December 13, 2023
In today's session, Dr. Doug covers:
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Dr Doug Lucas: alright. Hi, everybody. Okay, well, it's 1201. So well, let's get, started, I think who was it that sent me this study. Was it you was it you, Sarah? Or someone?
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Dr Doug Lucas: Oh, Cheryl, it was Cheryl
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Dr Doug Lucas: Cheryl. Here, I'll give Cheryl a few minutes to pop in and see if she's gonna join us. She sent me this study. She had a question about this study. I'll share my screen in a little bit. But it's kind of an interesting study. It's a randomized control trial looking at identical twins who were put on either an omnivorous diet versus a vegan diet and the the metabolic impact of that.
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Dr Doug Lucas: So I I'll review that. But I'll see if if shelly's gonna I'm sorry, not shelly. I was looking at your name, Shelly Cheryl, gonna join us? And so I can review that with her. If not, I'll just do it a little bit later, and and then she can watch the recording. But it's an interesting study, so it'll be fun to talk about.
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Dr Doug Lucas: I love nutrition studies. And then in the
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Dr Doug Lucas: slack channel. If you guys aren't using slack, it's a great way to get information in. And there's a lot of people that are interested in in helping other people, too. So if you you know, if you guys want to use slack, I know it's it might be new to a lot of people. It's what we use for communication in our practice, because we have. You know, we have a team that's nationwide. We have people all over the place.
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Dr Doug Lucas: and they're always traveling, too, so we never know where anybody is.
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Dr Doug Lucas: Excuse me. but we all can communicate through slack. We have the hipaa compliant versions. We can talk about patients all day long. And it's amazing the amount of
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Dr Doug Lucas: intercommunication that you can do through something like this. So I would encourage you guys to check this out
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Dr Doug Lucas: all right. And there was also a question that popped in here from candy, and I think candy is on here. Hi, Candy.
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So Candy asked a question in slack. I haven't read it yet, so I'll just read it out loud. Here, Candy says. Hmm.
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Dr Doug Lucas: I'm wondering if you could talk a bit more about all the types of vitamin e. I've listened to the doctor that found the Delta gold tocotrianols. I saw something about that recently, too, and it sounds good. It does sound good. They are talking about a specific one, and normally we see Tocopherol listed on supplement bottles, and I'm not sure ever seen a supplement stating that includes all 8 types of vitamin. E,
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Dr Doug Lucas: yeah. So let's start there. So great question. Candy. I hope you can hear me. I see you on there. But so vitamin is a really interesting vitamin.
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Dr Doug Lucas: When we look at vitamin e supplementation as she said, typically, you just see one form of vitamin e, and that's alpha to cougher. All. What she's referring to is that there's actually 8 forms of vitamin e.
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Dr Doug Lucas: and the 8 forms of vitamin E are 4 forms of tocopherols and 4 forms of what's called tocotrianols. And I think they just made these names just to mess with people. And so there's tocoperals and tocotrenols, and alpha Taco is what is in almost every vitamin E supplement out there. There was a period of time when there was a lot of research going into vitamin E and heart disease prevention and anti-inflammatory studies.
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And what they found in those studies is that about 50% of people did well, and about 50% of people didn't do well. And that's why some studies show tremendous benefit, and some studies actually showed harm, depending on what the outcome metrics were. And so vitamin E is probably one of those things where people are like. Well, I don't know. I guess you should take it. It's a vitamin. We probably need it.
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Dr Doug Lucas: But what they did in those studies is they only used Alpha to cougher. All. So one of the things I learned in my genetics. Training is that there are. There is a Snp with a single nucleotide polymorphism that is related to the impact of Alpha to Cougherall, specifically in high doses on your body. And so people that have the risk form of the Snp will actually have an inflammatory response to Alpha to Cougherall, specifically
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Dr Doug Lucas: so for those people that need to consume less than 400. And I can't remember if it's micrograms or milligrams. But whatever the the normal unit is there, but less than 400. I think it's milligrams of of Alpha to Cougherall and if you look at some Maltese, there's a lot of Alpha to cougher all in there. And so that's why we see people on multis generally we'll take them off.
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Dr Doug Lucas: and then we use a product that has, as candy was stating, it has not only Alpha to Cougherall, but in lower doses, but all 4 of the tocopherols and all 4 of the Tocotrenols.
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Dr Doug Lucas: What this particular doctor was was saying with this product I think it's called Delta gold is that they were looking at some of the Tocotrianols and the literature behind it, and they were saying that they found some tremendous benefit.
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Dr Doug Lucas: I always question any anytime somebody has until somebody has the solution to a problem, and that solution is a product that they sell. It's always gonna be something to question, and they kind of make it out. When you look at the cause. Somebody sent me this, and it was this like incredibly long sales page. It was like the longest sales funnel I've ever seen, and it was just success, story after success, story after success story, which is fine. I'm all for free market.
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Dr Doug Lucas: This has been around for a long time, and you can also get it through food, although I'd have to look up where to get it in food. And so there are several products that have all 8 forms. And really, you just need to look for something that says like a full spectrum of vitamin E, or it'll say, tocopherols and tocotrianols. I don't think there's anything special about that product necessarily. But most people are deficient in vitamin E, because
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Dr Doug Lucas: we we either we're only getting Alpha to car for all, and they're not getting anything else, or they're just efficient and diet, and they're not getting it so. So hope that answers that question candy and and candy. If you're there you're welcome to to chime in.
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Shelly’s iPad: And one quick question about vitamin. What is it actually good for?
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Dr Doug Lucas: That's a great question. So I don't know no vitamin E, and I've actually I was just on a call, or before this with a practitioner who's
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I'll have them on here at some point.
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Dr Doug Lucas: but he's really into vitamin, actually a DAE, and really, K, we're talking about all of them.
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Dr Doug Lucas: and they all really work together, and a lot of times. We don't really know. You know what they do like. Take Vitamin A, for example. We're just talking about it for like half an hour, you know. We think vitamin a think like eyesight like, Yeah, it's true. But vitamin A was the first vitamin that was ever found.
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Dr Doug Lucas: and there are vitamin a receptors everywhere. So it does more than eyesight. But we don't really know how they all interplay. Vitamin E is kind of the same thing. We know there's an anti inflammatory component from most people. But what else does it do? I honestly don't know. I know that there are studies on bone health cause. I've looked at those specifically so. It is part of our bone health protocols, but we generally will use a product that is a full spectrum E and then the D and the A as retinol
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Dr Doug Lucas: in K as is in k. 7. So those are the kind of forms that we we know are probably the best forms.
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Shelly’s iPad: but the the devils and the details. And how much of each is is really an unknown. So we're we're definitely still shooting in the dark on that. I don't hear much about EK. And D. Of course, couple of other vitamins for fun cause so many fun things about vitamins that people are generally misguided on.
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Dr Doug Lucas: So let me let me mention vitamin c so vitamin C. People hear about that, because it's part of the production of collagen, and we need vitamin c for bones, and we need vitamin c for our immune system. That's all true.
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Dr Doug Lucas: But what people don't generally know is that vitamin C usually comes in the form of Ascorbic acid, and Ascorbic acid is not vitamin. C ascorbic acid is a synthetic whatever, and it's not used the same as vitamin C. It gums up our vitamin c receptors, and it's probably not good for anything.
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Dr Doug Lucas: And so people take these massive doses of ascorbic acid and I used to recommend massive doses of ascorbic acid but, as it turns out, that's probably not the best thing we really need to get whole forms of vitamin C, and they are out there, but they're not many. And so there's a few products like
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Dr Doug Lucas: what we've been recommending is a product from
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Dr Doug Lucas: Oh, a product from a company called Jigsaw weird name, but they have something called the adrenal cocktail. That's kind of sodium heavy. But for those that need more sodium. It's it's sodium and vitamin a and I
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Dr Doug Lucas: vitamin c is what I meant to say, and there's something else on there that I forget what it is. Maybe potassium. There's a couple of other whole food forms, but you have to look for like something coming from. I think it's called SSR. S. Serolow, eserolo fruit, or something like that, but they'll say, kind of whole food forms of vitamin C. They usually don't taste very good.
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Dr Doug Lucas: but that's the different one.
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Dr Doug Lucas: And then K. 2. I could talk a lot about as well. But we don't need to go down that pathway if we don't want to. And then Breta said, Hi, Bretta Brett has said, it looks like Cheryl is here. Brett is our director of digital digital
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Dr Doug Lucas: everything, I think, is her official title. So she's here somewhere.
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She makes it all happen on the back end.
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Dr Doug Lucas: So, Cheryl, where is cheryl cheryl, cheryl cheryl cheryl? We got a lot of people here today. They're cheryl.
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Dr Doug Lucas: Alright. So, Cheryl, you would send me in this this study. Hi, so you sent me in this study. I have it pulled up here. So I wanna review it. I looked at it quickly. But we're gonna kind of review it, I think, together as a as a group which is kind of a fun exercise. If you guys are into that.
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So let me see, let me find the best way to share this. Let me pull it out of my
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Dr Doug Lucas: my overloaded web browser. Here
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Sheryl: it was a short one, it was, you know, only 8 weeks or something like that. Yeah, yeah, we'll we'll definitely talk about that. Because whenever
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Dr Doug Lucas: whenever we look at nutrition studies, we definitely wanna look at how long and how compliant people were.
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And then there's some interesting findings here. So
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Dr Doug Lucas: alright. So you guys see this this study?
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Shelly’s iPad: Anybody? Yeah, great. Thank you. So
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Dr Doug Lucas: so this is study recent study, really recent study. And like, I said earlier, it's looking at the the impact of basically biomarkers on 8 weeks on either an an omnivorous diet, hard for me to say an omnivorous diet or a Vegan diet.
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Dr Doug Lucas: and they use twins because there's a really cool way to do a study because you can eliminate so many variables if you use somebody that has the identical genetic background. So it's kind of a cool study, but it's always limiting, because it's hard to find that many twins. So you just can't have. You can't have a study with a thousand twins. It's just not gonna happen.
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Dr Doug Lucas: But I think it's always fun to look at nutrition studies. Sometimes you have to look at the authors. I did not actually do this in this study, but sometimes the the same authors will pop up over and over again like
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Dr Doug Lucas: Who was the guy from Harvard that just published the diabetes in Meat study Willett, Walter Willett from Harvard. So he's a really well known nutrition guy, and he just published recently that study. If you saw the headlines that said red meat causes diabetes.
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Dr Doug Lucas: But if you know anything about Walter Willett, you know that he's a he is a devout Vegan, and is a follower and believer of eating a plant based diet. And so everything he publishes is about the bad, the bad effects of meat, and so he used a lot of data to show that there's an association between red meat and diabetes. And I'm actually gonna do a podcast on that. But the
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Dr Doug Lucas: the short summary of that study is is simply that people that eat red meat also eat other things that go along with it, and it's more likely that it's from, you know the the bun on the burger, and the the French fries and the milkshake, and not the meat that was on the burger, and that's what they included in a meat and meat diet. So
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lots of stuff like that in the nutrition world which is really frustrating.
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Dr Doug Lucas: So then this study, as Cheryl said, yes, it's a short study. So it's an 8 week intervention. But that's still long enough for us to see some biomarker changes. So then, basically what they said in this study, if you just look at the abstract and we have the whole study, so we can. We can dive dive in. But if you just look at the abstract, you can kinda get a sense of what they did.
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Dr Doug Lucas: And so how big was it so? 22 pairs? So 44 people. And they were randomly divided into 2 groups. So one was a Vegan group. One was the omnibus group. What was cool about this study, too, is that they actually gave people the food. So that's always an issue with with nutrition studies. Is that a lot of times they're on food. Recall like, what did you eat? It's rare to see a prospective study. So that's a really great part of this is that they assigned people and then gave them what they wanted them to eat. So you're gonna have much better
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Dr Doug Lucas: realization of what's actually happening because they're hopefully eating what you gave them. Then they transition to their own food at some point. And you can see actually in the data how things change during that. But still, I think you get a sense of what happened.
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Dr Doug Lucas: Let's see here. So they were randomized. They looked at Labs at 4 weeks, and then labs at 8 weeks, and from week 4 to week 8 they were on their own foods.
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Dr Doug Lucas: The primary outcome was Ldl. Cholesterol. So we'll have to talk about the importance or or not importance of that, and then secondary outcome measures where plasma lipid. So that's what's happening with fatty acids in your blood. Glucose is your blood sugar, and then insulin is the hormone that drives glucose into cells, and is the response to glucose consumption. And then they also look at
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Dr Doug Lucas: Tmao, which, as they have spelled out here, is trimethylamine, an oxide, and Tmao is one of these things that rises with in certain people in response to certain foods. And there's a thought that it increases your risk of cardiovascular disease. And I can talk about that B 12 levels and then body weight.
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Dr Doug Lucas: Then they ask them some questions. And so you can just see in the results that they kind of like. What they're getting to here is just simply that
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Dr Doug Lucas: de de de. After 8 weeks
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Dr Doug Lucas: the Vegan diet experienced a significant mean decrease in Ldl cholesterol, fasting, insulin.
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Dr Doug Lucas: and body weight. So if they look at those 3 variables, those 3 outcome metrics. You can just simply say, like, Okay, well, this is probably good. And so you know, Ldl cholesterol, we need to talk about the significance there. But fasting insulin. We definitely want to go down. So it's nice to see that. And I'll talk about kind of what? How that's interesting. And then body weight would go down. So one of the things that can explain a lot of what happens in a short term change
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and diet is.
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Dr Doug Lucas: let me get to there. Yeah. So they have this. They have this really long supplement here. So let me actually just open this.
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Dr Doug Lucas: So I love studies that provide all this information. It's really great. It's hard to read. But it's really great, actually, that they do this. So let me just show you
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Dr Doug Lucas: couple of interesting things in these graphs. I can make this bigger for people on small screens.
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So
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Dr Doug Lucas: what they show here. And if you look at, I would look at the middle here, where it says the macronutrient distribution, the middle is the vegan and omnivore, side by side with food delivery, and then self provided. And so this is kind of an interesting thing where you can see like, what's the difference between these 2 diets? So I would argue that actually, they're not that different from a macronutrient perspective, right? Like pretty subtle differences in dietary, fat carbohydrate and protein intake.
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Dr Doug Lucas: you know, 20 to 13 or 14% of protein different. Is not that much difference? So I honestly, I'm kind of surprised we saw any difference. But we did see some differences.
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Dr Doug Lucas: And then on this table. You can see if you look at the energy. So energy right here. And if you look at this one of the things that's going to explain some changes is the difference in just simply in energy intake.
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Dr Doug Lucas: So you take people that before. So you look at their baseline, they're eating about 2,000 calories, and then you put them on a Vegan diet. And now they're eating 1,600 calories. So what happened? Well, now, they're on a pretty significant calorie restricted diet of probably 20 right now. The omnivore diet, didn't. It? Went down as well, but not as much. And this happens anytime. You restrict somebody's diet. So it doesn't matter if it's with keto or vegan or carnivore, or whatever it is, you're always gonna end up eating less initially until you figure it out.
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Dr Doug Lucas: So this is why, if you did a study over 12 months, it would be different than a study over 2 months. But anyway, so they eat a a calorie restricted diet. You can see the average calorie does go up towards the end of the study, so not a lot. But in both groups. It went up just a little bit, cause they kind of figured out how to eat more food.
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Dr Doug Lucas: and then same thing with protein. They were eating 304. I'm assuming this is that can't be grams. This must be oh, calories from protein. Yeah. So 304, 311 here in the baseline. And it went down quite a bit, right, 2, 37, and actually went up in omnivore. And again it's low. And it went up so higher protein, but still not high, highish.
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Dr Doug Lucas: so lower protein. For sure, in a calorie perspective, fat distribution. Not really that interesting
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Dr Doug Lucas: grains, not that different either, in this? Obviously, there's more animal protein and omnivore, no question there.
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Dr Doug Lucas: and carbohydrates more carbohydrates in the Vegan diet that's always seen. And then this is where they start getting into some of these outcome things. So cholesterol is is going to likely go up an omnibor diet when you add more protein and add more dietary fat for some people, but not all people. But what we see consistently is that Ldl cholesterol will go down on a Vegan diet. We see it for most people almost all the time, partially, initially because of the drop in calories, but also because of the drop in in dietary fat.
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Dr Doug Lucas: So here's the question, and I'm going to stop sharing for a second. So here's the question, is that a good thing? Is that a bad thing.
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Dr Doug Lucas: and what we see in people that eat a Vegan diet is, if you look at association studies, long term association, studies, epidemiology, studies, there is a reduced risk of heart disease and events in people that eat a plant-based diet.
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Dr Doug Lucas: But you can never separate out the difference in the healthy user bias. So people that are choosing in following a plant based diet are going to also, then do other things that are likely to be healthy versus what would be in a population study a quote unquote omnivore diet, which would include people eating everything under the sun, and likely making worse health choices as well. So
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Dr Doug Lucas: Vegans are less likely to smoke, they're less likely to be obese. They're more likely to exercise regularly. Sleep better not drink, not smoke. Then all the things all those things are are oppositely true for the on the war community. So
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Dr Doug Lucas: so you do see that improvement in cardiovascular disease, risk and disease itself in people that eat a plant-based diet.
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Dr Doug Lucas: There's never been a study that
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Dr Doug Lucas: it looked at a well formed omnivore diet versus or carnivore diet even, which would be interesting versus a plant based diet over the long term, because it just can't be done or it could be done. But nobody's going to do it, or nobody's going to fund it.
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Dr Doug Lucas: So we really have to look at studies like this that are short term. So then, that brings us to cholesterol. So Ldl cholesterol as a risk factor for heart disease is not great. It's not nothing you'll see people talk about, especially in the carnivore community. Lean mass hyper responders. Their cholesterol goes up, but because their metabolic functions better that there's no risk.
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Dr Doug Lucas: I don't think we can say that there's no risk. I think that's overstating it. I'd love to say that there's no risk, but I just don't think it's true. The traditional medical model would look at Ldl cholesterol and say, it is a primary risk factor. I don't think that's true, either. The truth is probably somewhere in the middle, which is, it is a risk factor for some people.
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Dr Doug Lucas: but the benefits potentially of consuming a diet that works better for you from a metabolic perspective allows you to maintain or gain muscle mass that allows you to
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Dr Doug Lucas: exercise more, you know. Feel better, sleep better all of those things. If it then increases your cholesterol a little bit. I would rather you eat that diet in, control your cholesterol, either through nutraceuticals or potentially even pharmaceuticals, rather than eat a Vegan diet and lose your muscle mass
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Dr Doug Lucas: generally be metabolically worse off, and not have the energy and deal with all the anti-nutrients of all those plants and volume. So for me, I don't really care about the cholesterol change that goes along with the diet. If that diet is right for you.
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Dr Doug Lucas: if that makes sense before I share my screen, let me see if there's anything else in here that's interesting. Oh, yeah, no, there totally is. Hold on! Wait! I geek out on this stuff. So if you guys are bored, let me know.
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Dr Doug Lucas: so other things that are interesting. So this was a really fast change so look what happened to to serum b 12 in the Vegan group, just like bottoms out because you can't get it through Vegan. Food you can't. B 12 is is only in plant. I'm sorry in animal products. So we see B 12 deficiency always. And people that eat a plant based diet unless they're supplementing and you see, an omnivore diet. It went up right. And this is what happens
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Dr Doug Lucas: consistently, probably still need to supplement it, though.
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Dr Doug Lucas: Iron distribution kind of interesting. It's sort of we sort of stayed flat and then kind of went down in both. And I can't actually explain that that's an interesting conversation. Vegetable intake obviously gonna be higher in the plant based group meat intake. Obviously higher in the in the on the war group, meat alternatives is a really interesting topic, so like people that were
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Dr Doug Lucas: that were eating an omnibus diet that then get shunted into a Vegan diet.
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Dr Doug Lucas: Look at all of these servings of these garbage. plant-based meat alternatives that is not good for you.
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Dr Doug Lucas: It's essentially dog food. It's highly processed, highly toxic. That is not a healthy move over the long term. and then I think that's all. It's interesting in there.
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Dr Doug Lucas: Basically, there was people saying how how happy they were. Oh, here's TMO. Let me just mention TMO real quick. So TMO. Like, I said, is associated with increased cardiovascular risk. So you can see that the omnivores, their TMA. Went up, begins TMO. Went down.
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Dr Doug Lucas: So here's the thing about Tmo. Those associations have never borne out in literature to mean anything whatsoever. Tmao is simply produced by the gut bacteria and some people, and not in others. It is produced in higher amounts, and people that are that are insulin resistant. I need to talk about insulin that are insulin resistant have metabolic dysfunction. So really, it's more of a sign of metabolic dysfunction rather than you know that you need to reduce your meat intake, cause that's what most people will say. It's like, oh, you gotta reduce your meat intake your T Mao went up.
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Dr Doug Lucas: But guess what also has tmao in it?
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Dr Doug Lucas: Fish? We know that fish consumption is associated with an improved risk of heart disease. So how is it that Tmio and fish is good, but tmio from red meat is bad, it doesn't make any sense.
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Dr Doug Lucas: So anyway, I think that's garbage and then the insulin component insulin went down in the I don't know where it is, but insulin went down in the Vegan group, but that could purely be associated with the reduction of 20% of calories. So I don't think that eating a higher carbohydrate diet is gonna reduce insulin. As long as you maintain the same calories, it's eventually gonna go up.
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Dr Doug Lucas: Okay, so does that make sense any questions on that? And there'll see some questions in the chat here.
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Sheryl: I had a couple comments.
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Dr Doug Lucas: Was that you shelly?
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Sheryl: It was me. Cheryl, yeah, I found it interesting. To be 12 was interesting, because that's a fat, soluble vitamin, so you would think it would stay in the system longer than that.
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Sheryl: And and then also, I wanted to just point out that
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Sheryl: that it, that they considered it a healthy vegetarian diet. But they did have all that junk replacement stuff in there.
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Sheryl: And that's part of the problem with some of the
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Sheryl: the other studies like you were talking about. Like, you know, they're Ca, considering people with, you know, big Macs and fries and all that stuff and sodas and things on the on the omnivore side, but then on the vegetarian side there, it's also got a bunch of people eating like like junk
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Sheryl: vegetarian food, cause you could. Still, French fries are still vegetarian, you know. Promising was kind of disappointing at the same time.
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Dr Doug Lucas: Well, and that's the challenge of of nutrition. Based studies. And thank you for that. Input so to your point, though, B 12 is actually a water soluble vitamin. So it is, gonna you have to continue to eat it and consume it, either through supplementation or through food consistently. Otherwise it'll it'll be gone.
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Dr Doug Lucas: Brett has thrown a whole bunch of stuff in here. Yeah, it's a water soluble vitamin, like all the bees.
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Dr Doug Lucas: And then so Bretta put some stuff in here that I'm going to read here in a second. But, Breta, you said, I'm going through the list of questions, but I don't see Sue's question in slack unless I just missed it.
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Dr Doug Lucas: If Prato wants to help.
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sjcsr: I didn't. Hi! This is Sue. I didn't put it. Hi! I didn't put it in slack. I put it on the health span. I sent it in. Brett will put that link in here. I was probably supposed to have it, and I don't know where it is. That's alright. II wrote too much. The bottom line is
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sjcsr: that
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Dr Doug Lucas: Oh, you muted yourself unless I muted you.
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sjcsr: Okay, I'm on a very. I'm 71 years old. I don't have any any medications. I'm in good health.
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sjcsr: and I insisted II went to several doctors. No one would give me the bio identical creams
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sjcsr: and the last dog. Anyway, I I'd found a place I live in Boca, Raton, Florida. I found a place called the Bio Station. There's 2 functional medicine doctors there, and they're very good. They give you an extensive blood test, anyway. They put me on a very low dose of HRT. With DHEA. And testosterone micronised Poges.
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sjcsr: Ii wanted it because I had terrible, terrible brain fog
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sjcsr: and within 3 days it was gone. The brain fog. Now I can remember where I put something 3 days ago. However, the the thing is, when I went to my gynecologist to follow up on a cyst. He found fluid in my uterus, and he doesn't prescribe HRT. And he said, It's from the HRT.
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sjcsr: So that made me nervous because I'm taking such a low dose, and I'm in fact, taking it every other day.
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sjcsr: So because the the the dose was too high. I have that MTHF. R. Gene. So I everything affects me, anyway. I wondered if you could tell me I'm concerned about that.
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sjcsr: and I'm concerned. About. He mentioned to me when I showed him I was on the HRT. He said, that that can cause plaque in your arteries. The problem with it is, it can cause plaque, and the plaque can break off, and then you can have a stroke.
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sjcsr: So my calcium score is 0, and my cholesterol is about combined. 200.
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sjcsr: So these are things I have on my mind, and I just wondered if you could address them.
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Dr Doug Lucas: Yeah, those are fantastic questions. And II love answering those questions. So cause it probably applies to so many people here and then. So yeah, II definitely sympathize with your challenge of getting prescribed hormones, especially in your seventies. Because that presents a challenge. Excuse me for a lot of doctors because of the potential increased risk. And I'll explain that in a minute.
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Dr Doug Lucas: Can I ask how long had it been since you'd been exposed to hormones? Did you go through menopause in your early
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sjcsr: yes, and I did take them. But I wasn't explained to me the importance of it. And and I'm in the mid. Oh, wow! How long did you take them for?
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sjcsr: Probably a few years? Okay.
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sjcsr: so you've been off of them for over 15 years, maybe closer to 20 correct, and then I went on, prolia cause I fell down from. I was coughing. I had a flu, and I got out of bed, and I hit the floor, and I ended up with an L. 5 fracture. So I had a kyphoplasty and everybody everywhere. I went. I'm in South Florida, everywhere I went. Oh, you need prolia, you must have it. You must have it.
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sjcsr: And and II did it, and I had Gerd for an entire year. I had asked, and I had acid reflux an entire year, and every doctor, if I went to the gastroenterologist and said, I have Gerd, it's from the prolia he'd say, what's prolia? If I went to the cardiologist who put the monitor on me, he'd I'd say this is from the prolia, he'd say, What's prolia?
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sjcsr: So I managed I managed to. I'd I stopped cold turkey, and I managed. I found a radio guy, Richard Pearl. He died, but he was fabulous, and I went to his supplement store, and he sold me about
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sjcsr: $300 worth of supplements, and I was really nervous about the rebound period from prolial, because no one explains about the osteoclass and osteoblasts, so he fa he sent everything he sold me. I got through the rebound period with no fractures.
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sjcsr: but one night. At 40'clock in the morning I was awoken, awakened with the most excruciating hip pain. I thought I would never walk again.
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sjcsr: and II couldn't get anyone to diagnose it. Nobody could figure it out with the X rays and the Mris, and then II went to my gym. I live in a community with lots of gym classes, and I took way protein and lots of collagen, and I rebuilt my muscle in my leg.
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Dr Doug Lucas: Great. Well, let let me address some of your concerns, and thanks for all that information I appreciate you sharing.
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Dr Doug Lucas: So
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Dr Doug Lucas: when it comes to finding somebody who will prescribe it is definitely a challenge. And let me just explain the the risk around the the 15 to 20 year period. So
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Dr Doug Lucas: you'll go if you go to, especially a traditional Doctor Obyn. They'll say if you're if you're over 10 years out from menopause, don't worry about hormones. There's too much risk.
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Dr Doug Lucas: They do that, because the recommendations from the acog, which is the American council or college of obstetricians and gynecologists, the endocrine society. Everybody has the same stance which is use hormones for as little as possible, or use as little as possible for as short a time as possible, and essentially help you get through the symptoms of of menopause, the evasive motor symptoms, night sweats, hot flashes.
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Dr Doug Lucas: And then once you're done with that you're done with hormones.
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Dr Doug Lucas: But that is very short sighted and does not then appreciate the potential benefits of hormones as you experience Sue from brain fog, energy, vitality, sleep, muscle, mass skin, you know. And then there's the the sexual function stuff that people actually talk about, which is, you know, important for some and not for others.
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Dr Doug Lucas: So it's hard to find when you find that right person, that gap, that that twenty-year gap is important.
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Dr Doug Lucas: The reason why is that the Women's Health Initiative, which I'm happy to talk about at great length, but that study from 2,002 that showed that potential increased risk of breast cancer with with primar and the synthetic estrogen
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Dr Doug Lucas: and and provera a synthetic progestin also showed that for those that were over 10 years out from menopause that started on hormone replacement therapy, there was an increased risk of events.
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Dr Doug Lucas: So that data is real. Those data are legitimate.
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Dr Doug Lucas: the the theory. And this is what was explained to you, Sue. The theory is that when we lose estrogen as women. I say we as if I'm there. But when you lose estrogen as women, your arteries will get more stiff, you're more likely to develop plaque if you have a stiff artery, and this is all kind of in theory, but it's likely to be true. And then, if you add estrogen back, and you make those arteries more compliant. Then you might knock off some chunk of plaque, and it could cause a heart attack or stroke. That's kind of how we think that it works.
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Dr Doug Lucas: There's still some issues with those data, because those women that were over 10 years out from menopause were also more likely to be obese. They were more likely to be smokers. They had other risk factors for having cardiovascular events, too, but take it for what it is, I still think it makes sense so for me, because I have a lot of women that come in in their sixties. In their seventies. They are interested in hormone replacement now, but they did not get the opportunity because they went through
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Dr Doug Lucas: menopause in the early 2 thousands, right when the Women's Health Initiative was published. So a lot of times, doctors, especially in the early 2 thousands, and really continuing on. They wouldn't even talk about hormones unless a woman begged them to or beat them to death. They would not talk about hormones.
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Dr Doug Lucas: And so that age group, there's just a lot of women who never even had the option never had the conversation. So now we're stuck in this position of okay. Now they have osteoporosis. Now they have early signs of dementia. You know. They're worried about all these things, and hormones would likely help. So what do we do? Well, the approach that I take is to address the cardiovascular risk. Specifically, you mentioned that you had a coronary artery, calcium score, or a cac, as it's called, and your Cac score is 0. So what that tells me is that you
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do not have calcified long standing disease in your coronary arteries, the arteries that lead to the the muscle of the heart.
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Dr Doug Lucas: That's really reassuring for me. I have started patients on estrogen testosterone and progesterone in their early seventys, who are 20 years out from menopause. If they have a 0 Kac.
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Dr Doug Lucas: They have not a strong family history of heart disease.
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Dr Doug Lucas: and they don't have others significant risk factors, you know. If their cholesterol has been relatively low, they have low inflammation all those things. If it kinda all lines up, then I will do it. But with the firm understanding that I can't guarantee that you're not gonna have an event, but I can guarantee you that your osteoporosis will likely get better, you know, and the other things you're suffering from will likely get better. So it's this case of.
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Dr Doug Lucas: you know. Treat the thing that you know. You have more so than worry about the thing that you don't know that you have, because we know, especially if they have severe osteoporosis that's likely to be a bigger issue. So we do that. It's risky, probably to some extent, but it's worth it, because we understand what their risk is.
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Dr Doug Lucas: so that's that component of the risk, as far as the the lining of the uterus. So this is something that happens in all women. This is not relative to a 70, 70, or 71 year old woman. So
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Dr Doug Lucas: for any woman who has not had estrogen in her system, and then is given estrogen back. It is going to then provoke a thickening of the lining of the uterus. This is what estrogen does during our cycle. If you look at the cycle in a premenopausal woman, estrogen rises, the endometrium gets thicker, and then estrogen drops Progesterone goes up and it all sloughs off right. This is the the menstrual cycle. So when that happens in a woman who's on estrogen replacement.
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Dr Doug Lucas: generally, it's a result of an imbalance of progesterone and estrogen. Rarely, if a woman has sort of a quiescent tumor or potentially cancer in her uterus.
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Dr Doug Lucas: then even a little bit of estrogen that's adequately balanced with progesterone will provoke thickening of that endometrium. And then, of course, they blame the estrogen. But it was already there doesn't cause cancer, but if you have it same thing in breast, if you have an estrogen, sensitive cancer and you add estrogen to it, it will grow faster. That's a no brainer, but it doesn't cause it. And so this is why, if a woman has breakthrough bleeding, we'll send them to the Ob, they'll do an ultrasound and see how thick that end
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true lining is. And if it's over a certain percentage thick.
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Dr Doug Lucas: then they likely will need a biopsy and see what's going on in there. It happens, but it's not common. If there's a little bit of fluid, and you haven't had any bleeding
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sjcsr: a I wouldn't have done the ultrasound in the first place. But, BI don't think there's anything to do there. But you kind of are stuck then, in this paradigm of saying, Okay, Oby, Ni appreciate your comments about my hormones. I'm going to ignore you, but I do need to figure out what's going on in my uterus, so do the things that they ask you to do. Does that make sense? I yes, but I was there because he was checking for assist.
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sjcsr: and the previous ultrasound didn't show fluid
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sjcsr: so when they put me on it originally. The progesterone, my breasts like doubled in size, and I called and told them I can't. This is too much. So they cut me back, and they had me on like every other day, so every everything was fine. But now I'm concerned, my mother is
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sjcsr: about the cardio. My mother had a four-way bypass. She was a terrible smoker. I never smoked, but she had heart disease. Yeah. yeah. And so there's always that balance. And if you had significant, you know, increase in breast size or tenderness. And that's an estrogen thing. And so it likely for me would mean that we just don't have adequate progesterone on board. So if you're seeing those symptoms of swelling breast tenderness potentially breakthrough bleeding. That's estrogen overload, and we're not balancing it adequately with Progesterone. And you know what I'm taking such a small amount, Doctor Lucas, that I couldn't take it any smaller. And when you click the thing.
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Dr Doug Lucas: yeah, it's all about this, it's then it's about the strength. So if if we need to reduce the strength because you can. You can compound estrogen, and I mean estradial and as as low, of as low a strength as you want. I mean to the point where it would do nothing.
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Dr Doug Lucas: So for me I would use a smaller strength or a lower strength, and then the amount of fluid that you actually need or the amount of cream you actually need. If that makes sense
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sjcsr: would. Okay? I wanted to ask you. Also, I was paying around $700 for these hormones. Is that the usual and customary amount
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Dr Doug Lucas: pharmacy you like? That's more reasonable. I don't wanna throw anybody under the bus. That's kind of a lot. I mean, it's it's it's depends on how you're doing it. So you know, for us in our practice we don't have a large margin on hormones, because it's I think it's kind of unethical. It's still past the sniff test to some extent, because there is, you know you have to. You have to make money somewhere. As a practice.
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Dr Doug Lucas: we choose to make it through membership fees. So we charge people to be a member of the practice. And then we essentially charge people. You know our cost plus the administration fees of whatever it takes cause. It takes a massive team to make all these things happen. So we have a really small margin for that reason. So for us, hormone replacement is much less than that. Some of the hormones are also potentially prescribable through commercial pharmacies. So Progesterone, for example, a micronized progesterone is available commercially. It might not be as good. But your insurance medic
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sjcsr: Oh, we lost you.
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Nancy Mandowa: Oh.
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sjcsr: yeah, died.
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Shelly’s iPad: He froze or he's gone.
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sjcsr: I'm sorry to take up so much time, but I've really been worrying about these things.
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Shelly’s iPad: Sorry about that, guys.
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I don't know why that happened. Anyway. I don't know where I left off. Can somebody tell me where I where I dropped?
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Nancy Mandowa: You were talking about pricing.
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Dr Doug Lucas: I was asking you if you could share the pharmacy that you use. Yeah. Yeah. So we use a bunch of different pharmacies. They're all going to be. And this is something to to consider to. They're all gonna be 403 b pharmacies. And what that means is that they are. They are regulated by the FDA to some extent, because they're providing bulk
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Dr Doug Lucas: hormones for other companies, and so we never use local compounding pharmacies because of concern of quality that can impact the cost as well, because these pharmacies are more expensive. But we use, we use empower. We use
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Dr Doug Lucas: can't think who else we use?
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sjcsr: Do you use? Create, create? No, I'm I'm also out of the ordering side. So I just, we have our guidelines. You know, they have to be a 403 B large compounding pharmacy but what I was saying and that probably got cut off is that
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Dr Doug Lucas: the different practices are gonna have different margins. And so it just depends on how what their business model is, you know. So some will get you on the. And I say, get you like. It's negative. They're gonna get you. But they have to make money. So some will make money on the the hormones. Some will make money on you know, membership, or or, you know, clinical time.
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Dr Doug Lucas: there's gotta be an income somehow. Otherwise they don't exist. So we choose not to do that. So for our patients, the hormones are less expensive, but it's more expensive to be a member of the program, you know. So we charge we charge people to get in the door once they're in the door, we try to do everything we can to make things as affordable as possible.
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Dr Doug Lucas: So for us, I prefer to compound all 3, but if somebody has financial challenges, then the the progesterone can be prescribed commercially so. There is a commercial micronized progesterone at 100 200 milligrams, which is totally acceptable for most people. Some people fall in between, but most women can tolerate 200 milligrams. Fine
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Dr Doug Lucas: and that's dirt cheap or free, if your insurance pays for it, so you can reduce cost that way. The Estradiol cream I prefer to compound, because the Estrada. Patches, I think, are. They're inconsistent, and I don't think they're as good, and we can't get adequate serum dosing. Usually it's possible. But it's not as easy and then testosterone has to be compounded because there's no commercial product in the Us.
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sjcsr: Is testosterone and DHEA. Are they an overlap, or do they work together? Yeah, they're they're kind of an overlap. So DHE is the precursor hormone to testosterone. So if you don't have DHEA. You're not going to be able to make testosterone effectively.
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Dr Doug Lucas: So for some people, if they're not candidates, are not interested in hormone replacement. We'll use
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Dr Doug Lucas: Dha and their studies. I have a video on this on Youtube for bone health. And we'll use Dha at significant doses. And the thing is, it doesn't really increase testosterone very much.
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Dr Doug Lucas: So when we use testosterone, which is often we, we don't necessarily use Dha all the time. I still like to if somebody can tolerate it. But here's where the the synergy kind of gets you in trouble is that testosterone is androgenic meaning has the potential side effects of potentially either hair growth potentially hair loss depending on the the person, but acne and oily skin. So just that's like, you know. Think of your 18 year, old man, with a lot of testosterone. Those are the side effects.
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Dr Doug Lucas: Dha is also androgenic, though, and so when you combine the 2, you you run into the potential of having more side effects. If we're gonna pick one, I would pick testosterone because it's less likely to have side effects, and it's more impactful. But I think Dha probably has other benefits, too.
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sjcsr: Okay, and I just have one other question, memory memory. Is there? If you go off cold turkey, or you go off these hormones. Is there any supplement that works? Because I'm addicted to these hormones because of the memory recall, is so good?
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Dr Doug Lucas: No, if there was something that were as effective, then I would use that instead. No, unfortunately
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Dr Doug Lucas: there isn't. Now, if you had to go off of estrogen, let me just. I'll just plant this seed, which is, you don't have to do all 3, you know we hear of, you know Progesterone and Estrogen has to come together. But that's not true. You can do progesterone and not estrogen. If somebody is, is not willing to, or has too much increased risk of estrogen, because we know Progesterone not proges, but Progesterone is relatively benign by itself. I can't think of a single side effect unless you take too much.
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Dr Doug Lucas: Whereas, you know, estrogen. Obviously, there is some potential increased risk, same thing potentially with testosterone. But you have to be careful because testosterone will aromatize into estrogen. So you just have to balance and know what know what you're doing. I wanna share this image real quick cause. This will blow everybody's mind if you haven't seen it yet.
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Dr Doug Lucas: So this is something. I've been showing this graph a lot because
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Dr Doug Lucas: most people don't know this. So let me explain this graph. So there's obviously 2 lines.
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Dr Doug Lucas: The black line with the black dots is obviously higher than the white dots in the black line. Now I already gave it away because the the key is up here. But this is sex hormones in women throughout the lifespan. On average.
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Dr Doug Lucas: this is adjusted for units. And so when we look at at biomarkers for hormones, we typically see. Oh, well, women have, you know, 5 times as much estrogen or 10 times as much estrogen as they do testosterone. But it's because the units are different.
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Dr Doug Lucas: Once you adjust for units and switch from nanograms per ml. To picograms per ml. You see that women have 5 to 10 times more testosterone at any point in their life
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Dr Doug Lucas: than they do estrogen. So what's amazing about this for me is that when we talk about hormone replacement for women, you don't hear about testosterone
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Dr Doug Lucas: right? We talk about estrogen. We talk about Progesterone. We don't talk about testosterone, and there's not even a commercial product available to give to people, to women if they wanted it. So we end up having to compound, or then using really small small doses of the the men male version.
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Dr Doug Lucas: But it's amazing. And I've really been digging into this. And I did a talk in New York a couple of weeks ago, actually for Osteostrong, but on the topic of of testosterone for women. And it's it's amazing that if you look at the recommendations, the recommendations from the endocrine society and the acog. I'll say the same thing which is, don't prescribe testosterone for women, because there's not a clearly defined syndrome that's associated with androgen deficiency or testosterone deficiency.
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Dr Doug Lucas: There was just a recent paper that was published that actually pointed out
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Dr Doug Lucas: that if you replace estrogen you can resolve some of the symptoms of of menopause, but not all of them.
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Dr Doug Lucas: And if you compare the symptoms, then that are left, as you mentioned, brain fog, Sue, that's one of em. But if you look at the symptoms that are left, and then you compare that to the symptoms of aging in men.
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Dr Doug Lucas: they're identical.
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Dr Doug Lucas: and guess what they do for men. They give em testosterone.
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Dr Doug Lucas: So why don't we do this for women?
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Dr Doug Lucas: It's it's it's crazy for for I just I can't wrap my mind around it except for the fact that we don't. As a society, we don't talk about sex
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Dr Doug Lucas: in basically women over 40, right? Like, it's just not a common conversation. It's sort of like the patriarchies like. No, we don't talk about that, you know, and if you look at the the symptoms of testosterone deficiency in the medical community. Literally, there is a diagnosis, a psychiatric diagnosis called Hsdd, which is a hypoactive sexual desire disorder so when women don't want to have sex over the age of 40. They call it a psychiatric problem. But for men it's aging.
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Dr Doug Lucas: and it just goes to show, like the the dysfunction in the medical community, and how we refuse to, as doctors recognize that aging in women and aging in men. A lot of those symptoms are due to testosterone in both
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Dr Doug Lucas: both genders. It's not just men, so I'm that's why I'm a huge fan of testosterone. I don't use it in everybody, but I use it in in most women that are deficient. And here's another point on that is that not all women are deficient in testosterone, because the adrenal glands make at least half of your testosterone as a woman.
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Dr Doug Lucas: So once the ovaries stop, you could actually still have adequate testosterone. So this is why, I see some women. Well, you know they'll go get a paladin. They're gonna think that it's gonna be the answer to everything and actually drive them crazy because they didn't necessarily have low testosterone in the first place. And so we we do have to be careful. But it is a powerful tool for a lot of women.
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Nancy Mandowa: could I could, I interject. I had a question that was, I think, a good buried in the replies I was asking about your video on Dha, it is in slack. I put it in there. Because it's good for bones. I had wanted to take it, but I find it intolerable for acne. And I thought you
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Nancy Mandowa: kind of reference that there are ways to work around that. Is there a solution? If you want? Sure? Yeah, you can, you can play with a couple of different things. So obviously, I'm not giving medical advice.
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Dr Doug Lucas: But if our patients were talking about the same thing, the supplement way to do that is to use essentially the same products that we would give to men for overproduction of Dht, and so this is what happens with Dh ea and testosterone, and the skin is that it gets converted to dht, which is the the
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Dr Doug Lucas: it's called dihydro testosterone is the more active form, and dht can cause acne in some people it doesn't me, too. So the supplement version of blocking that conversion of testosterone to Dht is called Sapall meadow. You'll see it in like every prostate
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Dr Doug Lucas: product out there. Softball, meadow, softball meow, and sap. Paul Meadow does work, and I don't think I can't think of any downsides. I have plenty of guys that are on it. If that doesn't work, then there is a prescription that we will use for people, especially if they're on testosterone therapy, and their levels are dialed in. But they're still getting acne. We'll use sporonalactone, which is actually a mild diuretic.
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Dr Doug Lucas: which again, also doesn't have a lot of Downside as long as you don't end up with too much potassium on board and reducing blood pressure by a couple of points is probably not bad for anybody. So Sporona Lactone is something that we use in a low dose as well, and that really helps clear up acne with again. Not a lot of Downside. But that is a prescription.
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Nancy Mandowa: Thank you. Yeah, absolutely. Let me hit a couple of these comments in the chat. So Candy was asking about meat substitutes and protein in vegetarian food.
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Dr Doug Lucas: I'll get to that. And then there was another. Monica asked similarly about some products.
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Dr Doug Lucas: So yeah, so let me just answer that. So the products that I'm talking about would be like I can't think of what it's called what is it called? What are the fake meat products? I don't even look at them anymore.
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Dr Doug Lucas: Beyond. Oh, beyond.
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Dr Doug Lucas: Yeah, that's it. Thank you. Candy, yeah. So beyond and impossible. And so actually, I met, I met the CEO of of one of those companies once. That was funny. I think he got fired because they're they're
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Dr Doug Lucas: share. Price went through the floor.
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Dr Doug Lucas: And I think that kind of speaks actually to their success. But in general, those products like I said, they're just. They're highly processed. They're full of garbage plant products that are Gmo and spray with glyphosate. They're just toxic. So I would eliminate those all together. And then what you wrote in here, where to go?
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Dr Doug Lucas: So Monica asked about like Boca and Morningstar products. It depends. So I mean, there are some morningstar products that we even have in our household. You know, and they, I think they actually have meat in them. But so just depends on how processed they are and where the what like, what's in it, you know. And so I like to stay away from anything that's highly processed. I kinda tell people like. If it didn't exist before 1,900, we probably shouldn't eat it so that would eliminate Boca and Morningstar products altogether.
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Dr Doug Lucas: But I'm a little bit strict and crazy. So you know, looking at are the products organic? What's going into it? How processed is it? How confident are we that it's not going to be toxic. So you just kind of have to decide what fits into your diet. And then, if you're hitting your goals and everything looks great, then that's fine if you're not. And you have issues like gut issues. If you're having autoimmune issues, then I would cut out everything
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Dr Doug Lucas: processed or how they processed, because it's all all potentially bad for you to answer your question further. Candy on. You know. What are the protein sources, then for a whole food, vegetarian or Vegan diet. It's tough.
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Dr Doug Lucas: So obviously soy is an option. How much soy should one eat? It has to be organic. It has to be non-gmo. And then there's the phytoestrogen concern. If that impacts you and ultimately, like we probably shouldn't eat the same protein source every day. And that's a lot of soy. So then you're left mixing and matching beans and nuts.
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Dr Doug Lucas: and you can do it. I know people that are very healthy, and they do it, and they're fine. My concern for most people is the carbohydrate content?
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Dr Doug Lucas: The guys that I know, and these are mostly men. But the men that I know that eat a Vegan diet, and they do it well, and they look great and they feel great and their labs look great. They're also really really active cyclists, you know, like borderline professional cyclists that do it. Weightlifters that are just mainlining a ton of food to get enough calories in through a plant based diet. And they're they're doing fine. But they also recognize they're like, I don't recommend this to most people because it's so hard to.
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Dr Doug Lucas: So it really is a challenge. Cheryl mentioned. Oh, yeah. So she was asking about Prometreium. But yeah, and that is the commercial micronized progesterone. And yes, it's available on 100 to 200 milligram doses. And again, that 200 milligram dose works for a lot of people. And it is almost always generic cheryl. So I think.
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Dr Doug Lucas: even if you were to write for it to be for it to not be generic. I don't even know if you can get it
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Dr Doug Lucas: And then, as she says, often generic, substituted.
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Dr Doug Lucas: know if those have to be micronized to, they do have to be micronized, and then, or can they change to other progestins and know cheryl, they should not change that to a synthetic progesterone it should still be a micronized progesterone, and if it says anything other than micronized Progesterone. Then throw it at em, because you don't want to take a progestin.
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Dr Doug Lucas: Okay, I think that answered that.
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Dr Doug Lucas: Any other questions. Brett, put a study in here. You guys can take a look at that. I'll take a look at it later. Maybe we can talk about this one. Next time I'll open it up, so I don't lose it.
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Sheryl: Yeah. The generic didn't say micronized anywhere, and I looked it up on the FDA and everything, and still doesn't say it's micronized, but it says it's generic for Prometheus. So I guess it's micronized. It's it should be yeah, Cheryl, and I've I've heard other providers say that the the Prometrium in the generic Prometrium is not as good as compounded. I don't. I don't know how you would ever prove that other than if you switch from one to the other, and you have breakthrough bleeding or breast injuries, or whatever you know. Maybe it's it's not being absorbed. But that's
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Dr Doug Lucas: I think it's probably reasonable, and the cost difference is is very substantial.
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Dr Doug Lucas: very substantial. I want to mention, too, if you're not in the chat. So, Brett, I put in here the product that we're currently using
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Dr Doug Lucas: for fat, soluble vitamins from health, Jevony. So if you click the link in there. That'll take you to our our resources. Tab, if you haven't been in on that side of the website, it's been Updated recently. So there should be, you know, if there's you click on the link, and it should provide you a discount or a discount. Code is listed. All the things that we're putting in there from pretty much from here on out are gonna be affiliates, and we're gonna have discounts for all the Hsn members.
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Dr Doug Lucas: If that makes sense.
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Dr Doug Lucas: Okay, any other questions. We've got a couple minutes left.
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Dr Doug Lucas: Alan. Oh, go ahead. Go ahead, Sue. No, it's okay. II took up lots of time if he wants. Okay. I was just gonna ask Allen Allen or Greg if they had a if they had a a man question.
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Dr Greg: III was curious about the injections of steroids. What's the half life of the testosterone that we're taking?
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Dr Doug Lucas: Yeah. Great question. So
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Dr Doug Lucas: the levels of testosterone will rise and fall if we're doing. If you're still doing, Greg, what I recommended, which is usually, you know, around 50 to a hundred milligrams at an injection. You're doing that twice a week. It'll rise and fall in about 3 days.
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Dr Doug Lucas: So that's why, for me, I recommend doing it twice a week. There are people that will do it daily, and at a lower dose it'll rise and fall in that 24 h. So people that are doing kind of kind of like trying to mirror the cyclic testosterone diurnal pattern. So it's it's it's within hours the half-life.
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User: Yeah, I do have a question.
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Dr Doug Lucas: Yeah, Allan.
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User: yeah, it was just
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User: the Bp 150 Bpc, 1 57, with the 25 day thing. It's like it. It was kind of like I just didn't understand. It's like tells you to take it for 3 months. Is that just 25 days a month?
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Dr Doug Lucas: You just gotta buy a 25 day supply and try to get 3 months is is so so just for those that aren't familiar with Bpc, so what Alan's talking about are kind of these advanced therapeutics called Peptides and Peptides are a funky space because they they come from compounding pharmacies. And they're so weird about how they produce them. So yeah, Alan, it's it's annoying because they make it.
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Dr Doug Lucas: They make it big enough so that you get 25 days out of it if you dose it correctly.
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Dr Doug Lucas: But the wait time to get a new vial is over 3 weeks.
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Dr Doug Lucas: so it's almost like we have to like order it, and then, as soon as you get it, order it again to keep you going for 3 months, and that's why Peptides are such a challenge to prescribe. But yeah, that's the idea is that you would stay on it, for you know, a specific period of time. You cycle them on and off. And then it's just. It's an administrative nightmare. Which is why I said, we have a whole team that does this. It's an administrative nightmare to get people what they need. Well, not paying attention. I just
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User: was going by 30 days, and then all of a sudden, I was out. I got a big gap there of 2 and a half 3 weeks. So does that
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User: ruin any progress that no, I don't. I don't think so. I mean, we don't have enough data on Bpc to understand. You know, what is the impact of of, you know, 90 days straight versus 25 days on 5 days off. There's just not enough data to understand that
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Dr Doug Lucas: probably would be better to do 90 days straight. But most people are also pulsing peptides, and it's not common to do you know? 5 out of 7, or you know 10 out of 14, or whatever? So I don't. We don't know. I mean my my intent, Alan, is that you are on it for 90 days straight. But, like I said, it is an administrative and kind of an unpredictive thing, too, because
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Dr Doug Lucas: the the back log on Peptide production could be one week. It could be 6 weeks. And so we're we're always playing catch up.
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User: But I mean, you could even order 30 30 day sub or 90 day supply. If it reconstituted right, they won't. They won't let you do it.
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User: Waited 2 weeks, ordered it again. It wouldn't start
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Dr Doug Lucas: going bad until you reconstituted it right? Oh, totally. And we can't. We can order them sequentially. But they're they. Still, it's almost like testosterone is a controlled substance which is super annoying. They won't let us refill until it's time.
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Dr Doug Lucas: and so a lot of times they'll say, well, he has a 25 day supply. You can't refill until 25 days, and I'm like, well, you have a 3 week backlog. So what do you want me to do you know? And and so sometimes we'll actually mix and match pharmacies, too, to say, Well, we'll order it from this one, and then we'll order it from another one. But not all pharmacists serve all states. So you can imagine we have this like
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User: at this spread this really confusing spreadsheet. That our poor administrative team utilizes to help order things for people. And it's it's really challenging.
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Dr Doug Lucas: Yeah.
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Dr Doug Lucas: I do have a question.
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Dr Doug Lucas: This candy. Oh, Hi, Candy, sorry.
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Candy Reichert: I've got a son who is 30,
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Candy Reichert: 33, or something, and he's having a really hard time putting on weight.
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Dr Doug Lucas: And
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Candy Reichert: he's like a hundred 25, 6 foot
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Candy Reichert: skin and bones. And I was just wondering, is there any way that he can
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Candy Reichert: do anything to?
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Candy Reichert: I'm I'm guessing that probably his testosterone has to be off.
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Candy Reichert: Yeah,
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Candy Reichert: So I don't know what the the what he could do just over the calendar is anything I don't. I haven't done any research. Yeah, so it's a great. I shouldn't say that most people would think that's a great problem to have. II know that the people that struggle with weight gain, though hate it every bit as much as somebody who's obese struggles with weight loss.
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Dr Doug Lucas: So it is a challenge, and sometimes it's a bigger challenge than weight loss, because it's not as clear as to why why somebody gaining weight. So what what we would do our approach would be to again try to figure out the underlying cause. Obviously, I'm sure he's eating food. So then why why is this body not absorbing it? Does he have gut dysfunction? So we would. Probably we would do a stool test. We would look at his gut function. Does he need enzymes? Does he have, you know, a parasite? Does he have a big worm in there that's eating half of his calories? Who knows?
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Dr Doug Lucas: So we would wanna figure out, why, look at the diet! See where the energy is coming from. Is it getting adequate protein? Test the hormones. Test the thyroid, you know. Maybe it's thyroid's overactive, you know, maybe has hyperthyroidism. That's a a common cause of inability to gain weight. Testosterone could be low could be so many things. So it's hard to say, like any one thing is gonna be the answer cause it's probably gonna be 10 things
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Dr Doug Lucas: and they all have to work together. So that's that's really the challenge with somebody who has weight to gain cause. It's it's a little more simple for most people to lose weight, or at least from the clinical side, not necessarily from the personal side. Does that make sense?
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Dr Doug Lucas: Yeah, it does make sense. I know it doesn't. It doesn't help you so alright. Well, we're after the hour, guys, I gotta run but this was great. And then make sure if you're interested in communicating with each other definitely use slack, and
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Dr Doug Lucas: mute everybody.
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Dr Doug Lucas: definitely use slack, look and look at the resources on the website. And then there is that form that goes out to ask questions. I apologize. I didn't look at it today because I don't know where it is, but I will find out by next week, so we'll do that. And thanks for showing up everybody. And I will see you next week, which should be at our normal time. Okay.
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sjcsr: great, thank you. So, thank you guys, bye.
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yeah, thanks.
