March 13, 2024
During the meeting, discussed were various topics related to health and wellness, with a particular focus on collagen and amino acids. The following points summarize the key discussions and information shared:
1. Collagen and Amino Acids:
- Dr. Doug has been researching collagen and amino acids, including branch chains and essential amino acids.
- Collagen is valuable for skin, hair, nails, and potentially bone health.
- The body produces less collagen with age, so supplementing may be beneficial.
- Collagen is considered a viable protein source despite lacking tryptophan, which is generally not deficient in a varied diet.
- Adding collagen to one's diet can help meet protein intake goals.
Collagen Products:
- Dr. Doug is considering creating a list of recommended collagen products.
- There are upcoming collagen products specifically for bone health to be released in the near future.
4. Vegetable Juicing:
- Dr. Doug expresses mixed feelings about juicing, noting that it may lead to abnormal glucose spikes and that consuming vegetables in their natural form is preferable.
5. Taurine Supplementation:
- Taurine is used in specific scenarios, such as when patients have high homocysteine and CRP levels.
- It has shown benefits for leg cramps and may have other positive effects in the body.
6. Hormone Replacement Therapy (HRT):
- Dr. Doug supports the use of HRT, including estrogen, testosterone, and progesterone, for various health benefits.
- Estrogen is important for heart, brain, and genital-urinary health.
- Testosterone is the dominant sex hormone in women and is beneficial for bone, muscle, and overall well-being.
- Progesterone is used to balance estrogen and has its own benefits.
7. Bone Health Medications:
- Dr. Doug is not a fan of bisphosphonates like Fosamax due to their suppression of bone metabolism.
- Evenity (romosozumab) is considered anabolic initially but may not have long-term benefits for bone quality.
- Forteo (teriparatide) is an option for patients with very low bone density, and it may be possible to maintain gains with lifestyle changes post-treatment.
8. Bone Turnover Markers:
- Dr. Doug discusses the importance of monitoring bone turnover markers, such as P1NP (a marker of bone formation) and CTX (a marker of bone breakdown).
- The optimal ratio of P1NP to CTX is still being researched, but a higher ratio indicates better bone-building activity.
9. Alkaline Water:
- Dr. Doug advises against drinking alkaline water, as it can interfere with stomach acid's role in nutrient absorption.
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Dr Doug: I wanted to talk specifically about collagen.
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Dr Doug: I've been doing kind of a deep dive on collagen, also a deep dive on amino acids. So I think we could talk about that like supplemental branch chain and essential amino acids.
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Dr Doug: I think those would be fun topics. And then, whatever else is on your your minds.
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Dr Doug: I think last time we touched on people meeting up on both on slack and an Instagram.
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Dr Doug: So people have any comments or questions about that, and for those that are new. If you haven't been spending any time on the slack Channel the slack channel is where people can communicate with each other, and we have some really active folks in the slack channel, which is amazing.
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Dr Doug: Jim and Dawn and Aubrey are all are all doing. Oh, Audrey, sorry, Audrey, are all doing really great work and answering questions in a great way. So lots of good information happening there. So if you're not on the slack community channel, I would recommend getting on that. And if you have concerns or questions about it, if you just don't know how slack works, then just reach out to the Admin team, and they can sort of give you a tutorial on slack. I know it's probably new for a lot of people.
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Dr Doug: And then the Instagram thing. Hey, Nancy, the Instagram thing I was telling people that I post a lot of exercise stuff will post on Instagram. Our our content is all bone health and hormone specific as well. But in stories we post a lot of exercise things you know, videos, etc. And I was recommending that if we all use the hashtag aim for optimal, then it'll drive those feeds into your own Instagram. So you don't even have to.
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Dr Doug: You don't have to have anybody following you. You can just use it for your own content. Absorption, anyway, and you can monitor kinda what you're seeing, which I think is really important in our social media world.
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Dr Doug: So all that said, I'd say, let's get started. Do people have any
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Dr Doug: immediate questions? I'll open up the chat there. Great!
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Dr Doug: I love that. It keeps going from the previous meeting. That's good to know. Didn't know that all right, anyway. So if you guys have any immediate questions. You can drop them in the chat.
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Dr Doug: and then I'll just start talking about collagen, because I've been doing a deep dive on collagen myself in the past. And if you look on our Youtube channel.
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Dr Doug: the video that I have on collagen is sort of suspect there's value in collagen. And we've known that for a long time. But the there's only one product that has a specific claim for collagen, and we talked a little bit about it last time. The for the
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Dr Doug: Ford bone which is comes from the company
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Dr Doug: chip. stretch of the G blanking on it. But anyway, you can look it up for your bone. and their research claim is based off of a single study, and we went through it last time. And it's you know, I
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Dr Doug: it looks
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Dr Doug: almost too good to be true, and it's sponsored by the company, so always raises red flags for me. The challenge that I have, though, is that we? There's so many
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Dr Doug: potential reasons to use collagen. And so I'm sort of rethinking my position on this to say, well, okay, maybe there isn't a good intervention study on collagen, but we know that there's value for skin, hair and nails. We know that our body
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Dr Doug: stops producing as much collagen internally so, adding an exogenous source or a source from the outside, makes sense from an anti-aging perspective. So I've just started looking into a little bit more deeply. And
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Dr Doug: my conclusion is really that probably collagen, because it's so easy to add, because it's a source of protein that it does probably make sense to add it into a stack.
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Dr Doug: Whether or not it needs to be Fordevon, I think, sort of remains to be seen.
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Dr Doug: there's some companies
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Dr Doug: that are potentially making products that I think I mentioned last time, too.
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Dr Doug: that I don't want to. I don't wanna spoil their launch, but there are some more products out there coming in the near ish future in the next few months on collagen specific for bone health. So
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Dr Doug: I would say, stay tuned for that. But the biggest thing that I found or doing the research I've always considered collagen sort of like an inferior protein source. People will say, oh, I get collagen protein, and I'm sort of poo, poo it and say, Yeah, but doesn't count
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Dr Doug: but really, when you look at the amino acid profile of collagen versus say, like whey protein, which is a complete amino acid profile. The only difference is tryptophan.
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Dr Doug: and we're not in general a tryptophan deficient population. So I had this conversation with a provider.
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Dr Doug: I think, earlier this week, and
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Dr Doug: it was an interesting perspective, because if you look at how much tryptophan we get in our diet. If we eat, you know, even a remotely varied diet. We're probably getting adequate tryptophan. So really, we could consider collagen then as a source of protein.
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Dr Doug: and if you're struggling to hit that 100 grams or 150 grams, or wherever you are.
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Dr Doug: you know, adding 10 grams of collagen to a drink while you're consuming 20 grams to hit 30 grams for that meal. That's probably legit. and I've never really considered it that way before. So that's kind of the biggest takeaway from looking into. This is even in my own protein
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Dr Doug: goals, you know, trying to hit for me. I'm much higher than that.
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Dr Doug: But if I add, I could add 2 scoops of collagen to my coffee, and then I'm already hitting 20 grams, and then add that to my 30 to 50 gram meal, and then I'm doing really well. Right. That's a great start to the day.
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Dr Doug: you know. Yesterday II 2 cups of coffee with 2 scoops of collagen, and then my normal 50 gram
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Dr Doug: protein breakfast, and I was already at a hundred grams before 10 Am.
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Dr Doug: So it can be done, and it can be added, so so does that all make sense
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Dr Doug: cool?
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alright. So our new faces. Hi, Marvin!
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Dr Doug: Nice to see you
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Dr Doug: right, and Tammy
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Dr Doug: Barbara. I don't know if I've seen you before, either. Nice to see everybody. So for those of you that are new we generally will will drop questions in the chat. You're welcome to, you know. Raise your hand, and you can see the question out loud. If it's more complex
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Dr Doug: you wanna do it that way? So we're kind of loose here for now until we get enough people where we have to be less loose about the rules. Alright. So a couple questions in here.
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Dr Doug: Yeah. So, Barbara, the first question she asks was about vegetable juicing. In addition to healthy eating.
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Dr Doug: I'm a little mixed on this. II think that vegetables provide valuable nutrients. I think the carnivore community does an interesting job of showing that we really don't necessarily need them, especially not in the short term, the long term. It's a little bit more of an unknown, you know. You know what is the impact of not eating any vegetables. And certainly there are communities that do that.
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Dr Doug: The things that come in vegetables, though I find that we're better off eating them in their natural form.
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Dr Doug: Once you remove the fiber cause, if you juice it, you're removing a lot of the the bulk right once you remove the fiber, and you're just trying to get some of the micronutrients into a condensed form. I think we're kind of treading in unknown territory.
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Dr Doug: I look at this the same way as I look at like green powders, you know, like the green smoothie powders like athletic greens. And now there's like a million of them on the market because they were so successful.
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Dr Doug: I think it's it's kind of bastardizing the the benefit, because if you take is something that's good for you like.
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Dr Doug: let's say like I don't know. Let's just use spinach. I don't really like spinach, but let's just use spinach as an example right like spinach, and it's whole form comes with, you know, fiber and water, and there's bulk, and it's slower to digest. And it has, you know, potential valuable nutrients. But it also has potential anti nutrients, right? So there's a balance there. But you can only eat so much raw spinach right like you can only eat so much spinach salad before you're like oof man, I'm full.
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Dr Doug: but if you turn that into a powder and dump that into a smoothie, you can eat a lot of spinach in a really short amount of time.
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Dr Doug: And so that's what I look at like. Athletic greens is kind of doing that where they're taking these, you know a massive amount of vegetable and putting it in a very small thing, and then dumping it in your stomach and assuming it's gonna have all the same benefits, and I think that's a a leap that we probably can't take
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Dr Doug: so I think juicing kind of doing the same thing. It's still. It's a little bit better, I think, than a powder. But I still think you're taking a lot of a lot of it and putting it in one place, and you're consuming it as a liquid. So it's gonna get absorbed much faster. So you're gonna get some like abnormal glucose spikes. You wouldn't normally get depending on what you're juicing like. If you're juicing, a lot of carrots comes with a lot of sugar, which, again.
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David Callen: now we can say everything we want to behind his back right?
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Dawn Aragón, PhD: That's hilarious.
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David Callen: He's coming back in cool.
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Dawn Aragón, PhD: I'm actually in Asheville.
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Dawn Aragón, PhD: in my hotel. So yeah.
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Dawn Aragón, PhD: I got to meet Doctor Duggan. The physical. It was awesome.
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David Callen: is he?
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Dawn Aragón, PhD: Yeah, but he's more awesome. He's more awesome in person than he is online. If you can imagine right? Right? You got to see the 3 dug.
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Optimal Human Health, PLLC: Hey? Everybody! Sorry about that, hey, Don? I just lost power. It'll be.
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Barbara berger: Could you go over that answer again. You went with carrots with glucose.
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Barbara berger: and then we heard nothing more.
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Barbara berger: -Oh.
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Barbara berger: you said, you must know again. Yeah.
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Dawn Aragón, PhD: yeah, he was saying that. You have to be careful of the sugar. It depends on what kind of smoothie you're making
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Dawn Aragón, PhD: cause. If you're pureing carrots. That's gonna really jack up your glucose levels. That's that's all. He was saying.
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Yeah.
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Dawn Aragón, PhD: Well, while Doug is trying to get power back, I'm John. Hi, everybody!
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Candy Reichert: Oh, hang on
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Dawn Aragón, PhD: Hi! Nice to see everyone. I am technically the
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Dawn Aragón, PhD: lead person on slack. If you haven't been on health Spanish slack, you may have seen me pop up every now and then answering questions, and this and that. I'm part of the team.
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Dawn Aragón, PhD: Brett and Julie are usually on this call, too, and they are also on Hsn. A huge part and a bigger part, actually probably, of answering questions.
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Dawn Aragón, PhD: but I would love to see everybody contribute more on slack. There's you all are so smart and know so much. There's so much knowledge, wisdom, and understanding out there in that community. I would love to see people ask more questions, give more of their knowledge to the group is, be it's
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Dawn Aragón, PhD: it's gonna be over the years. It's gonna be just so vital to everyone's support and ongoing understanding. So I'm excited to see a lot of you that I've seen your names in slack, and hopefully we'll see more.
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Dr Doug: All right. I'm back
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Dr Doug: next time.
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Yeah, Don got to see me and how I'm flexible. I am all at the same time
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Dr Doug: I was great sorry I grabbed a bite of food there.
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Dr Doug: Anyway, that's the value of a generator. So
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Dr Doug: we're on backup power. But Internet works so, as I was saying about juicing. Yeah, John, I don't know if you just mentioned this, but
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Dr Doug: if you put all the sugar from, you know, let's say you juice
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Dr Doug: 15 carats, and you put them into a little cup, and then you drink that. You're getting all of the sugar from those carrots in one place without the fiber so it could potentially have negatives that way again, probably better than a powder like a green powder.
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Dr Doug: but still, I think let's eat things in their their raw form. I don't think Mother Nature makes mistakes same thing. I don't think the body makes mistakes.
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Barbara berger: Thank you
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Dr Doug: absolutely. All right. And I love the fact that the chat just stays on top of it. It's amazing.
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Dr Doug: so the next question I have is from Nancy about
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Dr Doug: about the bulletproof collagen.
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Dr Doug: That has made a dramatic difference in in my nails. Yeah. So I think one of the things that would be helpful is for me to come up with a list of collagen like I, you guys have probably heard me say I'm not a fan of buying supplements on Amazon.
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Dr Doug: But I think this is probably an area where maybe there's an exception to be made because there are so many good products out there. There are a million collagen products.
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Dr Doug: I should probably make a list of collagen products and put them in the the Amazon affiliate list. Do you guys, have you been shown where that is. Do we know where that is?
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Nancy Mandowa: Anybody?
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Dr Doug: It's in the there's an affiliate section on the website.
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Dr Doug: and we're doing our best to kind of connect with as many companies we as we can to bring you discounts cause we can. We can sort of promote the idea that we have, you know, 200,000 views on our videos on Youtube. So we can drive companies to give us discounts which we then pass on to you.
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Dr Doug: So we're trying to make that happen. So there are a number of affiliates out there in the I actually don't know how to get to it. Don, do you know how to get to it?
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Dawn Aragón, PhD: Yeah, it's on it's on the main page of hell. Spanish Nation. There's a box that you click on. And then there are different categories for the different products. Yeah.
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Dr Doug: yeah. And so we're trying to clean that up and make it look better in one of the areas will be Amazon affiliates. And these are things specifically that
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Dr Doug: we'll send you to an Amazon link. And if you buy it from that link, then it'll give you a bigger discount.
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Dr Doug: So we're trying to do as much of that as we can.
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Dawn Aragón, PhD: Yeah, I've used few affiliates from that link before. So they they work. It's good and some work better than others. So some it's weird. Sometimes there's a code, and you have to use the code. Sometimes it's just the link that'll drive you to their website. It depends on which system they use.
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Dr Doug: But just follow it. The instructions should be hopefully clear. Mark was saying that he just started using chronometer this week.
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Dr Doug: should you adjust your supplements based on your daily intake, for example.
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Dr Doug: you included all of those and some days you hit the chron, the chronometer auto target for candy. So I, this is kind of a challenging one. It's really hard to get accurate data
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Dr Doug: tracking food from a micronutrient perspective. I think it's very effective from macronutrient composition
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Dr Doug: trying to track micros, I think, is tough because you don't really know what the absorption is like. So if you're tracking what's going in out of food, out of supplements, you don't really know what's happening on the inside. So let's say you were looking at Vitamin K, and you're like, Oh, my gosh! I'm over. Well, first of all, that's chronometer driven off of Rdis and Rdis are not good anyway.
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Dr Doug: So you could potentially be reducing a supplement that you actually need a super physiologic dose of like vitamin. K is a good example. So I wouldn't use chronometer for that.
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Dr Doug: If you really wanna know what your nutrient deficient in looking at functional testing like a Neutra Eval from the company, Genova, Genova, Janovo Jenova.
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Dr Doug: is a really good place to look. Some of those tests are available direct to consumer. Some are not.
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Dr Doug: But That's how I would look for deficiencies. It's more like, what what is your body actually seeing and breaking down. Versus what are you actually consuming? That makes sense?
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Mary Daly: Thank you.
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Dr Doug: Shut my way.
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Dr Doug: And then, Nancy, you asked, have I looked into the research on supplemental taurine in regard to possible osteoporosis, treatment and benefits I have. So taurine is on our list, and we use it in a couple of specific scenarios. So it is on our list, for osteoporosis protocols.
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Dr Doug: The evidence isn't great, though.
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Dr Doug: But in people that then have high homocysteine, and I'll explain what that means in a minute and high crp. Then taurine becomes a nice, a nice tool, because it has evidence to support improving all 3 of those
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Dr Doug: Homocysteine is a biomarker. We use that looks at
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Dr Doug: a couple of different things, but we know that when elevated, it's associated with osteoporosis, cardiovascular disease and dementia. So we know that we want it to come down. It's really a biomarker of B vitamin metabolism in the process called methylation.
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Dr Doug: If you optimize B vitamins a lot of times it comes down on its own, but sometimes it doesn't, and when it doesn't, adding something like taurine or creatine or choline, all those things can help to bring it down.
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Dr Doug: Also evidence to say that it would support bringing down crp, so it likely has an immune system function there? But again, if you have all 3 of those together, then Taurine might make your list as one of our patients.
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Nancy Mandowa: But make sense. Could could I comment on that
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Nancy Mandowa: just real quick thing. I don't have those blood test results that you're talking about, at least not currently. I have maybe in the past. But II was recommended that just for leg cramps, which I've had a chronic problem with all my life.
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Nancy Mandowa: and it was so dramatic. My physical therapist recommended cause. He said his sports clients were using that to prevent leg cramps or any kind of cramps, and the minute I started taking a a thousand milligrams of taurine. They stopped just for weeks. I haven't had any. So something that has that profound and impact like immediately. It just seems like it must be doing other things in the body.
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Dr Doug: Yeah. So if you look up taurine, and you look if you just go to pubmed, and you're like taurine benefit 4, and then leave it blank. You'll see a lot of stuff.
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Dr Doug: So it's been research for a lot of things. I don't think it's a powerful intervention for anything. Otherwise we would have a drug called like Suva Taurine, or whatever but it it is involved in a lot of things. Yeah.
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Dr Doug: I think, too, Nancy, if they come back one of the things we do is certainly optimize magnesium. Make sure that magnesium levels are adequate. Potassium sort of you know, it's a plus or minus a lot of people say, like, Oh, you have cramps, you know. Eat more bananas.
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Dr Doug: Okay? But potassium levels are, they could be too high or too low. And so that's sort of an iffy one. But I think one of the magic bullets there is the folic and humic products. We talked about that before from the company beam. There's some other companies out there, too. But folk and humach are these interesting molecules that can help balance electrolys and get them into cells? The what is she? I guess she's the CEO
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Dr Doug: I interviewed her on the Youtube Channel, but Carolyn some.
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Dr Doug: but she. She swears that all cramps are related to a deficiency of electrolytes, and that foldic and humic will make them all better.
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Nancy Mandowa: Well, it's interesting that I had already optimized, I think, optimize, or at least added more potassium and a lot of more magnesium and the oh, I forgot the name for the supplement that's from the Himalayan that has the fullic acid in it.
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Dr Doug: Oh, interesting! Yeah. I still having like cramps inventory and fixed it. Yeah, that's fantastic. Yeah, that's a that's a great hack.
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Nancy Mandowa: I've not used it for that purpose. It is pretty common, though, like, yeah, I call it she legit. I don't know whatever you wanna call it. No, that's that's great. Yeah. Good hack. So you did all the things I would have done.
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Nancy Mandowa: Yeah, and then fixed it on your own.
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Dr Doug: So, David, that's an interesting thing. So David says, I noticed that my bones are changed, and that I can crawl on all fours so hardwood flooring, chasing my dog, and it does not hurt at all. Not sure if that's from Collagen or not, I don't know as a surprise. I thought, Whoa.
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David Callen: this is going back. Yeah. Get on all fours and crawl on all surfaces, and it doesn't hurt, I think. What's going on here
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Dr Doug: I don't know. It's either that or you have dead nerve endings. One of the 2.
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Dr Doug: II do think it's it's interesting to to see, you know, as as we age adults that can still play like that. you know, like getting down on all fours and playing with your dog or kids, or grandkids, or whatever. There is definitely
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Dr Doug: a different capacity for people that can roll around on the ground with kids and dogs and people that can't.
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Dr Doug: And whenever I feel like I can't. I always wonder like what change you know. Cause some days I'm like, oh, I can't. It hurts! I'm sore. I'm stiff.
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Dr Doug: Don?
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Dr Doug: And let's see here.
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Dr Doug: Okay. Oh, this is a great topic. Alright. So, Marvin, where's Marvin. There's Marvin, hey, Marvin?
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Dr Doug: So Marvin ordered some blood work, and it showed iron anemia. I'm assuming low iron anemia
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Dr Doug: So I
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Dr Doug: I don't know what I did. But you went from a Vegan kind of blue zone to protein fish poultry striving for 100 grams.
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Dr Doug: How long do I recommend Dexter echo light after making changes. You're doing Lyftmore training and using a personal trainer. That's fantastic. So I actually had a patient that he just sent in a repeat rem
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Dr Doug: recently. And this is a guy I talk about him in some of my like the master class. I think he's in there. Then he's a super fun. He's a retired attorney, and so he does. He did an initial
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Dr Doug: follow up rams at 6 months, and show tremendous benefit. Another follow up rams at 6 months showed again improvement, and then somebody local to him got a rems, and so he was super excited about it, and then he got another one, and this was only a 3 month gap.
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Dr Doug: and it showed it was essentially the same. He said it looked a little bit worse. Some was a little worse. Some was better, I think. 3 months too soon. 6 months for rems. Probably. Okay. Really, I hate to say it, but it's we. It probably needs to be a 9 months to a year for rems honestly.
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Dr Doug: And the reason why is not that you're not making improvement.
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Dr Doug: But the issue is is that as bone remodels, it will pull away
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Dr Doug: calcium and pull away other minerals so that it can lay down new collagens so that it can then recalcify. If you're in this process of remodeling and improving your bone, and you're breaking down adequate bone to lay down new bone, it might look worse initially on imaging.
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Dr Doug: And so if you if you get a rems, you know, let's say at 3 months, or even at 6 months, and it looks worse.
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Dr Doug: It doesn't mean that what you're doing is wrong. Just means that you might be in the process of building, and it's all still collagen. It's like baby bones like they don't show up on X-ray. Right?
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Dr Doug: So I would say 6 months at a minimum, if not 9 to 12 months after making changes. That's why also, Marvin, the blood turnover, the bone, turnover markers and blood are so important because you can look at those on a more frequent basis depending on your budget. But you can look at those on a more frequent basis and see, you know, what does that ratio look like as your ratio going up or down, etc.
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Dr Doug: Does that make sense?
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Marvin Hymanson: How how often, doctor, would you do that? Would you do the complete panel annually, or or the well, we do it. We do it every 6 months, which you know. I wish we could do it like
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Dr Doug: I would honestly want to do it every 4 months.
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Dr Doug: but the amount of time in between like getting the blood. having a follow-up, getting all the things that we're going to do to change, whatever the plan is, and then actually doing the intervention.
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Dr Doug: You know, that's really still about 4 months. If you do the bug panels at six-month intervals. Excuse me.
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Dr Doug: so so 6 months is what we sort of have settled on.
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Dr Doug: You could do just the bone turnover markers more frequently if you wanted to. You could do them, I mean, again.
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Dr Doug: depending on how you're getting them done. Insurance is gonna pay for them more than I don't know how often once a year or 2 years. So if you're paying cash, they're kind of expensive. But if you have an unlimited budget, you could do it like monthly and keep a checkup on how things are going.
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Dr Doug: because there's really no downside
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Dr Doug: to doing that other than the money.
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Marvin Hymanson: Thank you, doctor.
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Dr Doug: Yeah, absolutely.
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David Callen: yeah, David, I was gonna answer your question. I was, gonna say, what would you see if you did it? Monthly?
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Dr Doug: Yeah. that's a great question. I don't know anybody that's done it monthly.
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Dr Doug: But here's what I think you would see is, I think you would see hopefully a continued kind of medium turnover, but high, p. One, and P. And so what I mean by that is, if you were to. I just had a great example of this with a patient last week.
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Dr Doug: She was on prole. So all of her bone turnover markers were squashed right? So prolia will squash ctx. That's what they say. That's the whole plan, is you wanna squash bone breakdown? That's what prolia does.
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Dr Doug: but what they never tell people is that it also squashes bone building because they're they're linked. You can't unlink them. And so if you squash G. Tx, you'll squash p one and P. And so, what was kind of interesting, and we've never seen this with the ratio thing since we started measuring it. But her ratio actually looked really good, but it was because they were both so low
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Dr Doug: and so what I would wanna see is a a sort of moderate amount of bone turnover. So a ctx, that is kind of somewhere in that, like, you know, 200 to 400 range, but with A and P, that's driving up, you know, 8,000 20. That's what I'd love to see
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Dr Doug: and then doing it monthly. You're just gonna be able to kind of follow it over time, knowing that these things do change based off of, you know, Circadian rhythm, they change based off of diet. So you'd wanna have be as consistent as possible. And one of the most important things is you get them done at the same time every time you test it, preferably first thing
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Dr Doug: the morning fasted, and ctx is gonna fluctuate the most throughout the day. It's actually higher in the morning. So if you if you want to, you know game, the system, then get it done in the afternoon, and your ratio will look great. But get it done first thing in the morning.
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David Callen: I was gonna say, it's been the part. I do. Process improvement. We're used to using metrics and checking them often like you would in a baseball game or a basketball game, where you see the score all the time. And so the frustration is is, we do all of this, and wait 6 months or a year to find out we're doing a right or not. And that's kind of frustrating. So this, this opens up a door and a new possibility.
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Dr Doug: Yeah, it almost be like, you know, we have continuous glucose monitors like, what if you had a continuous p. One. And P. Monitor, how cool that be!
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Dr Doug: That's nowhere near coming just for the record.
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Dr Doug: But you're right. Yeah, that would be. That would be cool, and I think more often is better. But again, you run into the challenge of just the cost of of running them to the right man, the question would be, Is it how? What is the right
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Dr Doug: time for our situation? Well, and and imagine, too, like it used to be worse, you know, because you would do. If you go through the traditional system, you're getting a dex every 2 years, right? Such a long interval that people just kind of get. You sort of like, lose interest. Right?
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Dr Doug: You're like, I don't know. Well, I'll worry about that next next year. The next next year. Yeah, Lorna.
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Lorna Nichols: You! You said it fast and I missed it. I'm wondering again what range you like to see the Ctx. And what range. You like to see the P. One. MP.
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Dr Doug: Yeah. So thank you for slowing me down. I'm notorious for that. So let me
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Dr Doug: I'm gonna I got a calculator here. So what? I said, yeah, sure. Well, let's just do it based off here. So what is your Ct.
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Lorna Nichols: The Ctx was? Well, the the.
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Lorna Nichols: It's point 5 4. By the time you move the decimal.
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Dr Doug: Okay? And what's your what's your p. One and p. 91.6
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Dr Doug: alright, so I would do 91.6,
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Dr Doug: divided by point 5 4 0 point 5 4. So your ratio is 1 69. Did everybody get how we did that so, and P in the in the values that they're delivered on the report. And then Ctx
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Dr Doug: divided by a thousand, which moves a decimal point. So it's point 5 4 on the report, it would reach 540 right? And so 1, 69. What we're kind of finding is, most people are falling between really about 1, 50 and 2 50. That's probably 2 standard deviations. Most people
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Dr Doug: hires better. So the question, then, Lorna, at 1, 69. Is that
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Dr Doug: good? Is it bad? But it depends on your starting point.
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Dr Doug: Now, both of those numbers are sort of in the range that I delivered right? So they're sort of like
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Dr Doug: you know. It's they're not overly suppressed, and that's where I think the ratio probably isn't valuable.
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Dr Doug: But you have good turnover of bone. So your ctx, you know you're at 5 40, you're turning over bone, but your P. One and P. Is high enough that you're building bone to match it.
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Dr Doug: I would just love to see, probably just a little shift. I'd love to see Ctx coming down and P driving up, and I think we talked about this with your like hormones right like with estrogen and estrogen, is a big driver of Ctx. So optimizing Estrada levels will likely bring that that Ctx number down. And let's just give an example. What was your and P again, was it? 81,
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Dr Doug: 91.6 91. Yeah, which is which is really good. So let's say you kept your P. One and P. Where it is. But then we divide that, let's say by point 4. Right? So now let's bring it from 5 40 to 400, and then your ratios to 29.
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Dr Doug: And that's really good. So optimizing even that that one thing optimizing, Estrada would likely get you to that point. And I know we're waiting
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Dr Doug: so so patiently on Kentucky, my home state.
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Lorna Nichols: I just found out that I've got a thyroid nodule, and by an ultrasound. And so now I'm I'm all about that. So I don't know how that I'm sure that impacts all this somewhere along the line. Yeah, it might. Well, we'll talk about that thyroid panel. Kentucky should be any day. I'm licensed now in 41 States.
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Dr Doug: probably 42. I just said the last thing in New Mexico. They they should all be done soon. I don't know why Kentucky has to be the last
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Lorna Nichols: I know. Thank you. Yeah.
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Dr Doug: thank you for your patience. This Barbara, who patiently raised her
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Barbara berger: yellow hand. Hi, yeah, I almost tried to write this, but it's would it be too long?
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Dr Doug: So I'm I'm 65 newly diagnosed, not terrible, minus 2.5 in the neck.
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Barbara berger: and I haven't seen a doctor yet. I have an appointment. I'm not going to want to do medicine right now, for sure.
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Barbara berger: And II hired a personal trainer taught me. Great exercise is great personal trainer.
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Barbara berger: but I, for someone like me, who's worked out my whole entire life and did done weights. I am extremely weak in my lower body. I mean, I am starting out with like 10 pound overheads, and
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Barbara berger: and deadlifts and stuff. I can't believe it. I mean, how am I gonna see improvement? Will I see improvement, and how rapidly should I be seeing this?
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Dr Doug: Well, thanks for all that.
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Dr Doug: So the nice thing about starting out in a a decondition state, which you know. If if you have that much weakness, I would call you deconditioned is that we see the most improvement and deconditioned people starting to train versus people that are in relatively good shape.
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Dr Doug: Right? So you take somebody like Don, who she's posting videos of herself like, Don's a beast. So how quickly is Don gonna get stronger? She's already starting at a really high point.
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Dr Doug: so the good news is, you're going to get stronger, faster than probably most people here, which is awesome. Right? You're going to see improvement quickly. But when isn't going to impact your bones. Yeah, that's the challenge is, you need to get more weight loading through your bones.
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Dr Doug: But you have to start somewhere, and you're not going to change your starting point so you can't do anything about it. You just have to take it and move on. And so let's start here, and let's just let's get going.
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Barbara berger: But but the the tough, the tough part is.
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Barbara berger: it's not the wait, it's the breathing, it's the heart rate. It's the whole workout that is so tiring that I'm like. totally exhausted. I mean, there's money right?
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Barbara berger: Well, it is exhausting
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Dr Doug: and the nice thing about resistance training is that it does do it does all of it right like it will have an impact on your cardio respiratory system.
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Dr Doug: You know, there's nothing like doing a 200 pound deadlift to make you feel like your heart's gonna explode right? Right? But again, like you're starting out relatively decondition, because lifting 10 pounds shouldn't do that to a human body
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Dr Doug: that's in good shape. Right machines. I go, you know, 40 and 50. But you know we're higher. But it's these. It's these new exercises that I'm learning well in in machines, machines have value because you can lift higher weights more safely right? Cause it's controlled. You're not, gonna you know, get into a weird position.
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Dr Doug: But there's something to be said about the the, the small muscles, the coordination, the balance, all the core stability that it takes to lift a free, you know, weight or a whatever
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Dr Doug: right like a baby off the floor. Those things are heavy. And so, you know, having the the ability and the agility, the cardio respiratory fitness to do that, I think, is one of the most important things about resistance training
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Barbara berger: above and beyond your house. I may even do the x 3.
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Barbara berger: Yeah. So if you're if you're struggling with that much weight, though, you might struggle with the Don has some, some posts on some. That's why I'm so interested. Great company, too. And II wrote. I wrote Jake wish about making lighter straps, and he never wrote you back, so
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Barbara berger: I just heard from them. They haven't done it yet, but they did. They still, bands is a great option for the lighter bands.
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Barbara berger: Yeah. Did they say that, too? Yeah. She gave me the link Samantha gave me the links and a great discount. I really love the company.
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Dr Doug: Okay, that's awesome good to know. Thank you.
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Dr Doug: Yeah, of course.
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Dr Doug: Alright, let's go back to the chat. Julie said. She's gonna add the Amazon affiliate to slack. So look for that in slack
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Dr Doug: and did it, did it, did it. So Kit.
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Dr Doug: who was stating about college, and any thoughts on impact on joint and tendon health. And yeah, Kit, I think this is where it really starts to come into play. The studies that I've looked at on joint health again are not great, but it's kinda hard to study joints. It's so subjective pain and discomfort and weakness so so hard to study in joints.
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Dr Doug: Joints are also a very protected area. So like is the collagen going to be incorporated into the cartilage matrix.
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Dr Doug: it's tough to say but if you're taking it for tendons that's different. Tendens have a blood supply that's not protected like joints. And I think for tendon health. Yeah, I do recommend it for that, and I always have, even as an orthopedic surgeon, I recommended it for that. So again, like, I just kind of run into this thing like, why not take it again other than cost, but
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Dr Doug: you can add it in to add it into fluid.
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Dr Doug: getting more protein. Why not take it? Even if the literature is not amazing.
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Dr Doug: Susan has a question about Alan, Alan drawn 8 Fossumacks that the Ph is really low, and is that why so many women have discomfort taking this drug. Is it a good idea to drink alkaline water on a regular basis to raise the Ph in water?
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Dr Doug: then, Susan, we have the questions that you submit on the Hsn website. And Julie does a great job of organizing them.
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Dr Doug: I have them somewhere on my computer. And she basically just organizes them. And and then if we have time, we'll get to them. The challenge we have is that you guys have so many great questions. And so I wanna respect the people that are here first and foremost. So, Susan, if you wanna go ahead and write again in the chat and we'll get it, answered, Hi, Susan.
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Susan Jaye: Well, do you want to just tell me what that question is? And then I can answer your other question, too sure. Okay, I said, hold on 1 s.
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Susan Jaye: Okay, basically, I said, I don't have any of the vaser motor symptoms taken hr, I'm taking HRT. But I have extremely debilitating brain fog, because they cut me back to every 3 days because I was complaining about my complexion
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Susan Jaye: and anyway. So the doctor said you might not need estrogen. Maybe you can just do testosterone
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Susan Jaye: and so my question was, What do I need? The estrogen? You know. Am I double dipping with the testosterone and the estrogen? You know, for the pla arterial plaque? And am I going to have a problem with my complexion if I keep taking them both, what can I do on or just the other one?
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Dr Doug: Now those are. Those are a great series of questions about those 2. So I would just say this about the kind of the trio of sex hormones for women. So you have estrogen or estradioles. What we would replace testosterone and progesterone.
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Dr Doug: Most people here have already heard me, but for those that are relatively new, let's just see a show of hands for those that have their camera on. Who thinks that estrogen is the dominant sex hormone in women?
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Dr Doug: Lorna does. Marvin does
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Dr Doug: most everybody else here has heard me say up the opposite. So the most dominant from a volume perspective sex hormone is testosterone.
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Dr Doug: So that's why I'm such a big advocate of replacing testosterone
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Dr Doug: finishing up a book on really like on testosterone, mostly. But it's also about the other 2.
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Dr Doug: The the research. There's so much research that needs to be done on it. But the research that's out there is valid enough from my perspective to say that it is safe.
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Dr Doug: We replace it in so many of our patients, and they love it.
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Dr Doug: So I think replacing testosterone is really important for bone, health for muscle, health, but also for overall well-being, for energy, you know, so many different words that you could use. But it's so valuable for women to get that back
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Dr Doug: estrogen, though, while it's not as I don't think it's as impactful from a mood perspective or from an overall well-being perspective.
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Dr Doug: I do think there is a lot of value in estrogen for heart, health for brain health. You will see improvements actually with skin and complexion for most women
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Dr Doug: also, then for genital, urinary things, so chronic uti, vaginal dryness, all those things are helped by estrogen.
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Dr Doug: So I don't really think there's a scenario where a woman wouldn't benefit from estrogen. The question is, is, what's the risk?
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Dr Doug: You know. So this is somebody who has a high chance of developing breast cancer. Somebody had a history of breast cancer with a high chance of recurrence. Those are kind of the only 2 scenarios where I even question prescribing estrogen. So you're certainly not double dipping. We're just trying to recreate some resemblance of normal. I don't want you to cycle, but some resemblance of normal Estrada and testosterone, and then Progesterone to balance the estrogen, but also Progesterone has its own benefits.
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So I think really, women need all 3. And why wouldn't they? You've had all 3 in your entire life until you hit menopause?
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Susan Jaye: Yeah, because I have extremely debilitating brain fog if I stopped the yes. Well, I stopped everything, you know, every 3 days, and I couldn't function. I was like a basket case. Then the doctor said, Go back on it every single day for a week. So I can be sure. Yeah, it's not some other problem that you have.
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Susan Jaye: So I went back on it. Now I'm good.
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Susan Jaye: but I just wanted to know if I should keep the I'm I'm I can't function without it it's impossible. So I just wasn't sure whether that knock off the estrogen. Go for the testosterone.
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Dr Doug: I mean my, I what I recommend our patients, if is, if possible, do both
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Dr Doug: and add progesterone as an oral micronized progesterone. I love to do all 3 when we can, and the only time we don't do. Estrogen, again, is if they are high risk of developing breast cancer. If they have a history of breast cancer personally, or if they are over 20 years out from menopause. Then we have to worry about the potential cardiovascular risk associated with starting estrogen at that point.
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Dr Doug: Right? That's my problem. I'm 71
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Susan Jaye: like around 44. And I did take the bio identical for about 3 years after that. But then I stopped. But you know, it's it's very complicated, and it's frightening. Because when you talk about the cardiac test that you've talked about, you know, you gotta get checked for the soft plaque, and you gotta get checked for this and that. And you know
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Susan Jaye: these doctors don't seem to be very interested unless you have a problem
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Dr Doug: right?
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Dr Doug: Well, it's cause you start dealing with the the cardiologists right? And and cardiology is such a fascinating field. I'm actually interviewing a cardiologist on Friday. He's got great. He's got great material on this. If you wanna dig into it from a cardiovascular prevention perspective. His name's Michael Twyman, TWYN,
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Dr Doug: but he looks at this the way that I do, which is, you want to know what your disease status is prior to an intervention like Estradiol, that could potentially increase your risk
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Dr Doug: when you reach, when you breach the 20 year mark after after cessation of either replacement or the onset of menopause, whichever is true for you. So for you, Susan, I'd say you're like 2021 years. So you're right there.
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Dr Doug: The data shows that there is a slightly increased risk of heart attack after starting estrogen. But it's only really within the first year. So if you've already been on it for a year, then you actually don't have an increased risk according to the literature. So you've kind of already. You've dumped over that hurdle. So now I would, if I, if you were my patient, I would tell you to keep taking it.
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Dr Doug: Because you've already jumped over that hurdle. The benefit continues. As long as you take it?
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Dr Doug: No problem.
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Susan Jaye: Oh, go ahead. Sorry. Sorry!
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Dr Doug: That's fine.
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Dr Doug: Yes, so oh, go ahead! Go ahead! Go ahead! Well, the other thing is that I was given a saliva test, and I had a 955
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Susan Jaye: with a 235, you know 0 to 2, 35, and I went to a second doctor for a second opinion, and he he said, this, your your progesterone's way too high, and so he told me it could build up in your body. So I called the Create Pharmacy, where I get the hormones.
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Susan Jaye: And I asked the pharmacist with the Mt. HFR. Gene, and you know the the rating I had with the saliva test. Could this be, you know, Co, build up in your body. And he said a absolutely so. When I called back the original place where I got the progesterone, they said, we only give slow release, that's all we'll give.
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Susan Jaye: which kind of forced me to go to the second guy.
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Susan Jaye: So my question is, do you agree that slow release Progesterone can build up?
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Dr Doug: I mean, they're they're all gonna have a half life. So traditional progesterone micronized progesterone immediate release, if you wanna call it that has a pretty short half life. So the problem is that for some women, when you take that orally and you're gonna see a a peak and then a drop, and then that drops gonna happen mid E. Mid overnight, and then you don't have the gaba benefit, and then you'll you'll wake up cause you don't have the continued benefit. So most women do better on the sustained release.
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Dr Doug: The pharmacies we use will do both, and we can adjust. But most women are on the sustained release.
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Dr Doug: You know, could you potentially stack doses and see it potentially rise? Yeah, I guess that's possible.
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Dr Doug: saliva testing is is worthless. So if they're using saliva tests. You have no idea what your levels are. Cause the gold standard for testing hormones is in blood always has been, always will be. If you wanna look at hormone breakdown. We can look at your metabolites. But saliva is not a reliable test for blood.
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Dr Doug: I mean sorry for
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Dr Doug: or blood, but for hormones. So you don't really know what it is. Progesterone really, dosing should be driven more off of symptoms.
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Dr Doug: you know. Are you having symptoms of estrogen? Too much estrogen. Are you getting tender breast? Are you having breakthrough bleeding? Even potentially? Then you need more progesterone.
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Dr Doug: If you have too much progesterone and using oral. Then you're going to kind of feel hung over in the morning. That's the the tale. Tell sign of that. But outside of that there's a pretty wide range of tolerance for Progesterone. And if you feel like, you know, if you are having build up symptoms, then you could switch to immediate release.
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Dr Doug: But it really is driven by symptoms. So that saliva salivary test I would just ignore completely. That's 2 functional doctors that insisted on on the saliva test.
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Dr Doug: Well, that's the problem. Functional medicine field.
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Dr Doug: Anybody can be a functional medicine doctor. You can be a chiropractor. You can be a whatever right you can be a nurse practitioner, and and there's nothing wrong with chiropractors or nurse practitioners. But you can go to a weekend course in in functional medicine.
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Dr Doug: A medicine doctor.
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Dr Doug: Oh, it's a it's a very dirty space, which is why I don't call myself a functional medicine doctor.
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Dr Doug: I really appreciate that. Thanks, Doctor Doug. Yeah, it's it's so tough. And this is why I think a lot of traditional doctors hate hormones in general is because there's a lot of people with a lot of opinions, and I think a lot of mismanagement. And if they're using salivary testing, I think they're setting themselves up likely for malpractice more than anything. But they're not taking good care of their patients.
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Susan Jaye: I just asked, Who's on first, that's all.
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Dr Doug: Yeah. Well, and the the problem is, too, is the the company that that dominates CRT, that dominates the the salivary tests will allow anybody to order. So you don't have to be a physician.
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Dr Doug: which is a very smart business move. But then you have again. You have chiropractors, you have Rn's, you have, you know, all these professionals that are maybe not well trained, making clinical decisions off of a test that isn't really giving good data.
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Dr Doug: And so, you know, they make money ordering the tasks. The company makes money selling the tests. You know, patients are getting treated kind of
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a lot of those practitioners can't prescribe
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Dr Doug: prescription products. And then they're gonna use over the counter products like it's just a it's a mess. So I understand why doctors don't like to talk about hormones.
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Susan Jaye: So the aldrenate aldrinate Fossumax.
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Susan Jaye: I was thinking of maybe trying to take it. But I was told by a person who gives out vanity and prolia that if you start with fast, Fasa Max, you're not a candidate for prolia or eventity.
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Dr Doug: Well, that's not true, because a lot of people will go from bisphosphonate to Perlia.
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Dr Doug: They usually will take a a holiday after being on a bisphosphonate for a period of time. Ii wouldn't recommend either, depending on the circumstance. But so let's just talk about your concern, though. So
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Dr Doug: the Ph of the drug at 4.4 remember that your stomach is at a Ph of one.
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Dr Doug: So it's actually raising the ph of your stomach when you drop something in there that has a ph of 4.4. So you don't need to alkalize your stomach that would actually inhibit it from of doing what it's supposed to do. So it's not the ph of fossa Max, that causes problems in the stomach and the esophagus. I think it esophagus as the esophagus. I think, though, that it's it. Something about the drug itself
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Dr Doug: or the delivery method is irritating to the stomach in the esophagus. That's why they say, like you have to sit up and like don't lay down after taking it and then esophageitis, and even reports of oesophageal cancers are pretty common for people that have been on Oralbus phosphonates.
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Dr Doug: So that's why, if you're going to take a bisphosphonate, you know, the Iv version is probably the one to take, but then it's in your body for a really really long time.
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Dr Doug: So there's downsides to that, too. I don't like this phosphoon ace in general, because they squash bone metabolism. So you take fossum ax, and your C. Tx. Will drop to almost 0, your and P will drop to almost 0. So you're gonna continue to build bone. But it's gonna be very slow. Your your Dexo will look better
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Dr Doug: on average, but your bone quality probably won't be better, and that's why they have this timeline you can't take. I think, Fossa Max. I don't know if it's 3 years, or 5 years, or whatever but it's somewhere between 3 and 7 years is the window that you can take a bisphosphonate, because what happens is you end up with more dense but more brittle bones. It's like chalk.
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Dr Doug: and so it's not a good long-term solution unless you have rapid bone loss. You have, you know, a cause of bone loss that you can't do anything else about
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Dr Doug: that makes sense. So then, in in general, the alkalinity thing.
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Dr Doug: I talk about this a lot in the videos.
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Dr Doug: We don't want to alkalize our body by consuming alkaline things like drinking alkaline water is a total marketing gimmick, and it's a disaster, because again, your stomach is supposed to have a ph of one.
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Dr Doug: So drinking alkaline water all day is just inhibiting your stomach's capacity to do what it's supposed to do.
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Dr Doug: If you think about the the downsides of taking drugs like blockers and PPI's the reason why they're dangerous. The reason why they're associated with increased fracture risk is because they reduce stomach acid. You need stomach acid to absorb calcium. You need stomach acid to absorb other nutrients and vitamin d and break down protein.
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Dr Doug: So we don't want to raise our stomach. Ph
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Dr Doug: if you have like. Like a structural problem like a hernia or like an esophageal sphincter that doesn't work. And you have, you know, precancerous cells in your esophagus different story.
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Dr Doug: But for people that don't have those structural issues. We want to have an acidic stomach
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Dr Doug: that make sense. Yeah. wow. thank you. Wow.
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Dr Doug: yeah. I know that's they've made billions of dollars off of alkaline water.
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Dr Doug: Crazy? Yeah, Helen.
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Helen: I just wonder if identity does that suppress your ctx, or np, what this issue to those values?
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Dr Doug: Yeah, so identity is interesting. So vanity is.
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Dr Doug: it's kind of sold as an anabolic drug. So you know, like Forteo and temlos are anabolic, they will push p. One, and P. Through the roof. And as a result, Ctx. Goes up too. Again. They're they're chained together, so they have to climb and fall together.
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Affinity, though, is kind of sold as an anabolic drug. But if you look at what p. One and P. Does, it comes up, but then it falls off.
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Dr Doug: So over the course of 12 months it will be anabolic initially, but at around the 6 to 8 month market falls below the where it started, and then it goes down. That's why you only take infinity for 12 months. Because after 12 months, I think you're only gonna see, you know, probably a similar result. Is it this phosphate? And I don't think I don't know, since I'd love to know. Sort of sit in the boardroom of the drug companies and figure out like, why did they only run that trial for 12 months? Seems very questionable for me.
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Dr Doug: I know that affinity will slow down. It will slow down bone loss. It will reduce fracture risk, especially in the short term. So I like avinity for people, and I've never prescribed it for the record. But I like affinity in the circumstance for somebody who is actively fracturing and seeing like fracture after fracture after fracture, because it'll snap that cycle.
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Dr Doug: But then you gotta do something else. And so most people most doctors are gonna do avidity, and then follow by reclass.
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Dr Doug: So then you have that iv bisphosphonate right?
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Helen: Well, thanks my ctx has gone down quite a bit, but my Np. Has also gone down.
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Helen: and I was put on identity for one month. I couldn't tolerate it. It upset my gut so badly I couldn't. I couldn't continue it.
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Helen: so I just didn't know. You know it was interesting, cause that was in August.
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Helen: and my P. One MP.
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Helen: Dropped the end of August, and in February draft even more so. I didn't know whether it could possibly be
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Helen: the identity exposure for one month.
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Helen: I don't know what the half-life is, you know the the recommendations are monthly injection, so it's gotta have a half life, you know, somewhere around a couple of weeks, but it's gonna vary from person, and I don't know what that that range looks like. Well, that's what that's what I was told to get better.
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Helen: And it took a month for it to to slowly recuperate.
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Dr Doug: Yeah, that's really interesting. So I've got a good issue. Interesting? Well, sorry that happened. Yeah.
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Dr Doug: So yeah, Jim, jim was asking about, and P. And Ctx, and you've got that correct, Jim, and P. Is a marker of bone formation. It's a collagen marker, and then Ctx is a marker of bone breakdown. It comes from osteoclasts.
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Dr Doug: Loretta was asking, or just.
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Dr Doug: Oh, yeah, now you're asking. So she was talking about taking Alejoni for 7 weeks, how long to get it out of the system. And so, Loretta, that's kind of the same question we were just answering with divinity. So each of these drugs has a half life. Now, Fossimax, is shorter because you take it more frequently. So the half life is shorter. It's probably out of your system after a matter of weeks, you know, versus like affinity. It could be months. A drug like reclass could be years.
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Dr Doug: And that's the downside of taking an Iv drug that's once a year, you know, or Perleas every 6 months. That patient I was talking about that had suppressed markers. you know. She was over 6 months out, and it was obviously still doing what it does?
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Dr Doug: So it's really variable from person to person.
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Dr Doug: Tammy was asking, how do you calculate the bone, turnover ratio? And is there a point when you can tell if bone is building or breaking down. Yeah. So, Tammy, we kind of talked about that. So that P. One and P. Over Ctx. Divided by 1,000. So you end up with a usually a 2 digit number over a point, something something something
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Dr Doug: and then you get a number somewhere between kind of 100. 300. Over 1 50 is what we're looking for, preferably over 200 and higher is better.
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Dr Doug: Oh, yeah. Hi, Tammy, there you are. shaking your head like that, was your question, and it was
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Dr Doug: alright.
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Dr Doug: yeah. So similar question from Michelle. You've been taking it for 5 years. How long? Until it ends? It's gonna be pretty short with fossil Mex.
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Dr Doug: In, Marvin. What's the optimal ratio? We're still learning that. So we are. Ii got the idea of doing this out of some research studies. So I've seen that people have used this ratio before to look at improvement, so I didn't come up with it. But there's not enough studies to know, really.
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Dr Doug: what does the ratio mean when it comes to improving imaging scores. What does the ratio mean? You know, as far as how quickly. So we're kind of in the early phases of this
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Dr Doug: we probably, you know, we have. Actually, we have 250 patients. After probably 2 or 3 years. I think we'll have enough data to probably report on it and say, You know, we can expect that if your ratio is this, that you're going to see an improvement in this
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Dr Doug: you know our goal is to build up to having somewhere around, like, you know, 600 700 patients. So we have enough power to start collecting data like this. I think it'd be amazing to have you imagine this many data points on hundreds of people over the course of years. Then we could really make some very strong recommendations, and I think that'd be very powerful
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Dr Doug: to everybody in the community.
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Dr Doug: I think, candy. I'm gonna let's reserve your question for next time. So let's stop here.
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Dr Doug: And then, Aranta, I see your message here that was direct to me. I will send a message to Chelsea, and see if she's seen those or not. For some reason they're not getting through. If you haven't heard back.
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Dr Doug: Alright, so we'll stop there with Nancy. We'll start there rather with. I'm sorry I said candy with candy next week. And yeah, it'll be me next week as normal. So I think we're gonna send out a message to about the optimal time for this. We've been getting a lot of feedback about the middle of the day and that it's not convenient, and there is no right time, because we're in like every time zone in the world. But there's been some requests for an evening
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Dr Doug: East Coast time that more people would be able to attend. So I think you're gonna get a survey to ask what would be the best time for you, and then we'll kinda make a decision based off of that cause I can. I can be flexible. I just have to be careful with after hours. Things
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Dr Doug: see what works best for people. So you'll get that hopefully through email. And then we will kind of report on that. But we're gonna continue with this noon on Wednesdays for the foreseeable future.
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Dr Doug: Alright.
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Dr Doug: alright! Great! Nice to see so many faces! Love seeing new faces and new names.
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Dr Doug: Lots of people here
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Dr Doug: so great.
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Dr Doug: All right. Anybody have any last minute comments
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Loretta Kellogg: you? No?
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Okay?
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Dr Doug: Well, should I answer Candy's question? Then we have 60 s.
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Dr Doug: Alright. Candy candy says she's 62. Recent rems showed fragility. Score around 25
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Dr Doug: t. Scores spine. Negative, 2 hips. Negative, 2 7
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Dr Doug: but recent Dexa went from negative 4 to negative. 4, 7.
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Dr Doug: That's low candy
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Dr Doug: rheumatologists is S suggesting going on forte, considering it for 2 years due to being a large difference between the Rem and Dexa question. If going on Porteo, is it necessary to continue on pro Leo? They won't let you, anyway? Or is it possible to maintain any increase
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Dr Doug: with lifestyle exercise, etc.? Does Foreteo carry over?
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Dr Doug: So so we do this we do use Forteo in our practice. So Forte and Demos, really the only drugs I will prescribe. If I had a patient that had a dexa in the negative. 4 s. They would be a conversation for sure, even if your fragility score on rams looks pretty good. That's concerning to me. Negative. 4, 7 is really freaking low.
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Dr Doug: So being on foretell, because there's really not a lot of downside other than cost inconvenience. And the, you know, the subtle risk of hypercalcemia.
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Dr Doug: But outside of that I'm not worried about the Osteosarcoma risk using it for 2 years to massively bump up P. One and P and really working on the lifestyle and driving everything toward maintaining it. When you come off on the other end.
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Dr Doug: I think it's a totally reasonable thing to do, and I've done that in a handful of patients. Whether or not you have to go on prolia after cause they won't let you do both at the same time it wouldn't work. But if you went on prolia after to maintain that you know it's a short term plan. You can't take it forever. So my preference would be for my patients to work on the natural stuff
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Dr Doug: and see if we can maintain it. I have seen that work. So see if you can maintain that bone building, and then, if you had to add a drug, then you would at least know that you've done everything you can before you started.
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Candy Reichert: Yeah, that's that's what her. Her plan was originally for tail. And then Paulia, immediately after going off for tail. Yeah, that's protocol cause that they don't think that there's any other option. Yeah.
