January 29, 2024
During the meeting, various topics related to health, exercise, and medical treatments were discussed. Here are the key points from the meeting:
Discussion about the effectiveness of activities like walking heavily, jumping, and other impact exercises for bone health. The effectiveness of such exercises depends on various factors, including the intensity and technique. Standing jumps and heel drops were mentioned, but it's unclear if they reach the threshold to stimulate osteogenesis.
There was a discussion about bone remodeling markers, specifically C-terminal telopeptide (Ctx) and procollagen type I N-terminal propeptide (P1NP). How to compare these markers by converting Ctx to a decimal and then calculating the ratio of P1NP to Ctx. The ratio helps determine if bone remodeling is more towards breakdown or building. A ratio range of 50 to 300 was mentioned, with higher numbers indicating better bone metabolism.
A question was raised about hormone levels, particularly estrogen and progesterone, and their associated risks of stroke and heart attack. Topical and vaginal estradiol, as well as oral progesterone, do not increase these risks, unlike oral estrogen and progestins.
Labs for bone health markers like Ctx and P1NP can be ordered through Life Extension if a doctor won't order them. They also discussed the importance of tracking these markers over time.
Question about MRI for evaluating bone quality. Dr Doug mentioned quantitative CT as a more reliable method, although it involves radiation exposure.
Dr. Doug expressed skepticism about thermography as a tool for breast cancer evaluation, suggesting that mammograms, despite their downsides, are still necessary, especially for those on hormone replacement therapy (HRT).
Dr Doug discussed bone quality, indicating that it is not fixed from birth but can change over time with treatment. Peak bone mass is reached in early adulthood, and maintaining a high starting point is beneficial.
VO2 Max, a measure of aerobic capacity, was discussed as an important factor for longevity. Dr Doug suggested interval training as a way to improve VO2 Max.
Concerns about HRT prescription shortages were addressed. Dr Doug suggested having multiple suppliers to avoid running out of hormones and discussed the potential risks of starting HRT later in life, especially in relation to heart health.
Questions about the benefits of biotin, collagen, and other supplements were addressed. Dr Doug noted that while some supplements may have benefits for hair and nails, their impact on bone health is not well-established.
A guest shared her positive experience with cold therapy, and Dr Doug discussed its potential benefits, including recovery and mental health.
Concerns about cholesterol, plaque, and the safety of continuing HRT given her heart health indicators. The doctor discussed the complexity of these issues and the need for more extensive testing to make informed decisions.
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Cathy: Well, my question was just about jumping and hopping and skipping and running. And
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Cathy: those kind of things
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Dr. Doug Lucas: sounds like, my 5 reel. Yeah. And are you in reference to building bone?
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Cathy: Yeah. Yeah. Cause when I get out like on the golf course and stuff. I just try to walk real heavy, you know, and then I've actually started jumping, which I couldn't do before. So just on the ground, like 50 times, you know, jump up and down and things like that, just wondering if that's helping at all.
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Yeah, so actually, I have Mick Truby, our exercise physiologist, looking into this. We're building out a
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Dr. Doug Lucas: an impact program for our patients. And I don't know how we're gonna share it or what it's gonna end up looking like I have an idea. But I don't wanna
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Dr. Doug Lucas: say anything that's not true.
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Dr. Doug Lucas: the challenge was some of the smaller things, just like standing jumps and heel drops and
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Dr. Doug Lucas: some of the things that are a little bit more subjective in nature. You know the challenge there is like, How high are you jumping? How are you landing? Are you landing with? Are you letting your heels impact are your knee bending like so many variables
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Dr. Doug Lucas: that it's kind of a hard thing to study, and I haven't seen good studies on it. There are some studies on more like plyometric box jumps. So you start getting into more advanced like. and you're actually jumping off of stuff which clearly you'd have to do cautiously.
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Dr. Doug Lucas: So we are building that out? The short answer is, probably all of it helps. It's just a matter of whether or not it's enough.
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Dr. Doug Lucas: you know like, are you actually achieving the you know the the 4 multiples of body weight threshold to stimulate osteogenesis?
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Dr. Doug Lucas: It's hard to say. My guess is with a heel drop? Probably not, you know. Standing jump.
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Dr. Doug Lucas: maybe probably not. Depends on how you're landing, so I think it's probably good for you as long as you're not hurting your joints. But is it enough? Is the question.
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Cathy: Yeah.
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So
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Dr. Doug Lucas: it's a good question, though, we get that a lot.
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Dr. Doug Lucas: So in this list. Such a great list.
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Okay?
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Dr. Doug Lucas: we've got some imaging questions.
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Dr. Doug Lucas: a lot of Ctx. P. One. Mp, questions. So we maybe we should talk about that.
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Dr. Doug Lucas: hmm! 0 long ones, though.
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Dr. Doug Lucas: Let's talk about. Let's hear David here. I don't see David.
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Dr. Doug Lucas: Let's talk about C. Tx, p. One and P. For a little bit
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Dr. Doug Lucas: And so David was asking about Ctx. And P. One and P. And they seem to be in different units. So let me just talk about that for a minute.
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Dr. Doug Lucas: So let me just give you some examples of this.
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Dr. Doug Lucas: I'm gonna take these off as we go. So I think we have some repeats.
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Okay, so the way that we do this is p. One and P. And Ctx are in different units, and the way that you put them into the same units is to
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Dr. Doug Lucas: divide the Ctx. Number by a thousand.
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Dr. Doug Lucas: So I'm going to go ahead and drop it in the chat just as an example.
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Well.
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Dr. Doug Lucas: there we go. Sorry
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Dr. Doug Lucas: all these things that were in the chat. Okay. Well, these are from last time
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Dr. Doug Lucas: got it. Okay, here we go. So here's an example. So let's call it. Let's just use round numbers for easy for good measurement. So np, let's say, is it 100
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Dr. Doug Lucas: and Ctx is at let's call it 500. Right? So if you were to do the ratio that we typically do, which is, and P. Over C. Tx.
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Dr. Doug Lucas: Then you would get a obviously a very small number. Right? You get point 2 right if my math is right.
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Dr. Doug Lucas: When we do this. What we found to be the easiest way to look at this is to take the Ctx. Divide it by a thousand and make it a decimal point. So basically, now, it should look like this.
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Dr. Doug Lucas: which is 100 divided by 0 point 5
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Dr. Doug Lucas: which of
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Dr. Doug Lucas: My math is correct, I should be 50 right? Just move the decimal point over 2 points.
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Dr. Doug Lucas: So so so that would equal 50. I use a calculator. But anyway, that should equal 50. The range that we typically see is about 50 to 300, with 300 being really rapid.
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Dr. Doug Lucas: Metabolism being both building and turnover and then 50 being more bone breakdown and not much bone building. If that makes sense so higher, is better.
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Dr. Doug Lucas: When you start looking at these numbers. What's really important is that we see. I think I've mentioned this before. We see the numbers tend to go up and down together. So, for example, if somebody starts out with a let's say, A and P of a hundred and a C. Tx. Of 500, and they start building more bone, we might see the Ctx. Rise to 1 20
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Dr. Doug Lucas: would love to see that. I'm sorry I said, that wrong the and P. Rise rise to 1 20, and I'd love to see the Ctx drop. But they're not typically gonna do that. They do sometimes, but usually we see them move together. But it's the ratio that matters right? And so that's why we started using the ratio more so than the absolute numbers
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Dr. Doug Lucas: which has been confusing for some. That was a good question.
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Dr. Doug Lucas: so another question in the same section, I think it's on hormones, but I'll just answer it.
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Dr. Doug Lucas: So this is from Karanina, who, I don't see, is on
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but Karenina asked. She said, her starting estrogen and progesterone.
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Dr. Doug Lucas: and she has a number here.
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Dr. Doug Lucas: Her doctor says that this leads to an increased risk of stroke and heart attack.
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Dr. Doug Lucas: What is my opinion?
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Dr. Doug Lucas: That's why this is in here, because there's also a question about p. One and P. And Ctx. So let me mention this estrogen
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Dr. Doug Lucas: stroken heart attack. She doesn't mention what form of estrogen
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Dr. Doug Lucas: oh, she does, she said. She started the after dial ring. even though it's just local and non-systemic. But I think there is actually a systemic version of that. But vaginal Estradiol topical Estradiol, either through cream or patch, does not increase the risk of stroke or heart attack.
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Dr. Doug Lucas: Oral can increase the risk of blood clot, which obviously could be a stroke or a heart attack, but topical and vaginal. Do not
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Dr. Doug Lucas: same thing with Progesterone oral. Progesterone does not increase that risk, but proistens do so make sure you know which one you're taking. And then her P. One and P. Question. She says her doctor will not order it, and will only order. The Ctx
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Dr. Doug Lucas: labquest does not offer this self-pay. But it but it but it
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Dr. Doug Lucas: so basically how do you get it? We found it at lab, life extension life extension has a website, and you can order labs for cash there. And it's part of their von health panel. You can get both Ctx and P. One and P.
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Dr. Doug Lucas: So if your doctor won't order it, you just have to order it yourself. That's the summary there. Okay.
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Dr. Doug Lucas: and if anybody ever finds it on other platforms, let us know, because we can spread that out.
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Dr. Doug Lucas: This is shelly. Did she say quest would not do it.
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Shelly’s iPad: That's what she said. Yeah, okay. Cause I had a doctor order him, and I did get them done by Quest. But they'll run it through insurance. Gotcha. Okay?
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Dr. Doug Lucas: And then, Cheryl, ask a question about
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Dr. Doug Lucas: Have you established what you think a goal ratio is in order to be building bone. We don't have enough data to say this confidently, but
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Dr. Doug Lucas: kind of where we find again, people lie in that 50 to 300 range. So you know middle of the road there would be
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Dr. Doug Lucas: around 1 50. So that's kind of what we're using as a benchmark. But I don't have enough data to say that if you're under 1 50 you're not gonna improve on imaging, and if you're over that you are we're gonna keep collecting this, and it'll probably be. I mean honestly, a couple of years before. We have enough data to say this confidently, but we'll continue to monitor that, and I will
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Dr. Doug Lucas: probably publish it if we can.
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Dr. Doug Lucas: some lab testing questions. Kathy is on here, Kathy, I think this is your question. She said, that you mentioned that bone testing and or quality can be measured on MRI. And if a person wants to get an MRI to evaluate bone or something specific to ask for. The answer. There, Kathy, is
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Dr. Doug Lucas: quantitative, MRI. I don't know that that's true.
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Dr. Doug Lucas: Quantitative ct. For sure.
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Dr. Doug Lucas: The problem with quantitative ct is that there's a lot of radiation associated with it. So while it could be done once.
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Dr. Doug Lucas: you know, to to really verify what the bone quality is, I wouldn't do it repeatedly, because a lot of radiation.
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Dr. Doug Lucas: So I don't know about quantitative MRI for bone, density or quality. I don't think it picks it up very well.
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Dr. Doug Lucas: Lorna's got a couple of questions.
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Dr. Doug Lucas: I think I've talked about this before, Lauren. I don't know if it was your question or not, though thermography as an assessment tool. I'm only familiar with it for breast cancer, evaluation.
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Dr. Doug Lucas: and I know that it's popular, and people that don't like mammogram.
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Dr. Doug Lucas: I don't like mammogram either, but I'm not convinced that the data on thermography is is any better than mammogram. I think it's probably less sensitive and probably less specific. I wish there were a better tool.
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Dr. Doug Lucas: but there's just not. I don't think either a mammogram or thermography are great mammograms gonna lead to more unnecessary biopsies and anxiety. But II don't think we can get around it. I think we have to do it, especially if we're on Hrt. I think we have to
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Dr. Doug Lucas: look as best we can. Obviously, ultrasound is better. MRI is better if you can convince your obji, and to order that and make that the primary tool
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Dr. Doug Lucas: that makes sense. Lorna, you're here. Hi, Lorna.
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Dr. Doug Lucas: yeah, you had answered that. That was an old question. From a week or so back. I had some newer questions in this week. So thank you for going through that again, though. Yeah, I'll talk to my team about how we're creating this document. I see some things that are repeated on there. I hadn't been deleting them. I probably just need to delete them as we go.
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Dr. Doug Lucas: and then I'm sorry I don't remember this, is it, Jim James Bondi?
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J Bondy: You can call me Jim all right, Jim? So? Jim asked in the chat. Do the numbers vary from one lab to another. I think they're consistent in the Us. The units, if that's what you're referring to, Jim.
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J Bondy: Yes, I had them, you know Np. And Ctx. Done at Lab Corp through your program, and then I convinced my end of chronologist to order them, but did it at a different lab.
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Dr. Doug Lucas: they should be consistent where the number is wildly different.
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J Bondy: They.
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J Bondy: The ratio went down a little bit, which surprised me.
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Dr. Doug Lucas: Yeah. Do you have all those numbers.
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J Bondy: first time was
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J Bondy: Np. Was 35, and ctx was point AR. No, no, no sorry. What were they originally?
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J Bondy: I don't have them right handy. That's that's fine. If you wanna if you it can look him up while we're on
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Dr. Doug Lucas: perfect.
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Dr. Doug Lucas: Alright and I think, Lorna, we talked about Igf one last time as well. right
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Dr. Doug Lucas: or recently, you're muted.
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Lorna Nichols: yeah.
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Dr. Doug Lucas: alright, cause you're right, cause they wanted to do the MRI did you end up doing the MRI?
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Lorna Nichols: You know? I can't even remember the question.
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Dr. Doug Lucas: So I think the question was, your Igf. One was kind of high, and I think your doctors were concerned about that, and they wanted to do an MRI of your pituitary gland.
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Lorna Nichols: Oh, right! No, I did not have an MRI done
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Dr. Doug Lucas: and make no comments.
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Dr. Doug Lucas: alright! We talked about that
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Dr. Doug Lucas: fast
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Dr. Doug Lucas: aranta who was nice enough to put the pronunciation of her name in here, cha like Cha cha cha.
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Dr. Doug Lucas: Rancha she says. I just had a RAM scan down that showed a moderately good fragility. Score 15 to 30. That's not moderately good. That's really good.
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Dr. Doug Lucas: However, the Bmd indicate indicators are noticeably worse than Dexa. She did only 4 months previously.
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Dr. Doug Lucas: Can these 2 tests be compared? Or should we only compare Dextedex or Rems? To Rems? A related question is, whether one is born with a fixed bone quality, or does this indicate change over time with treatment, etc.
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Dr. Doug Lucas: So great questions. And we don't have a complete answer to this question, because Dexa and Rems obviously are different technologies.
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Dr. Doug Lucas: What I like about rems is that the numbers seem to be more consistent from body part to body, part meaning spine and hip generally line up better, whereas dexa there can be a lot of discrepancy. I've seen people that have, you know, negative fours in one body part, and then not even osteopenia in another. And I feel like, unless somebody's non weight bearing that's not realistic, because osteoporosis is a systemic disease, not a local disease. Again, unless you're not using an extremity.
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So
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Dr. Doug Lucas: so again, we're not really comparing apples to apples. Here.
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Dr. Doug Lucas: I kind of take it for just take it as a with a little bit of a grain of salt like you have to look at both. We still use both. If we're going to pick one. I would choose to use Rems.
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Dr. Doug Lucas: because I think it's probably more accurate. But again, we can't prove that, because there's no. You know, biopsy like what was was discussed the other day, you know, there's no like biopsy option.
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To go on.
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Dr. Doug Lucas: at least not that I'm aware of. And then, as far as the fragility score goes, I think this does improve over time.
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Dr. Doug Lucas: We've seen it improve in people that are going through our program that are getting multiple rams. It's not
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Dr. Doug Lucas: genetically driven for the most part, and it's not something that is the way that it is from birth, but it is the way that it is starting at peak bone mask. So you reach your peak bone mass in your early adulthood, you know 20 s. Maybe early 30 s. And then it's a downhill slide from there. The higher that starting point is, the less likely it is to be a problem over time.
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Dr. Doug Lucas: So that is something that does change for sure.
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Dr. Doug Lucas: Good morning. Don
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Dr. Doug Lucas: alright. So, Jim. So your scores were
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Dr. Doug Lucas: 49.1
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Dr. Doug Lucas: over 5 39, so almost the same as the
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Dr. Doug Lucas: example I showed.
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Dr. Doug Lucas: and then 35 and 40, 10.
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Dr. Doug Lucas: Yeah, so this is actually gonna be, oh, I see. Yeah.
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I see.
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Dr. Doug Lucas: So 35, over 4, 10. So then we'll do the math unless you have those numbers. I'm sure you probably know how to do them. But I'll just go ahead and dome.
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J Bondy: Yeah, my ratio went from like 91 down to 85
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Dr. Doug Lucas: I see. So forums gonna do it. 49.1, divided by point 5 3 9
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Dr. Doug Lucas: is what we would do. So that's 91, which, as I mentioned, feels pretty low to me out of the gate. And then, when we repeat.
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Dr. Doug Lucas: I do 35, divided by point
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Dr. Doug Lucas: 4 1 0. And now it's 85.
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Dr. Doug Lucas: So you know it is lower. But here's what I look at. When I see these numbers. I see that your ctx went down.
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Dr. Doug Lucas: So the bone breakdown marker went down, and then Your. And P. Went down a little bit as well, and this again is kinda just mentioned. This, like we see them tend to move in the same direction, but it has to do with how much so the goal here would be that really we want them almost both to go up, although 5 39 for C. Tx is kinda higher than I would expect to see for you, Jim. So my guess is what we're seeing is that C. Tx is headed in the right direction.
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Dr. Doug Lucas: and we just need to really focus on the and P. And continue to bump that up. So this would be, you know, making sure we're doing all of those things. And I don't remember your plan. Off the top of my head. But talking about things like hormone optimization, getting adequate protein nutrients, resistance, training, and dialing in all of the other. Micronutrients. All those things should be pushing p one and p up
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Dr. Doug Lucas: if that makes sense. So the difference between 91 and 85 is that actually, clinically relevant?
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Dr. Doug Lucas: I don't really know the answer to that. It seems pretty darn close to me, so that it might just not be changing significantly at this point.
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Dr. Doug Lucas: Alright, thank you.
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Dr. Doug Lucas: Yep.
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Dr. Doug Lucas: and we'll track those, too. If you wanna give us those numbers, we'll put them in our tracker, because what we're doing is we're basically tracking and P. And C. Tx over everybody. And when we see people either flat or not changing, we're really looking into the program and seeing what's different between those that are really
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Dr. Doug Lucas: getting better and those that are either flat line or not.
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Dr. Doug Lucas: Alright. Angela
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sent me a question
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Dr. Doug Lucas: asking a question I don't know the answer to, but I'll bring it up here.
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Dr. Doug Lucas: So she asked. The question is, how does Biotin affect our lab work for osteoporosis, and the answer is, Angela, I have no idea, but I know that it's a recommendation from our Dietitian team to stop biotin. It's a recommendation from labour in quest. 2. But it's kind of buried in the recommendations. I have no idea what it does actually
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Dr. Doug Lucas: And then the challenge is is, if you if you were to take it, what does it impact? It doesn't impact all of it. It impacts.
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Dr. Doug Lucas: I think, a couple of specific biomarkers. I just don't know which ones.
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Dr. Doug Lucas: So I wouldn't worry about it. Don't lose sleep over it.
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Dr. Doug Lucas: There was a lot of things to work on there.
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Dr. Doug Lucas: Okay. keep going.
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Dr. Doug Lucas: And, Julie, thanks, for Julie is on our call. She's on one of our team members.
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Dr. Doug Lucas: She's Updating this list as we go.
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Dr. Doug Lucas: You're welcome, Angela.
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Let's see here.
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Dr. Doug Lucas: Umhm.
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Dr. Doug Lucas: I think we talked about. We talked about this one for holiday reset stuff. If you fall off the wagon. How long does it take for your gut to reset? I think we talked about that last time, and it's going to depend on how hard you fell off the wagon and
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Dr. Doug Lucas: how sensitive your gut is! So just get back on the wagon. Don't worry too much about that, James.
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Dr. Doug Lucas: Saying Jim had the same question. That's funny.
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Dr. Doug Lucas: It happens
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Dr. Doug Lucas: we live life, and then we get back on track.
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Dr. Doug Lucas: Kathy is asking about fasting, and so is Lois. Let me see?
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Dr. Doug Lucas: yeah, I'm just gonna answer the them both together. So basically, the question around fasting is, can we get enough nutrients through fasting?
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Dr. Doug Lucas: Or if we're fasting, and it really depends on what your feeding window is and how good your gut is. So what I mean by that is, let's say you're doing up a one meal a day.
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Dr. Doug Lucas: Right? So you're doing basically a 22 h fast.
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Dr. Doug Lucas: No, I don't think any of our patients are doing that. But it is a really good program, let's say, for potentially weight loss early on, but definitely for metabolic dysfunction, insulin resistance.
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Dr. Doug Lucas: if you were to consume all of your nutrients through one meal a day. I think you'd have a really hard time getting adequate protein, because, even though there was a recent study showing that you could assimilate a hundred grams
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Dr. Doug Lucas: over the course of a day. That's one study. And they were using a protein that was mostly casing, which is not realistic for most people.
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Dr. Doug Lucas: So really, we have a probably have a maximum of what we can absorb at one time between 30 and 50 grams. depending on how good your gut works.
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Dr. Doug Lucas: So you're not going to get enough protein. And then all the micronutrients. Similarly, you're just gonna Max out what you can probably absorb. And so I think that if we're our goal is to build muscle and bone a one meal a day, probably not enough.
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Dr. Doug Lucas: What about if you did a a 16 8, and you could squeeze 2 meals and a snack in there. Could that be enough? It could be if they're well designed. I don't recommend fasting for anybody who is trying to build muscle and bone as their primary goal, because I think it just makes it harder.
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Dr. Doug Lucas: I don't think if we shorten the fasting window, that we're going to get significant impact of atophage or cellular senescent clearing.
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Dr. Doug Lucas: We don't really know what those thresholds are, anyway. So why aim for something that's sort of spurious like that, and just work on the things that we know that are going to work and improve our muscle and bone for the meantime.
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Dr. Doug Lucas: So that's my thought.
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Dr. Doug Lucas: Yeah. And, Kathy, you should avoid biotin prior to testing labs again, I don't really know why. That's just the recommendation.
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Dr. Doug Lucas: It impacts something I just don't know which labs.
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Cathy: but but what I think you had said before, something about not taking diet at all, or you don't need it, or so I don't. I? I may have said that I probably didn't say don't take it at all. I think that it's not specifically related to bone that I'm aware of. It's relatively easy to get through diet, but people do find value in it for other things like hair and nails, and
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Cathy: there's probably some value in taking biotin but I don't recommend it specifically for bone elf. So I put that that usually ends up in the optional category for me.
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Hmm.
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let's see here.
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Dr. Doug Lucas: Speaking of collagen. So Kit was asking about collagen whether or not, it is
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Dr. Doug Lucas: worthwhile to use. So here's the thing about collagen, which is from an anti-aging perspective, it does actually,
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Dr. Doug Lucas: we, we reduce the amount of collagen that we can make over time as we get older. So from an anti aging perspective, it is one of those things that that meets the criteria of hey? We should probably add this in if we wanna still get all the benefits of having it in our system. So I do recommend collagen.
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Dr. Doug Lucas: There's only one collagen that's been studied specifically for bone. and that's the Ford Bone product from Ford gel
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Dr. Doug Lucas: They had one study and they funded it. So there's obviously potential bias there. There's nothing else wrong with that study other than that. So you know, I guess. Take it for what it is. It's a specific formulation of collagen. I don't really know how it's different. But no other collagen has ever shown an increase in bone marrow density.
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Dr. Doug Lucas: So I like it, I take it. But I don't know that it's going to help your bones specifically.
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Dr. Doug Lucas: Great question on longevity. So Cheryl and others.
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Dr. Doug Lucas: Thank you. Julie Cheryl and others asked if I could clarify VO. 2, Max. So VO, 2. Max is a measure. There's only 2 exercise measures that have been shown to strongly correlate with improved longevity. And that's a grip strength. And VO. 2 Max.
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Dr. Doug Lucas: they're kind of funny measures, because
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Dr. Doug Lucas: when I hear people dig into these, they say, Well, I'm going to improve my grip strength, and that's going to improve my longevity. I don't think that they're related like that.
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Dr. Doug Lucas: meaning that if all you did was just do like forearm exercises all day long. It's gonna make you live longer. I think Grip strength is a
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Dr. Doug Lucas: surrogate marker of your overall string, you know. If you're able to pick up heavier stuff and carry it around, it's not just your fingers and your forearm. It's all the other stuff that your arms are connected to, and your legs and your ability to control that, etc.
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So I think grip strength is a surrogate marker.
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Dr. Doug Lucas: But VO. 2, Max is going to be very specific to the capacity of your aerobic system, which, just like many other things, declines as we age. And so, if you can continue to maintain VO. 2, Max, by doing some very specific exercises which I'll talk about then it should help you to have a more functional cardiovascular system. And this this is the probably the most important part, a reserve, for if you get sick or you get injured.
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Dr. Doug Lucas: and I think people will kind of ignore this often, which is the the less conditioned you get over time. the more difficult time you're gonna have. If you get sick or injured.
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Dr. Doug Lucas: And I saw this a lot in practice.
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Dr. Doug Lucas: you would see people who were, you know, relatively healthy appearing, but obviously deconditioned low muscle mass, you know, hadn't done hadn't gotten their heart rate up over whatever 80 for a decade. And what happens is, your body just loses the capacity to accommodate, and then they, you know, they break a leg. They have to have surgery. They don't do well under anesthesia or they get you know, a virus which obviously we've seen a lot over the last 5 years.
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Dr. Doug Lucas: and they just don't have the capacity to tolerate it, and then they end up passing away.
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Dr. Doug Lucas: And so I see that lack of reserve as being a really really big thing. And I think. VO, 2. Max is a measure of that. If you have a very high functioning. VO, 2, Max, let's say you have the cardi respiratory system of a 30 year old, you're gonna be able to accommodate a lot of stress on your body before it gets to you. So I think, continuing to drive that through some specific exercises. The way that you improve. VO, 2. Max.
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Dr. Doug Lucas: Kind of a painful workout. But you do kind of longer interval training. So the intervals between 2 min and 4 min is sort of the sweet spot for VO. 2, Max. It's not really a sprint like a 30 s or 20 s sprint.
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Dr. Doug Lucas: It is an attempt to drive your heart rate up and push your capacity to actually move oxygen in and out. And what's happening is you're you're functioning somewhat below your anaerobic threshold. So you're still functioning on oxygen. That's why you can do it for 2 to 4 min a true sprint. You're driving into the anaerobic threshold, and you're not really utilizing oxygen.
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Dr. Doug Lucas: So VO, 2. Max, is your capacity to use oxygen. So you have to stay below that anaerobic threshold, something that you can do for 2 to 4 min and then take enough time off to recover. So that's going to be about the same amount of time, 2 to 4 min.
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Dr. Doug Lucas: So the workout that I have done and I probably don't do it enough. But the workout that I do is basically a 4 by 4, and we do it. I think we do it 6 times. So 4 min on 4 min off. Do that 6 times, and it'll absolutely wipe you out or a heart rate monitor to kind of see where I am. But you really don't even need it, because if you can maintain the same output over 4 min, you're below that anaerobic threshold.
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Dr. Doug Lucas: The harder you can push the higher your Vo 2, Max.
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Dr. Doug Lucas: You can test this at any exercise physiology center. We have one here in Asheville,
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Dr. Doug Lucas: and I got mine tested a couple of months ago, and I was pretty happy with the results. I've always had a good VO. 2, Max, but still at, you know, 45 my VO. 2. Max is off the charts for a a 20 year old, so
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Dr. Doug Lucas: that part still works well.
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Dr. Doug Lucas: Here's a long question about hormones.
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Dr. Doug Lucas: Cheryl was asking about HRT. Prescription shortages and how to deal with them.
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Dr. Doug Lucas: That's a pro. That's a real problem. She's saying. Currently Micron Progesterone is hard to get. Cheryl, are you here?
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Dr. Doug Lucas: Yep.
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Dr. Doug Lucas: yeah, Lorna, that's VO. 2, Max.
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Dr. Doug Lucas: Janina. I'll answer that in a second. Let's see here.
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Dr. Doug Lucas: Okay, so let me just talk about obvious things. So basically, the question is, what happens if you can't get access to hormones and so, Cheryl, we went through this process when we only had one. I think we had one, or maybe 2 suppliers of HRT.
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Dr. Doug Lucas: Yeah. And it became an issue when
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Dr. Doug Lucas: It became an issue when they were out of stuff, right? And so we couldn't get people hormones. And we were scrambling and trying to do all these different things to get people what they needed. So what we've done to accommodate for that is, we now have, I think, 8 suppliers
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Dr. Doug Lucas: right? So we pretty much have the capacity to get whatever we want at any time. If there were a nationwide shortage of something, then we would have to figure out what to do about that?
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Dr. Doug Lucas: The question specifically is, what if I can't get Progesterone? And I'm taking estrogen, and I have a uterus. And that's a real problem, because you don't want to develop hypertrophy of the endometrium of your uterus. So I would actually, if that were the case.
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Dr. Doug Lucas: I would potentially back off of both. But there is a commercial progesterone that you could take as an intermediate.
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Dr. Doug Lucas: So a 100 200 milligram micronized progesterone is available commercially, and that should be available of pharmacies so that that should be able to be covered creatively if you had to.
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Dr. Doug Lucas: Estrogen, if if you were out of estrogen. You could always take a break, you know, because estrogen dropping off and coming back. And then that's what happens in a menstrual cycle, anyway. So your body has the capacity to manage that you might have some brain fog as a result of it. Also might have some symptoms of hot flashes actually.
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Dr. Doug Lucas: But that is another thing, that there are some commercial preparations of estradial through a patch that could be delivered, even if it's not perfect. It could get you through testosterone. If people are out of testosterone, then you're just added testosterone. There's actually nothing you can do about that, because it's only comes from compounded pharmacies.
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Dr. Doug Lucas: But the question here, too, said, Is this a reason not to start? I think absolutely not. Don't worry about a potential shortage is a reason to not start something.
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Dr. Doug Lucas: yeah. And Angela experienced that same thing.
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Dr. Doug Lucas: So let's see here, Jenna. Janina. Sorry. Asked about my opinion on coffee. I love it. But that wasn't the question. Organic low acid mold tested and bone loss. So yes, organic low acid. I don't. I don't know how I feel about that, because I don't know that the higher alkalinity coffees are gonna make a significant difference again, because we're dumping it into our stomach, which has a Ph of one, anyway. So I don't know that actually plays a role in the
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Dr. Doug Lucas: The symptoms that some people get from coffee. If you feel better with a low acid coffee. That's fine. I just don't know that it really matters. I think. Mold test. It probably does matter. There's a couple of different coffees. If everybody has a favorite coffee, if they wanna throw it in the chat here, so I'll just go ahead and throw mine and
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Dr. Doug Lucas: so let's see here. So bulletproof one of Dave Ak, Dave. Dave Asprey's old company is a great coffee. Keon makes a great product. That's been Greenfield's company. dave Asprey has a new Coffee company called Danger Copy.
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Dr. Doug Lucas: which he says is better. I don't really remember why, but I know he got he got kicked off the border bulletproof because he was relatively loud during the pandemic, and I didn't like that
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Dr. Doug Lucas: And then there's another one I want to say, purity, I could be wrong about that. Put a question mark beside it.
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Dr. Doug Lucas: So those are all products that I've tried, and like. My favorite, though, is bulletproof. I just love the flavor.
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Dr. Doug Lucas: Let's see here.
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here's here's a question from Don.
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Dr. Doug Lucas: So do I have any knowledge, understanding, or wisdom regarding testing the thyroid, and specifically peroxidase and thyroid globulin antibodies.
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Dr. Doug Lucas: Hers have been high for a long time. Endocrinologist was unconcerned. That's not surprising.
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Dr. Doug Lucas: current. Tsh, of 2, about 2.0 7.
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Dr. Doug Lucas: Yeah. So these are things that we definitely measure.
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Dr. Doug Lucas: I find that we see low, level tpo, and and thyroglobulin antibodies occasionally watch. That's true. Frequently. We see high levels occasionally
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Dr. Doug Lucas: when I see this, though, my first response is typically to ask about symptoms, you know. Are you having symptoms of low thyroid, etc.? I'd say about half of the people are, and half of them are not
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Dr. Doug Lucas: either way. I look at the, and I look at the antibodies as a
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Dr. Doug Lucas: a sign of gut dysfunction out of the gate. and if that's not the case, you know, then there's other causes. But for most people there's some gut dysfunction. The immune response is kind of kicked up as a result of increased gut permeability. So we go after the gut. And then oftentimes we see those resolve.
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Dr. Doug Lucas: If they're very high, then I'm concerned about other things. I mean technically, if you have any. If you have any Tpo, then technically, that's Hashimoto's by definition.
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Dr. Doug Lucas: But that doesn't mean people are symptomatic of it.
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Dr. Doug Lucas: But the thing is the treatment for Hashimoto's. The treatment for any autoimmunity against the thyroid that is not out of the like through the roof high. It's all lifestyle, anyway.
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Dr. Doug Lucas: Right? So it's all the things, Don, that you're already doing.
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Dr. Doug Lucas: You know the all of the things that you wrote down in your comment to me yesterday. So all the things that you're already doing which would be all the lifestyle stress reduction. You know, cleaning up the diet all the all those things and then going after the gut, making sure that gut is is working well
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Dr. Doug Lucas: if you still have it after that, that's when I start to get concerned. But honestly, I don't know that I've seen anybody maintain high antibodies after cleaning everything up
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Dr. Doug Lucas: that makes sense.
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Dr. Doug Lucas: No.
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Dr. Doug Lucas: let's hear Gabriel. I don't think Gabriel's here.
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Dr. Doug Lucas: Nope.
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Dr. Doug Lucas: but Gabriel was saying, after taking the thyroid
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Dr. Doug Lucas: hormone replacement, it seems to make. Oh, sorry! Let me rephrase that taking thyroid hormone replacement seems to make osteoporosis worse. However, if you don't have a thyroid, you don't have a choice. Very true.
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Dr. Doug Lucas: Are there any studies. Comparing T. 4 or t. 3 t. 4 commas
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Dr. Doug Lucas: through natural desiccated thyroid
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Dr. Doug Lucas: versus other options. And so let me just rephrase that for people that don't have a thyroid, or that have a low functioning thyroid that need replacement.
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Dr. Doug Lucas: Is there an optimal formulation that people feel the best on, and that doesn't have an impact on bone. And this is a gray area. So I did a video on this recently.
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Dr. Doug Lucas: And the studies all look at people that have low thyroid, but not necessarily without a thyroid. So they have a thyroid generally. but they look at people that have low function, low numbers on replacement, and there is a threshold around. How much
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Dr. Doug Lucas: replacements
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Dr. Doug Lucas: how much replacement was associated with an increase in phone loss, and it turned over the number off the top of my head, and I can't remember it.
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Dr. Doug Lucas: I want to say it was 150 micrograms of synthroid, and most of the studies were on synthroid, because that's what most people use.
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Dr. Doug Lucas: And 150 micrograms is a pretty big dose. So if you were to compare that to Mp. Thyroid that probably be somewhere like, Oh, gosh! I wanna say 2 grains but I'm kind of making numbers up as I go here.
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Dr. Doug Lucas: So that's a pretty big dose. She's right, though, that in p thyroid the desiccated thyroids may have too much T. 3 for people that have no thyroid at all.
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Dr. Doug Lucas: And so then you have to do either t, 4 only, or t, 3 t, 4 combo, and it's really tricky.
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Dr. Doug Lucas: So that's just it's something that we really have to play with, and there's a lot of trial and error associated with that. It could be a challenge. But the goal there for me is just to keep
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Dr. Doug Lucas: the replacement as low as possible, to improve all the lifestyle things, to help the thyroid function as well as possible. If you have a thyroid
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Dr. Doug Lucas: that makes sense.
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Dr. Doug Lucas: so there was a previous QA. This is a question from Angela in the chat where I mentioned rice, and I mentioned a brand that I liked.
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Dr. Doug Lucas: and, Angela, I can't remember off the top of my head, either. My dietitians tell me that organic rice from California has the lowest potential contamination. And I don't have a brand off the top of my head I'm currently using
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Dr. Doug Lucas: because I don't have a lot of time for a food prep. I'm currently using a brand from whole foods which is prepared and frozen, which is kinda lazy rice preparation.
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but you can make it in 2 min.
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Dr. Doug Lucas: So that's I think it's the 3 65 organic rice at whole foods. If that's something you want to consider.
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Dr. Doug Lucas: Janina, says Lundberg, I've seen that. Yep, I think we have that in our pantry. Lundberg is in the chat there.
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Dr. Doug Lucas: It's another option.
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Dr. Doug Lucas: Thanks, Janina.
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Dr. Doug Lucas: these are fun topics.
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Dr. Doug Lucas: So Jan asked about red light therapy. Is there any evidence behind the claims of red light therapy and phone health? I looked into this I couldn't find anything directly
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Dr. Doug Lucas: for bone health. I was all ready to make a video on this, and then there was just nothing to talk about. I think red light therapy has some interesting.
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Dr. Doug Lucas: some interesting mechanisms behind it. There's some science behind it, but not as much as you might think. Actually because of, they're really popular. So I have a small red light. I've thought about investing in a bigger red light panel. But II kind of I don't know. There's just not enough evidence for me to to put that kind of money into it. I think it looks cool, feels good. I feel better when I use it. So maybe that's all that I need. I don't know.
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Dr. Doug Lucas: It's kind of an expensive placebo, if that's what it is. So nothing specifically for bone health that I know of. Similarly, Lorna asked about cold therapy. So
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Dr. Doug Lucas: yeah, good. Great question, Laura. So basically, she's saying, this is, it's stress which is true. Is that gonna be worse for the bones or better for the bones? I've never seen any specific. And I dig. I did dig into this. I've never seen any specific
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Dr. Doug Lucas: studies on cold therapy and bone health. But what I will say is in the video I did on cold therapy on the Doctor Duck Show. We really went into a lot of the evidence behind the potential benefits. A lot of them are are mental. So psychiatric because of the change in the
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Dr. Doug Lucas: neurotransmitters. Excuse me
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so. There is some resolution of symptoms of depression, of anxiety.
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Dr. Doug Lucas: I think that's really compelling changes. Your kind of dopamine pathway. So I think it could probably potentially help with things like addiction. And that kind of stuff, too, which is pretty cool. I like it, cause it helps very clearly with recovery. So as as somebody who's trying to train harder do more volume, you know, feeling the impacts of old injuries, etc. I feel much, much better after I'm in a cold plunge, so that 3 min I do every morning every weekday morning.
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Dr. Doug Lucas: I really feel better when I do it. So I'm I'm very I love having that in my morning routine. Is it specifically gonna impact my bones? I don't know. Probably not in any appreciable way. I her question was, is it similar to fasting where the stress is going to be a negative? I don't think this is the same thing. My issue with fasting isn't necessarily because of the stress associated with it. It's because of the nutrient deficiencies that could potentially come from it.
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Dr. Doug Lucas: It's a great question, though. I like a cold plunge.
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Dr. Doug Lucas: but I'm a little crazy.
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Lorna Nichols: I did. I did cold therapy for at least a year. For one month. I did
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Lorna Nichols: cold showers in the morning, and icebath in the evening.
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Lorna Nichols: and I never felt better in my life.
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Lorna Nichols: And over time the the positives started to wane a little bit.
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Lorna Nichols: and that's when II backed off. And that's what made me think I was stressing my body too much. But
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Lorna Nichols: That could have been, for who knows? You know.
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Dr. Doug Lucas: Yeah, I think it depends on what other stressors you have. And so for me if I'm using it as a tool to help improve recovering.
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Dr. Doug Lucas: You know I'm always stressing my body through exercise and through training, so I don't know that that would go away. I could definitely see some of the other things, cause you can accommodate anything right?
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Dr. Doug Lucas: so for me, the mental
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Dr. Doug Lucas: headspace that I get around. But you know, getting in that thing first thing in the morning is a. It's a head game totally.
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Dr. Doug Lucas: And so
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Dr. Doug Lucas: if I can do that in the morning. I'm pretty confident that there really isn't anything that I can't get through during the day, so I really like that component of it for me. Would that fade over time? I don't know.
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Dr. Doug Lucas: It's pretty powerful, so I like it. And 2 things there, too. I wanted to mention.
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Dr. Doug Lucas: So cold shower is is probably as effective or nearly as effective as having a fancy cold plunge. So people feel like, Oh, I don't have the tools. I don't have the resources, and whatever cold shower is pretty much available to everybody, unless you live in a really warm climate. So cold shower probably would have this a similar impact.
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Dr. Doug Lucas: yeah, and Don put in a link to the wim hof method. So wim hop is
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Dr. Doug Lucas: It's called a cold therapy guru, and you can learn a lot about cold therapy on his website.
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Dr. Doug Lucas: And it's pretty cool stuff. Oh, and the other thing. So for me, doing cold plunge in the evening would would be too stimulating, so that would impact my sleep if I did it. Probably within an hour or 2 of sleep, so I would recommend doing it earlier in the day again. I like doing it in the morning, but that's a little bit intense.
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Dr. Doug Lucas: so it's just different timing there.
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Dr. Doug Lucas: Susan just dropped a a question in here.
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Dr. Doug Lucas: And this is one I might not be able to answer Susan, but let's go through it. So Susan says. She has a 0 calcium score. So for those who don't know what that means calcium score is a coronary artery calcium score. That's a heart imaging test that can be done in a Ct scanner low radiation. Ct. Tells us about calcium formation in the coronary arteries, which are the arteries that give blood to the heart.
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Dr. Doug Lucas: So then, she goes on to say, you asked me to send my blood test for the session to go over. I think there's a lot of interest for everyone. I was late sending them, and just spoke with Christie and sent them to her.
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Dr. Doug Lucas: Christy and our team. Susan.
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Dr. Doug Lucas: she says, even with a 0 coronary calcium score the carotid ultrasound, says I have some plaque. We'll talk about that when taking Hrt. Later in life, Dr. Davis, a guin on Youtube, and who prescribes each. He says that once there is plaque.
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Dr. Doug Lucas: and her experience always gets worse. Well, plaque always gets worse anyway. But okay, let's just stop there. Talk about those things. So so a carotid ultrasound. So what that looks at? If your your carotid arteries are in your neck, you can use an ultrasound. You can get a sense of the
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Dr. Doug Lucas: amount of plaque in the carotid arteries.
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Dr. Doug Lucas: Those arteries are unique because of the way the the blood essentially comes out of the heart, and it goes through the aortic arch, and then it it pushes up into the carotid, and it's a very high pressure area. And so there is a split in the carat, and it goes into 2 different arteries, internal and external.
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Dr. Doug Lucas: something. That split because there's turbulence there at that split. It is an area where it is likely to build up plaque. So we look at. I don't. I don't. But doctors will look at this as an area of concern of alright. How much plaque are you building up?
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Dr. Doug Lucas: It does correlate with coronary, artery, calcium, and plaque, and it's easy to look at with an ultrasound. So there's value in that test.
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Dr. Doug Lucas: But the difference between the 2 is that if you're looking at coronary artery calcium.
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Dr. Doug Lucas: the calcium is going to be plaque that has been built up over time, and then calcified that calcification is the healing of the plaque.
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Dr. Doug Lucas: whereas the plaque in your carotid arteries isn't necessarily calcified, although it could be but that same soft plaque, as it's called, is also going to be present in your coronary arteries, and this is where using a tool like a Ct angiogram with a secondary add-on, a software add-on called clearly, which is really cool stuff, but more expensive. With more radiation. You can look at the soft plaque formation in the and sorry in the coronary arteries as well through that pathway. But obviously it's harder to do
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Dr. Doug Lucas: so. They do go together. I don't know. Gosh!
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Dr. Doug Lucas: The likelihood saying like. So this doctor is saying that if there's any plaque that HRT. Is going to make it worse. I don't think there's any evidence of that.
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Dr. Doug Lucas: Also, I don't know that I've ever seen, and this is what this is. What we see with clearly
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Dr. Doug Lucas: in the coronary arteries is that even if you were to do that study on like a 20 year old there would be some plaque.
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Dr. Doug Lucas: So I don't think it's fair to say that you have to have a 0 plaque
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Dr. Doug Lucas: to start. HRTI think that's too low of a bar. I think that would eliminate too many people.
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Dr. Doug Lucas: And then the the follow up to that is, while everybody
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Dr. Doug Lucas: everybody on Hrt gets their plaque gets worse.
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Dr. Doug Lucas: But everybody's plaque gets worse. That's the nature of the disease. We can't ignore that. That's why we have to have this conversation over and over and over again around cholesterol. And how important it is because plaque will develop if we live long enough.
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Dr. Doug Lucas: Right? It's like prostate cancer and men. It seems like it will develop in all men if we live long enough.
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Dr. Doug Lucas: So then she goes on to same. No testing for Apo. B. So I can explain what that means should be reading that it can be dangerous with 0 calcium scores.
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Dr. Doug Lucas: and then
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Dr. Doug Lucas: it gives some numbers around the Cor. The carotid!
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Dr. Doug Lucas: And then she's 71, went on Hrt. For brain fog, which is completely gone.
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Dr. Doug Lucas: Do I think it's safe for you to continue? I love that question
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so lots of great information there, and so my summary of that is, she has some, probably mild. I don't know where the threshold of Moderate is, but probably mild stenosis in the carotid. She has some disease.
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Dr. Doug Lucas: There's been no testing for apob, but she has a 0 coronary calcium score, so is it safe? There's no way to safely answer that question or accurately answer that question. Right? So so we can. We can say you're lower risk. And I think if you have a 0 cock.
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Dr. Doug Lucas: you're probably lower risk just by saying that. But what I would wanna do is actually look at your I'd wanna do it clearly, which is a again that more extensive CT. Angiogram of the heart would tell us how much disease you have from a soft flak perspective at 71. I'm assuming. If you went through menopause, you know, probably around 20 years earlier, and you're just starting it. Now.
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Dr. Doug Lucas: you know you're in that group. That is, it's concerning right. You're 20 years out. There is risk with that. I'd probably want to know more before I said. It's it's reasonably safe to continue. I can never say it's totally safe to continue
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Dr. Doug Lucas: any questions on that. That's a really
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Dr. Doug Lucas: really complex topic.
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Susan Jaye: Doctor Lucas, I've been watching the Prev. Med. That guy Ford Brewer.
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Susan Jaye: He does a lot of heart very heart. He mentions that having a low coronary calcium score isn't necessarily
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Susan Jaye: great.
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Susan Jaye: He's saying that if you have a higher score sometimes it's better not, and the lower one could be more dangerous.
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Dr. Doug Lucas: yeah, it's it's true. So this is why a coronary calcium score is not a perfect test.
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Dr. Doug Lucas: I would argue. It's a good test. I wouldn't even call it a great test.
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Dr. Doug Lucas: but it's it's cheap. It's easy, and it gives us some idea. I think it's more. It's a more valuable test if it comes back positive meaning nonzero.
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Dr. Doug Lucas: And the reason for that is. if it comes back non-zero and you have some calcification, then we know that you have some element of disease that's been there for decades.
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Dr. Doug Lucas: and if you're 70 and you're thinking about going on. Hrt, I would say, maybe let's start on Progesterone and testosterone, and leave estrogen alone.
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Dr. Doug Lucas: or consider getting the Ccta.
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Dr. Doug Lucas: If you get the Ccta, you get the full picture. But here's the problem with a 0 cac.
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Dr. Doug Lucas: If you have a 0 corn artery calcium score, you don't know what kind of soft plaque you have. You might have unstable soft plaque. And again, that calcification is part of the healing process. So if you have a significant burden of unstable soft plaque without healing. Then, yeah, you are at higher risk. And this is why we see lots of reports, maybe not lots, but there are reports of, you know, the 50 year old runner who gets a 0 cack, and he goes out and runs a marathon and dies of a heart attack.
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Dr. Doug Lucas: I mean that that happens
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Dr. Doug Lucas: so. That's why there are some providers like, if you ever listen to Peter Atia.
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Dr. Doug Lucas: He was a big longevity heart, Guy, he gets a ccta that more extensive test on all of his patients.
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Dr. Doug Lucas: I struggle with that because again, it's expensive. It's kind of a pain to get. There's iv contrast and I don't know that we always need it. I'd love to have it, but I don't know that I could ask everybody to get it.
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Dr. Doug Lucas: That makes sense the A POB. Blood test.
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Susan Jaye: I noticed that. You know you have to request that they don't put. They don't do that voluntarily on your blood test. Not in my program, Susan.
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Susan Jaye: Well, I believe that.
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Susan Jaye: But but the question is, even if you get that test? Is that, no comparison to the clearly that you're mentioning?
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Dr. Doug Lucas: It's not going to give you the same data. No, apob is really just a surrogate marker for Ldl cholesterol particles
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Dr. Doug Lucas: or Ldl particles. And I let me just run through that cause. This is a good point. So when we talk about cholesterol, everybody. That's not true. Most people are talking about cholesterol itself, the actual molecule that is made in every cell in your body, but there's more of it made in the liver. So your body moves it around right.
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Dr. Doug Lucas: It's moved around in these things called particles. The particles are the things that are actually atherogenic meaning that can cause plaque.
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Dr. Doug Lucas: It's not the Ldl cholesterol itself, the quote unquote, bad cholesterol. It's the particles that can be troublesome. So really we don't want to know as much about the cholesterol as we do with particles. Apob is a protein that lives on the surface of all Ldl. Containing particles, so it tells us more about cholesterol than does cholesterol itself. But it doesn't tell us anything about plaque.
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Dr. Doug Lucas: You could have super high Apo. B. And have no plaque, and the opposite could be true as well.
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Dr. Doug Lucas: But it does tell us more about risk than does Ldl cholesterol itself. So it's still a better biomarker. But it doesn't substitute for imaging
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Susan Jaye: and when you say, take you can take progesterone and testosterone. And leave out the estrogen. In my case I have brain fog very bad. So if I was to stop the estrogen, wouldn't that bring back the brain fog
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Susan Jaye: question is, does the brain fog from the estrogen deficiency or from the testosterone deficiency. And since we know that testosterone deficiency
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Dr. Doug Lucas: is associated with brain fog in men and probably in women. I you could try.
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Dr. Doug Lucas: I see. Wow, okay, wow! Because I was reading an article about estrogen metabolites. And, boy, it was scary
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Dr. Doug Lucas: that really scary. Well.
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Dr. Doug Lucas: remember that you've had them your whole life
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Susan Jaye: so they shouldn't be that scary. Oh, when I was reading about the breast cancer and this and that blah blah blah! It's like really complicated
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Dr. Doug Lucas: it is. That's why it's not just that simple right? And so you can add estrogen. You can do the imaging you can risk, stratify and then you can do a urine metabolite test, and you can look and see what your metabolites look like, and then you can add potentially supplementation or lifestyle things. It'll shift you from 4 hydroxy to 2 hydroxy or 16 hydroxy.
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Dr. Doug Lucas: All those things are
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Dr. Doug Lucas: all those things are possible, right? But none of that stuff's being done by most providers.
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Dr. Doug Lucas: Yeah, it's it's cool stuff.
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Dr. Doug Lucas: Couple other quick questions before we got to go.
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Let's see here. So Lorna was asking about lumber kinase. And can that help with plaque?
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Dr. Doug Lucas: I don't think it changes plaque, and I don't. A a cardiologist or interventional cardiologist might know this better. I don't think it changes plaque development, Lorna, but I do think it changes the capacity for your body to clot right? That's why you that's why you take it.
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Dr. Doug Lucas: there's a couple of products that we recommend that have lumber kinase in it. And I, if people have high fibrinogen levels, and it's a measure kind of of the the stickiness of your blood. Then I like that for people. It's sort of like a safer version of taking a daily aspirin.
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Dr. Doug Lucas: But I don't think it's gonna change plaque formation. It's just gonna change the potential to develop a plot a plot. and then, Lorna, you also asked about Canberra and Lower Apo. B.
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Dr. Doug Lucas: I wanna say, the answer to that is, yes, probably not a lot.
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Dr. Doug Lucas: The challenge with burbering is that it can be. It can have a negative impact on gut health. And so our coaches and dieticians don't like us to use Burberry long term.
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Dr. Doug Lucas: which is what was new to me when they showed me those data. But it is real, it is. It's an antibiotic, natural, antibiotic
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Dr. Doug Lucas: Doctor Lucas? What about Sun Flower? Less a thing. What do you think about that?
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Dr. Doug Lucas: So I think there's some role in it. What do you? What, specifically or is your interest is in cholesterol?
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Susan Jaye: I yeah, I think so. I went to a whole foods. There's a guy there. He's unreal. And he told me about some flour less a thin. and he said that he it's good for your I think the plaque not developing it, or something.
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Susan Jaye: I don't know, he said. He does it every day, and
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Susan Jaye: said something about A. PO.
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Susan Jaye: The A. POI think it was not the B
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Dr. Doug Lucas: help you little? A
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Dr. Doug Lucas: Umhm, yeah. Little a one. Yeah. I've not seen data on sunflower less of thin. Easy for me to say and lp, little a.
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Dr. Doug Lucas: The thing about that is, LP. Little. A. So for those that aren't familiar with that term LP. Little a. Is another protein that lives on the surface of Ldl containing particles.
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Dr. Doug Lucas: If you have it, it's a genetic risk factor for increased risk of developing plaque and disease.
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Dr. Doug Lucas: So we want lp, I'd love to see lp, little. A. Be low, but it doesn't matter if we can change it or not. If we can increase it or decrease it by 1020%, or whatever it doesn't actually change events. And this has been studied.
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Dr. Doug Lucas: but not a lot. But some. So things like niacin, for example, can reduce Lp little. A. But it doesn't seem to change events.
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Dr. Doug Lucas: So I think lp, little a. Is one of those things that you have it or you don't, and you don't want it. But if you have it you can't change it. And so you just have to accept, you have higher risk if you have it. So I wouldn't lean on something like sunflower or less within, or really anything that lowers. Lp, little delay. It's gonna have an impact on on plaque development and events.
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It might lower cholesterol. There's a lot of things that lower cholesterol. And I question if any of those really have significant benefit
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Dr. Doug Lucas: all the way down to statins. And what is the real benefit of statins for those that take em.
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Dr. Doug Lucas: That's a conversation for another day.
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Susan Jaye: Yeah.
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Susan Jaye: wow, so interesting.
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Dr. Doug Lucas: Yeah. it's a really interesting space. Alrighty. Well, I have a meeting right at 10. So let's talk about next week. So next week we're at the same time, and I think we're at the same time consistently now for a few weeks.
