March 6, 2024
During the meeting, the primary topic of discussion was the efficacy of collagen supplements, specifically Fortibone, in improving bone health. The group examined several studies, noting that the same author appeared across multiple publications, which could potentially indicate a bias or a lack of independent verification of the research. The studies in question were industry-funded, and the improvements in bone mineral density (BMD) reported were statistically significant but raised questions about their clinical relevance.
The group also discussed the potential benefits and downsides of collagen supplements. While collagen is not an essential protein, it is produced less as people age, and supplementation could help with skin, hair, and nails. However, the cost of products like Fortibone was a concern, and the group expressed a desire to see more studies not funded by the industry.
The conversation then shifted to a discussion about strength training for bone health, specifically addressing concerns about lifting heavy weights and the potential for causing spinal issues. It was noted that the LiftMore study is the only one showing an increase in bone density from exercise, and the importance of proper form when performing exercises like deadlifts was emphasized.
The group also touched on the topic of trace minerals, with the understanding that contamination is a risk when growing anything in the environment, including supplements like AlgaeCal. The importance of the body's ability to detox was highlighted.
A member shared a report about AlgaCal, which led to a discussion about the potential presence of lead in supplements and the variability in the amount of listed ingredients found in products. The conversation also covered the regulation of the nutraceutical industry and the challenges of ensuring purity and consistency in supplements.
Questions from participants included concerns about the advice from healthcare providers regarding exercise and osteoporosis, the use of Pilates reformers for bone health, and the safety of lifting heavy weights with a history of back issues. The group also discussed the appropriate levels of vitamin D supplementation, with some members sharing their experiences and blood test results.
The meeting concluded with a reminder about the importance of long-term planning when managing osteoporosis, especially when considering the use of medications like bisphosphonates and the potential need for a follow-up plan after treatment with drugs like Forteo or Prolia.
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Dr Doug: all right. So for today. We have, of course, a million things to talk about. I wanted to continue on with the supplement stuff.
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Dr Doug: the reason why is we got? I think we had like 3, like 3 or 4 versions of the same question. So I think we should just start there, which is around collagen. Specifically, these the the Ford bone product, the collagen specific peptides, as they call it. Does anybody have anything urgent? They need to bring up
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Dr Doug: before we do that
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Dr Doug: great. I love not urgent things so way way, better way to live life.
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Dr Doug: Alright. So let's talk about this, these studies. So a couple of different studies. So David, and Nancy and someone else. all sent in different versions of the same question and different versions of the same study. So let me just actually share my screen. We'll show a couple of these.
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Dr Doug: it's unnecessary, but this will be fun. So you should be able to see my screen in this study and the journal nutrients from 2018. Everybody see that? Yeah.
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Dr Doug: so this is a study, and you can see very clearly some some
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Dr Doug: way we're gonna kinda go through this. And I wanna just show you some ways to look at this yourself. So maybe this will help you to to kind of look at literature. So you can see very clearly that they're talking about a specific college. And Peptide is what they're calling it they're calling this a randomized, controlled trial, and we'll talk about that. I've not actually read the study just being critical out of the gate and then when you look at the authors, it's unlikely as a a non scientific person, they're gonna recognize authors.
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Dr Doug: But what I want to show you is that when you see, you know, multiple studies on the same thing. And you see the same author. So here's a study.
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Dr Doug: Here's a study, there he is.
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Dr Doug: there he is
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Dr Doug: so a lot of times when somebody does some work like this they will publish it
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Dr Doug: different. You're not supposed to publish the same
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Dr Doug: clinical trial in different journals. But there's different ways that you can kind of manipulate that. So you end up publishing in multiple places. And it it looks like you have then, more credibility to the same research. But a lot of times it is the same research. So we'll kind of look at that. So this publication and nutrients 2018, this one journal of metabolism, 2021.
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Dr Doug: And so we have the whole paper here. So this is great. So now we can really kind of look at this, the big takeaway, though, if you look at the
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Dr Doug: if you just look at the abstract
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Dr Doug: what I generally wanna look at. And the reason why people are bringing this up is that this was a randomized, controlled trial. 102 women completed the study.
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Dr Doug: I'll talk about some of those other details.
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Dr Doug: average T score the spine negative, 2.4 female neck negative, 1.4. So worse in the spine than the neck and infernal neck. That's a hip and actually kind of osteopenic although average age 64. So right age group post menopausal women.
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Dr Doug: And then here's where things get a little challenging for me. Which is it? Did
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Dr Doug: they look at the
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Dr Doug: improvement and what they report.
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Dr Doug: BMIT. Squared.
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Okay.
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Dr Doug: here we go. Bmd, in the spine of the feminine neck increase significantly compared to the control group.
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Dr Doug: If you look at this, though. T-score of the spine.
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Dr Doug: to look at what scp means. Oh, so specific specific collagen peptides.
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Dr Doug: It went up plus point 1
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Dr Doug: which doesn't seem like very much, does it?
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Dr Doug: And then t-score plus point o 9. So it met statistical significance.
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Dr Doug: But is that clinically significant? So we'll let's we'll circle back and talk about that and then this one.
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Dr Doug: It looks like it's a different study. Alright. So this is
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Dr Doug: follow up observation. So what they say, they they did this previous study. And then they did a follow up. So now they're using. This is kind of sub group analysis of people that followed up for a certain period of time.
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Dr Doug: And then in the abstract, they don't really give us a lot right. All they say is that it was. It was significant.
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Dr Doug: And
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Dr Doug: although they do give us this, that's cool.
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Dr Doug: So then they're following people.
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Dr Doug: We'll go back and look and see if they were saying it was significant compared to annual loss. So they are extrapolating data here.
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Dr Doug: but it did go up. So that looks good. Okay, great. How much did it go up? Me?
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Dr Doug: Not a lot. So they don't give us the data here. I don't know if I have access to this a lot of times I do.
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Dr Doug: But look at that
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Dr Doug: great
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Dr Doug: they have a longer abstract here. See if they give it to us.
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Oh.
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Dr Doug: to do to do to do? Small group 23. A complete follow up data.
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Dr Doug: And and they were divided right? So 10 receiving treatment and 3 or 13, and the and the placebo group so really small, follow up group.
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Dr Doug: I'm going to be a a lot of bias there.
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Dr Doug: This is what they're showing. Again, they're saying, it's statistically significant. There's your p-value. they don't actually say.
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Thomas Schellberg: Here we go. Yeah. And these are the numbers that I've seen.
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Dr Doug: Alright improvement of 8% in the spine and 1.2% in the front of the neck.
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Dr Doug: So 8% in the spine.
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Dr Doug: But they don't give us actual numbers. And so, oh, here we go. Here we go. Here we go. Vmd spine.
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Dr Doug: So this is always challenging. Here's the T score spine so negative 2.5 2 to negative 2.4 4.
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Dr Doug: So is that does that sound like 8%.
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Dr Doug: I was always taught when I was going into doing research work, that there's this is a fun cliche. There's lies, there's damn lies, and there's statistics.
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Dr Doug: and you can make things look
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Dr Doug: different. It's hard to lie with statistics. But you can definitely tweak things with statistics. So this is an example of an industry funded study. I didn't actually point that out. But it should say in here that this is an industry funded study. Let me just look.
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David Callen: It's same group. The 4 year study.
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Dr Doug: Right? Well, it's the same author. And they they used a subgroup.
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David Callen: When I'm looking at the original study. Umhm.
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Dr Doug: You guys can't see what I'm doing.
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Dr Doug: But
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Dr Doug: So conflicts of interest. It says no conflicts of interest. But here we go acknowledgments. So this isn't a conflict of interest per se. But it's an acknowledgement that part of the study was financially supported by Jelita, Ag.
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Dr Doug: Which makes the specific collagen peptides.
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Dr Doug: So that's an industry funded study that shows that you have pretty significant increase statistically, and it looks good on paper. But how clinically relevant is that? I mean, I think it's always a question of upside Downside. So what's the risk? What's the benefit? There might be some benefit.
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Dr Doug: There's not a lot of risk other than dollars or wherever you are in the country. You're
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Dr Doug: monetary
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Dr Doug: unit. but
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Dr Doug: it is expensive. So 4 to bone is their product, and it is expensive. Available in lots of countries. It is the. Here's the other challenge I have with the the collagen approach for bone. Health is that? Yes, collagen is a part of bone, but 4 to bone is the only collagen that's shown that.
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Dr Doug: So I don't know. I'd love to see another study. I know they did a follow up study. So it's a second study, but it's the same group.
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Dr Doug: so it's never been repeated.
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Dr Doug: So I'd love to see a repeated study. I would love to see it not be funded by the company that makes it. But I don't think that's ever going to happen, because why else would anybody study it?
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Dr Doug: Or why would they use that specific formulation. So you have to ask yourself, Is this a magical collagen that this one shows benefit to bone and and none of the others do
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Dr Doug: I don't know but from an anti aging perspective, and we are actually, we're engaging with with Jilita to try to see if we can bring this to people at a lower cost.
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Dr Doug: But the reason why we're doing that is because, again, what's the risk? If you have unlimited resources, and you want to add this to your stack. It's reasonable. I don't think that there's any risk from an anti-aging perspective. We do reduce collagen production. So it's not an essential protein to the human body, but we do make less of it as we age. It makes sense, and people definitely report in the literature would show improvement in, you know. Skin hair nails
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Dr Doug: so other than the downside of trying to pick, which supplement is the right one for your budget. I don't see a lot of Downside
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Dr Doug: any questions about that.
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So stay tuned hopefully. Hsn. Will have a fortubone
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Dr Doug: discount code. That's my client. That's my my goal. Oh, and I shouldn't say this. There might be a company out there looking to make a proprietary product out of that same product.
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Dr Doug: that's all I'll say
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Dr Doug: So it's like the first 3 things.
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Dr Doug: Let me
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Carolyn left witch, is Carolyn. Here.
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Dr Doug: Carolyn, raise your hand if you're here.
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Dr Doug: A lot of people here.
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Dr Doug: I don't see it. Carolyn. Okay. Well, so, Carolyn. She, I think she put this in the the Hsn. Slack.
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Dr Doug: and for those that aren't in slack great place to communicate with each other. Ask each other questions. You'll get your questions answered faster there, and then you will hear, since we only do this once a week. But I think she put this in slack after. I think it was 2 weeks ago when I made the announcement of OJ. And we're kind of shifting over to that direction of using Oj. Cal. Products from the bone up products or Gerald Products. And she wrote that there was a
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Dr Doug: 2023 report
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Dr Doug: referring to a 2,011 and 2,017 test on an algacal
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Dr Doug: that showed that there was a an elevated leg out and so this is something that I've actually talked to Dean about the CEO, because I had heard this before as well, and I'd actually seen these numbers, and they did follow up in this report. They said that it was
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Dr Doug: quote unquote, high in in 2,011, and then it was better in 2,017 and then they also only found 86.7% of the listed ingredients in the the products.
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Dr Doug: So I, when I asked Dean about the contamination this was my perspective already, but he just reaffirmed this for me, which is that when you're growing something in the in the world? You know, it doesn't matter if it's algae, or if you're growing cows, whatever they're exposed to is gonna be in the product.
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Dr Doug: So they grow this stuff in protected environments. But lead is in the environment. Right is a natural thing. So strontium. That's why it's an algae. So you know, we look at the the constituents of the algae, and we say, Oh, well, these things we want.
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Dr Doug: We don't want anything else, but we can't.
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Dr Doug: We can't grow them in a sterile environment. Otherwise they wouldn't actually have the products in there. So they measure each batch. And they look at levels and they're controlling the environment. There's always going to be. If you were to grow any plant in any environment. There's going to be other, you know, potential toxins, things you don't want in there. It's just a matter of at what level. So they're always looking for that. So that report doesn't surprise me. You know. What you don't see is you don't see that same aggressive
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Dr Doug: approach to looking at ground up cow bones to see what kind of stuff is in that and so yeah, I think you would also see toxins that way, too. Things you don't necessarily want a year supplements
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Dr Doug: as far as the only having a certain percentage of the stuff that they say is in the cap capsule in the capsule. That's also pretty common. I'm happy to see that they at least had 87%. Compared to other products where there's been literally 0,
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Dr Doug: you know. People will say, this is a 20 milligram dha, and then you examine it, and it is literally there's no dha and think maybe better
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Dr Doug: so. The pharmaceutical industry is pretty tightly regulated, and I'll actually mention more about that in a second. The nutraceutical industry is essentially unregulated. We require them to regulate themselves, which is challenging in a capitalist environment.
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Dr Doug: But even the pharmaceutical industry, I'd have to look this up. But I remember the the plus or minus being between 10 and 20%.
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Dr Doug: So if you're taking, let's say previously's progesterone. For example, if you're taking a commercial progesterone, it could be anywhere between. I think it was 10%. So anywhere between one 100 and
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Dr Doug: 190 to 210 milligrams.
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Dr Doug: I remember it was a bigger swing than I thought it would be. So that's it's it's hard to create something that's that pure. And everything is as evenly divided as even a pharmaceutical should be.
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Dr Doug: So that's not common and not surprising to see that the 10 to 15% swing either way.
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Dr Doug: And then there was somebody in the chat.
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Dr Doug: yes, Susan, native is another 41 product. Yup
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Dr Doug: and then Diane said, it seems like as long as I choose a reputable collagen peptide powder that is similar to 4 to bone. Then in the very least, I'm getting another 10 grams of daily protein. True. So, Diane, that's a good point when it comes to protein.
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Dr Doug: collagen is not a complete protein, and actually had an interesting discussion around this with a guy that makes a protein product we're considering bringing out. But I still can't get my mind around how he's getting his numbers.
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Dr Doug: There's a a guy local to Asheville is really smart. Md, that that creates products. And we're actually gonna start promoting his branch chain amino acids. So a lot of you might be using Bca's from like Thorn or Keon as a company that we support because they make a really good product.
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Dr Doug: so this guy's making a a I think, a better product for less less dollars, double the amount for less dollars. So we're gonna support. We're gonna start pushing that. So you'll see that come out I'm gonna do a video on that. So you have more information. But he, we were going back and forth on this collagen is is protein, and the answer is, collagen is protein. But if you look at the amino acid profile, it's a not complete, and it's gonna be lower in Leucine than say, weigh, or even a p protein, if you wanted to go vegetarian
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Dr Doug: but it is protein. So you are getting amino acids. You're just not getting the leucine that you would get from a complete protein, particularly from whey or from beef.
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Dr Doug: Does that make sense, Diane?
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Dr Doug: Wherever Diane is?
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Diane’s iPad: Yes, it does. Thank you. Oh, you are. Hi, I appreciate that. Yeah, of course.
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Dr Doug: Alright. Susan has a question about strength training. Susan. Before I get to that. Let me just see as I think we were.
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Dr Doug: Yeah, alright. So then I just have a whole list of different
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Dr Doug: products to talk about, not my products. I wish let's talk. I wanted to talk about social media real quick. So for people that are following us on particular Instagram
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Dr Doug: is anybody here at Instagram. People I know, don's an Instagram person. Raise your hand if your video is on and you use Instagram
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Dr Doug: a few, a few.
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Dr Doug: Alright. This is why I don't have any Instagram followers. I'm just kidding so there's a a way to connect with people on Instagram is to use hashtags. I know this might be totally foreign for some people. I don't. I don't do it either. But when I post stuff, particularly in stories, I use the hashtag aim for optimal. I'm just gonna drop it in here.
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Dr Doug: Aim for optimal.
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Dr Doug: Since that's what I say, and all of my podcasts. If you follow that hashtag. You'll see, then anybody that puts hashtag aim for optimal and a post. So you'll see people cause nobody else is writing this. You'll see. People that are are part of this community putting in aim for optimal. So if you ever post, and you think it's appropriate for this community, then put in aim for optimal. And then other people in the community will find you. Does that make sense?
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Dr Doug: Okay? Great. That's as social media, as savvy as I get
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Dr Doug: alright. So then, before we get into this long list of potential supplements to talk about
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Dr Doug: where
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Dr Doug: I love this community, you guys are so smart. Great questions.
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Dr Doug: so let's answer Susan Hurley's question about strength training. And then, Susan JI will answer your question about trace minerals and reasonably priced. That's a
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Dr Doug: that's a heated question.
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Dr Doug: So Susan Hurley asked the question in chat. She says, after I heard you discuss the Liftmore study, I started lifting heavier, aiming for 80% of my Max today. My endocrinologist told me to not lift heavy. Doctors especially deadless because I could create problems for my spine. I'm 61, and have been doing strength training for a long time.
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Dr Doug: Susan. Where, Susan, there you are.
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Dr Doug: Susan, what does your endocrinologist look like
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Dr Doug: you're muted.
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Dr Doug: can you unmute. She's young and healthy looking.
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Dr Doug: she's fearful. I was hoping you were. Gonna tell me she was like 40 pounds overweight. No, not at all.
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Dr Doug: Yeah. So I mean, did she give you any? Any recommendations of weights are good. But don't go heavy.
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susanhurley: Don't, don't go heavy. Don't go heavy. I'm gonna send her that. II found the Lyft more randomized control trial. I'm gonna send a link to it.
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Dr Doug: Yeah, you should could also send her a link to my Youtube channel.
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susanhurley: Okay.
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Dr Doug: yeah.
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So here's the thing. Could you get Andrew doing a deadlift, of course.
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Dr Doug: But if we protect ourselves from anything that could potentially cause damage. Then
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Dr Doug: we're just going to continue to degrade right. The natural evolution of all energy is is degrading into death. That's what we are all doing over time.
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Dr Doug: Our goal is to do it over a longer period of time and to feel better while we're doing it.
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Dr Doug: So I would say that that the Liftmore trial, and actually I just reviewed another study today. But the Liftmore trial is the only study that shows an increase from exercise and bone marrow density.
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Dr Doug: So to tell you, not to do that would be to go against the only data that supports using exercise to increase bone marrow density.
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Dr Doug: Now, arguably, the impact may have played a bigger role in the bone. Mineral density increase, but when I think of the deadlift and Don. I don't know, Don, if you put those in your Instagram feed, or if they were just in your story.
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Dr Doug: But Don had some great videos, great form, I think better form than I do of doing deadlift. and when you watch somebody do that, especially somebody lean like Don.
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Dr Doug: When you watch somebody do that you can see all of the different muscle groups you have to engage to do the exercise of a deadlift. Right? It is hamstrings, it is glutes. It is a ton of core and then it's also your upper body. You're loading your scapula. You're loading all the muscles that are supporting your shoulder. All of that's going through your spine.
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Dr Doug: So I think a deadlift is an incredible exercise, but it has to be done right as a key. So I think as as a fearful endocrinologist doctor who has a bunch of unfit, unmotivated patients who they have on prolea.
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Dr Doug: That's probably the right thing to say for her.
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Dr Doug: Because if you told most of that population because her population is not my population, you guys are motivated. You're here.
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Dr Doug: and you have good form. If you're done so, she has a group of people that are unmotivated. If she told them all to go out and do dead lips, she would probably see fractures right? And she would probably get sued.
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Dr Doug: So it's just a different mindset. It's a different population.
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susanhurley: Yeah, I don't think she knows a lot about cause she she didn't even make a dead left was a good exercise to do so that'd be better to do squats which I know should also be done in our part of my routine. But
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susanhurley: III just don't think she's like doctors can't know about everything, so I don't know. When when was she ever taught about deadlifting?
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susanhurley: It's not part of medical school. Yeah.
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Dr Doug: I would argue. I know more about deadlifting now than I did a year ago. because I worked with a coach who was making me do a deadlift.
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susanhurley: and she makes me do a lot of deadlocks. Just take it into consideration right like, thank you. Thank you for your opinion
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and not lift heavy.
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Dr Doug: I'm going to lift 80% of my one rat. Max.
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susanhurley: yeah. And what like Al or someone said about being careful. Yeah, if you're in what you said, you've got to have. Really, you've got to have good form, because a lot of people do them incorrectly.
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Dawn Aragón, PhD: If if you're on slack, I can post the what I put on on my Instagram, I can put the 4 the lift more trial for exercises because I do them at least twice a week. I weigh about 95 pounds, and I dead. That deadlift is 75 pounds.
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Dawn Aragón, PhD: and and the the squats also 75 pounds. That's 80. That's 80 of my Max. And I do a 5 by 5, all of them beautiful. So yeah, Don, if you want to post those that'd be great, I will give you. Can I give you an open criticism of your form? Yeah, please. Your form was great. Just slow down.
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Dawn Aragón, PhD: Oh, yeah.
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Dr Doug: I do this. I'm I'm guilty of it as well, cause I'm like, I gotta get this dog. I got 30 min I gotta knock these out. And then I watch videos of myself. And I'm like, that's way too fast. When I do the I have my
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Dawn Aragón, PhD: What do you call the the thing that ticks every second? What do you call this thing?
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Dr Doug: I have to have that on, or I go too fast. So at the gym I don't have my little thing ticking to tell me to do 3 s to go down.
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David Callen: I just ask 5 5 of 5 walk me through that cause I like I'll do sets of 6, but II start light, and then I go heavy. Then I kinda like a bell curve. Explain me what you mean by that. Yeah. 5 by 5 is simply doing 5 sets of 5 reps.
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Dr Doug: So 5 5 by 5 is what that means. So then, my, what my coach has been doing now. She is not a a osteoprosis specific person. She is a body building coach, but she'll have me build up over 5 sets. So, for example, for me, like I was doing back Spot yesterday, and this is this is the heaviest I've ever lifted. But it started at 1 35, you know, and did a set of like 3 or 5 ago, 135185205225, and then put on my lifting weight. And so then I did 5 sets of 5 reps at 2, 65,
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David Callen: and that's way too heavy for anybody in this room. Don't do that.
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Dr Doug: but she wants to torture me.
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David Callen: Well, and that explains why you go. The 80%. I ended up settling on maxing out with a rep, a set of 8 to 12 reps, and as I move more toward the 12, then I would increase the weight. That's exactly right. Yeah. So if you can get to 12
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Dr Doug: and you never really want to go to failure, there's really no benefit in going to failure. I just post it. A couple of days ago II accidentally went to failure, but that's why either work with somebody or have it set up so that you don't hurt yourself if you do but there's no benefit from a strength, or you know, even if your goal is to build muscle hyperroy. You don't need to go to failure.
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Dr Doug: I'm just asking for injury.
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Dr Doug: or Hansa. Ii love that your under chronologist told you not to climb on chairs as an orthopedic surgeon who did a lot of trauma. I will also tell you not to climb on chairs.
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David Callen: Please don't
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Dr Doug: bladders same thing, people that hang their own Christmas lights don't do it.
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Dr Doug: Just ask him for trouble, not because you have osteoprosis, just because it's dangerous.
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Dr Doug: So, Susan, you were asking about trace minerals. And the answer is, there are a number of different products out there. I want to say we're using
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Dr Doug: Claire labs. Oh, the K.
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Dr Doug: But it kind of depends on what your needs are. So we have.
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Dr Doug: Excuse me for people that don't need extra calcium. So if they're not on algae, that we have them on some kind of a trace mineral. We have a list of a few different things it depends on if they have thyroid dysfunction, do we think that they need iodine or not? Because iodine is always gonna be in there or not in there? Very intentionally I've used trace the concentrate stuff, but it says, you know, it's it could be polluted. But again, if it's coming from a natural source, there's always gonna be that risk of contamination.
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Dr Doug: I think we just have to do our best to maintain the ability to detox. I've been talking about this a lot lately. Even in my own house. We're changing our diet with our kids because they're they just have this. They don't have a great capacity to detox and so
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Dr Doug: I think, as adults, it's so important for us to be able to detox, to spend time in the Sauna, to make sure that we're sweating, you know, to make sure that your your bowels are regular, that you're getting. You know as much out as possible. And then, if you're not, you know. There's a way to test for that. But most people don't need that
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Dr Doug: Michelle. Michelle fired her endocrinologist.
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Dr Doug: I like that. I shouldn't. I shouldn't laugh for some people it's hard to find another doctor, so I always it cringe when I hear people say like, Find another doctor. Sometimes you don't have a choice, you know, like you can't. It's hard to doctor shop endocrinologists. There aren't that many in a lot of areas.
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Dr Doug: the question I would have is, do you really need an endocrinologist? In the first place, and hopefully you don't
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Dr Doug: so, Mary.
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Dr Doug: she says your physical therapist said that Pilates reformer with added weights can build bone.
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Dr Doug: Her main point was to do something consistently starting from scratch and wanna use your time and money efficiently. Yeah, great, great Mary, I love that. I was just recording a video about like if I if somebody said to me, I just got diagnosed with osteoporosis. What are the first 3 things I would do? One of them was, you know, getting into the right kind of training.
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Dr Doug: I love Pilates, and I love reformers. In fact, I'll put this in here. There is a if you guys want to look up a type of Pilates reformer called Legree.
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Dr Doug: this. Basically, this guy took the Pilates reformer thing, and he kind of made it into a big what they call it a mega reform or a Mega form or something. There's one of those in Asheville we've kind of ventured all over the place, and they're
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Dr Doug: II like them better. It's more like slow time under tension really great for core. My wife and I do it for date night. That's how weird we are. But it's a really great workout if you can't find Pilates reformer. But here's the thing about reformer work in general, which is, it's a lot of tension. You definitely get the muscle
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Dr Doug: to get engaged. But it's not high intensity, and it's not impact. So I've never seen a study that would suggest that it could build bone. And I wouldn't think that it would build bone.
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Dr Doug: not to say Don't do it. I just think that if your goal is to build bone you could do that and impact.
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Dr Doug: But I would. I would prefer to do free weights, because, depending on your starting point, free weights are gonna give you all of that other. You know the balance, control, the all the other fine motor things, you know. Like I said, when you're doing a dead lift, it's not. You're not just doing your your hamstrings and your glutes. It's all of the upper body, you know. It's it's your neck, it's your spinal, erect muscles, it's your shoulders. It's your your traps, all of it.
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Dr Doug: So I just I don't think that you can replace that with anything. Honestly.
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Mary Daly: Thank you. I appreciate I'm new to the group, and I'm trying to figure this all out, and I'm starting.
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Dr Doug: Let me mention the other 3. The other 2 things I guess, that I said in the video that I recorded today. So the the first thing that II said that I would tell anybody to do if they were recently diagnosed is to learn as much information as possible. So, Mary, you're you're in the right place. I'm assuming that you're also going through the bone foundations content? Yeah. And then, and plus or minus the master class, if you haven't gone
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Dr Doug: through that, that's sort of like bone foundations in 50 min.
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Dr Doug: All of that content is going to be great to get a sense of what's going on. I just re-recorded about a third of the videos in the master or sorry in the Bone Foundation's course, just with some updated information. So once you go through it, then go through it again.
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Dr Doug: Okay, thank you very much. Yeah, you're very welcome. Welcome. So so that was number one that I would recommend doing. You know, making sure, Mary, to, you know. Get if you have access to a Rems, get a rems to sort of backup the diagnosis from Dexa, and then also getting those Npn Ctx bone biomarkers that don't turn over biomarkers so that you know what's happening over time so that you can improve your bone over time.
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Dr Doug: And then what was the second thing I said. oh.
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Dr Doug: don't take a drug out of the gate is what I said and the reason for that is that most people here know, you know, that drugs come with side effects, and they might be right for some people. But ask the question, what's the long term approach? I see some young faces popping up in here, you know. If you're 40, 50, you know, 60 years old. What's the 1020, 30 year game plan here.
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Dr Doug: You know, as we get into our 70 s, you're sort of on that like in between, as you get into your eighties and nineties, you know, maybe a 10 Year Plan is right. But honestly, it really depends on your starting point. So I always ask that question, what is the long term plan here, if you're 50 years old and your doctor wants to put you on a bisphosphinate.
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Dr Doug: what are you going to do in 3 years.
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Mary Daly: Yeah, right now, before I found you, they put me on Fasa Max. I'm now 59, going to be 60 in like 2 months. I got to figure all this out.
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Dr Doug: Yeah. And and so, Mary, there's such a great, just a great example. So did they tell you what the 5 Year Plan is what the 10 Year Plan is.
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Dr Doug: Yeah. So you're you're 59 years young, I assume you have probably 20 to 30 years at minimum of life expectancy. So then, what are we gonna do when you can't take fossil, Max again after 3 years?
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Mary Daly: Alright, yes, see, I didn't know all this at the time. So I've been on for like 8 months. Not quite a year. And actually the Dexo went up.
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Mary Daly: I was like, Hey, this is great! That was my 6 months, Dex. I think
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Dr Doug: so. I don't know. I'm learning. Yeah. Well, and so, Mary, here's the the obviously, I can't tell you what to do. You're not my patient, but what we find with Dexa on Bisphosphonies is that it will go up.
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Dr Doug: It'll go up more initially, and then it kind of plateaus out. The reason why it goes up is because it does squash your bone breakdown. So you still have a little bit of bone building, and you're not breaking down bone.
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Dr Doug: The problem is over time. Imagine if you are building like construction on a roadway, if you're if you're building a road, and you don't clear out the old road. The new road's not going to work real well, right? You're just building on top of a building. You've got to clear out the old to build the new. That's why we have 2 sides of that equation.
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Dr Doug: So initially it looks great. But then, over time the bone. Architecture isn't very good, and then you have more dense but potentially brittle bones. And that's why the recommendation is to stop either after 3 years or 5 years depending on the drug that you're on.
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Dr Doug: So getting off of bisphosphonate, not as challenging, as getting off of something like prolem where you have this like known rebound of bone loss, bisphosphonate, you will just, if you stop it now, which I'm not telling you to do. But if you were to stop it. Now, then, you would see that the bone breakdown climb again. So then, our approach when we do that is to say, okay. Well, now we need to do everything we can to push the bone building to match it.
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Dr Doug: and we might lose a little bit of that gain that you saw, but the whole goal is to balance that, anyway. But you need bone turnover. You need bone breakdown to build bone in the long term.
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Mary Daly: It's like, is that? My official recorded answer is, Ask your doctor, but from a physiologic perspective. Yes, there's no reason why you can't just not take the next dose.
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Mary Daly: Okay? Alright, thank you very much. There's no tapering that has to happen there.
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Dr Doug: Perla is a little different, because then you you really need to have a solid game plan in place. If you're going to come up early.
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Dr Doug: you're welcome. So then Juan Juan is translating for his mom. That's awesome. Juan.
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Dr Doug: And then performed at Dexa, and told her her doctor told her not to exercise at all that anything could make a tendon or something, break or snap
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Dr Doug: all the rot scores were at negative 3, and the doctor pushed for the drug affinity. hoping to hear counterpoints or guidance.
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Dr Doug: Yeah. So, Juan, it's tough. Without knowing all the details. You know what the recommendation should be. You know how how frail is there a reason why she's worried about tenden snapping? That's not really a thing with osteoporosis. So it's a little bit tough to know. I will say that affinity as a drug. The only time that I think event really makes sense is if somebody is actively fracturing.
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Dr Doug: So there are some studies to show that if somebody's having like spine fracture after spine fracture, you know, one after another, and they're stuck in this really crappy cycle because you can't load. It's hard to get better if you keep breaking your spine.
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Dr Doug: So in in that scenario, affinity will stop that cycle.
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Dr Doug: But you can only use affinity for 12 months anyway. So again, like, what's the what's the plan after 12 months. Is it affinity, and then reclass, you know, which is a an ibis phosphate? That's a common move. So just understanding what the role is there? What is her starting point, you know? What does she actually have the capacity to do? So definitely more to learn there for? Sure.
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Juan Barona: Yeah. Nice to meet you, Doctor Lucas. How's it going?
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Juan Barona: So wanted to add, there is no breaking. There's no fractures. She just went on a follow up last time she did. A test was 7 years ago.
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Juan Barona: and it only got worse on the femur, I believe, by negative point 5 from 2.5 to 3. Sorry 3, and there's there's no injuries, there's nothing she just want to follow up. And then she said, You better not go to the gym. This is getting worse. You need a vanity.
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Juan Barona: So what I'm hoping to hear is, Hey, you know exercise is good.
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Juan Barona: You don't have any history, or is, is that kind of the the route that we should go as we get started?
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Dr Doug: Yeah. So again, it's it's tough without knowing more. But a t-score of negative 3 for me doesn't say, doesn't tell me that that person shouldn't be doing resistance training.
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Dr Doug: The question is, just what are you? What are you capable of. So even if somebody had a T-score of negative 4 or negative 5. Right? Let's take somebody who's at an extreme. Can they lift weights? Sure.
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Dr Doug: are they at risk of fracture? Yeah.
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Dr Doug: it's hard to know when that fracture point comes, though, because again, there's so many details around like, what is the form. Where do you put the weight, you know? Are you loading? Do you have bad mechanics? If she's really concerned, potentially having her start with somebody, some something super simple and starting with very lightweight and building up. I was just doing a recording today on heel drops, you know. A heel drop is something that anybody can do
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Dr Doug: right, and you can do it with a T score of negative 5, and you're unlikely to fracture, although obviously you could sneeze and fracture. So II think that not doing anything again. It's that we were talking about earlier. If you're if you just choose to not do anything. Then you will be drug dependent indefinitely.
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Dr Doug: because you have to stimulate the bone to build bone
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Dr Doug: cool. That makes sense.
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Juan Barona: Yeah, yeah.
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Juan Barona: appreciate it.
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Dr Doug: Yeah, Ron Ron, where is your is? Are you guys in the Us. Or you guys, international?
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Juan Barona: Yeah, we're in Miami.
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Dr Doug: You're my workadorian. Yeah, right on
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Dr Doug: all right. Diane was asking about endocrinologist told her not to let Heavy as well
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Dr Doug: keep doing what I'm doing. T-sco is negative. 3, 7 and negative. 3, 4. Yeah. So a good good example.
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Dr Doug: so I've been doing the lift more exercises without the jumping exercise, and squat with Barbell in front of me, not behind the neck diet. Are you? Are you available to talk.
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Dr Doug: Tan? We have 3 pages of people here. But yes, I am.
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Dr Doug: I'm right here. I don't know where you are, or I don't know where you are. It's supposed to bring you to the front. Oh, there you are! Hi, Diane!
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Dr Doug: Actually your cameras on. Okay. Great. So Diane, can you tell us why bar in front, which I find really hard to do? Front squat, by the way, but why
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Dr Doug: versus back.
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Diane’s iPad: Because both the radiologists and the physiatrists that II got to speak to a radiologist after an MRI that I paid for, and then physiatrist. Because that's the only exercise they rec. They like what I'm doing, and the 5 by 5 modern 20 pounds. So I started my deadlist. 65. I'm at 100 right now. That's not quite a year, about 8 months or so, but felt that that because of this
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Diane’s iPad: potential of 6 vertebral fractures that I have no idea when or how they occurred.
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Diane’s iPad: So there's that's the radiologist says he's not really sure that it's actually fractures, and it could just be my spine. So I'm I'm working with that. But
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Diane’s iPad: and the physiologist so they both said like, because of that, putting it behind my neck. That is, is that axial loading.
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Diane’s iPad: and that's what I want to my correct there, Doctor Doug, and that's what I need to avoid, but keep the keep, the barbell in the front.
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Diane’s iPad: And then I it's kind of convoluted how I do it.
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Dr Doug: Okay, well, yeah. So I. So for me, I find that the the wrist range of motion required to do a front squat is is really hard on my wrist, so my my coach will have me do those, but I have to drop the weight quite a bit, cause II just can't like I can't hold it on my body.
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Dr Doug: So then, my, so then my weight is lower.
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Dr Doug: But my question would be, and I don't know the answer to this. But front squat, you're still loading right. You're loading your clavicles, your collar bone. You're loading your shoulders, which is indirectly loading your spine. If you have. If you're on a back, squat, it is sitting on your spiders processes, but it's not really sitting on your spine.
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Diane’s iPad: You know what I mean it the way that I actually do. It is a barbells in the front, but I'm hooking my elbows.
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Diane’s iPad: The the barbells kind of sits on my on my, on the inside of my elbows. and then I wrapped like this, and I hold it more like chest height.
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Dr Doug: so rather than do it with a dumbbell I do it with a bar bell dropped across my chest
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Diane’s iPad: like awkward.
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Dr Doug: Are you, Diane? Are you on Instagram at all?
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Diane’s iPad: No.
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Dr Doug: you should get on Instagram. Post yourself, post a a video of yourself to your stories and tag me, and I'll take a look at I'll I'll be doing the squat.
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Dr Doug: Yeah, I wanna see. I wanna see where you are, because what I'm worried about Diane is if you if you put your barbell down lower.
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Dr Doug: so let me just back up. If you were to put it up high, right? So if you do a barbell, I should just go grab a barbell. But if you put a barbell up on your collarbone, which is the way that it's supposed to happen, and my coach has actually trained me to. You can do it like this, and you can support it, but it should literally be sitting like on your neck, which is also why it's uncomfortable. But it should be sitting up here. If you put it down here, I'd be worried that you're actually putting more
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Dr Doug: stress on your spine.
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Diane’s iPad: I understand what you're saying, and that's the I keep running that question through. I'm going to hook up with my great trainer when I get back. But yeah, no, okay. I I'd like to. I would appreciate your input because no one's actually seen me do it, but by the same token, I can't put it behind. I got a left shoulder that includes me being able to get a barbell behind my neck.
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Dr Doug: Yeah. You and me both. Diana.
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Diane’s iPad: Great. Thank you for this. This is helpful. I know exactly.
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Dr Doug: it's good, though. Yeah, it's good.
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Dr Doug: Great! But thank you for bringing that up. I'm keeping my spine straight. I have someone spot me on the streets. Fine. So yeah, thank you
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Dr Doug: course? All right. And then Barbara was asking about Al Jakal.
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Dr Doug: She's new and already so you have already. I already have a supplement of 2,000, IU of d 3 alga cal plus has 16. Is that too much?
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Dr Doug: I would be switching from calcium citrate. Well, my recommendation for my patience is to not take calcium citrate anyway. Where's Barbara? Barbara? Are you here?
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Dr Doug: I know you're here because you put it in the chat question is, do you want to turn on your video? And you don't have to?
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Dr Doug: So here's the thing with the how much vitamin d do we need? Has anybody watched my video with Morley Robbins
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Dr Doug: on Youtube? So.
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Dr Doug: Morley, if you guys haven't read his book, what we haven't talked about in those videos is his perspective on vitamin D. He is a vitamin d hater and I'm still a little mixed on this message, because for I'll just take a little step back. So the reason why he thinks that vitamin D has been overblown is purely for financial reasons, which I kinda have a hard time with, because I don't think we make that much money off of vitamin d supplements. I don't know. I don't sell one.
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Dr Doug: but I think what has happened is that when the early data came out and the Women's Health Initiative was a great example of this.
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Dr Doug: If you added even 400 iu of Coli Calcifer, all, which is, it's not really, but that's what we call it. If you added 400 iu of of choli calciiferal, 2 women with osteoporosis, plus. I think they had a thousand milligrams of calcium citrate
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Dr Doug: or carbonate one of the 2 you saw a significant improvement and bone density, so we know that that we need vitamin d. We know that if that population, which was vitamin d deficient, truly deficient, like less than 20
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Dr Doug: in blood. they benefited from vitamin d. But over the last
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Dr Doug: 2030 years we've seen this push to keep increasing, increasing, decreasing the amount of vitamin d that that people are taking.
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Dr Doug: there's still a large group of doctors who say, you can't take that much. If you go over a hundred, you're gonna have, you know, calcium stones. I was sort of an early adopter of going high looking at the study on the immune system and anti cancer thoughts, and said, we need to be 8,000 or more. I'm not worried about calcium because I don't see it change, and I have never seen high calcium in somebody that has vitamin d. Of 100 or 150.
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Dr Doug: I have colleagues that give people 50,000 IU of vitamin DA day. That's a lot of vitamin d. But if you go back to Morley's concern, Morley's concern is vitamin d. When taken that way, causes
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Dr Doug: 2 very specific things. So one is when we bring vitamin d in that way, and then it circulates in our body, it goes to our skin.
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Dr Doug: it gets converted. That requires sulfation, that sulfation requires the it wires magnesium, like magnesium, is required for so many things. But what we're doing is adding another mechanism that then requires more magnesium. We are mostly all magnesium deficient. So we wanna reduce the amount of magnesium burden that our body has. Anyway, what he calls the magnesium burn rate.
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Dr Doug: And so by adding vitamin d as the way we supplement it, we're increasing our magnesium burn rate. So that's one. The other thing is we talk a lot about, you know, vitamins that interact with each other when you supplement
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Dr Doug: this is kind of an unknown one, which is when Colicalciferol is added in it will block the absorption of retinol.
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Dr Doug: which is vitamin a, so that gets into the whole like retinol versus beta carotene. But let's just assume we're taking retinol in the form of cod, liver, oil or beef liver, or wherever natural source, we're getting real retinol.
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Dr Doug: It'll block the absorption of retinol. So what we've been doing in our practice is we're testing
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Dr Doug: 25 hydroxy d, which is what vitamin d usually is when tested. We're also testing 1, 25 hydroxy d, which is the active form of of vitamin d, which is what we really wanted to see. And then we're testing blood levels of retinol. And what we're seeing is the people that have high levels of 25 hydroxyd have low levels of active D, and they have low levels of retinol.
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Dr Doug: So I think that there is an issue with taking too much vitamin d. But the challenge is, we have an osteoporosis population, so we know that they also need vitamin d. where's the sweet spot, and the sweet spot probably is gonna vary from person to person. But what we've been doing for our patients is actually adding the algeal plus and the aljacl complete. No. D. 3 complete and that gets you with 2,600,
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Dr Doug: are you?
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Dr Doug: So that's sort of that's that's where we're headed. And that's pulling back on that product that protect plus product that we had the the video on.
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Dr Doug: And I like that product. But the D 3 complete is almost identical. but with less vitamin d.
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Barbara berger: Oh, thank you. But but I'm taking there. It would be 3,600 a day. That's perfectly safe for the liver
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Dr Doug: for the liver. Sure. Yeah. The probably issue with taking too much vitamin d would be precipitation of calcium in theory.
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Dr Doug: So whether or not. You're gonna have too much calcium.
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Barbara berger: I'm a 10 already. That's not. That's like the high side
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Dr Doug: that's high. But is it coming from your vitamin? D, what's your 25 hydroxy level?
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Barbara berger: It was taken like a year ago. It was normal. II don't remember the number.
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Barbara berger: It was. I think it was less than what you had said in one of the videos I saw. So if your if your Ca, if your blood calcium is 10,
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Dr Doug: then I would be looking for another reason.
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Dr Doug: Because I don't think that's too much d, especially if your d levels are normal thyroid to be the number one thing.
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Barbara berger: Okay, so much to figure out. Thank you.
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Dr Doug: Yeah, you're welcome. I don't think it's the deal, though.
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Dr Doug: yeah, I don't think I'm I'm gonna see a rheumatologist, I was told, because I'm
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Barbara berger: new SEO patient, minus 2.5 on the neck.
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and I want I don't want to be on medicine right now. So
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Barbara berger: I picked the best one I could find in the State of New Jersey, and we'll see what she says.
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Dr Doug: Okay, thank you.
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Dr Doug: I have a guess. Let us know.
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Barbara berger: Okay, thank you.
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Dr Doug: so yeah. Joanne Andrews is asking about An exercise question. Is it better to do less range of motion and heavier weights
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Dr Doug: for muscle gross you, you think it's the opposite brand new welcome, Joanne. Content has been life-changing also. Thank you.
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Dr Doug: So
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Dr Doug: is it okay to do less range of motion and heavier weights? This is a little bit of a tricky one in general. The answer to that's gonna be. No, we wanna do full range of motion. But we also wanna protect our joints. So this is gonna be another one of those things like, if you're on Instagram. Joanne put it on Instagram. If you don't have any followers, no one's gonna see it.
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Dr Doug: So put it on Instagram. We can all critique you, but I struggle with range of motion, particularly my hips. My hips are just really tight. I'm always jealous of the bodybuilders, you know. They can just like go all the way down, and their butt hits their heels. And they have, like, you know, 300 pounds on the bar. I'm never gonna be there. So for me, my goal is to get my my femurs parallel to the ground and come back up. My coach tells me I'm cheating.
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Dr Doug: but I'm also growing muscle. So, goals being achieved. But you don't want to get too short in your range of motion, if that makes sense, and it's going to vary depending on what it is.
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Dr Doug: so I would say, long as a long answer short answer is.
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Dr Doug: do the amount of weight that you can do for a full range of motion that is appropriate for your joints. Is that is that big enough?
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joann andrews: Sure, that makes good sense, and thank you so much. I'm really excited to be here today and to keep learning.
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Dr Doug: We appreciate you. Okay, I appreciate that.
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Dr Doug: Alan saying, you got a back. You got a bad back doing deadlif scares me to death fair enough.
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Dr Doug: So, Alan, it's gonna depend on.
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Dr Doug: you know, like what is what's the cause of the bad back.
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Dr Doug: I have had people. I have one patient that I'm thinking of off the top of my head, you know. She tried to increase what she was doing through her back, and she just has. You know, she's got really tight openings. She's got bad discs like for her deadlifts. Just not her thing.
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Dr Doug: And that's okay. Other ways to load the spine. So I love a deadlift. If we can do it, I think it's gonna be good for the back as long as you're not going too heavy with bad form. But if you were to, you know, start light and go super slow and increase. Maybe you'd be okay. But if it tweaks you, then just don't do it. You don't have to do it.
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Al Kral: Well, I have been going really slow, and I go lighter. And actually my weight plates are short.
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Al Kral: So I actually set it down on milk crates so that I don't have to bend over.
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Al Kral: I know I could lift more. There's no problem, but it's just it. I'm just too scared, you know, and I'll just go a little bit at a time, and if it takes me a couple of years to get a lot of weight, then that's what's gonna take me
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Dr Doug: totally fine. This is a this is a long game to hurt the back, and then you can't do anything right? Well, that's why our number one role in training is don't get hurt because it takes way too long to recover. Wait.
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Dr Doug: Yeah, so totally. If you're scared of it, either don't do it or start really slow, really low, and work up.
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Dr Doug: Did it, did it, did it?
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Dr Doug: Sorry. So, sherry. I was just looking skipped over a couple of things there.
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Dr Doug: that'll answer Susan's question, so Sherry is Canadian, and she lives in a small town on the prairies. I don't know where the prairies are in Canada.
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Dr Doug: I don't know anything about Canadian geography. anyway. Had blood work done and had an appointment, had an appointment next week. Results show something weird. Vitamin d levels are very high, but not toxic. Been taking 2,000 iu per day, 70 years old exercises 5 times a week.
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Dr Doug: Sherry, are you? Where are you? Are you here? Can you? Can you speak?
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Dr Doug: Yes. Oh, Hi! Sherry so! What is very high? Do you know you remember what those numbers were.
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Sherri Egbert: And Stephanie
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Dr Doug: 1 70.
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Dr Doug: Yeah, and I think Canada uses the same units as as the Us. So by modern standards. 70. Is not that high.
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Dr Doug: although it is above normal, depending on the reference range.
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Dr Doug: There are a lot of docs right now, and we were the same. We were saying 70 to 90 was sort of the sweet spot. So that's not really that high.
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Dr Doug: My new stance is sort of going to be to pull people back down under 50, because I have failed to find any any data whatsoever that supports 25 hydroxyd over 50.
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Dr Doug: Morley says over 30.
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Al Kral: I think that's a little too low.
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Sherri Egbert: Does that make sense sherry? That's good. So if I'm on 2,000 a day, drop it back by one pill just to 1,000, or drop it altogether until I
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Sherri Egbert: stabilize.
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Dr Doug: Yeah, I can't. I can't tell you exactly what to do. However, if I had a patient that was at 70 and they were taking 2,000 iu a day, I would probably back it down to a thousand. Yeah.
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Sherri Egbert: okay, good. Thank you.
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Dr Doug: You're welcome. So Susan was talking about going to a rheumatologist, and went on, Fossa Max, if you went on Fawsa Max as a bisphosphate, you wouldn't be able to do prolia or affinity.
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Dr Doug: And there is. There is some literature looking at how to stack these drugs. My goal, Susan, is that we don't need to stack the drugs at all
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Dr Doug: for people that need to be on a bisphosphinate. And II use this example often, which is, let's say, somebody has, you know, rapidly. Let's say they're rapidly losing bone for one reason or another. A a classic example of that is.
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Dr Doug: a woman with breast cancer who is on an aromatase inhibitor.
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Dr Doug: So on a drug with blocking estrogen, particularly if she wasn't postmenopausal to begin with.
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Dr Doug: So you take like a 49 year old woman, you put her on rheumatase inhibitors, and her estrogen level falls to 0, she will a feel absolutely terrible. But B, she will lose bone precipitously.
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Dr Doug: That's a scenario where being on a bisphosphate makes sense because you can halt that bone loss temporarily
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Dr Doug: right? And you're not on it forever. You're just on it while you're on the aromatase inhibitor now that 49 year old, is also gonna go through menopause while she's on it. Likely so she will likely not have normal estrogen again. But then you just get into the, you know, once you come off of the aromatase inhibitor, then you get into the okay. You know. Am IA candidate for estrogen. Now, if not, what are all the other things I can do? And you deal with that, then?
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Dr Doug: So I find that's that's a reason to be on bisphosphonates. So I never want people to think I'm anti-drug. All of these drugs have a place it's just a matter of. Are you in that place.
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Dr Doug: John had a good. That's a great follow up. Do you guys time those?
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Dr Doug: So John had a question about how to stop foretail without doing reclass after.
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Dr Doug: I think that's kind of an interesting combo of reclass after Forteo, because you're doing a drug with an even shorter time span after a drug with an already relatively short time span. I like Forteo as a drug. I've used it
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Dr Doug: several times for people that are in a really bad starting point, just to build some bone. Just Ca, like, get them going in the right direction. Right? It's like like on a video game like hitting the the rocket, you know. Button, whatever that button looks like. I don't play video games but once that rocket burns out, then how do you keep your trajectory going?
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Dr Doug: The traditional medical model would say, well, you should use a bisphosphonate.
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Dr Doug: Right you go. You built bone for 2 years, and then you don't want to lose that bone. So you go on reclass, and then you will slow down your bone resorption, which is true.
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Dr Doug: However.
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Dr Doug: then you have. Then you're just squashing your bone metabolism. So my preference would be. Let's push people forward on, Forteo. Let's get their bone up, and then let's do all the other things right? So I'm thinking of a woman off the top of my head. She had pretty bad T. Scores like close to negative 4, so we put her on she was actually on temples, but she was on temos for 2 years, and then we brought her off of temblos
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Dr Doug: and then we were able to. You know she was a candidate for Hrt. She was on testosterone, she was, you know, changed her entire way of eating her way of training. I used to work with her in the hospital, and Franklin's wonderful woman and she we've we've been able to maintain her bone. T-scores that we saw and proven in with Forteo. So you don't have to go on a bisphosphinate to now lose bone.
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Dr Doug: The bone metabolism is still working normally. It's just in hyper drive when you're on forte or temos
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Dr Doug: that makes sense.
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Dr Doug: Oh.
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Dr Doug: all right. We have 1 min.
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Dr Doug: Linda asks one last question on calcium other than hydroxy appetite, which form of calcium supplement. Do you prefer
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Dr Doug: most people who know the answer to that?
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Dr Doug: Go ahead, Diane.
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Diane’s iPad: I can. I can never! I can never pronounce it.
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Dr Doug: I went by Cisco Lake. Oh, yeah, yeah. yeah. So well, let me just I'll
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Dr Doug: But you're right. So
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Dr Doug: algae Cal, is what I've been pushing people toward, because it has a natural calcium in it, coming from natural sources which should do better and it has a reasonable. So to answer your question what I would am pushing people towards now is using Algom. Wow
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Dr Doug: calcium from algae-based sources, and algae cow is the preferred product, because it has the the best sourcing and the best consistency.
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Dr Doug: Alright.
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Dr Doug: that's enough. I got a patient at one. So thanks everybody for coming in biggest audience we've had at 56. So hope everybody's getting something out of this. If you're not in slack, get in slack. If you're not on Instagram. Get on, Instagram. I'll see you guys next week.
