December 27, 2023
HSN Q&A 12/27/2023
During the meeting, various health topics were discussed: the implications of weight loss surgery on nutrient absorption, the management of osteoporosis post-surgery, the use of calcium and vitamin supplements, the risks and benefits of hormone replacement therapy (HRT), and dietary considerations for protein sources.
Weight Loss Surgery and Nutrient Absorption:
Calcium Intake and Osteoporosis:
Hormone Replacement Therapy (HRT):
Dietary Protein Sources:
Other Health Topics:
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Debbie Kline: About 10 years ago, and and mine Dexes were always good, but now I was just diagnosed with osteoporosis.
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Debbie Kline: So I mean, I feel like
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Debbie Kline: I made a deal with the devil with that surgery, because now I'm learning a lot about, because I have malabsorption.
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Debbie Kline: and they're telling me to take so much calcium. But then I'm also hearing it's not good to take that much calcium. So what is your opinion?
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Dr Doug: Yeah. And if we could just go back in time and and talk about that decision. It's not necessarily a a wrong decision, obviously can't go back and take it back anyway. But it's not well understood generally by people going into it, the issues of absorption that they'll have later. So I saw this when I was in practice in orthopedics. I saw it, and people that
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Debbie Kline: mostly had ruin. Why surgery cause that was more popular back then, but with that surgery in particular, you really lose the capacity to absorb protein.
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Dr Doug: So people would. People would undergo the surgery, and then they would come to me, needing to have surgery on something else.
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Dr Doug: But they were so protein malnourished that there was no way that they would ever heal a wound.
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Dr Doug: or a fusion or a whatever. So we we really struggle with that, and we would try to get them optimized. But usually it couldn't ended up not being able to take them to the operating room, because I was too concerned about their risk.
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Dr Doug: So from an osteoporosis perspective, there is some concern there now. Fortunately, it's a little bit different, because in the duodenal switch, I don't remember this specific, an anatomical move that they make there. Do you? You might not know this, but off the top of your head. Do you know. Are they removing a section of the duodenum and the first section there of the the small bowel?
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Debbie Kline: No, I believe they just. There's some type of Lim, that's just hanging there. So I think they, I think they functionally remove it.
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Oh.
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Debbie Kline: right?
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Dr Doug: Fact.
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Dr Doug: yeah, I'm gonna make a quick switch to my Internet. It might be me. Hold on just a second. If I lose you, I'll log back on.
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Dr Doug: Okay. Okay, no. I'm here.
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Dr Doug: I have. I have to turn off my Wi-fi. So it it forces me to be hard connected. It's a better connection that way. So yeah. So the the short answer is, you're gonna struggle to absorb, particularly your minerals.
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Dr Doug: because calcium is absorbed in the the upper part of the gi tract, the stomach, and the the jejunum and the duodenum, and so
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Dr Doug: increasing the amount that you consume, is the recommended way to do it. I am concerned about that, but at the same time
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Dr Doug: I think that we might just need to. I don't think that there's enough data to say that there's a right answer, as far as how much, how much are they telling you to take?
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Oh.
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Debbie Kline: like the the 600 3 times a day.
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Dr Doug: So 1,800. So that's not a huge stretch. It's not even double what the recommended doses for postmenopausal women in the Us. So that's probably okay. How much are you getting through diet? If any.
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Debbie Kline: I would say a good deal, cause I do. I do like milk. I do drink like one cup a day, looking some of some of your videos and also having some yogurt
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Dr Doug: so if that's true, I mean, you could be getting, you know 500 600 milligrams just through those 2 things alone. So then, taking the recommended dose that there that your doctors are telling you to consume, and then dividing that between supplementation and what you're getting through diet that would actually bring down your required supplementation to what's pretty common, which would be like a thousand milligrams
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Dr Doug: of calcium. And you can do that through good forms like Jero Bonup is what I recommend for a lot of people. We'll have a thousand milligrams in certain forms of it. And then, like Algae, Cal has 720 milligrams, and that's a product that I'm talking more about. I will be talking more about. As I learn more about it. I've kind of poo poo it in the past, because I've I've downplayed calcium forms of I'm sorry algae forms of calcium
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Dr Doug: cause. There isn't evidence outside of what Alga Cal has done. But I went back and looked at that evidence again, and chatted with the company. After doing a webinar with algae cal representatives for the osteoastron community, and some of the things they said were different than what my understanding was. In the first place, so, looking at it now from a whole food source of calcium is a little bit of a different
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Dr Doug: equation than looking at it as a supplemental form of calcium. It's sort of riding the line, you know. Like, is it? Is it? Still count as a whole food source? If you're consuming a big chunk of algae that you wouldn't normally consume. I don't. I don't know but it is compelling. When you look at the data on calcium from food versus calcium from supplementation, the difference in absorption and utilization so potentially getting it from something like algae.
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Dr Doug: or, I think still, the the Mchc form from from Jarrow bonup would be the way that you should get better absorption and fighting against what your your body's limitations are.
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Debbie Kline: Umhm. and you have that in your is it? The functional
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Debbie Kline: pharmacy is it called?
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Dr Doug: If you go to full script.
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Debbie Kline: yeah, it's definitely in full script, and we have a recommendation. I should look and see what's in there, cause it's always changing. But
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Dr Doug: we do have like a generic osteoprosis stack that it's likely in there. But there are a bunch of products from Jero in there, and you can take a look. Algal is also now in there as well. But stay tuned. Don't buy too much, because we'll probably end up having some kind of an affiliate deal with algae in the future. Just don't know exactly what that is yet. Okay.
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Debbie Kline: yeah, yeah, thank you, since I still have you. The other thing taken Prile a second. I'm trying to get off of that and
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Debbie Kline: trying to find an alternative to take, because I do have a high end of hernia.
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Debbie Kline: They they did. They did fix that. But now it's back again. Yeah. But I mean, I'm just beginning stages. I think my T. Score
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Debbie Kline: was minus 2.5
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Debbie Kline: rheumatology said, I'm just, you know, beginning with it so.
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Debbie Kline: And and you know the other frustrating thing is, my mom's 91, and her is better than mine.
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Debbie Kline: Yeah, that's that could be. But remember to. They are the generation ahead of us lived in a totally different environment than we did.
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Dr Doug: That's true, you know. So it's that we're you're not comparing apples, apples. But I could imagine how that'd be frustrating. Yeah. So the PPI thing is, if you have a hernia, sometimes you there are, you know, there's a reason to be on a PPI, because you have to be careful of the tissues, and if you are getting an unnatural and unanatomic exposure of certain tissues to stomach acid that aren't gonna tolerate it. Then that is a reason potentially to do it. I always encourage people to fix the problem if possible. But
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Dr Doug: you've been there once. You know what that looks like? And whether or not is even fixable is a different question. Another thing you could consider, though, is working on gut function and potentially using one of the agonists like Pepsid versus a PPI, and seeing if you can control it that way, but that's gonna require some trial and error. And also making sure that you're getting follow up upper endoscopy, making sure that you know that you're that somebody's watching those changes in your esophagus.
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Debbie Kline: Yeah, I was considering going to gastroenerologist. It's now my bariatric nurse that is prescribing it for me.
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Dr Doug: Yeah, we find that for most people improving gut function can alleviate the need for a PPI some people still need an occasional blocker if they have, like a sphincter dysfunction, or potentially a small hernia. That's kind of pushing things up there. But we try to keep them off PPI, as if possible. That said, if somebody has Barrett's esophagus. They have pre cancers, changes in their esophagus. We keep them on a PPI
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Debbie Kline: because oesophageal cancer is
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Debbie Kline: way worse than osteoar than osteoporosis so. You know you have to. You have to figure out what's right for each individual person, and then one of the things cause I still my vitamin ease I've been taking supplements. I don't remember the amount that I'm taking, but it it's still low, like Borderline, low
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Debbie Kline: vitamin e or vitamin d vitamin e as an Edward.
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Dr Doug: And how are you measuring that?
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Debbie Kline: I well, every year I get blood work through the bariatric department
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Debbie Kline: and
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Dr Doug: and they're measuring E in your blood.
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Debbie Kline: Yes.
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Dr Doug: interesting.
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Dr Doug: So I've I've not seen a serum measurement of vitamin e and I don't. I wouldn't know what to think of it if we did. Most of the vitamins in in serum are not good representation of what's happening in the body.
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Dr Doug: So that's why there's there's ta like functional testing, like the neutral eval is something we've used in the past. Hair tissue mineral analysis is something we're using. Probably in the future as we move forward, it's it's less expensive. And we could do it on a broader scale. But understanding what's happening in the body from vitamin and mineral amounts is a little bit tough, because what's happening in the blood as a snapshot of literally probably what was just consumed
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Dr Doug: and not what is what is a true deficiency. Some exceptions to that would be like when you're looking at vitamin D, you're looking at vitamin d in its storage form, because it's actually a hormone, not a vitamin.
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Dr Doug: Similarly like we can measure retinol, which is a true vitamin, but fat, soluble, is a little bit different than like B 12, and Folate, for example, like B 12, you know, if you just ate steak, you're gonna have a high level of B 12. If you're fasted, it's likely gonna be low. Does that mean that you're actually deficient in B 12, maybe.
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Dr Doug: But that's why we it takes more than that to know. So I would be suspicious.
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Debbie Kline: Serum vitamin e. Because I've never seen anybody, even in the functional medicine space. Use serum vitamin e.
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Dr Doug: you know, and what that means. Also. Then replacing vitamin E in supplemental form is a big question mark, because there's now a lot of discussion. If you've seen the the conversation around, you know, delta, tocotry, and all versus delta to cough, roll versus Alpha to Co. All these different forms of vitamin E. There's 8 forms, and how much of each we need.
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Dr Doug: We don't really know. I know that most companies will lean on the alpha to coffer all form which is the most common and cheapest form because it's the most common and cheapest form there is potentially downside to that. So what I tell people is, basically, you need to get a spectrum. You want a product to have all 8 of them in there, and how much
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Debbie Kline: we don't we don't know. It's a big, unknown it's probably hard to do too much, and I don't think you're gonna get that unless you're really taking too many over the counter supplements, but having a single broad spectrum, E is probably giving you enough
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Dr Doug: and then using something like a neutral eval or a heritage mineral analysis to understand more about what's going on from those nutrient deficiencies which, with your history, it would be. I would strongly recommend that if you're a patient.
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Debbie Kline: okay?
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Debbie Kline: You could say they want it to put me on prolia, and then I read with prolia. I guess it affects your immunity. And I thought, Wow, if my immunity, you know, that's the way my brain was working. So I was not. That's not an unreasonable
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Dr Doug: this way to string that together. So totally reasonable way to string that together the prolee dysfunction of the immune system is pretty weak.
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The reason why they say that is because it blocks
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Dr Doug: the osteoclast, the bone breakdown cells. It blocks them from the stem cell origin. So when you block those stem cells to becoming osteoclast, you also block them from becoming macrophages and macrophages are part of the immune system. And so you see, an increase in the risk of like cellulitis and skin skin infections
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Dr Doug: is what came up in the literature, and it was not always consistent either, so it probably is not a a big change in the immune system. I still don't like that drug, anyway, but it's probably not a huge change in the immune system. But it is an interesting, just. It's interesting thing to see and bring up.
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Debbie Kline: Umhm. Yeah, cause I?
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Debbie Kline: I I've just. I'm not really. My friends are all on it. And so it's like, my, something doesn't sound right with that. And then I'm you, and I'm I'm so I'm
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Dr Doug: paying attention more to tell your friend. Tell your friends to come to the health Span nation, and we can talk about prolia. The the thing about prolia, too, that I that I am discouraged with is that it doesn't. It reduces fracture, risk in the short term.
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Dr Doug: But I don't think that it's going to be the answer long term, particularly as people are looking at the 10 year to 20 year and beyond risk.
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Dr Doug: We know that we have safety data out to 10 years.
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Debbie Kline: But what happens after 10 years? And if you want to come off of it, that increased fracture risk as you as you transition off of the drug is really concerning. So II think there is a time and a place right well, I just turned 70. So am I in that time span, or
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Dr Doug: I mean ideally, I mean what I know we don't. Nobody have a crystal ball, but I don't view 70 is even chronologically, that old, unless somebody is very physiologically aged at 70, which certainly exists. But I mean, really.
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Dr Doug: if you're so, if you're my patient and you're 70. I think we should be looking at the 20 to 30 year time span right like it's not unreasonable to say if we live well and avoid the most of the things that will kill us.
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Dr Doug: that that's not an unrealistic
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Dr Doug: range to live to. So if we're talking a 20 to 30 year window for you. Then
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Dr Doug: prolia can get you to 10, but then you increase your fracture risk in your 80 s. That's probably not a good idea. So you know, when is the right time to go on it? I think it really depends on on what else you're capable of doing at 70, you know. Are you a candidate for things like hormones, you know? Can you lift and do more resistance training? In other words, can you build bone more naturally. And that's gonna be in the 70 s. That becomes very independent of what someone's capable of doing or tolerant of doing. Okay.
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Debbie Kline: So II do hear you with the exercise part, and I want to find
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Debbie Kline: someone to help me
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Dr Doug: do the heavy lifting. Yeah, definitely have someone help. You do the heavy lifting just to avoid injury, you know. And and we we are big advocates of of resistance, training, and doing as heavy lifting as possible without injury. But there are also other things, too, and the more I chat with the people at Osteostrong, recognizing, you know, a way to do impact training without impact
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Dr Doug: is essentially what osteogenic loading is. And then we're also creating an impact program that we will roll out to our patients in the in the New year. So Nick Trubi is working on that cause. There are ways that you can probably improve bone without lifting heavy weights. But I think if you wanna maximize, your gains and maximize health span and lifespan lifting heavy weights or as heavy as possible, is is part of that equation.
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Debbie Kline: Okay? Alright. I really appreciate your time. I see more people logged on. So yeah, a few people. Well, Tom, Tom is back. So, Tom, if Tom, if you want to drop your email in the chat, and you can send it just to me, Tom, so we can make sure that not everybody sees it unless you want emails from everybody and then it looks like arena or, yeah arena. Probably how you would say that is here as well.
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Irina Ryjova: Yes. Hi! How are you? Good, good.
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Dr Doug: good good. We were just chatting about some exercise things when you popped on and before I get into the list of questions that were submitted, do you have any specific questions for yourself that I can answer for you, since you're here?
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Irina Ryjova: Not yet. I'm Star starting now, trying to learn everything, trying to get in use to your old classes and all that stuff. Not yet. Okay, okay, perfect. Alright. Well, hang out and let us know what questions you have, and I'll jump into the list. So I think I did the list backwards last time. So for those that are watching this on a recording. I apologize. I'm gonna actually make sure that that's true. Cause I can see when they're
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Dr Doug: listed. Yeah, because I have one from here from Tom. That was submitted an hour ago. So there we go alright. So we're gonna go back in time.
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Dr Doug: I see they changed the way that it looks. Okay. We're gonna go back in time. This first one is a one of these really long, long questions stems from Cheryl. And she actually starts by saying, you don't need to read this whole thing out loud. I won't but basically her concern is about the the potential risk of eating animal protein.
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Dr Doug: And most people have heard me talk about this. So I'll just mention the the highlights, which is that the biggest change that you're gonna see when you eat more animal protein over plant-based protein in blood work is an increase in cholesterol.
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Dr Doug: It doesn't happen to everybody, but it happens to some people
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Dr Doug: for some people that's driven by saturated fat. But for some people it's just driven by dietary fat. Because when you switch from a a plant based diet to an animal foods based diet. You're going to consume more, more dietary fat across the board and potentially more saturated fat depending on your choices of animal products.
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Dr Doug: So if it's the saturated fat part that you can eliminate by choosing to eat. You know animal sources that don't have much saturated fat. So chicken fish, and especially smaller fish will have a much more favorable fat profile.
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Dr Doug: But that's the minority of people. Some people just increase cholesterol with the increase in dietary fat. So then we have the question of is that actually bad? And this is where the bad research around cholesterol is mixed with the bad research around dietary fat.
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Dr Doug: And so there's the the overwhelming consensus that cholesterol is a big risk factor for heart disease. And there is a counter argument which would say that cholesterol is not a risk factor for heart disease at all. I don't think that either are true.
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Dr Doug: I think that cholesterol is something that we can measure in blood. It is something that if you are developing plaque, if you have a lot of it, you will develop more plaque. It just makes sense physiologically, because we know that the cholesterol is in the plaque. So something is driving that. But we know that there are plenty of people that have high cholesterol and have absolutely no plaque. So it is not.
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Dr Doug: It is not the only factor. And as we learn more about other things that we can measure inflammation, function of the epithelium, the lining of the vessels. We are learning more and more about why some people would develop plaque from elevated cholesterol, and why some people wouldn't.
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And
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Dr Doug: when you look at those data, you can kind of start to separate people out to say, Well, if you are metabolically well, you have low inflammation. Your immune system's working well, and you have high cholesterol. Is that a problem?
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Dr Doug: Probably not. But I would still wanna do some imaging like a a study to look at the heart vessels to learn more. But probably we're gonna let that fly. If they do end up having disease and their arteries, then I would wanna bring that cholesterol down, but I would. I would rather them eat the diet that supports their
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Dr Doug: supports their metabolic health and other profiles, and treat the cholesterol pharmacologically, if needed.
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Dr Doug: rather than tell them to eat a protein deficient diet, have their glucose, their a one c. Go up their insulin, go up their muscle mass, go down and become less metabolically. Well, to have lower cholesterol. Naturally, I don't think is the right trade-off.
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Dr Doug: so the questions stem from Cheryl is very well written, and she talks about a lot of different research, and I see this all the time, because people that eat a vegetarian diet are a philosophy. It's a belief, right? And so I totally get that and respect that. But everything that she's pointed out here in the questions stem
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Dr Doug: is pointing to data, that is, association driven so big studies that look at associations between people that eat a plant-based diet versus quote unquote omnivores, or people that eat meat.
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Dr Doug: Whenever you see a study that is population based like that, there is no way to separate out what's called the healthy user bias, which means that people that choose to and stick to a vegetarian or vegan diet are going to make healthier choices across the board than people that are quote unquote meat eaters, not because meat eaters are bad people, but because meat eaters include people that eat a whatever the heck I want diet.
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Dr Doug: So they're not only eating meat they're eating, you know, the hamburger with the bun and the milkshake and the French fries, and the you know the coke right? So like that person is not the same person as me who chooses to eat beef
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Dr Doug: without a bun, no gluten, no grains, vegetables, starchy vegetables, and fruit for carbohydrates, and
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Dr Doug: fast for 12 h in between my last and my first meal. That is a totally different way of eating than is an omnivore versus a Vegan. There has never been a study comparing a healthy meat, consuming diet versus a healthy, plant-based diet, because let's face it. There are unhealthy, plant-based diets, too. Skittles and French fries are all Vegan.
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Dr Doug: but when you look at population studies, those that claim to eat a Vegan diet generally are going to be healthier across the board and make healthier decisions despite their diet, not because of their diet.
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Dr Doug: If that makes sense. So
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Dr Doug: I'll stop there because I can talk about that for an hour by itself.
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Thomas Schellberg: So that makes sense your own.
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Dr Doug: Can you hear me now? I can hear you, Tom. Good everything but camera. That's fine. I don't need your camera, and I've even got a name there.
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Dr Doug: I see that. Thank you. It's nothing I did. It just happened. Yeah. Well, you can still take credit for it. Tom, did you hear me about putting your email in the chat?
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Dr Doug: Yeah, I didn't understand it, though. Okay, you know what? I'll just make a note to myself, and I'll find it okay. Because because Tom is a patient.
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Dr Doug: I got it somewhere.
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Thomas Schellberg: Yeah, I just need something about straps I can get. Now.
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Dr Doug: Yeah, I'll send you. Yeah, I will have. I'll actually have Julia reach out to you.
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Dr Doug: and I will have her send you a picture and help you to to figure out how to use them, cause there's a little learning curve there. And you'll, you'll be happy to know, is actually talking this morning with a trainer, my trainer, about how to build more trainers into our program, so we can have somebody that you would specifically ask that question to other than Julia. Not that she's not great, she is great, but
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Dr Doug: I think we need a trainer on staff.
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Dr Doug: That's great. Thank you, of course.
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Dr Doug: The next question is from another patient of ours. Jr, he has been with us for a long time. And Jr. Is asking, is there a Peptide for muscle mass for seniors? That is not an injection? Great question. Jr.
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Dr Doug: And then he asked a question about one of the Peptides that we use called melanotan 2. He was talking about a concern, about an increased risk of cancer.
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With that. So let me address both of those.
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Dr Doug: So let's say the first one is, is there a peptide for muscle mass? That is not an injection? And the answer is, yes, we actually use it relatively frequently in our bone health population. Because they tend to be older and not tolerant of injections or injectables, so that peptide is called M. Another name for that is abutamorin, which is ibu a MORE. M. Butamorin, I think.
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Dr Doug: and that is in the Igf. One category or growth hormone secreticog category. And what that means is that it pushes up this biomarker, Igf, one
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Dr Doug: which stands for insulin growth factor. And essentially, I consider that the anabolic switch. So if we want to build muscle and bone, we want to drive Igf one up, and we can do that through
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Dr Doug: eating more calories, eating optimal protein, resistance training, getting adequate sleep, optimizing hormones, specifically testosterone and then using tools like the Igf one Peptides like ibutamor and Mk 677, because that will drive again. Drive igf one up, and it'll just flip the switch, and your body should be able then to more effectively make protein driven things like muscle and bone. Does that make sense?
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Dr Doug: Okay.
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Dr Doug: hopefully, that makes sense. To JR. And JR. You have access to that. Let me know. What's that? No, II was talking to my wife. Oh, all right, I'm gonna meet you then.
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Okay?
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Dr Doug: And Shelley's on. Hi, Shelley. Hi, how are you? I'm doing great. How are you? Good? Good! Thanks, good! Good! Nice to see you, too. I was just running through some questions. Do you have
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Dr Doug: any questions for yourself that we can answer? Yeah, I did send you one this morning, so I don't know if you got it yet. Let me see it should be on this list here. Yes, Shelly.
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Shelly’s iPad: it's a general one for everybody to listen to, but I don't think it's gonna help a lot of people. Cause it's a program. And it's only available in New Jersey.
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Dr Doug: Yeah, is it? So? Is it a specific bone health program? So she so Shelley's talking about a program called, Is that on O'nearo O'neir? Yes, yes. Have you heard of it? Yeah, no. Yeah. Do you know, Margie Messenger.
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Shelly’s iPad: she's from happy bones. I kind of follow her to. Okay. And she had a Youtube video with a lady Dr. Claudia Tomas. She's a physical therapist, anyway. It's very interesting.
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Shelly’s iPad: She follows the Liftmore study. It's all about weight training. But she so I didn't know if you were familiar with it, I think it'd be an amazing program for people that live in New Jersey. I didn't realize it.
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Dr Doug: We have a fair number of people actually. But I'll I'll look her up. So you said it's kind of based off of Liftmore like heavy resistance training and impact training.
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Shelly’s iPad: Yep, and one thing she's, she stated, was
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Shelly’s iPad: there was a study out there that they found, like the 6,000 year old femur bone.
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Shelly’s iPad: and they redid a bone density on it, believe it or not, and they realize that it was a lot better than some of the people of today. And she said, because those people get everything on their backs walking around the countryside right pretty interesting. And she was she was very
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Shelly’s iPad: thorough, and it was very informative, so I just wondered if you know anything about it, that's all. Yeah, no, I will. I'll check it out, though, and I will do a video on it. So really fast, I got some magnesium from full script.
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Dr Doug: Did you recommend taking those? Is there is better time of day to take those so different schools of thought? So people will say, Take it at night, and it'll help with sleep, which is probably true. I think if you're if you want one to help with sleep, though I actually like the form better. Which has less magnesium per capsule because it's just. It's a it's a more dense.
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Dr Doug: It's not true. It's a bulkier raw form of of magnesium because of the 3 in 8 component, but the 3 in 8 component allows it to get through the bloodbrain barrier. So I think for sleep. You're actually better off to take a different type of product. And that's a common form that people will buy of, that is called Magmind from the company. I think it's Jero
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Dr Doug: but it's a mag mine specifically, because it crosses the blood brain barrier. So for me, I wanna get as much magnesium in to my body as I can. I think the best way to do that is to take it with food, and then to take it. Probably throughout the day. Our goal is to get around 5 milligrams per pound. So again for me, at 200 pounds, that's easy, math. That's a thousand milligrams. If I were to take that all at one time, I would spend most of the rest of the day in the bathroom.
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Dr Doug: spreading it out taking it with food, helping with the absorption, and then slowly ramping up that 5, 10 dose. That's quite a bit of magnesium and 3 capsules. So I would start out by taking them like one, you know, every 8 h or so. Take it 3 times a day until you can build up your tolerance. And so I take that same product. I take 4 of them. I can take 4 at once at this point, and it doesn't, and it doesn't bother me.
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Dr Doug: But filled up to that. And then again, about 5 milligrams per per pound. Okay, cool? Alright, thanks. Yeah.
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Dr Doug: All right. So this is a question from Kit Lurie, and she says that in a previous Q&A.
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Dr Doug: oh, she's asking about Merrick. So Merrick is a company that does hormone optimization for both men and women that we should have access to.
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Dr Doug: I'm actually Kit, if you can. If you watch this, send in the slack, I'll actually send a slack to you. But whenever you have tech questions like this, anybody who's listening send a message to the tech channel in slack, and Bretta or one of our team members will answer that.
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So Kit Lurie Merrick
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Dr Doug: and it might have, just when when I pointed to it in that QA. It might not have been there yet. So that's a new affiliation for those that don't know what that is. For those that don't know what that is. Is a way that people that aren't working with us can get hormone replacement in a way that I think is reasonable. I've talked to their their medical director. You wouldn't necessarily work with their medical director, but they're very protocol driven. It might not work for everybody, but it is a less expensive way to do it, and they are using bioidenticals for women, both with estrogen, testosterone and progesterone. So I think it's a reasonable way to do it. I haven't had a lot of people go through it yet, but it sounds like it should be promising.
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Hi, Nancy!
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Dr Doug: See new people popping on alright, so I'll keep going.
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Dr Doug: Susan
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Dr Doug: had a question on
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Dr Doug: the topic of heart, health, and bioidentical HRT. For postmenopausal women. So she says that she's in her 70 s.
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Dr Doug: had a fracture of her lumbar spine subsequent. Chyphoplasty. She's a a maleene woman
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Dr Doug: so there's a long questions Tim.
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Dr Doug: Here we go. So she asks she's concerned about whether or not Hrt. For older women is harmful. And the question is.
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Dr Doug: this is a very long questions, Tim, when we're writing questions, if possible, keep them to a paragraph or so, so that I can actually get through them. I believe the question here, though, is.
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Dr Doug: is it safe from a heart perspective?
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Dr Doug: And then she puts some numbers in here as far as what her blood results are, and they look really really high. Oh, and they are what she's taking.
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Dr Doug: Yeah. So she's on a very low dose. So these numbers don't entirely make sense. But basically what she's saying is that she's concerned, and her heart cardiologist is concerned that going on hormones can be bad for her heart.
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Dr Doug: So the short answer to this is, it shouldn't be. And if we think about that, if estrogen and testosterone and progesterone were bad for the heart, then we should see more heart attacks and events in women when they have those things, not when we take those things away.
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Dr Doug: So just from a physiologic perspective, it's the same thing with men in in prostate cancer and testosterone. Physiologically, it doesn't make sense that high levels of testosterone be associated with prostate cancer. Otherwise we would see teenagers with prostate cancer, right? So it doesn't make sense from the get. Go now, whether or not putting it in from the outside will have a different impact than your own hormones is a different question. That's why we like bio identical hormones, not using synthetic products
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Dr Doug: and then watching what happens and what she's talking about in here is kind of the same question that we just had, which is, I went on, Hrt. And my cholesterol went up.
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Dr Doug: Okay, so again, go back to that same question we were answering earlier, which is, which is better. Having cholesterol that went up from I'll give you your numbers.
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Total cluster all went from.
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Dr Doug: or she didn't even have it before. So it went up to 220, all right. So from what was it? 210? If so, who cares?
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Dr Doug: A 10 point bump is nothing. It's not significant of anything. And also total cholesterol is a terrible marker, anyway, because we need to know the other biomarkers more so even than Ldl and Hdl. We need to know your particle number through Apo. B. We need to know if you have lp, little. A. So making any decisions off of total cholesterol is silly. What if that's all bump in Hdl which Estrada will do so? We we really don't know enough.
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Dr Doug: Cardiologists are concerned about heart health, particularly around testosterone, which most women aren't on. But but my patients are. They're mostly concerned about testosterone because of the fear that testosterone increases the risk of heart disease in men, which has also been proven to be untrue, because, again, if that were true, then we would see heart disease in young men younger than we see it. So we right now we don't see heart disease in in men until they start to lose testosterone same thing with prostate cancer. So why would adding testosterone back, increase those things? And it doesn't.
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Dr Doug: So I think that most doctors just don't aren't comfortable with, and don't understand the risks of of hormones, and for someone to say, well, your total cholesterol went up. Therefore you should come off of your HRT. Especially if you have a disease that could be treated with Hrt. Like osteoporosis is really really short sighted. So just getting a second opinion and and trying to work your way through that bad information is is sort of the answer. There, Susan, so
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Dr Doug: sorry if that's frustrating. It is frustrating. I would also say, too, based off of the levels or the the doses that she put in here. So I'll just say that she put in here that she's on a very, very small dose of biased, so biased is both Estriol and Estradiol, and she even put in here the 80 20 ratio which is pretty common. So she's on a one milligram per gram biast, which is 80% estriol and 20% estradiol, which means she's on a point
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Dr Doug: 2
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Dr Doug: point 2 milligrams of
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Dr Doug: Estradiol, which is an absolutely tiny dose in a cream. So honestly, whatever's happening to her cholesterol has nothing to do with her hormones because she's not on enough to do anything anyway.
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Dr Doug: to do anything to improve her. Her bone, health, or anything, probably, for that matter, and a hundred milligrams of Progesterone is also likely too small of a dose to do anything significant, and if they're only giving it to balance the estrogen which they likely are the reason why they can give that small dose is because she doesn't have any estrogen. They actually did put her on testosterone at 3 milligrams, which I'm surprised at.
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Dr Doug: and she's using 1 one click on a topy click of 3 milligrams. So that's less than a milligram which might bump her levels. We'll see some people absorb under that rapidly, so she might be getting some benefit from testosterone. But that's still a pretty, that's a reasonably low dose, although that's not a bad starting dose.
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Dr Doug: So, anyway, I think she's not on really any Enough estrogen to do anything if she's seeing a bump is from testosterone, which I would prefer for her to be on testosterone and have higher cholesterol.
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My preference?
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Dr Doug: James James asks, where should my protein come from? Can we talk about meat sources, commercial beef and pork.
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Dr Doug: different things, bison, lamb, game, meat.
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Dr Doug: fish. Yes, we can talk about all these things. It's fun. Okay. So then he has a question about supplementation protein forms. So let's talk about real sources of meat. So at least we're talking about animal sources. I can talk a little bit about vegetable sources, too, for those that are interested in that, but from an animal source perspective. In my opinion, beef is king. The reason why beef is king is because cows have the capacity to absorb nutrients that nothing else can eat, for the most part.
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Dr Doug: because a cow has 4 stomachs. It upcycles all of these basic garbage plants that nothing else can eat into high quality protein. It is a miracle of nature that we can produce high quality protein from cows, because it has 4 stomachs and confirm it. Things
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Dr Doug: so, in my opinion, beef is the way to do the majority of your protein depending on the impact of your heart disease risk factors. So for me again, I would rather eat it and have higher cholesterol. But I also don't have any disease in my arteries to my heart. So there's a balance there.
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Dr Doug: The type of beef, though, does matter so the fatty acid profile between call it, you know, grass fed, grass finished versus conventionally raised, you know. Grain fed. The fatty acid profile is actually not that different? And this is a big point of confusion for a lot of people, because people will say, well, grass fed, grass finished. It's gotta be if it's gonna be beef.
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Dr Doug: Well, if you can afford it absolutely. I think it's fine, but mostly for other reasons, because the fatty acid profile is not actually that different? And because cows have 4 stomachs a lot of like the Gmo. The garbage that they're consuming through a conventional feed is actually gonna be mostly filtered out
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Dr Doug: again. That's the miracle of the cow. So really, if it's a price thing, I would actually eat
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grain finished cows
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Dr Doug: that are going to have all the protein and other micronutrients that you need the creatine, choline, B, 12, etc. Rather than eating organic chicken.
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Dr Doug: because organic chicken just means that they ate organic grains. But that might include things that you might not tolerate like soy and corn so, and it could still be Gmo, if it's organic, depending on their definition.
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Dr Doug: So I would rather eat conventional cow from a concentrated animal feeding operation in Cafo rather than base my protein solely off of chicken. Now I eat chicken, too, but I get most of my protein from cows. For that reason, if you can afford grass fed grass fish, that's better. And here's why. Yes, the amino acid profile is better. The fat ratios are better, but not by that much.
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Dr Doug: The reason why I like grass fake, grass finished, and preferably, if it says pastured or regenerative agriculture is another kind of buzz word that I like. Regenerative agriculture basically means that they're using the cows to help sequester carbon dioxide from the environment back into the ground.
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Dr Doug: Whether or not we want to eat a fully plant based diet or a fully carnivore diet. We need animals to put carbon dioxide back into the ground, and no animal does it better than the cow.
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Dr Doug: which is, it's remarkable we talk about. You know the greenhouse gas emissions from animals. Cows are the only animals that put it back into the ground, so that you can actually not add more carbon to the environment. And this is a big misunderstanding around plants is plants don't make as much methane. True, but they do when they decompose. But anyway, the biggest carbon issue for plants is that you need fertilizer to make mono crop plants
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Dr Doug: to make fertilizer, you end up pulling carbon out of the ground and putting it back into the environment or into the environment where it wasn't before. Whereas cows are recycling carbon in the environment, it's a totally different way to look at environmental issues. So again, we need the animals to produce plants.
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Dr Doug: We can choose to not eat the animals if you want. I wouldn't. But we need them either way. That's why this whole concept of eliminating cows so that we can improve our plant production is crazy, and we're not going to have enough soil or space to grow the plants to eat a plant-based diet. It just won't work, so we have to have cows in the system, choose to eat them or not.
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Dr Doug: as far as other sources of meat I mentioned. Chicken, chicken, and pork are kind of in the same boat for me, so they are both whiter meat. They have a lower saturated, fat content.
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Dr Doug: but they only have one stomach. So if you're eating a conventionally raised chicken or pig, they're going to have whatever they eat in their meat. So if they're eating Gmo, corn and soy, you're eating gmo corn and soy, if they're eating pesticides, you're eating pesticides.
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Dr Doug: you're getting a whole lot more of that. So I eat chicken. I eat pork. I just don't make it my primary source of protein.
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Dr Doug: Other kind of fun things like, you know, like wild game, like deer and elk.
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Dr Doug: You don't know what they're eating, right? So, depending on where they are, they could be eating garbage for all you know. But if you're out in the wild, if you're hunting in in good protected areas, it's probably better. It's gonna be leaner. If saturated fats a concern. I think it's a great idea. But again, it's a little bit of an unknown, but I'm a big fan of understanding
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Dr Doug: where your food is coming from I'm actually going through the process of teaching myself how to hunt. So I can teach my boys how to hunt so that they understand what what it means to take a life to feed a life.
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Dr Doug: And I think that's something that's happened in our culture is that we've been very removed from where our food comes from, and if it comes in a bag or a box, or you know, you have to actually look at the meat to get it from the counter, but ultimately we are so removed that it's it's very easy to say, well, plants are better, because look, this box is clean, and now that meat's dirty, no, none of it's clean.
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Dr Doug: And so, understanding where it comes from, I think there's a huge spiritual component to that.
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Dr Doug: So I hope that answers that question. Oh, man, I talk about fish.
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Dr Doug: Fish are cool amino acid, profile, Fatty, acid profile is great, but fish come from contaminated waters, and we live in a toxic planet sadly. So I think we have to be careful. Small fish are better. So like sardines. What are they with small fish, the mashed fish,
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Dr Doug: anchovies, sardines, herring and mackerel, I think.
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Dr Doug: and so those small fish will have less toxicity, less heavy metals cause it. Bio accumulates and their their nutrition profile is amazing. So I just had a patient. Yesterday she had the highest omega 3 to 6 ratio I've ever seen in somebody not on supplementation. She eats sardines every day
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Dr Doug: so good for her. So keep doing that. So I think that's great. If you start moving up in size, though, like salmon, is very popular, it can be made and potentially not toxic with heavy metals. But we don't know, and where it comes from it's really hard to know is wild caught better, man. It depends on where they catch them, you know. Is it is farm raised better? Probably not because of what's in the feed again. They only have one stomach. You're gonna eat what they eat.
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Dr Doug: you know. And then they put antibiotics in the water, and there's so many things I use a company, and I wish we had an affiliate agreement with, and what we don't. I use a company called Ctopia, SEAT. OPIA. They have. They're basically a company that that buys farms. But the farms are not traditionally like the same like. If you talk about raising fish in a farm you think of like big, you know.
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Dr Doug: tubs of water and fish that are in very close proximity to each other. That's not what these people do. These people are are creating and sustain are creating these sustainable farms where they're using wild areas. But they're in protected regions, meaning that because of the flow of the ocean and the currents, there are areas of the the ocean that are protected from microplastics and other toxins.
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Dr Doug: So they're using these very protected areas, creating a more natural environment, allowing them to feed on natural things and then harvesting them in a more. You know reasonable way. And then the way they process them keeps the the again, the amino acids and the fatty acids. If the same as you would get if it were fresh.
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Dr Doug: It is the most delicious fish we get the salmon from there. It is unbelievably good, so good it is not cheap, but that's the only fish that we'll eat
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Dr Doug: unless it's an anchovy or sardine. And then the last part here is around supplementation. So whey versus plant sources, and then I will actually add another one in there. And those of us that are patients here of ours know about this. But there's basically 3 sources of protein that we would recommend. The first one actually isn't way, because we find that several people, lots of people, including myself, don't tolerate whey protein. I just don't feel good if I eat it, but
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Dr Doug: the our number one is a beef isolate, so it sounds gross, but they can take beef, turn it into a protein powder. It tastes like a way protein powder has that same consistency. It comes in chocolate and vanilla, just like whey protein, but it's beef. So it has a better amino acid profile, and you don't run the risk of not tolerating the whey. So that's my favorite. That's what IE. There's a couple of different companies out there. The one that we have should have this in the affiliate
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Dr Doug: section is a company called Equip Equipe. I use their chocolate, and it's what I eat if I eat it. I try to eat a whole food diet if I can, but if I need protein, that's what my go-to, Wei is Ok
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Dr Doug: has the potential to be good. I just find that a lot of people don't tolerate it, and they don't really know they don't tolerate it. They just don't feel good after they they consume it.
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Dr Doug: And then plant. If you're gonna choose. Plant P. Protein is the only complete protein that you would find in a in a powder.
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Dr Doug: My concern is what else is in there? That's a whole lot of peas in one place. So if it's if it's toxic with anything else, if there's any other if there's anything else in those peas like, if it's a a glyphosate or a pesticide. It's gonna be so ultra condensed and dense and a net protein powder. That's what worries me about that. So I know people do fine with it. So if you have to eat plant-based, and that's the one I would recommend.
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Dr Doug: Good question
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Dr Doug: sinks to my heart. Of those that have joined us. I saw a few names pop up any questions from the audience here, since you guys are here.
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Dr Doug: Another great keep going.
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Dr Doug: Nancy, was that you? I'm sorry I my Internet went out for a few minutes, so I don't know whether you went through the questions in the queue I had. I did have a question in the queue about
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Nancy Mandowa: hcl.
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yeah. I
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Dr Doug: here's you. Here, here you are. Let's see.
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Dr Doug: Yeah. Do you want to? Just do you want to describe your question, or I can read it either way. Yeah, go ahead. Okay. All right. So Nancy says that she watched a video on the Ppis that we had on the Youtube Channel, and was wondering if I recommend Hcl. Supplements in general, even for people who don't have a problem with acid reflux and have never needed acid-reducing drugs.
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Dr Doug: So you've read that we most of us will have less gastric hydrochloric acid as we get older. And that's true.
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Dr Doug: Is there a potential downside? Or can it just be helpful? Yeah, that's a great question. And I find that enzymes
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Dr Doug: in general are probably helpful. But there is a potential downside. So let's run through it for those that aren't familiar with the topic. So Hcl stands for hydrochloric acid, and Hcl. Is what our body makes in the stomach to keep the Ph very, very acidic. So our stomach ph is about one. We
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Dr Doug: do reduce stomach acid secretion over time as we age. This is one of those things that you know. We have just have less of it. One of the reasons why people as they age, need more protein instead of less, because you're breaking down less. So you need more input to get the same amount of amino acids.
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Dr Doug: So if we just look at that and say, Well, should we just give hydrochloric acid to everybody? And I think the answer is probably not cause. There is the potential for upsetting your stomach, imbalancing things. You have to take it with food. It's kind of a pain. And I think you do run the risk of potentially irritating your esophagus if you are over driving it? Arguably, though it should only be getting your stomach back to the ph of one. So how do you actually overdrive it? I don't know. I just worry about giving your body something that it doesn't need
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Dr Doug: in interrupting feedback loops. So what I would recommend. If you were my patient, I would say, let's test because we can look at products of protein breakdown. We can look at products of of dietary, fat breakdown. We can actually test the amount of Hcl in your stomach acid through stool.
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Dr Doug: So I would actually do a stool test. See what your stomach function looks like cause. That'll also tell you what other pancreatic enzymes look like. So then you'll know like, do you not only need Hcl, maybe you need bile. Maybe you need you know the other pancreatic enzymes, or maybe none. And we see that, too.
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Dr Doug: So that's a good question, Nancy. Thank you. Thank you.
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Sheryl: I had a question. Yes, ma'am. Cheryl. yes, okay. So
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Sheryl: pardon me, but I'm driving
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Sheryl: good Kathy.
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Sheryl: Does that work. If you haven't been eating the food that you're testing for
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Dr Doug: great, great question, and I see your question in the chat. Thanks for putting that in there. I hope you didn't type it in there while you're driving. Thank you.
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Yeah. So the question from Cheryl is about food testing. And I'll I'll clarify that. So food, sensitivity. Testing, right? Cheryl, is what you're referring to.
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Dr Doug: And this is, yeah. So this is a little bit. There's a lot of there's confusion in this space. So there's food allergies. There's food sensitivities. We're talking usually about food sensitivities, because allergies generally, you're gonna know, like, if you have an allergy to milk you, you know, if you consume milk, it could kill you right? So we generally know when we have true allergies. Food sensitivities is an immune response. That is not allergic. So not ige ige mediated. I think
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Dr Doug: it's a different type of immune response. So when we do food sensitivity testing, we're looking at immunoglobulins like Igg also can look at Igm, there's some other things from this other system called complement called CD. 4. But we're looking at the impact of the immune system from the things that you're consuming. So you're right, Cheryl, if we're testing a full panel and you haven't consumed those things for a long time, but you might otherwise be sensitive to it. It's gonna look like you're not sensitive to it.
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Dr Doug: Conversely, though, if you have a leaky gut or increased gut permeability, which is what it should be called, and you do a food sensitivity test like the first time I did it I was quote, unquote, sensitive to all the foods that it eat on a regular basis.
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Dr Doug: not because I actually was sensitive to them, but simply because I had increased gut permeability, and those proteins were making their way through my gut and exposing my immune system to them inappropriately. So the answer for me was not to stop eating those things. The answer for me was to heal my gut and then keep eating those things. And and so food, sensitivity testing is something that we use. But I don't really like it. And it's definitely not a starting point, because most people need to work on gut function and gut permeability before we start eliminating things based off of food sensitivity
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Dr Doug: if that makes sense.
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Sheryl: Yes, I have been working on that.
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Sheryl: But part of that was eliminating.
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Sheryl: That seems to be a problem. And so
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Sheryl: I'm trying to figure out like how I find out if those
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Sheryl: things are actually going to be a problem. If I had effect
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Dr Doug: without having to be a problem. Yeah, that's the challenge. And so the traditional approach using food sensitivities is just that right? So you do the test. You eliminate the things that are positive, and then you work on healing the gut, and then you add them back in. But then, in theory you also, then have to retast to see if you're also picking them up again. And what I don't like about that is that it still doesn't really clearly explain. If you've just
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Dr Doug: improved your
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Dr Doug: your gut permeability or not improved your gut permeability. If you eliminate those foods indefinitely, and I guess it's like, if it's one or 2 things. Then that's probably okay. Assuming that they're not your favorite one or 2 things. But if it's, you know, like, I mean, when I did it the first time I went through this whole process I mean, it was like everything that I ate.
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Dr Doug: and so to to completely change a diet and think that that's gonna be? The answer is probably not the answer. So this is where again, we, we use them mostly actually, in the interest of dairy. We use it, but we we don't. We've less. We've started relying on it less and less, and looking at other things like gut function. There's other tests like from vibrant they test called zoomers. That look at different aspects of the immune system that I think are more relevant
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and can tell us. Really, if if your immune system is reacting in a different way to some of these things, specifically, dairy is one that we do a lot in lectins as well.
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Hey?
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Dr Doug: Okay. So then you wouldn't do the
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test for that. Then.
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Sheryl: you would do a function of that.
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Dr Doug: III would
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Sheryl: cause. I was wondering like, How long do we have?
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Sheryl: Hello.
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Dr Doug: yeah. And there's some protocols for this. But if you, if you eliminate it for gosh, I don't remember what the actual number is, but if you eliminate it for a couple of weeks.
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Dr Doug: it's probably not gonna show up. If you tested it again. So we have people. If we are gonna go through that route, we'll have them like we have them. We used to use often we do it some now of what's called a wheat zoomer. So we're looking specifically at wheat. Gluten tolerance and intolerance. We wanna know
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Dr Doug: if people are gonna have an immune response to gluten and and non gluten proteins and wheat. And so we would have them consume gluten containing grains before the test. So to make sure that that would light up if that were the case. But we stopped doing that test, too, for the most part, because guess what? Nobody should be consuming gluten containing grains.
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Dr Doug: because we I never saw anybody that didn't light up with it.
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Sheryl: Yeah, I think I probably would. Okay, thanks.
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Dr Doug: yep, sure. And then arena, you popped in about power plate. So the question here is what I recommend. A vibration plate and specifically power plate. I actually just had an interview with a doc from power plate. This Ph. D. Exercise physiologist whose name I have
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Dr Doug: I don't know somewhere, but I'm going to put that up on Youtube, probably this week or next week. It was very convincing that the
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Dr Doug: the what he calls the the displacement or the oscillation amount
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Dr Doug: is ideal on power plate as well as the frequency, and so the low, the the home products on a low setting is ideal for bone health. Now, he actually just wrote a chapter in a book on this and that book is being sent to my house.
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Dr Doug: So I'm gonna read those studies. And I'm gonna do a follow up video on those studies to talk about that. But it was really convincing. To hear from somebody who does not make money selling the product to talk about the research behind the product more so than when I talked to Dr. Ruben from meridine I was
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Dr Doug: less impressed by his conversation around it, and the follow up research that I've done has has also been less impressive where people, researchers other than him have not been able to reproduce his results.
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Dr Doug: which is which is concerning
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Dr Doug: so
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Dr Doug: alright. And that brings us right to the hour any last minute questions from those that are here.
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Dr Doug: Dom, yeah.
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Thomas Schellberg: tis fast your own and BPH. Anything to say about the relation between the 2? Sure.
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Dr Doug: I have lost. To say, the relationship between testosterone and BPH.
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Which, for those that aren't familiar with that acronym, is benign, prostatic hypertrophy. So this goes back to again what I was talking about earlier with with testosterone and prostate cancer and
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Dr Doug: estrogen and testosterone and heart disease. If high levels of testosterone were associated with prostate hypertrophy, we would see young men with prostate hypertrophy when they have the most testosterone. So clearly, there's not a direct or linear relationship. There is a relationship between the breakdown of testosterone into DHT. Or dihydro testosterone
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Dr Doug: and prostate cells getting bigger. So there's a little bit of variation here. But what we find is that low levels of testosterone with high levels of dh, t are probably the most dangerous for the prostate. There is what's called a saturation model, which basically says that if if you increase testosterone total testosterone levels over about 2 80,
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Dr Doug: that there's no increased impact on the on the prostate whatsoever.
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Dr Doug: So what that tells me is that low testosterone is dangerous, for the prostate
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Dr Doug: optimized testosterone is not so. I don't worry about testosterone replacement. And men that have. Bph, because there's more to Bph than is testosterone. And I would rather have optimized testosterone, the energy, the sleep, the mental clarity, all the things that go wrong with testosterone replacement, and then treat the bph, if you need to, surgically, even if you have to.
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Thomas Schellberg: That sounds like I just. I've already had most of the prostate removed. It sounds like, I need to have the testosterone test
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Dr Doug: totally. Yes, absolutely. Okay. Thank you. Yeah, of course.
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Dr Doug: Alright. Well, that brings us past the hour. So thanks everybody reminder that next week I think we're gonna do this on the holiday day.
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Dr Doug: So hopefully, that is something that people can come to, but I thought it'd be a good way to start the year. Actually. So. 9 Am. Sorry, Tom. I know that's early for you, but 9 am. On the east coast no better way to start your year in California than meeting with your health provider at 6 in the morning, so we'll do 9 Am. On the first, and I look forward to seeing everybody there who can come, and thanks for your time, and this will be sent out
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Dr Doug: here shortly. And, Tom, I'm gonna follow up with you. And as somebody else I was gonna follow up. Oh, Kit, I'm gonna send a slack to kit alright. Thanks, everybody. Happy New Year!
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Dr Doug: Happy New Year! Thank you. You're welcome. Bye.
