


00:45:28.725 --> 00:45:35.284

Dr Doug: I think they're not absorbing it like they think they are. So you're getting the macros. But we're more than macros.


00:45:35.865 --> 00:45:43.835

Dr Doug: However, life is life, so I get it, and some days I need to do that, too. And so if you're going to use a protein powder. There's definitely some things to consider.


00:45:44.135 --> 00:45:57.535

Dr Doug: making sure that what you're getting is really as as clean as it can be. So I've actually switched to a new protein powder. I gotta see where my wife got it from, because I know it's not on your list of protein powders yet, but it is essentially, it's just


00:45:57.535 --> 00:46:21.244

Dr Doug: way it is. There's nothing else in it. There's no, there's no flavors. Literally the ingredient list says way, that's it, which is cool, but it doesn't taste very good. So you have to, you know, put other stuff in it. So you have to balance like, are you able to actually consume it, but as simple as possible, because protein powders are an easy place to hide. You know. Fillers, you know, gums, artificial flavors, and artificial sweeteners


00:46:21.245 --> 00:46:31.125

Dr Doug: so make it as clean as possible. And then the actual protein source. So there's basically 3 variations. There's whey, there's beef. And then there's plant sources.


00:46:31.435 --> 00:47:00.274

Dr Doug: So way is probably the most well studied way, has been studied to have shown benefits for muscle building and show benefits, for, you know, cognitive function, like the research behind way is really good. The problem is that not everybody tolerates way, and it doesn't even necessarily seem to be like I can consume like if I can't consume dairy. I can't consume way. That might be true, but I see people like I can. I can tolerate dairy just fine, but if I eat up a you know, 2 scoops of a whey protein powder, although I haven't noticed it with this new one.


00:47:00.275 --> 00:47:23.604

Dr Doug: But historically I did not feel good. I was able to tolerate it. But it wasn't as clean feeling for me as if I used a beef product. But the research is better behind way. So if you can tolerate way, it's probably the best protein powder. I like the beef protein powder, because again, it just feels better for me. It's cleaner the products that we use either equip. And there's a couple other ones that we have links to. I think it is literally just


00:47:23.605 --> 00:47:40.174

Dr Doug: powdered beef, which kind of sounds gross. I don't know why, but I don't know why. It's different than powdered way, but it just sounds weird, but it doesn't taste like that. It tastes like way it tastes like chocolate, whatever. So that's sort of my number 2. And then the challenge I have around plant-based things so like pea protein, for example.


00:47:40.335 --> 00:48:07.014

Dr Doug: is that they're billed as complete protein sources hopefully, if they're paying attention to that, they should be. But whenever you're getting it from plants, you still are dealing with deficiencies and usually certain amino acids. And there might also be an absorption challenge. And so you're probably not gonna absorb it as well. You might need more grams per per pound, or whatever. So probably just not as good. So people just feel better and like consuming those better. So that's fine, but just plan on consuming more.


00:48:07.815 --> 00:48:22.615

Breta Alstrom: Yeah. And if you can find a plan, if you do choose a plant based protein. For whatever reason, if you can find one that has a mix of different proteins that's going to be better for you from the amino acid profile like stance.


00:48:23.565 --> 00:48:35.205

Dr Doug: Can we answer a couple of these questions and chat about? Yeah. So copper citrate versus glycinate? Diane asked this so copper. Excuse me.


00:48:35.485 --> 00:48:55.205

Dr Doug: what's the word I'm looking for? Glycinate is a chelated there we go. So any chelated product is gonna be better than a citrate. So citrate is is a I don't know how they actually make that, but it's a synthetic. A chelated product is something that has 2 natural things on it. And so the glycinate is always gonna be better absorbed than a citrate, I think, across the board.


00:48:55.635 --> 00:49:06.825

Dr Doug: The vitamin a toxicity that's kind of a whole topic. So let's let's PIN that, Mary, until after we finish protein. And I do wanna talk about vitamin a, because that's a big misconception around toxicity.


00:49:08.095 --> 00:49:32.545

Breta Alstrom: awesome. So then, when we're talking about collagen and amino acids, right so amino acids are the the building blocks of protein, just just, for, like a foundational understanding here, so collagen is going to be made out of some of those amino acids, and then our proteins, depending on what you choose are generally, if they're an animal based protein, they're made out of all of those essentially amino acids. So when


00:49:33.055 --> 00:49:47.705

Breta Alstrom: when a collagen says that it has like 20 grams of protein. That's probable that that is why it's because it has those amino acids. So one, are we ever worried about people getting too much protein. And how do you feel about using collagen as a supplement for protein?


00:49:48.245 --> 00:50:11.164

Dr Doug: Yeah. So I don't know anybody that's ever consumed too much protein, especially in this patient population. You know, you get to a younger body builder like that has the capacity to consume more than 300 grams of protein in a day. Maybe we'll have to start talking about it. But until you start hitting 3 grams per pound, which for most of us would be 3 to 400 to 500 for me, 600 grams of protein.


00:50:11.165 --> 00:50:21.555

Dr Doug: We don't need to talk about too much. So you to wipe that off of you're concerned. As far as collagen 4 protein. I went into this, and actually have a pending script on this.


00:50:23.121 --> 00:50:23.725

Dr Doug: So


00:50:23.895 --> 00:50:42.145

Dr Doug: collagen is essentially a complete protein without tryptophan. So it is nearly complete, and we don't tend to be tryptophan deficient in our diet. So we're probably okay. As long as not, the majority of your protein is coming from collagen. But we're probably okay using collagen and counting that as a protein.


00:50:42.145 --> 00:50:56.215

Dr Doug: I historically have said, no, I was sort of led to believe like it's not a complete protein source. Don't count it as protein. But again, if we're just missing one, and you're getting especially because it has reasonable amounts of leucine.


00:50:56.295 --> 00:51:13.435

Dr Doug: I I think it's reasonable to use this as a protein source, especially cause it doesn't taste like anything. You can put it in liquid. I've been putting, you know, 10 grams in each of my 2 cups of coffee in the morning, and I don't know that it's there. So I'm getting an extra 20 grand bump right out of the gate, so I think it's probably worth doing.


00:51:14.295 --> 00:51:31.195

Breta Alstrom: Yeah, I think it's really great, as like a little booster, plus like, right, if you add some collagen into your coffee in the morning, and then you're able to get, you know, 15 to 20 grams from a a meal. Then you're able to get that, you know, recommended minimum of 30 without even feeling right. You're getting a lot of extra. So if you have turt trouble


00:51:31.255 --> 00:51:50.164

Breta Alstrom: meeting your protein goals digesting a lot of protein, you know those protein shakes, adding extra collagen here and there. It can be really helpful. You can also mix collagen into water, and you probably won't even notice it. So not into like sweet stuff that can be really helpful, too. And then how about amino acids saying that they provide like 20 grams of protein.


00:51:50.535 --> 00:52:18.514

Dr Doug: Yeah, I struggle with counting this. So we've been, we've been advocating. And I did that video obviously on essential amino acids. So I like amino acids, and I do liken the scoop so that 5 to 6 gram serving of amino acids of essential amino acids to about the same as eating 20 grams of protein, but I don't know that we should count it as eating 20 grams of protein, so I wouldn't add that to your protein list. I would just consider that a a supplement hack.


00:52:20.820 --> 00:52:21.585

Breta Alstrom: specific


00:52:21.645 --> 00:52:26.679

Breta Alstrom: brands of collagen. And then we'll circle back to vitamin, a,


00:52:27.715 --> 00:52:30.295

Breta Alstrom: anything, you like for collagen.


00:52:30.435 --> 00:52:31.710

Dr Doug: You know we


00:52:32.345 --> 00:52:50.074

Dr Doug: I'm a little collagen agnostic, I think, looking at collagen peptides so that they're chopped up. They're more they're better absorbed. And then there's some different sources. I haven't really locked on to a good source, and I'll give you a little secret that the reason why I'm waiting on this is that


00:52:50.422 --> 00:53:07.804

Dr Doug: algae Cal has a great product that they're releasing in June. And so I'm not committing to anybody else's collagen. And because this has for bone fort gel a couple of other like great collagen proprietary products that are gonna become available in the Us. In June. So


00:53:07.865 --> 00:53:15.405

Dr Doug: we're sort of waiting on that. I think that might be secret. So don't tell anybody I know we're recording this, and we're going to send it out to the world. But you know what I mean.


00:53:16.098 --> 00:53:17.865

Dr Doug: Keep it in the community.


00:53:18.673 --> 00:53:34.696

Breta Alstrom: Yeah. And right now I would say, Oh, if if you are looking for something to get, there's, you know, get there's some store bought options that are great. I think vital proteins is a good go to and then you can also find


00:53:35.455 --> 00:53:42.014

Breta Alstrom: some marine based ones as well which I bought mine off of Thrive market. I have no idea what brand they are, so.


00:53:42.015 --> 00:53:48.775

Dr Doug: We have a different brand like every other week. So there's just a lot of good products out there. Collagen Peptides clean


00:53:49.175 --> 00:53:50.525

Dr Doug: enough, said.


00:53:50.525 --> 00:53:54.274

Breta Alstrom: Look at the ingredients list. Okay, let's talk about vitamin. A.


00:53:54.275 --> 00:54:05.564

Dr Doug: Yeah, so vitamin a so people will say, vitamin a is toxic. I think that is a gross over exaggeration of some research that came out a long time ago.


00:54:05.565 --> 00:54:29.144

Dr Doug: And really, what the research showed is that there is a a U relationship between vitamin, A and blood and osteoporosis, or I guess there's fracture risk. Actually. So the study showed that if you had really high vitamin A that you had an increased risk of fracture. But the sweet spot was actually really high. And so what most people don't understand is that we are in general are going to be retinol, which is the active form of vitamin a, we're going to be retinol deficient.


00:54:29.145 --> 00:54:52.865

Dr Doug: We also test that in blood. I wouldn't use it as a tool necessarily to recommend vitamin a. Because again, I think we're mostly deficient, because retinol, you can only get through animal products and specifically for people that are eating liver. Those are the only individuals where you're potentially getting too much vitamin a cause. That's gonna be a more dense form of liver. There's a classic medical test question of somebody who's


00:54:52.865 --> 00:55:17.264

Dr Doug: hunting in Alaska, and is eating polar bear liver like whatever I guess they'd be in the Arctic, whatever so, but, like polar bear liver, is exquisitely high in in retinol, and so don't eat polar bear liver. But outside of that you're probably not getting too much vitamin a. And if you're talking about vitamin a from plants, then it's a totally different deal. So when you're talking about Beta Carotene and the carotenoids, those are the Pre, or those are the pre


00:55:17.265 --> 00:55:39.994

Dr Doug: vitamin A, and those are gonna have to be absorbed and then converted into retinol for the body to use them. And there's a lot of genetic variability. And how well we absorb them, and then how well we convert them, and is something that can be tested. But in general, if you're looking at the amount of beta carotene versus the amount of retinol you would have to then divide that number by some kind of factor around like 16 to 30


00:55:39.995 --> 00:55:57.034

Dr Doug: to actually get? How many of the retinol activity equivalents, which is what the the actual amount of retinol that we're supposed to consume is listed in. So the equivalent of retinol that you're getting at Beta Carotene, and it's essentially really hard to do so. Most of us are probably deficient in vitamin A. And I would not worry about toxicity.


00:55:58.085 --> 00:56:11.434

Breta Alstrom: yeah, awesome. Well, I'm gonna just take a second here. To grab this pretty common question that I got quite a few times in the chat. Any thoughts on caffeine or coffee and bone, health and calcium absorption.


00:56:11.575 --> 00:56:18.565

Dr Doug: You guys have just convinced me to finally look into it. I've said in the past I don't want to look into it because I love my coffee, and I'm not willing to let it go.


00:56:19.105 --> 00:56:26.514

Dr Doug: But out of your best interest I will turn the research team loose and have them look into coffee and caffeine.


00:56:27.045 --> 00:56:27.465

Breta Alstrom: Yeah.


00:56:28.075 --> 00:56:30.494

Dr Doug: I'm gonna put it in here right now, while we're talking.


00:56:30.705 --> 00:56:41.525

Breta Alstrom: Awesome. Okay? I'm just gonna go ahead for the last 4 min. If any of you wanna pop on, if you have any other questions surrounding this topic. Now, it'd be really awesome time if anybody wants to speak up.


00:56:45.254 --> 00:56:46.964

Dr Doug: There was a question.


00:56:47.865 --> 00:56:49.144

Dr Doug: oh, yeah, Lorna.


00:56:53.265 --> 00:56:53.945

Lorna Nichols: Oh.


00:56:55.594 --> 00:56:58.615

Lorna Nichols: to to make it a quick question.


00:56:58.714 --> 00:57:00.315

Lorna Nichols: B vitamins.


00:57:00.365 --> 00:57:05.595

Lorna Nichols: I know that I could eat liver for b vitamins, but then there's the vitamin a issue.


00:57:06.905 --> 00:57:08.364

Lorna Nichols: what is the best


00:57:08.895 --> 00:57:11.245

Lorna Nichols: way to get b vitamins


00:57:11.575 --> 00:57:16.735

Lorna Nichols: in a condensed form that I can almost use like a supplement. If there is anything?


00:57:19.075 --> 00:57:22.174

Lorna Nichols: Anything off the top of your head for that.


00:57:23.375 --> 00:57:31.875

Dr Doug: Yeah, we have a bunch of different products right now, we're using active B complex as a supplement. And that's who actually makes that Brett is that Claire.


00:57:31.875 --> 00:57:32.795

Breta Alstrom: Claire? Yeah.


00:57:32.795 --> 00:57:34.074

Dr Doug: Claire labs. Yeah.


00:57:34.814 --> 00:57:45.164

Dr Doug: there are a ton of different products out there. But that one is available in full script. And I think I recently updated the Osteoprosis list and full script. With that product I could be wrong. But.


00:57:45.174 --> 00:57:47.814

Lorna Nichols: The reason I ask about food, though, is because


00:57:48.034 --> 00:57:51.362

Lorna Nichols: I think the supplement I'm having a problem taking a supplement.


00:57:52.100 --> 00:57:52.535

Dr Doug: Gotcha


00:57:53.134 --> 00:57:58.155

Dr Doug: not not uncommon. That happens so food, then best sources are going to be red meat


00:57:58.265 --> 00:58:10.334

Dr Doug: period. And then you mentioned liver and vitamin a toxicity. But again, unless you're eating like a pound of liver, you really don't need to worry about it. And assuming that's not polar bear liver


00:58:10.505 --> 00:58:12.484

Dr Doug: hard to get polar bear liver.


00:58:13.985 --> 00:58:15.705

Dr Doug: Okay, thank you.


00:58:16.795 --> 00:58:18.115

Dr Doug: Don't hunt polar bears.


00:58:19.185 --> 00:58:25.885

Breta Alstrom: I just wanna give a little tip here on this question. I'm answering in the chat on taking your supplements all at one time


00:58:26.845 --> 00:58:39.644

Breta Alstrom: you can, depending on the supplements. Some of them do need to be taken fasted. If you are at home during the day, or even if you have a desk, if you can put all your supplements in a little cup, and then just kinda take them throughout the day.


00:58:39.685 --> 00:58:41.575

Breta Alstrom: That might work better for you.


00:58:43.755 --> 00:58:44.554

Dr Doug: That's what I do.


00:58:45.525 --> 00:58:46.815

Dr Doug: They're currently gone.


00:58:48.025 --> 00:58:49.105

Dr Doug: They were all there.


00:58:49.315 --> 00:58:49.965

Breta Alstrom: Yeah.


00:58:50.555 --> 00:58:52.554

Al Kral: Which ones need to be


00:58:52.565 --> 00:58:53.715

Al Kral: basten.


00:58:55.275 --> 00:58:58.815

Breta Alstrom: Those are. Gonna generally be like your thyroid.


00:59:00.985 --> 00:59:07.495

Dr Doug: yeah, I mean, outside of thyroid on an empty stomach. I don't think anything actually absorbs better on an empty stomach.


00:59:07.865 --> 00:59:11.135

Dr Doug: because again, we're our body's used to getting nutrients through food


00:59:11.905 --> 00:59:16.435

Dr Doug: right? So we would want to consume them with food and try to trick our body if that's possible.


00:59:18.425 --> 00:59:19.445

Dr Doug: Yeah, Helen.


00:59:21.385 --> 00:59:29.824

Helen: I I take. You know I can't do serotyam and couple of the things like that. It's just too too much for my gut.


00:59:30.714 --> 00:59:34.774

Helen: And I do. Wanna take 4 on so I eat


00:59:34.785 --> 00:59:46.925

Helen: a few prunes every day. You know they're they're so sweet, and they're so carbohydrate 3 of those a day. But is there a good plain boron supplement? I could try.


00:59:48.335 --> 00:59:51.454

Dr Doug: Yeah, absolutely. There are several boron


00:59:52.005 --> 00:59:54.664

Dr Doug: I think I'm using one right now from trace


00:59:55.535 --> 01:00:15.135

Dr Doug: trace minerals, trace nutrients whatever that company is called trace Threce, and they have us. They have a 6 milligram per ml, a liquid based boron. So you probably only need half of that to get the what I what I talked about in the Boron Video, which I don't think we've released yet. But I have a Boron video coming out 3 milligrams is the sweet spot there.


01:00:15.325 --> 01:00:16.935

Helen: Okay. Great. Thanks.


01:00:17.365 --> 01:00:18.355

Dr Doug: Yep, you're welcome.


01:00:18.885 --> 01:00:29.275

Dr Doug: all right, guys. I think I got to wrap up. I'm interviewing someone in 30 s. So I'm going to pop over to Riverside. That's why I have my blue background on.


01:00:31.015 --> 01:00:38.865

Dr Doug: I'm going to pop over to Riverside and do this interview, and I think next week we're all on. I think it's me right, is it me?


01:00:39.055 --> 01:00:41.794

Dr Doug: It's me. Okay. So next week it's me.


01:00:42.405 --> 01:00:55.604

Breta Alstrom: Yeah, I think guys, just make sure you're in slack and check out the left hand side and all you have to do is click into each of those channels. You should be able to see them now. So just make sure you click into each one. So you get those notifications. Okay.


01:00:55.605 --> 01:01:01.545

Dawn Aragón, PhD: Yeah and sign up. Sign up for all of those. If you're not in the channels, put


01:01:01.755 --> 01:01:06.945

Dawn Aragón, PhD: get yourself in there, cause you'll miss out on a lot of stuff unless you are in every single channel.


01:01:08.265 --> 01:01:08.998

Dr Doug: Thanks, Don.


01:01:09.365 --> 01:01:10.964

Breta Alstrom: Alright! Bye, everybody!


01:01:10.965 --> 01:01:11.625

Diane’s iPad: Thank you.