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Jo Ann Hardig: yeah. I know. But I think I don't know. I'd have to look at the list. But II wanna say, that's probably and so for those that are just joining us. The the question was, is, is alcohol something that we should not have before we do a tool test for for got function. And I don't remember the answer to that. But I'm thinking the answer is, Yes, but it should say it on their website, too.

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Dr Doug: Yeah, they and I don't know they might. Alcohol is one of those funny things that some people just like to not talk about

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like. It's okay. Don't worry about it.

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Dr Doug:  alright. Well, good morning, and Happy New year, everybody as we roll into the hour. Nice to see some familiar faces, some new faces Lorna. Nice to see you.

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Dr Doug:  alright. Well, I'm glad my watch reminded me that we were doing this today at 9 Am. Cause I was upstairs playing a game with some kids, so I'm glad I got. I'm glad I got spurred to run down to my office. So you get maybe in my my holiday casual of attire.

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Dr Doug: But I've got all the questions that we have, and we have more questions than we have time to go through. But before we do that I'd love to hear, and I'm happy to volunteer mine as well. I don't like the idea of New Year's resolutions, but I like the idea of doing vision work at the beginning of the year. Has anybody done any any compelling work either last night or today already? That they wanna share with the group for a vision for 2024.

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Dr Doug: No. One. I'll share mine. I haven't actually done the full work on this yet. I did some work with the kids last night, and one of the things I love to do with them cause mine are 11, 9, and 4. We did not include the four-year-old in this, but the 11, and to be 10 year old this next week. We included them this year in visioning for work what they wanna do as a family. So travel.

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Dr Doug: and it's fun to hear their ideas of what they want to do. It's just totally different than my ideas of what we should do as a family. So that was kind of a fun exercise to go through.

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Dr Doug: Personally, I'm gonna go through an exercise with a group that I'm a part of on Friday. So we have a half day, and we'll go through

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Dr Doug: the whole like I'll look at, you know, a vision for the business in 2,024, which we've kind of already done with the leadership team. But then, personally, things that I want to really focus on this year, and I think it's relevant. If you're gonna do this yourself, relevant to think about this, not as a New Year's resolution, because we know that New Year's resolutions fail.

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Dr Doug: Almost 100% of the time, but just a vision to keep track of. And I have last year's vision on my whiteboard. It's out of camera shot intentionally, but things to look at from a personal perspective, things that you wanna really focus on so that you can grow those things. And I know for me. One of the big things is gonna be a meditation practice, something that I talk a lot about. And I tell people to do.

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Dr Doug: But I just schedule over it almost every day, something that I really need to do for myself and for those around me, cause it has a significant impact on how I treat others. So that's gonna be one big thing for me. Anybody else want to share one big thing for them that they wanna focus on this year.

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Dr Doug: It's okay. If the answer is No.

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Dr Doug: alright, you're here to learn not to share. That's okay. Alright, I'll just dig into the questions unless anybody has a compelling question they want to ask out of the gate.

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Kitt Lurie: I do have a question that I did submit, and it is compelling, because I'm meeting with my new primary doctor this week. I'm just moved to a new state and just started Medicare. So I do have a question.

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Dr Doug: is in my name, Kit Lori. So II get yeah, I've got. I've got your question here, but go ahead and ask, live, and I'll I'll read this as you're asking it.

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Kitt Lurie: Okay? Basically, I'm just wanting to know how to prioritize what I'm gonna try to talk to my new primary physician about as far as you know, I wanna get baseline. I wanna figure out how to move forward with my bone health, and everything I've been learning about. And I

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Kitt Lurie: you know II haven't met this doctor A and you know, it's mainstream medicine. B, so I just feel like I need to really prioritize, and I know I'm I have Dexa.

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Kitt Lurie: actually, it's not scheduled yet. II will get that scheduled. It's been over 2 years now? But you know, and I know the pros and cons of that from what I've been learning. But what else should I really prioritize in this first meeting. And

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Dr Doug: yeah, so great question. And one of the things that's really challenging in the traditional medical model is just feeling out your doctor, and how open. They are to your input

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Dr Doug: doctors. I try not to talk about about doctors in the traditional medical system, but they're under a lot of pressure time pressure financial pressure sometimes.

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Dr Doug: and they don't necessarily want to hear from their patients, which is a challenge. And if that's the case, then then you really have. You have no leg to stand on, no pun intended. So feel that out and and ask them just up front, hey? I'm really concerned about my bone health. And I have some things that I've been researching on my own. And I would like to get your input and your support, you know, and just directly. Ask them, say I need. I want your support and see what they say.

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Dr Doug: And if they say absolutely love to hear it, then you know, then see how far you can go. I think the prioritizing of probably labs to see if they're open to running labs through insurance or Medicare would be great. You run the risk of Medicare or secondary insurance, not paying for them. So there's a little bit of a risk there. But I think the bone turnover markers are so valuable so that Ctx and Np.

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Dr Doug: Because you can get a sense of what's happening in real time in between imaging studies and watch the video. I think we just put it out on the ratio between the 2. So and I'm happy to, I'll just. I'll mention that here for everybody but the the and P. Over C. Tx,

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Dr Doug: times that

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Dr Doug: divided by a thousand. So move the decimal point over so that it's like a 2 digit number over Point something, and and we are finding pretty consistently that that is telling of what's happening.

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Dr Doug: Because we know, like you just said for Dexa. There's

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Dr Doug: there's, you know, there's so much variability between imaging centers and machines, and with the position that you're in. So even, you know, year to year or every other year. It's still not a great imaging modality for bone density. But if you're following your bone turnover markers, then

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Dr Doug: you can get a better sense of if what you're doing is working. So I think I would definitely prioritize those.

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Dr Doug: If you haven't gone down the rabbit hole of making sure that you don't have a secondary cause of osteoporosis like looking at parathyroid numbers.

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Dr Doug: I don't like the urinary serum calcium markers, cause I don't think they're helpful. But really, parathyros gonna be one of the biggest. And then making sure that your gut is functioning. Well, so we were talking earlier about doing gut function testing. Now, that's something that your primary Co primary doctor is probably not gonna order, but something that could be done either on your own or th through through some kind of functional testing.

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Dr Doug: Okay, okay, that all sounds good. Yeah. Yeah. And then,

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Dr Doug: I, depending on your, you know, your interest and capacity, talking to see what what their interest is in hormone replacement. If that's something that you're open to.

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Kitt Lurie: Yeah, yeah, which I I'm thinking also looking into more my cardiovascular health and status at this point, which I don't know if they'll also be resistant to.

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Dr Doug: Yeah. So thanks for bringing that up. So then, if you know, if you are in that, in that group of of women that we need to ask the question of cardiovascular status before we start hormone replacement, seeing if they're open to doing a coronary artery calcium score. And I need to update a video on this. But are they open to doing a coronary artery, calcium score, or potentially even a ccta. In looking at your arteries to get a sense of, can we?

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Dr Doug: How how safe is it? And of course it's a gray area. We don't really know the answer. But we can get a sense of how significant of a disease do you have, because we all have some. But how significant is yours? And is it doesn't make sense to start estrogen that late in the game, or consider some other forms of of form on replacement like testosterone. If they're open to it, they're probably not. But even Progesterone, which is pretty darn safe and still has benefit.

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Kitt Lurie: Okay, alright great. Thank you. Yeah. Of course.

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Dr Doug: I'm just gonna run down the list here unless anybody ask a question that is here.

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Dr Doug: I know, Laura, I've got yours, so we'll ask those.

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Dr Doug: a quick question from Robin Codon. She is a patient who is. She's been with us for a little over a year now, and she has a great story that I'm happy to tell, but I don't know if she wants me to. So her question, though, is, she's struggling to find a non toxic dairy, free organic milk with lots of calcium

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Dr Doug: dairy, free organic milk. Yes.

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Dr Doug: okay, it's quick and easy way to get more calcium through food, but every brand seems to have at least one or more issues. Do you have any recommendations? So I. This is a great question, because I see this a lot where people want to find dairy that's not dairy.

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Dr Doug: and get all the benefit of dairy without consuming dairy, and the thing is is, I just don't think it's possible, because when you start highly processing things, you're gonna end up with stuff in there that you don't want, like the gums and the preservatives, and the this and the that.

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Dr Doug: And so, if you can't tolerate dairy, I think, just avoid dairy. Now, I consume, and I have patients do this for smoothies or protein shakes to use nut milks so like almond milk.

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Dr Doug: not because I like the calcium or other nutrient content. I actually just sort of ignore the nutrient content in it. I just use it as a base for a smoothie, because it's better than water making a protein smoothie with water is just terrible.

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Dr Doug: And so II recommend just using as as clean of an organic almond milk as you can as a substitute, but don't consider it a substitute from milk. I think milk has, especially if you can get raw milk, if that's available in your state, and you can get it from a great source. We have a company that we use. I'll mention in a second, but if you can get good quality dairy that you can tolerate.

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Dr Doug: then that's going to be a totally different thing than any kind of substitute.

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Dr Doug: If that makes sense. The company that I wanted to mention. We don't have an affiliation with them, but Miller's organic like Miller, like a miller, Miller is organic. If you look them up, they ship. I don't know how far nationwide. But they're in New York. They're in Amish country and up in somewhere in New York, and they ship to a lot of different areas, and they ship to Asheville. And so we can get raw dairy from them every other week.

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Dr Doug: And so we've started doing that. And I've

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Dr Doug: continue to do more research on raw dairy, and it really impressed that the the proteins and growth factors that are in raw dairy, if you want to build muscle and bone and work on immunity, and you can tolerate the lactose and the casing. I think it's a pretty cool thing. I find a lot of people, too, that can't tolerate conventional dairy can actually tolerate raw dairy because it's coming in its whole form, and our body knows more what to do with it. It's still unnatural, so don't be confused. We're not baby cows.

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but I think it is a tool that a lot of people can use

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Kitt Lurie: so that helps. Can I? Add something in I've been making almond milk myself, and it's really pretty darn easy kind of a mess. But you know, takes a couple of minutes. And anyhow. So it's just, you know, almonds and filtered water. So

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Kitt Lurie: it's workable.

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Dr Doug: Yeah, that's interesting. How many almonds does it take to make like a half gallon of almond milk?

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Kitt Lurie: Well, the recipe! I uses one cup of raw almonds to 5 cups of water. and then II

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Kitt Lurie: soaked that overnight. Then I put in my blender, and I put it through a cheese cloth in a sieve, and let it drain. Squish up the liquid as much as possible, and then I use that almond pulp for a variety of things. And that makes 5 cups of almond milk.

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Kitt Lurie: which

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Kitt Lurie: I've done the math in terms of how much it costs. It's it's probably like about 2 60 a half gallon. So

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Dr Doug: okay, it's competitive. Right? Yeah, yeah, well, that's interesting. Yeah. I struggle with almond milk, too, because I know that from a environmental perspective almond growing is is a challenge, you know. And it's it's such a waters, a water suck in the Central California area. So I don't know there's no, there's no perfect answer. But I do I, don't we? I probably consume I don't know. Maybe a cup cup and a half like every other day.

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Dr Doug: I'm trying to get my protein through whole food sources rather than through a smoothie  but thanks for that

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Dr Doug: alright so the next question is from an and asks about really having a lot of issues with bloating, taking things like gas. X doesn't seem to help

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Dr Doug: any other suggestions. So whenever I hear somebody complaining of bloating, and we ask this in our intake because it's really common. But when people start having bloating, especially immediately after eating or within that hour after eating, I worry about bacterial overgrowth. So if you guys have heard of Sibo, small intestinal, bacterial overgrowth, it is pretty common, and comes sort of in a spectrum of severity.

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Dr Doug: so I would recommend a test, not necessarily for Sibo, because the testing for Sibo is kind of challenging to do. It's like you have to blow, you know. Blow into this thing, and they measure the amount of methane. But you can test that, or you can test just gut function and get a sense of somebody has Sibo, or just treat it, and the treatment for Sibo is, can be variable, depending on what kind of sibo you have which you would have to test to know. But essentially it's fighting back the bacteria

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Dr Doug: that have made their way until you're a small intestine. And they're fermenting food before they're supposed to. And so it's pretty common if you're getting bloating really pain in the upper part of your stomach within that 30 to 60 min window after eating, that's likely from bacterial overgrowth, and the traditional medical model is to throw antibiotics at it which works. But then it often comes back. You can treat it naturally with natural antibiotics.

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Dr Doug: somebody who really knows what they're doing from a gut health perspective. But that's what I would worry about in that place.

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Dr Doug:  And then there's a whole dietary component to that, too. The low fob map diet is a good way to kind of diagnose this. So fob map is fodmap. If you go on a low fob map diet, and it makes it better. And that means that probably the bacteria that are in your small intestine are fermenting the things that are not in the low fob map diet, which would be things that you would need to eat otherwise. So

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Dr Doug: I would either

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Dr Doug: to summarize that either get tested. Use a low fob map diet to see if it gets better, and then, if it does get better than you need to get treated either way and get rid of that overgrowth.

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Dr Doug: Many questions about Sibo

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Dr Doug: is why I have a team of 5 dieticians that treat Siva

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Dr Doug: so I don't have to. Yes, ma'am, I learned it.

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Lorna Nichols: I had a gi test, and it showed Sibo.

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Lorna Nichols: and

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Lorna Nichols: but I haven't gotten

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Lorna Nichols: I got.

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Lorna Nichols: I haven't worked with you all yet too much on it. But I but I had some functional people that did the test on my own that tried to. I've had several people look at the test results and tell me different things. Yeah.

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Lorna Nichols: And so I feel like, I'm sort of all over the place.

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Lorna Nichols:  and

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Lorna Nichols: so there's probiotics.

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Lorna Nichols: There's colostrum. umhm.

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Lorna Nichols: lactoferrin. Do those things ring a bell is things that are helpful.

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Dr Doug: Yeah? Well, it's funny. So colostrum and lactoferrin are Lactoferrin is a dairy protein that's in raw milk that's not in conventional milk because it gets pasteurized out.

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Dr Doug: It is also the part, I think, that has the most impact on bone from dairy if you're consuming raw dairy. So the funny thing about Sibo and gut health is that there are

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Dr Doug: an unlimited number of ways that you could potentially treat it. And this is why the gut health and the functional medicine space is so challenging because you can go to 15 providers, and you will get 15, probably very different protocols.

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Dr Doug: There is an overarching way to treat overgrowth, and that is that you? So there's this thing called the 4 R. It's funny, not my 4 R. Method, but the fourr Gut health program through the functional medicine. I think this came from Ifm, maybe, but it's been around for a long time, and the whole principle is, let's see if I can come up with all 4 Rs. You have to remove the offending agent, and so remove

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could be either it could be bacteria if it is true, or it could be something that's bothering your gut, so something that you're intolerant to, but removing

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Dr Doug: removing whatever it is, and then you need to

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let me see if I can come up with this remove.

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Lorna Nichols: I get confused between that one and my own. So store has to be one of them.

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Dr Doug: Well, and there's also a 5 R version.

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Dr Doug: and there's a couple different ways to say, restore, remove, replace, repopulate.

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Dr Doug:  I'm not going to come up with it, but anyway, it's something like, remove, replace whatever is missing, and then you have to repopulate your small bacteria

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in your gut, and that would be the probiotics.

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Dr Doug: So the overarching thing, then, is to remove whatever it is you have to repair or repair as the other one repair.

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Dr Doug: You have to repair the gut. Say you have to repair the gut lining, and then you have to replace what you're missing and then repopulate the microbiome. I think that's the 4 Rs. In some manner.

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Dr Doug: So then.

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Dr Doug: working with somebody who can help you do that, then the number of different products that you could potentially use is vast.

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Dr Doug: We like to use to remove the bad bacteria. We like to use the the stool, study the Gi effects, and the other Gi map will do it as well, but they'll actually show you the bacteria that are in your gut that appear to be pathogenic and what they're sensitive to. So it's almost like looking at. I'm not actually tell you this, too. But what antibiotics would be effective. You can also look at what natural antibacterials

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Dr Doug: would also be effective. And then you can do a course of those things, plus or minus antibiotics to help knock them back. But then you have to also, in conjunction with that repair the gut lining. And so that's gonna be some of the things that you mentioned. I wouldn't use lactoferrin specifically. Some of the more common things would be like L. Glutamine. L. Glutamine is very healing to the gut lining. I really like immunoglobulins, so lactofer

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Dr Doug: and I don't think is actually an immunoglobulin. But there they generally would come together in in raw dairy. But immunoglobulins can come as a separate product as well, and those are very healing to the gut lining. And then once you have the gut lining healed, then you're gonna need to go in the process of repopulating your microbiome cause you are, gonna have a negative impact to the microbiome. And that's gonna be a good probiotic.

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Dr Doug: and there are a lot of different versions out there.

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Lorna Nichols: Does that make sense? Yeah, luckily, I have. Ro, I am drinking raw milk. I have a local farmer that I'm getting up from. So I'm very lucky there. Yeah, beautiful.

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Lorna Nichols: I really need to get on top of this because

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Lorna Nichols: I guess I need to figure out

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Lorna Nichols: the maybe the the test that you talk about Gi effects that I need to do to find out something more specific. Because this is

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Lorna Nichols: I'm getting nowhere. And and related question is, I'm making a smoothie with prunes in it every morning, and I'm wondering is the sweetness and the carbohydrate of the prunes aggravating this?

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Lorna Nichols: Could even the milk sugar be aggravating it? I don't you know how the milk sugar shouldn't be so dairy raw dairy used to be a treatment for it.

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Dr Doug: Back when everybody had access to raw, dairy but prunes, maybe there's a there's a lot of digestible fiber and prunes. So if you have overgrowth, and I think that's possible. But again, this is something that our our team does all the time, and it is sometimes a back and forth cause it's not always a a once and done success story, because it's the gut is challenging and all there's so many inputs going into it. It's challenging.

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Dr Doug: okay, thank you. Yeah, yeah.

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Dr Doug:  So. And then, Lorna, I'll get to your questions in a second. Let me just answer this one. So Nancy asks.

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You've talked about a couple of tests we can use to track osteoporosis besides the Dexa scan. So I think we were talking about the

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Dr Doug: bone turnover markers earlier. She says my doctor runs a lot of tests because I'm on biodonical hormones, and I stumbled across the ntx ratio among them. It claims in the reports to track the probability of bone loss. Can you comment on this test?

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Dr Doug:  so she's referring to Ntx. And I talk about ctx. They're a very similar test. Ntx is the urine version, and I find that most people don't want to pee in a tube or a bucket when they do their labs. So we use Ctx. I think it's probably more accurate as well, because once you add in other organ systems. Then we, you know, there's more variables.

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Dr Doug: So I would use Ctx over ntx. And then also she's mentioning here that can this be affected by me taking hydrochlorathiaside, which is a dioratic, and I don't know how it would affect ntx. But again, you're

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Dr Doug: you're dealing with the kidneys. Hydrochlorthioside is a diuretic which is going to impact the kidney function. So maybe so I would just use Ctx and do it in blood.

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Dr Doug: Cut those things out.

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Dr Doug: Oh, Hi, Nancy, yes, that was your question.

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Nancy Mandowa: By the way, I have to applaud you for doing this, I mean, you could have just said it's New Year's. Just take it off. If you're gonna do this, people better show up. So I'm never usually up at this hour. The the Hyde side. I read somewhere on the Internet. II can't quote the source that that hydrochloric thighs I actually had

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Nancy Mandowa: for some strange reason, had a very slightly positive effect. I couldn't understand why.

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Nancy Mandowa: But I guess it's a protein that you're measuring in urine. And what happens when you change

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Dr Doug: the the kidney function as hydrochlorthioside does so I don't know. It would be very complex to understand the physiology behind that, which is why I try not to mess with kidneys if I can avoid it.

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Nancy Mandowa: So it's not as good as the yeah. I would just do it in blood, and I don't think it's any cheaper to do with your urine.

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Dr Doug: so I would just do ctx in blood. And that way, you know.

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Dr Doug: All right. So then, let's get into Lorna's question. So Lorna has a few that she put in here. The first one, Lorna I have is on hair loss. And so you noted that you've been losing hair for several years and now that you're on Hrt with testosterone, it's getting worse. Hair loss is a toughie. So we we talk about this a lot. And I'm actually writing a book on testosterone in women right now, because it's such an underserved and very confusing space. So I've looked into this quite a bit, and the answer is, I don't have a clear answer.

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Dr Doug: Testosterone and androgens can make hair loss worse.

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Dr Doug: But the tough thing about hair loss is that generally it doesn't happen quickly after any potential you know, quote unquote insults or change in anything. It is a trailing indicator by like months.

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Dr Doug: And so we know that. You know if you have a stressful event, you can lose hair, but you don't lose hair until 6 months later, and so I feel like with hair loss. We're always chasing our tail because we don't know why. Now, when we start, because we, you know, we'll we'll start women on testosterone and relatively high doses of Dha at the same time, and that can provoke hair loss.

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Dr Doug: And so but that does it pretty quickly. And so we know that if if a woman's gonna have an impact to that. Then we, the first thing we do is stop Dha, because it's more likely to have an impact than as the testosterone. Remember the testosterone. If you're getting it at physiologic doses.

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Dr Doug: and physiologic blood levels. If you weren't losing hair when you were younger, when you had adequate levels of testosterone. There's really no reason why you should be losing hair now.

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Dr Doug: And so I find that it's probably not the testosterone, but at high doses it certainly could be, or perhaps for some reason, when you're getting it from the outside, you're over converting to Dht. Or maybe your hair follicles are more sensitive now, so I think it's real so again, first thing we would do is stop. Dha, cause I'd rather people be on testosterone than dha, and then if you still feel like you're seeing it, or and well, at the same time, make sure your levels are not too high of testosterone.

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Dr Doug: But but as long as your levels are good. then you could consider blocking Dht a couple different ways to do that. So one would be using. This is like the the male

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Dr Doug: pattern thing is to use a dht blocker like soft palm meadow. And and this would look funny because you're you're gonna be essentially be looking at male prostate supplements, because they're all gonna say prostate health and prostate Max, and whatever cause they're marketed to men. But the reason why they do that is because the same thing happens in men with conversion of testosterone to Dht and prostate hypertrophy.

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Dr Doug: So you can use that same mechanism to block conversion in the hair follicles of testosterone or dht, I've never seen a woman a woman's specific product for that. Probably something I should make but I think that's an option. And then the other thing that we've been talking about within my provider group is using the drug spray and a lactone.

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Dr Doug: So Sperona Lactone is used particularly for men on testosterone that struggle with acne. And so this is something that you know, like I think about my own journey with this like, when I was a kid, I had pretty bad acne, and this was probably when I had. And I say, kid, like young adult. I had pretty bad acne, and I looking back on it. It was very androgenic appearing, you know, like. And so if I if I had taken Sprone a lactone back. Then I probably would have had

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Dr Doug: great skin when I started testosterone a couple of years ago. For myself, I started seeing not the same like not a lot of facial acne like when I was a kid, but more like body acne, and when I doubted my dosing, and II came down from my initial dose, cause I'm like a pretty rapid responder of it. It almost went away, but not quite. And so now I take a small dose of Spronal Lactone, and it helps Block that it hasn't done anything for my hair. But I think that's because of a different reason.

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Dr Doug: So I think Sprona Lactone is something that women could also leverage. These are all off label and clearly, we're in a gray area. But Sprona Lactone is actually a very. It's a very safe drug. I think that for even for myself, you know, dropping, it's a blood pressure drug. So dropping my blood pressure by a point or 2 is probably good from a health span perspective. I don't get any symptoms of that.

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Dr Doug: And then again, you're messing with your kidneys, which I'd prefer not to do. But the overall picture for me looks better with a small dose, and we're talking, you know, 100 milligrams is sort of like the the starting dose. If you were to treat it, use it to treat blood pressure, and we start at 25 milligrams so like a whiff of a dose.

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Dr Doug: and that seems to be all you need to impact to that conversion of Dht in the periphery, which is what you would see with hair follicles that make sense.

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Dr Doug: Yeah.

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Dr Doug: that's going in the book.

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Nancy Mandowa: Hmm!

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Dr Doug: It's my Q. One goal we have that buck, and then we have the Osteostrong. Folks want me to write a book with them.

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Dr Doug: basically the book that I wrote, but with their research in it

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Dr Doug: be fun to reach bigger people.

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Dr Doug: Alright, Lorna, your next question is that you've heard that too much. B 6 or lack of B 12 can cause tingling in the feet. Are you aware of any of other supplements that too much or too little can have this effect.

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Dr Doug: So yeah, so when I was practicing as an orthopedic surgeon, because footn ankle was my sub specialty. I saw neuropathy all the time. People would come in with with

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Dr Doug: pain in their feet, and we would diagnose them with neuropathy. And so they would have tingling. And and so often the question was, why.

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Dr Doug: now, most people that have early onset neuropathy or neuropathy without any other symptoms, so that not iodrogenic.

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Dr Doug: whatever it's called Monday morning.

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Dr Doug:  idio video traffic. There we go. So when people would have that, we would say, Well, you know. What could it possibly be for most people? It was probably because of early diabetes, and they just didn't know if they were impacting their nerves in their feet because they had high levels of insulin high levels of glucose. They weren't quite diabetic yet, but they were on their way. So I think that's the primary reason for most people, but

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Dr Doug: the nerves are also very sensitive to B. Vitamin dysfunction. And so B. 12 deficiencies certainly can do it. I've not heard that too much. B. 6,

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Dr Doug: especially in supplementation, could do it. But there is the the form of B. 6 that matters, and I can't remember the name of that off the top of my head. But there is

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Dr Doug: hold on, let me

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Dr Doug: let me find this in here

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Dr Doug: there is a synthetic form of B 6.

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Dr Doug: And then there's the natural form of B 6, and we we changed all of our products recently.

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Dr Doug: Let's see here.

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Dr Doug: yeah. So the there. What you usually will see is pyridoxing hydrochloride

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Dr Doug:  as the most common form of B 6. And and this is just synthetic. B vitamin. It's cheap and easy to make. The natural form is p. 5. P. So pyridoxal, 5. Phosphate. So make sure that when you're getting a B complex or a methylated B complex, and it has in it, and it'll say that not the Puritan hydroxy, chloride, or hydrochloride, or whatever

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Dr Doug: we are finding more and more that the synthetic versions of vitamins.

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Dr Doug: They're not well absorbed. They have negative impact that that we're just really kind of finding out. And so b vitamins are one of those things where we're trying to find the right combination of methylated forms, natural forms, you know, folite's the same thing like methyl tetrahydrofolate versus folic acid. Folic acid is not a naturally occurring thing. We should not be consuming it. And yet it's it's in every grain that you could possibly buy in the United States.

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Dr Doug: We don't need to consume folic acid. We need to consume real folate.

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Dr Doug: So this is a big challenge in the supplement space.

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Dr Doug: so I wouldn't say Lorna, that you're getting too much well, I shouldn't say that. Probably just getting the wrong form. Make sure you're getting the right form other things from a neuropathy perspective. I have a whole list. So let me just pull up my.

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Dr Doug: I had this whole protocol, and I thought I was really cool

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Dr Doug: because I was an orthopedic surgeon that had a natural protocol for neuropathy.

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Nancy Mandowa: Do do leg cramps fall into that awesome.

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Dr Doug: not really kind of a different deal. Lake cramps also kind of a challenging thing. But generally for me, lake cramps are, gonna be. We would start from a

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Dr Doug: an electrolyte perspective. Make sure that magnesium and potassium are repeated.

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Dr Doug: Make sure that things aren't going weird in the kidneys.

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Then there's a product that I still don't really know what to do with

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Dr Doug: by a company called Beam BEAM. And we actually should. I don't know if it's live yet or not cause. I I'm doing a podcast with the CEO of the company later this week. But beam makes a product out of these things called folic and humic acid. Which are these proteins that live deep in the earth and have these really interesting properties?

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Dr Doug: They supposedly will help people that have leg cramps, because essentially what they do is to take the vitamins and minerals that we're consuming and allow them better access in transport through our cells.

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Dr Doug: And so their products.

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Dr Doug: I've started using them. I have patients that are using them. But the challenge is that it doesn't replace anything. So it's another. It's another add-on product. It's like, let's just take another supplement, another liquid, another powder. And so I try not to do that to people. So I don't really know what to do with them yet. But if you're suffering from like Gramps, then something that you could check out, and again, it's b eam folvic and humic acid in.

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Dr Doug: I want to say that the product is

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Dr Doug: something boost.

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Dr Doug: That's interesting. Don't really know what to think of it yet. Here, I'm gonna look at the comments in Zoom. I'm sorry I'm look at the comments, the comments, the questions in the comments. Section in Zoom. Right after I finish this on neuropathy. So Lorna, some other things on neuropathy.

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Dr Doug: There is some evidence to support using a BA form of the of B one which is called Binfod bin fatiamine, and that's

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Dr Doug: actually here. I'll just put this in the chat. So

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so you know what? I'll just put all this in the chat.

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Dr Doug: You're ahead. you ready for this. This is a lot of stuff.

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Dr Doug: Alright. this is research-based

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Dr Doug: and sorry. There's too much of it.

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Dr Doug: I can't copy it off. Hold on.

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Dr Doug: here we go. I got it.

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Dr Doug: It won't let me do the whole thing. So here's the 2 top ones which are Benphetamine and Alpha lipoic acid.

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Dr Doug: I might drop these in the chat for you, Lorna Oops!

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Dr Doug: I just messed it up. Copy. Your message is too long

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great. I'm going to write it in here. So benfitiamene.

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Dr Doug: 150 to 300 milligrams twice daily.

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Dr Doug: then the other one, Lorna is Alpha Lipoic. And this is basically an Antioxidant, and I've seen this for

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Dr Doug:  1,800 milligrams daily.

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Dr Doug: So I've seen Alpha ipoic used for everything from blood sugar to you know, autoimmunity I have different studies here, and then the other one is magnesium, of course, acetyl carnitine.

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Dr Doug: and then dha EPA, so omega is.

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Dr Doug: I'll put acetal carnitine in here. That's an interesting one.

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Dr Doug: There we go, all right. Evidence based neuropathy treatment. How effective will it be? No idea.

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I never had anybody tell me that their neuropathy went away when I told them to take that. But I also don't know that they took it

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Dr Doug: all right, Janina. I hope I'm saying that right. She was asking what my opinion is on a no-oxylate diet to help repair bone density.

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Dr Doug: Yeah, it's an interesting one. I think oxalates they certainly exist.

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Dr Doug: I feel bad when I consume them, so I know if I consume kale or spinach, especially in the raw form, even oatmeal, I feel terrible, and I think the oxalates have a component of that. People that eat especially like a raw whole. Food. Plant-based diet are getting a ton of oxalates. They bind minerals. They can be inflammatory to the gut.

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Dr Doug: So I'm a fan of eliminating oxalates. But the problem is that there's oxalates in a lot of stuff. So at some point you have to figure out how restrictive you want to be. I don't think that the foods that have oxalates in them are necessary to have an optimized diet, but it starts to look more and more like a pretty meat-based diet. If you do that

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Dr Doug: which I'm not opposed to? The question is, do you want to live like that? So I think oxalates have the potential to be damaging. But people have obviously tolerated them for a long time, so I don't really know what to say about that.

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Dr Doug: Susan asks, she said. I tested positive for the Mt. Hfr. Gene. Yeah. And should we not be taking L. Methyl folate. I thought. The thorn has that product. And now, taking Mercolo's L methyl folate. Yeah. So, Susan, that's different than folic acid by itself.

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Dr Doug: So Gary Brecka, who was on Joe Rogan's podcast recently, when he started talking about this company called Tenx Health, and that they test Mchfr Gene, I mean they broke the Internet with the number of comments and people that sent that to me.

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Dr Doug: So what they're doing through that process is checking nthfr function. If you're not familiar with that, it's actually a group of genes that

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Dr Doug: will enhance or

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Dr Doug: limit your capacity to go through this process called methylation. So b. 12, as it comes in food, or actually through supplements, especially, comes in like cobalamine versus methylcobalamine. Your body has to put on the methyl group, which is just a carbon and 3 hydrogens, but your body has to go through this process to do it. Your body also has to methylate your DNA every time it winds and unwinds the DNA DNA. So you can imagine like this happens.

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Dr Doug: I don't know millions, billions of times a second. I don't even know if you are not efficient at it, then you do not metabolize B. Vitamins well, and you could use some support or pre methalated B. Vitamins, as the way that we do this. So the methyl folate, or L. Methlf Folate is one isomer of this. That is a way to get around that. So we do use that. We generally see it as methyl tetrahydrofolate. And I actually

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Dr Doug: don't know the difference there. They're probably the same thing. There's a lot of different forms of these things depending on you spin them around. But as long as it's methylated folite I think you're fine. What I'm saying that we shouldn't consume is folic acid.

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Dr Doug: Folic acid is a non methylated and actually non-natural form of folate

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Dr Doug: if that makes sense

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correct.

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Dr Doug: So Lorna asked. If I'm familiar with a protein powder by Makuna, called pure Chaco protein powder. Only. Ingredient is a legum called Chaco. It sounds delicious cause, it says Chaco.

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Dr Doug: They claim it has 9 essential amino acids and is lectin free. So here's my question there. And I,

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Dr Doug: interesting to actually, you could actually use Chat Gp and find this out. But compare the amino acid profile in that

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Dr Doug: legum-based protein versus a complete amino acid profile of essential amino acids from a meat source.

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Dr Doug: What you're probably gonna find, and II won't spend the time to do it right now, Lorna, but what you're probably gonna find is that Leucine LEUC. INE. Is low. Leucine is the key amino acid essential amino acid for

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Dr Doug: protein metabolism, and to build protein. So most plant sources are low and Leucine, and that's the the key thing that you need to add. In fact, some people that do really well on a plant-based diet will actually just add leucine as an amino acid to their to their food or protein shake, or whatever, because it's really hard to get leucine through plant sources. So my guess is that? Yes, it has 9 essential amino acids, but how many of each? And it's probably low and leucine.

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Dr Doug: And if you are, you guys familiar with chat. Gpt this whole AI revolution.

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Dr Doug: Yeah. So so, just for those that aren't. This is a tool. I mean, it's it does not substitute. But here, let me just show you

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Dr Doug: as a tool to empower you. Let me just show you what this looks like.

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Dr Doug: You have to be careful, though, because it can be really inaccurate. Oh, yeah, totally. Yeah. So I'm not. I'm not saying it's a substitute for anything. I use it as a starting point, for you can see all my previous 30 days collagen calcium silicon like. I use it as a starting point for research, because it it gives you a lot of information.

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Dr Doug: But I do not. I don't trust it. I just use it as a search engine, basically. But it's so something like this would be interesting. So you could say what?

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Dr Doug: Even better? So compare the essential amino acid profile in  the ligium

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Dr Doug: Chaco. D'you say it was larna

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Dr Doug: chaco to

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Dr Doug: the essential asset profile of beef.

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Dr Doug: particularly if I could type particularly.

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Dr Doug: What is the difference in Leucine?

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Dr Doug: Certainly.

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Dr Doug: So it looks like Chaco. Mr. Chick. B.

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Lorna Nichols:  I think that's the wrong. I it's it's spelled CHOC, HO,

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Lorna Nichols: CHOC, HO,

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Nancy Mandowa: hmm.

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Dr Doug: CHOC. HO.

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Dr Doug: They are 2 different things. You're right.

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Dr Doug: There you go. It's a Lupini bean

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Dr Doug: like giving me numbers, though. But anyway, you can see how you can use this to get an idea. I would then also verify that. But it's a really nice starting point, because it'll it just helps you to sort of figure out what to search for. And so for me, from a research perspective, I can throw something in there that I've never heard about, and it'll actually direct to, you know particular studies helps me to orient my team. And when you have certain questions like that, and here's another thing, too. If you haven't used it for this. Use it for meal planning.

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Dr Doug: because you can throw in all the different variables. I wanna eat a Vegan diet that has this many grams of protein and hit this many grams of amino acids, and you can have it. Give you a week's worth, and it can. And then you can say, please show me what a grocery list for this meal plan looks like, and it'll spit out a grocery list for you, too.

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Dr Doug: It's not perfect. But wow! It's fast.

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Nancy Mandowa: Great idea. Yeah.

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Dr Doug: Yeah. So I think there are. There are plenty of dietitians that are using that as their sole source of you know, custom, nutrition.

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Our team uses it, but not like that.

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Dr Doug: but it's free.

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Kitt Lurie:  Great! Can I? Can I ask a quick question about that? It feels like a dumb question, but so chat. Gbt, which I've certainly heard about. But I have not used much. So is that a website. Is that a app? If you just if you just Google Chat, Gpt, it'll take you to the website. But it's was it actually called. It's called Chat openai.com.

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Dr Doug: and it there is a free version. We have a the pro versions like 20 bucks a month that just gives you the updated version. But

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Dr Doug: the free version's fine honestly, and there are several different engines out there, but that's one that I think has the most support behind it.

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Dr Doug: Can you say the name of that again. Yeah. So here, I'll just drop it in the chat. Okay, thank you. I'll drop the chat in the chat.

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Dr Doug: Maybe there we go

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Dr Doug: welcome to the future. It's kind of scary, actually.

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Dr Doug: Alright. So then, Lorna, you're asking about another product from a company called Natural Vitality is called calm. So it's a mag carbonate powder that also has citric acid.

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Dr Doug: So you're basically making mag citrate. Okay?

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Dr Doug:  yeah. So when using mag citrate for as a source of magnesium. You are getting it.

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Dr Doug: But here's the question that I have with Mag citrate alone, which is. how much are you absorbing?

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Dr Doug: Because we know that it's it's helping to resolve constipation. It's going to hasten. You know your your transit of of stool. So are you actually absorbing all of it. I think it's a fine source, depending on what your needs are.

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Dr Doug: But check the rbc Mag, and make sure that your your levels of magnesium are appropriate

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Dr Doug: that make sense. Yeah, so I think it. It could be fine. It's inexpensive, too, I know, because I'm I'm familiar with the the product calm. I'm not. I don't remember it being from that company, but probably the same thing.

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Dr Doug: And then, Lorna, you're asking about using chronometer, which, for those that aren't familiar with chronometer. Chronometer is what we use in our practice for people to track food. And you say that you consistently don't get enough thymine and folate

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Dr Doug: let the other B vitamins seem okay.

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4 months ago your Homocysteine was 8.6,

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Dr Doug: and you're concerned about getting too much. B, 6.

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Dr Doug: yeah, II think it's hard. So your her question is is, how do I mix and match a supplement, do I? How do I not get too much. B 6. II wouldn't worry so much about getting too much. B 6 as long as you're getting the right form, because, as a water soluble vitamin. You should be peeing it out.

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Dr Doug: I would try to get as much through food as you can, and take as little supplement as you can. And so you're not potentially over driving it. The challenge I think that chronometer is going to have is that

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Dr Doug: unless you're putting in everything, and if you are. God bless you! It's it's so hard to do like for me, like I'm almost. I use chronometer more to track Macros more than anything else. So for give you an example, like, if I eat a salad.

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Dr Doug: I actually don't even put the vegetables in, because they have so little macronutrient composition that the only thing I actually put in with a salad is salad dressing, cause I wanna know how much dietary fat I'm getting. But if you're not putting in

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Dr Doug: the vegetables. And obviously it has no idea what kind of micronutrients I'm getting. And so it's not perfect, is what I'm saying.

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Dr Doug: And some of these things are hard to test through blood. So that's when using things like a Neutrae Val, which is a vibrant test.

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Dr Doug: Or we're actually, we have a couple of people that are training in hair tissue mineral analysis right now, as well to try to get us a better sense of what what we're potentially deficient in cause. I think it's just hard to know. And it's really hard to split B vitamins like you're finding like, how do I get more of this one and less of that one. But then it's different every day. So if I have 15 different b vitamins, how do I know which one to take, and the answer is, Don't do that.

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Dr Doug: You're overthinking it

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Dr Doug: all right. I'm gonna switch to some other folks. Here, Lorna.

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Dr Doug: excuse me.

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Dr Doug: Tom asks about weight, training and thumb arthritis. I think we talked about this live. But basically thumb arthritis is a really really common thing. I used to treat it when I was in the journal part of my practice, and usually it will happen down here at the base of the thumb.

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Dr Doug: And so it's called basil, or joint arthritis or basal joint and it makes it hard to grip stuff. And so if you have that issue, then using machines so that you're not having to grip. But you're just pushing with your the palm of your hand, and then pulling with your fingers or potentially using wrist straps. And I actually sent. I hope I sent Tom a

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Dr Doug: or no, I told his coach, but what wrist wraps look like cause you can pull with wrist wraps and not have to use your thumb at all. It's really great that we have these, this cool, opposing thing, but we don't need it to lift weights necessarily

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Dr Doug: so. I hope that answers that question. Super common.

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Dr Doug:  Here's a comment for a comment. Here's a question from Susan J. About. So she says that last week I mentioned that Mchg. Versus algae is something that I hope to explore. More.

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Dr Doug: oh, yeah. And she had some concerns about the elevated lead content of their products. And she's been taking garden of life, raw vitamin code, raw calcium. That is half the price

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Dr Doug: that's good to know.

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Dr Doug: it used to say, on the bottom they had the same formula as Al Jakal, and then she called the gof to confirm. It was told that Al Jakal was sourced from the same place.

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Dr Doug:  And that's the

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Dr Doug: called GOF. Garden of Life. Assuming I'm assuming you're not here.

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Dr Doug: Oh, you are here, Susan. J, Hi, Susan, they take the information off the boxes. Yes, garden of life. Got it. So yeah. So it's I think it's interesting. Whenever we talk about cause I've heard this same thing actually from

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Dr Doug: oh, gosh! What was it

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Dr Doug: we were talking about? Oh, I know what we're talking about! I was talking about micronutrient products.

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Dr Doug: I forget the excuse to me.

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Dr Doug:  I forget which product it was, but it was a plant or sorry a soil-based, micronutrient product. I think whenever we're pulling things out of soil, we're going to see.

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Dr Doug: Quote unquote contaminants. We're gonna see heavy metals because they're in the soil.

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Dr Doug: So the question is is, how much are we?

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Dr Doug: Are we condensing them into an unhealthy thing? So this is where I really struggle with the whole green drink idea. I think the green drinks are probably terrible for us, because we're taking

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Dr Doug: a lot of plants, and we're condensing all of the

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Dr Doug: potential nutrients, but also the potential contaminants into a powder and then mainlining it into our body.

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Dr Doug: That's not how plants were meant to be consumed. And so I think there's a dramatic potential to consume a lot of fertilizer, a lot of glyphosate, a lot of you know, other potential negatives through something like a green drink.

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Dr Doug: And I think the same thing could potentially happen through a supplement like this.

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Dr Doug: The challenge is, you need to consume something.

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Dr Doug: So then, if you're talking about Mchc, which is the the form of calcium that we like that comes from bones. You kind of have the same issue, right? So what were the cows consuming? What kind of heavy metals are in their bones. What's being ground up and then condensed into a product that you're then consuming as a supplement.

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Dr Doug: The truth is, we really don't know.

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Dr Doug: You know, a company like Al Jakal, and hopefully garden of wives doing the same thing where they're testing batches. They're looking for impurities, but I don't really see that

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Dr Doug: being openly

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promoted.

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Dr Doug: So that's where that person that that company probably said, well, they have an elevated lead count, I think, elevated compared to what and is it? How unsafe is it? Cause if you just go out there and consume anything that comes out of the soil or out of the ocean. It's gonna have something in it. So I don't know. I don't really know how to guide people here. Ii can ask them that I'm gonna meet with their team, their marketing team on Wednesday.

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Dr Doug: so I'll be sure to ask him that.

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Cathy:  Do you see my questions, Dr. Duck.

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Dr Doug: Kathy, Hi, Kathy, Kathy.

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Cathy: okay, yeah, let's dig into these Cathy. So now we're running out of time.

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Dr Doug: All right. So

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woo number one

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Dr Doug: would isometric exercises, such as pushing or pulling as hard as you can do the same thing as Osteo strong equipment. The answer is, no.

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Dr Doug: I can't really explain why I could. I could have John Jakeish on, and he could tell you why. But, There's something about the way that it pushes back. It's measuring what it is, and I think it's pushing into you. So again, I haven't actually been on this equipment in a long time, but I don't think that an isometric would do the same thing

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Dr Doug: which would make sense, because I don't know how you could generate 9 multiples of body weight by pushing on the wall.

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Dr Doug: you know, so I don't think so.

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Dr Doug: and you have a question about whole grains. You say whole grains are part of the dash, and Mediterranean diets are said to be healthy for weight.

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Dr Doug: weight, loss, glucose control, lowered risk of cardiovascular disease and improved cognition. What is unhealthy about grains? See this link from Dr. Weil. So

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Dr Doug: so all right, I'll say this as objectively and non-emotionally as I can. Have you seen Dr. Weil lately?

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Cathy: I mean, seriously, the guy is a visceral fat ball.

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Dr Doug: I mean, it's just like it's frustrating when I see cause I know his name is is is he's a he's a legend, and I don't know what he eats. I have no idea, but I see him on social media with his daughter, and his daughter is trying to do something with his name, but the guy literally has so much visceral fat. Just looks like he's gonna have a heart attack right now. Now is that cause? He eats whole grains. I don't know.

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Dr Doug: but it definitely makes me question his statements about what is healthy and what is not, so I don't know that I would listen to whatever Dr. Weil is saying. But here's the thing about the dash and the Mediterranean diets in any diet that compares that diet to the standard American diet, which is terrible diet is that they're all gonna be better. That's why Vegan diets are better. That's why carnivore diets are better. That's why Mediterranean, all of them right

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Dr Doug: until we start doing studies that actually compare one dietary intervention to another. We really can't say which is better.

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Dr Doug: The other challenge with diet studies is that even if they are intervention studies and not just epidemiologic studies, but even when they are intervention, they have so many components and so many inputs. It's hard to know that something like whole grains is beneficial. If the diet is beneficial, or is the diet beneficial in spite of

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Dr Doug: right? And so I see this all the time like, if you look at the cardiovascular benefit and the dash diets, actually a great example of this. But look at some of the older research by Pritikin and a blanket on the other doctor that does this but shoot what's on the tip of my tongue?

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Cathy: But another

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Dr Doug: well, Atkins is the other side of it, but another plant-based guy. And so if you look at their studies, they say, well, we reversed cardiovascular disease using a plant-based diet.

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Dr Doug: Okay, they reversed cardiovascular disease kind of.

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Dr Doug: but with an intervention that included meditation, improved sleep. Quitting, smoking, eating, a plant based diet, you know, like all these, all these different lifestyle things. And then they said, Well, see the plant-based diet did it. It's the same thing with the blue zone conversation.

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Dr Doug: These people live to 100 years old because they eat a plant based diet. Well, actually, they don't eat a plant based diet. And there's so many inputs there that they might live to 100 years old, despite the fact that they eat a plant based diet we don't know, and to say that whole grains are part of a healthy diet is certainly possible. But I think not in the United States, because our our grains are all Gmo.

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Dr Doug: They're mostly sprayed with glyphosate. They're contaminated. They're inflammatory. So I think. Unfortunately, our grains, you know, maybe a hundred years ago

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Dr Doug: wheat was a totally different wheat. European wheat to totally different wheat.

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Dr Doug: In the United States our wheat is grown to be gluten dense because it's genetically modified. It tastes amazing.

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Dr Doug: but it is terrible for your gut.

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Dr Doug: so to say, that you know the people that are 100 years old in the blue zones that ate grains from 1920 is the same thing that we're eating now. It's not

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Dr Doug: so. What I find is that people do a lot better when they start to eliminate these from their diet

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Dr Doug: just across the board. You can always challenge that right? So you can take them out. See how you do, and then you can add them back and see how you how you don't do or do. I just did the same thing with oatmeal, because I go back and forth on oatmeal all the time, so I haven't eaten it for a long time. I've got a buddy that has an oatmeal company

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Dr Doug: called Creatures of Habit, and so I've had this oatmeal sitting in my pantry for like a year. It's not expired. Don't worry, but I tried, because it's it's kinda cool. It has protein powder added to it. So it's 30 grams of protein, and then I add more protein powder to it, so I can get 50 grams of protein with a bowl of oatmeal, but I feel like garbage when I eat it.

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Dr Doug: And this is organic. you know, glyphosate, free oats. so I just can't consume. I can't consume them. Some people can, but I don't recommend it.

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Dr Doug: Next question about fasting is fasting or intermittent fasting. Good for bones. I think the only potential benefit of fasting

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Dr Doug: is that it's anti-inflammatory in nature. but it is cortisol and epinephrine and norepinephrine, provoking

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Dr Doug: one of the cool things that happens with fasting is that it. It provokes this sort of a stress response which for people that aren't stressed is good

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Dr Doug: for people that are stressed. I don't think that more fasting is necessarily a good thing. And so I've actually backed off of fasting quite a bit. The problem I see with bone health and developing muscle is that it's hard to fast for long periods of time and get adequate protein.

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Dr Doug: especially if you're not absorbing it. Well, and you're having a hard time getting it in if you were to eat for 16 HA day. So I find that it's a beneficial thing for some things. But if bone, growth and muscle growth is your primary goal. It's probably not a tool to to utilize

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Cathy: even the intermittent period. Yeah, I mean, it just depends on what your like. What's your

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Dr Doug: what's your window? You know. So, for example, people are talking about doing intermittent fasting. That's like a a 12, a 12 and 12. That's just not eating overnight, right like that's not really intermittent. Fasting. 16 8 is skipping breakfast, so can you get all of your protein in in 8 h, probably. Sure. But are you really getting any benefit from

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Dr Doug: going from 12 to 16 h? Maybe you know. What's that? What's that skipping breakfast doing? I don't think it's necessarily bad as long as you can get all of your protein in. But are you actually getting any benefit? And I think the answer is, maybe for some people I love fasting for people that have metabolic dysfunction. So people with diabetes, prediabetes, elevated fasting insulin. It is the best tool

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Dr Doug: outside of that, though I don't know that we can really make a great argument from a longevity or anti-aging perspective, I don't think it's a powerful tool for weight loss.

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Dr Doug:  I think it's something to have in the bag. But for bone health patients, if you want to build muscle health and you want to, you know. Optimize all of your systems. I don't think it's a tool that I would leverage

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Dr Doug: especially for women. Who are still cycling. So premenopausal women, you have to be really careful, and only use it at certain times during the cycle, when you can tolerate the stress

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Dr Doug: that makes sense?

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Dr Doug:  And then, was it you that brought up this Yarl Berg study before? Yeah, I haven't read it yet, but I'll I'm gonna read it for next week.

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Dr Doug: And then you have a question here about you've heard that exercise can actually deplete bone nutrients. Should you eat protein before and after workouts?

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Dr Doug: Ii think that your body's gonna respond to whatever stress you put through it. I've not seen a study that showed nutrient depletion specifically from a workout. I think that would be hard to prove but certainly, if you are to stress your body and not give it the nutrients that it needs, I think you certainly could provoke. You know, minerals being pulled out of bones.

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Dr Doug: That would be the example of, you know, like chronic cardio, especially somebody who's malnourished like a long distance runner, right like we see long distance runners have terrible bone quality and density. Do you need to eat before and after you train? It wouldn't hurt. I mean, think about this from a bodybuilder perspective.

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Dr Doug: The the pre workouts that they consume, I mean, please avoid the grams of caffeine, but the pre workouts that they consume that have amino acids. There's a little bit of protein, not so much that it slows them down, but it's enough that your body has whatever it needs. For the immediate consumption of amino acids. And then there's that quote unquote

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Dr Doug: metabolic window after a workout, and that is, you know where they're consuming, you know, there's a recent study that looked at the amount. But previous to this study it was up to 50 to 70 grams of protein in the post-workout phase. Again, because your muscles are just sucking in the amino acids. Right? There was a study that recently showed that there was essentially no ceiling on how much protein you could utilize in the post-workout phase. So they had people consuming 100 grams of protein, and found that the protein synthesis.

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Dr Doug: Didn't it just continued to go up the more protein they ate. So that's different than what I was taught, and what I tell people, which is, you really can't

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Dr Doug: assimilate more than 30 to 50 grams at a time.

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Dr Doug: According to this study, potentially, you can but that's I mean eating a hundred grams of protein in one setting is a lot for even me. So I wouldn't. I wouldn't necessarily go there. But I think definitely eating after and then eating before probably beneficial, you have to start watching your weight.

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Dr Doug: If you start having issues with putting on weight which most people in this call. Don't have an issue with that.

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Dr Doug: Yeah.

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And then I'll read this study for next week.

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Cathy: Ca, all right, we are a few minutes over any last minute burning questions, and I'll save the rest of these for next

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Dr Doug: weak.

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Nancy Mandowa: No. This is a quick, could you? Not, for now it's probably a bigger question, but at some point could you address

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Nancy Mandowa: I'm not sure the correct term aromatizing. I'm concerned about Progesterone turning into testosterone or something like that. That's just the general topic that yeah. Well, I can address that actually, really quickly. So the aromatization is the process, and an enzyme that converts testosterone to estrogen or estrogen to testosterone. I think it's the same name. Regardless

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Dr Doug: Progesterone is actually not in that.

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Dr Doug: Not in that equation. It's higher up. I can pull up. If you want me to remind me, Nancy, I can pull up the the chart from the Dutch test. They do the best job of looking at urine metabolites of hormones.

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Dr Doug:  and you can see exactly where all the hormones and the the enzymes are. So if you were to take a lot of testosterone. It'll convert into estrogen at varying rates depending on your genetics. This is where men get all of their estrogen.

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Dr Doug: or I shouldn't say that almost all other estrogen cause. We have more more testosterone. So we convert to a certain amount of estrogen. And that's the estrogen that we have. Women can do the same thing. So we can use testosterone alone in postmenopausal women and impact estrogen levels. But you have to use a lot, and it gets pretty super physiologic. So I think you're gonna see more side effects if you use that approach. That's why II choose not to do that

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Dr Doug: But Progesterone by itself is not going to convert into either testosterone or estrogen.

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Dr Doug: If that makes sense estrogen when given in higher doses, can also convert into testosterone. That's why we see women that are on Hrt. That has estrogen, and progesterone alone will also improve levels of testosterone. But it's not very much.

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Nancy Mandowa: Thank you.

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Susan Jaye: Doctor Doug. Did I ask you one quick question? Okay? I wanna know she on her topic. I'm taking a hundred 25 Mgs. Of micronized Progesterone every night.

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Susan Jaye: and I wanted to know if I could also take What is it?

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Susan Jaye: Oh, my God! Strontium! Citrate with silica boron Maganese! Oh, like like, within a few hours of that of taking the progesterone. Would that be helpful for your Osteel class?

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Yeah, I think it would likely be additive.

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Dr Doug: And I would say, osteoblasts, actually, because of of what the you know, all the things that you're combining there progesterone impacts osteoblasts and then the other things that you're doing with the silica. The strontium in theory and boron are all gonna have an impact on osteoblasts, more so than osteoclasts that that the systems connected. But yeah, you can take those 2 together, or at least I should say I would recommend taking those 2 together if you were my patient.

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Susan Jaye: Okay, thank you. Okay, you're welcome. And then, Thomas, your question in the chat, which is, if I don't answer all these questions will answer them in the future. Yes.

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Will, we will get through them all. Someday

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Dr Doug: we are developing quite a list.