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Breta Alstrom: Here we go. Today. We're gonna be talking about hot topics and nutrition, pulled a ton of your guys questions from slack.

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Breta Alstrom: but as always feel free to hit us up in the chat because we're gonna cover a ton of different topics today. So as you have questions about the topics that we're covering. Send those messages in, and we'll try to just get them, answered as we go, cause there we are. We're gonna have a big span of topics within this. But some good pressing questions here. So

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Breta Alstrom: just gonna dive right in. We're gonna start with the idea of getting nutrition from food 1st and then supplements. So how do you approach that? And what's your just in general like with recommending supplements versus whole foods to meet nutrient needs.

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Dr Doug: Yeah. So there's there's, I think there's 2 really good points here. So one is we shouldn't try to out supplement a bad diet.

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Dr Doug: because as much as I think supplements can be helpful. Nutrients from food are what our bodies understand. It's the language it is how our bodies have been doing it for however long.

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Dr Doug: right? Thousands of years, hundreds of thousands of years. Whatever it is. So our bodies understand. Food supplements are for the most part unnatural. They're super physiologic doses like you don't eat

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Dr Doug: whatever 700 milligrams of calcium at one time. Right? But yet you take a capsule you're like, oh, well, I'm going to consume all this calcium, and my body's going to know what to do with it. So it doesn't make sense. So I think it's important that we try to eat the best diet possible. But then, understanding 2 issues with that one is that our food supply doesn't matter where you live really, but our food supply, especially in the Us. Is terrible.

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Dr Doug: Our soil has been depleted, our fruits and vegetables don't have the same nutrients that they used to animal depending on how it's raised, doesn't have the same nutrients, because they're eating the plants that don't have the same nutrients from the soil, etc.

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Dr Doug: It's harder than it used to be to get good nutrients from from natural food. So supplementation then starts to make sense.

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Dr Doug: Also, if you have osteoporosis, you are starting from a diseased starting point. So it's unlike somebody who is 30 years old at the peak of their health. They have all the muscle mass in the world. Metabolism's perfect, and they're like I can get everything from food cool. Maybe you can.

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Dr Doug: But if you're 65 years old and you have osteoporosis, and you've lost a lot of muscle mass, and you have metabolic dysfunction. That's not the same starting point.

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Dr Doug: So, understanding where you are, and then trying to use these tools and the technology to help push forward out of this. I hate to use the word disease state, but it's just what it is so this state of having osteoporosis, having bone loss, having muscle loss and trying to then get super physiologic. So you're able to build in a 65 year old body. That's not easy to do. It is definitely possible, though, and I think plenty of people here can attest to that.

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Dr Doug: I had one more point on that.

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Dr Doug: but I lost it well on.

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Breta Alstrom: Fill in for a second, then yes, we so sometimes, right, we might want these therapeutic doses based on

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Breta Alstrom: how you are able to absorb. And what's happening in your body? And I will just share to. I just came from our coaching call the other day. Someone had like a really cool experience, because we do end up having people on a lot of different supplements to be able to meet their needs based on whatever's going on in their body, and I think what was shared is just you know, is a lot of supplements. It can be really overwhelming. But this is what your body needs right now to heal

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Breta Alstrom: was kind of the mindset around that which I thought was really cool. But when it comes to whole food based supplements like algae. How do we factor that into like kind of the.

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Dr Doug: Yeah. So we're we're just sort of like in the in between, right? So it's like.

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Dr Doug: you know, what are, what's the spectrum here? It's like I could eat, you know, a steak. And I'm gonna get amino acids and protein and all the nutrients that come in that meat product, you know versus like

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Dr Doug: about like a beef. Hydroscillate powder like

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Dr Doug: is that absorbed the same?

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Dr Doug: Probably not. Still, proteins still, amino acids? Do you still get the same magnesium, the minerals, the choline. Is that all in there?

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Dr Doug: Maybe.

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Dr Doug: Are you going to absorb it? The same? Probably not, you know. And then you go to like the extremes of like. Well, what if we artificially create something? Right? So I think your body's going to respond less well the further away from natural food we get.

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Dr Doug: And so the the whole food forms

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Dr Doug: are probably going to be better. But it's really hard to know how good any of them are, because the research it just is never going to be done the way that it needs to be done. So it'd be too expensive.

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Breta Alstrom: And then just related to like agile calcium, all the things. Angela, in the chat has asked what about taking calcium, supplements, when you have plaque built up in your arteries, or heart disease.

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Dr Doug: Yeah, this is such a hot topic. We have a few videos on this on Youtube, where I think I talked just way too long about it. But the big picture here is that there is. There are studies that show an association of calcium intake through supplementation and increasing calcification of especially coronary arteries, potentially carotid arteries.

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Dr Doug: So that is concerning right. If you look, though, at the studies that look at calcium supplementation and vitamin D, that signal starch to go away still kind of there. But if you look at studies, and this is where, when I did the switch back to Algical, I was looking at all the literature on whole food, calcium sources. And it's actually an inverse relationship. So if you're consuming calcium from dairy, from other whole food sources of calcium. There's actually an inverse relationship with calcification of the arteries, meaning that the more people consume

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Dr Doug: the less they converted into having calcified arteries. So I feel like the whole food forms again. They're somewhere in between. You're not going to see the same spikes in blood calcium that you would, as if you were consuming calcium, carbonate or calcium citrate. And that's clear in the literature that the whole food forms don't do that. We should in theory see that same protective effect if it's a whole food form. But I can't say that for sure, because that's never been studied. That would be a pretty complex study to do

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Dr Doug: so. My thought is again, you're in this disease state. Let's get you out of it. Let's give you the body the things that it needs. But let's probably not do that forever. Let's make some movement. Let's get some forward progress. And then you could potentially back off of some of those things so that you are potentially protecting again, in this gray space where we don't really know what's happening.

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Breta Alstrom: Yeah.

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Breta Alstrom: awesome. Okay, where we really do have like a ton of variety of questions. So I'm gonna try to like, run the gamut on this we get as much information packed into this hour as possible. So since we're talking a little bit about supplements and whole foods and calcium vitamin d, let's hit on that wha like. Give us the rundown on your recent recommendation changes, and then we'll talk about how to best take it.

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Dr Doug: Yeah. So when we started this practice, I was still in the mindset of like more vitamin d better, you know. And this is, you guys have probably heard me say this, but as an orthopedic surgeon, you're sort of trained like. If it doesn't fit, get a bigger hammer. Just hit it harder, and it'll all work out

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Dr Doug: that doesn't work in orthopedics, either, just for the record. But from a supplement perspective. I was following the literature that said Man. If people have natural vitamin D levels of 60, 8,100, they seem to be protective of cancer, immune dysfunction like, Oh, man, let's get on this.

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Dr Doug: and then it was when I started chatting with some individuals in sort of like the iron space we're in vitamin d and iron crossover where they pointed out. Look, all of those studies are not on vitamin d supplementation. Those studies are on natural levels of 25 hydroxy D in the blood, which is what we measure when we're generally measuring vitamin D,

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Dr Doug: and it's definitely an extrapolation. It's a leap to say that if you supplement with 25 Hydroxy D, or actually Cholecalciferol, which isn't even that. If you supplement with this artificial form of d. 3, and you increase 25 hydroxyd in blood, that you're going to have the same results that's actually never been studied. And so when you look at the intervention studies on bigger doses of Cholecifral, you don't see those same protective effects.

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Dr Doug: So I think we were making this extrapolation out of naturally high levels of vitamin d, which is a very different situation. So these are people that are living on the equator. Getting a lot of sun probably have a lot of other lifestyle things that are different from how most of us live.

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Dr Doug: So then we started looking at what potentially can go wrong if you're supplementing too much vitamin D, and there is an impact on vitamin a, we know that we need vitamin a to actually have the active form of vitamin d, your active form of d actually drops. If you supplement too much.

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Dr Doug: There's an impact on iron and copper regulation as well. So it's kind of this like, well, maybe too much isn't. Or maybe more isn't better. So we started to back down to where the intervention literature shows the most benefit, and that's 30 to 50, and I forget the units. But in the Us. 30 to 50,

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Dr Doug: and that's where our recommendations are now. And so for most people that's been, we've been pulling back on the coliccal because they were all, you know, 8,100, whatever. We weren't seeing complications like kidney stones, calcification, whatever that we were aware of. But I think this is going to allow us to then see that vitamin, a level that retinol start to rise. And we're seeing that in the labs in the 2125, hydroxy, the active d start to rise in the blood.

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Dr Doug: So that's sort of where we are with vitamin d right now, and I don't hear a lot of people saying that so this is probably not a well talked about topic at this point.

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Breta Alstrom: Yeah.

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Breta Alstrom: How? How would you recommend taking vitamin d, when people are taking it.

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Dr Doug: Yeah. So I like to get it. I mean, get as much through food again. Go back to the 1st question, right? So get as much through food as you can. But vitamin D is hard to get through food. So you know, unless you're consuming dairy some cheeses which is dairy, you're not going to get a lot of

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Dr Doug: vitamin d through nutrition. I am a big advocate for UV exposure, so I see a lot. There's a lot of controversy around this, particularly in the 60 70, 80 population. Because you've been scared by the dermatology world that, like UV is bad at UV will cause glaucoma and eye problems and cancer and melanoma, and all those things are true

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Dr Doug: to some extent. But I'll give you an example where I was just on the beach. I was there for an hour and a half. I am not actually this red. This is not a sunburn.

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Dr Doug: but I only used sunscreen just right here because I was out throwing football with my kids, and then let my body get the UV exposure elsewhere. That's more ub exposure than I would normally get but an hour and a half sort of my limit, but as long as you're not getting burned you shouldn't be receiving excess damage. Our bodies are meant to be in the sun. So that's really where we should be getting our vitamin d from, for those that don't have adequate Uvs. So that would be like

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Dr Doug: everybody in Europe.

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Dr Doug: you know most people north of the Mason Dixon line of the Us. If you don't have adequate UV, it's very likely that we're gonna need to supplement vitamin D, especially during the winter half of the year.

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Dr Doug: So then I prefer to get it again from like something like objectal plus which is going to have not a lot, and then adding it with other fat, soluble vitamins. So ae and k to get a combination of whatever's right for you, and that could be as little as like 400 iu. It could be as much as say, 3,000 Iu. It's probably not 5,000, which is what I see most people on.

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Breta Alstrom: Yeah, and with the UV exposure to, I'm pretty sure the recommendations are based on only like ours, like, if you ring a T-shirt, so arms, face, and neck. So if you are showing more skin or your legs or ring shorts, things like that, you're gonna get more. Do you have any perspective, though on vitamin d. Absorption from the sun, with like a higher body, fat and high, higher adiposity.

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Dr Doug: Yeah, that's

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Dr Doug: The answer is yes, and if you know the answer to this, I'd be happy to have you speak to it. I know there are differences because of especially subcutaneous fat, but I don't remember actually how it changes. So if you know that answer, feel free to answer it.

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Breta Alstrom: Yeah, you know, metabolically, I actually would have to double check. But it does kind of tend to get trapped in, since it's fat, soluble, and it being fat, soluble kind of circles around to the next question is, if you are taking vitamin d, you do want to take it with a source of fat and then how do you feel about the the split doses on that like, or should they take it all at once.

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Dr Doug: I don't know about the like. What is the absorptive capacity? If you consume it with fat, are you gonna get all 5,000? Iu, if that's what you're taking in, I've I've certainly seen it be effective. So even when at 1 point we were using 10,000 Iu, right like that was that the Protect plus 1st

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Dr Doug: version was 10,000 Iu. And we were seeing people I mean their vitamin D would get to like 140, you know it was too much, but it seemed to be effective even at 10,000 in one dose. So I don't know that there's an absorption, limitation at all. I certainly don't see that in the results in the blood.

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Breta Alstrom: I think the absorption capacity has to do with. Like. The higher you push, the blood levels, the less your body absorbs from the gut, so.

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Dr Doug: But sense.

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Breta Alstrom: Yeah.

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Breta Alstrom: So when you know it's, it's harder to go from 60 to 80 and 80 to 100. You need higher doses, but we're not recommending that, anyway. So you should be good to go at a lower dose. Awesome. And then let's just touch on the other fat, soluble vitamins vitamin a for osteoporosis, thoughts.

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Dr Doug: Yeah. So I have an interesting video on this, too. The research was surprising to me, because I'd sort of seen this fear around vitamin a that you know that too much vitamin a or any vitamin a and retinol is going to be bad for bones.

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Dr Doug: But what the literature shows is, there's a u-curb. So you curve with risk so meaning like, if at the low end of consumption, there's an increased association with osteoporosis and fracture. Risk. Same thing is true with the high end. But when you dig into that, what I found is that it's

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Dr Doug: it's really hard to get to the high end, and I can't put numbers on it. It's in the video. But basically, unless you're eating polar bear liver on a regular basis.

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Dr Doug: you're not going to have too much retinol.

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Dr Doug: It's really hard to get too much. And then, if I can, we talk about Beta Carotene versus retinoids.

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Breta Alstrom: Yeah.

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Dr Doug: Yeah. So when most people, when they think vitamin a, they think, carrots, yellow orange vegetables right like this is vitamin a, and that is, but those are the plant versions, which is Beta Carotene. So Beta Carotene are a sort of again plant version. I forget what the actual term is, but they have to be converted into retinoids, or some form of retinol.

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Dr Doug: Retinol is vitamin, a in blood in humans, in all animals, and so your body has to convert. So there's 2 issues there. So one is you have to absorb it in your gi tract, and then your body has to convert it. And genetically, there's variations in both of those, as far as how good bodies are at doing that. So some people who probably don't tolerate a plant-based diet don't absorb it well, and then they don't convert it well.

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Dr Doug: And so then you have very little vitamin a, and we need vitamin a for vitamin D to do its thing. So this is a big issue.

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Dr Doug: Getting all your vitamin. A from plants can be challenging for some people is probably possible for others.

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Dr Doug: the retinols, the retinoids are going to be the vitamin a that you find in animal products. You're going to find it more in organ meats, particularly liver, but it is available in flesh and meat as well, just in lower levels. And so this is why I think it's challenging, probably to get enough vitamin a in our current diets. And that's 1 of the reasons why we have most people on a fat, soluble vitamin supplement that would include vitamin a in the form of retinol.

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Breta Alstrom: Yeah. And then to the next fat, soluble vitamin. Let's talk about vitamin e and then thoughts on vitamin e, and we also have a really great question the chat on. If there's a connection between vitamin e progesterone, and progesterone for postmenopausal women, if you know.

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Dr Doug: Interesting. So there is a doc. I can't remember what his name is. Somebody probably knows, and they can throw it in the chat, but I think he's a i forget what kind of doctor he is, but he just wrote a book recently, and of course he's selling a product that goes along with the book.

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Dr Doug: but it's a vitamin e thing. And so he I looked at his book and read it, and it's a pretty good tons of research on vitamin E, and so the challenge with vitamin E is that

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Dr Doug: until I don't know, maybe 5 years ago.

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Dr Doug: seems like every vitamin E that was available in supplementation was one specific form.

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Dr Doug: But there's 8 forms of vitamin E, so there's sort of 2 families. So see if I can say these right? So one is called Tocauferol, and the other is called Tocotrianol.

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Dr Doug: And then there's Alpha Beta, Gamma Delta. Of each of those. So you have 4 of each, so you have 8 total. So the easiest and cheapest one to make is Alpha

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Dr Doug: to cuff for all. So Alpha to cuff for all, and that one is, if you look at most like multivitamins, where they say vitamin e, they'll say vitamin e is alpha to cufferol.

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Dr Doug: and that is an interesting vitamin, because it is not

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Dr Doug: tolerated by about half of the population. So when you look at literature on vitamin E. In some places it seems to be protective. It's antioxidant like it works well for cardiovascular prevention. But then, in other studies, it doesn't. And it's because they were just using this one form. So then, if you look at studies where they start using more like a broad spectrum of vitamin e, or specifically like the delta to the Delta. Tocotryls

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Dr Doug: seem to work better. And so now there's new products out there that are sort of trying to be more percentage of this than that. I don't know if we have enough research to say what the right spectrum is. But this is another example of like, hey? Guess what if you get it through real food. You're going to get the full spectrum, anyway. But if you're going through supplementation trying to find something that has

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Dr Doug: all 8 of them, if possible. It's usually listed in an odd way. If you look at

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Dr Doug: the way that Altacal lists it, as well as the one protect plus from health jevvity they both have. I think it's the same proprietary product which is a blend of all 8.

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Breta Alstrom: Yeah.

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Breta Alstrom: and then any thoughts on vitamin E for menopause

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Breta Alstrom: or post gonna.

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Dr Doug: Question specifically about progesterone.

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Breta Alstrom: Oh.

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Breta Alstrom: let me see. Is there a connection between Vitamin E and Progesterone

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Breta Alstrom: for post-menopausal women.

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Dr Doug: The answer is, probably I don't know what it is. I'm trying to think in in his book if he mentioned that. But I I have not researched it personally.

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Breta Alstrom: Okay? And Audrey shared the book. The truth about vitamin E, so.

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Dr Doug: It's it's a short read like it's a free, downloadable Pdf, and I think it's I mean, he's he's promoting his product. But it's still actually a pretty good deep dive and divide him any.

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Breta Alstrom: Yeah. And you know, to like zoom out a little bit here, guys, because if you're if you're taking like a fat, soluble vitamin complex you're or like algae or health, Jevuty, you're gonna be getting that like broad spectrum, like the gamut of all vitamin E, and so maybe don't stress about it too much. And see how you do, and then we'll move on to Vitamin K, and let's talk about vitamin K and bone health.

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Breta Alstrom: Do we need it.

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Breta Alstrom: How does it interact with calcium?

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Breta Alstrom: What's it doing for heart health?

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Dr Doug: Yeah.

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Breta Alstrom: Where do we stand?

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Dr Doug: Yeah, I think Vitamin K will will eventually become more popular than vitamin D, and we'll kind of realize, like boy, we probably went overboard with vitamin D. We probably did.

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Dr Doug: As much as we thought we did. Yes, vitamin d deficiency does exist, but it's probably people that are less than 30, with 25 hydroxy, not less than 50, 80, or 100. It's like it's. It's not actually as common as we think

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Dr Doug: vitamin K is really important because it helps vitamin d to do its job. It helps to absorb calcium, but it also helps to put calcium into the appropriate places. And so this is where you start seeing studies that show. If you add D and K, then you're going to get better utilization of calcium. You do get higher blood levels of calcium. So some people say, Oh, well, that's bad. Well, no, it just shows that it's doing what we think it's doing.

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Dr Doug: So I would recommend using them together. And that's why we can use a product that has both in there from a cardiovascular perspective. This is studied on the the

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Dr Doug: in the heart health side, because there are studies that show actually reversal of calcification of the arteries with vitamin. K.

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Dr Doug: So then, the challenge is okay. Well, how much? And in what form so similar to the vitamin? A conversation where you have the beta carotenes and the retinoids in the vitamin k world. You have k. 1

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Dr Doug: k. 2

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Dr Doug: and vitamin k.

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Dr Doug: One is how you're going to find it in plants and vitamin. K. 2 is how you're going to find it in the animal form

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Dr Doug: and k, 2, then has there's multiple k, 2 s. So there's mk, 4. There's mk, 7, which most people are familiar. There's actually others in there as well.

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Dr Doug: And that's right. Stephanie K. 2 is in in NATO. If that's how you say it. And

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Dr Doug: The difference between MK. 4, and MK. 7 is that MK. 4 is has a shorter half-life, so it's it gets broken down faster. MK. 7 has a longer half-life

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Dr Doug: k. 1 has to get converted into K. 2. And again, there's genetic variability as to how that happens. So for people that are consuming all their vitamin K from plants. They might have enough. K. 2. But they might not. So again, getting it from animal sources, if possible, and then from supplementation, probably a good idea

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Dr Doug: the challenge around how much is a bit of a quagmire? Because K, 2, as mk, 4 has been studied in really big doses, so has k 1

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Dr Doug: K. Mk, 7 has been studied in much smaller doses.

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Dr Doug: but it's a little hard to know what the sweet spot is, so we're somewhere between, like 100 300 micrograms of K. 2 as mk, 7. If you look at the Algic Cal products, they provide all 3. So it's sort of like. There you go.

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Dr Doug: you know, have all 3, and then it'll it should work. We just don't probably have good enough data to say which

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Dr Doug: you know which and how much is right. But I think getting some of each is important.

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Breta Alstrom: Yeah.

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Breta Alstrom: and questions around. Mk, 7, and genetics. I I'm I'm actually looking up right now. If we pull the

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Breta Alstrom: if we pull vitamin K snips in our genetics panel or not.

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Dr Doug: I don't remember them.

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Breta Alstrom: Yeah, cause I don't. I don't actually think they're included on the Ostia process, like in in the Ostia process panel. But, Sharon, I will make sure that I just I'll I'll show you what we have on

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Breta Alstrom: vitamin K and genetics, and I'll send that, and then, if somebody has a

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Breta Alstrom: cac of, say 13, and maybe we'll explain how you kind of stratify the risk of somebody with a cac of 13. Should they be eating more foods with vitamin K in them.

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Breta Alstrom: If that's gonna predominantly, be those plant foods, or or if we're getting it from other sources, I don't know. Or would you recommend supplementing? In that case.

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Dr Doug: Yeah. I I think that we're probably all deficient in vitamin K. We don't have a good way to measure it. There's really no way to know.

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Dr Doug: and it's a fat, soluble vitamin. So is it possible to get too much? Maybe so, there's just a lot of maybes around here.

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Dr Doug: But let me talk about the cac for a second. So when somebody has a positive coronary artery, calcium score, we call it a cac for short, the coronary calcium score is just looking specifically at the calcification of the coronary artery, so the arteries that feed blood to the heart.

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Dr Doug: If you have calcification in those arteries. It's a sign that you have had probably decades of buildup of plaque that's slowly been calcified by your immune system over time. So if you have positive coronary, artery, calcium score, then you have essentially you have coronary, artery disease, you have atherosclerosis, you have buildup of plaque in those arteries. So that is then a patient where we're going to take a closer look at risk factors, cholesterol. We're going to kind of do the whole cardiovascular workup

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Dr Doug: from a K, 2, perspective. What I recommend that they get, you know, more definitely, get some. Absolutely. This is osteoporosis and atherosclerosis are the 2 areas where Vitamin K 2 is probably the most important. And honestly, that's like

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Dr Doug: everybody, right? I mean if if most of us live long enough, heart disease will, it will be the thing that kills us.

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Dr Doug: So

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Dr Doug: but

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Dr Doug: yeah, I when I look at a cac, I I kind of look at it. Let me just answer this part. I look at it as positive or negative, so the number doesn't mean as much to me as just anything other than 0. And I think this is really important, because, especially as we get older, people will say.

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Dr Doug: people will say, Oh, well, I had a you know, a Cac. And my score was whatever 13. And I'm in the 20th percentile like, I feel really good about that.

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Dr Doug: But what that tells me is that you have longstanding disease. So even though it's low and it's low for your age group, it still means that we need to be concerned about your disease.

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Dr Doug: and that's where. Then, moving on to like the next test. We talked about that last time, the Ccta. Looking at soft plac. That's kind of how we march down that pathway, but I want it to be 0, and I want it to be 0, probably forever. But that's wishful thinking with a lot of family history and genetics. It's not going to be. But then we just have to figure out what we need to do about it.

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Breta Alstrom: Yeah, okay, so important things about Cac, and I don't want to spend too much time on imaging here, guys. So we're gonna move on after these questions, but I do think they're important. How high of a Cac. Would you hesitate to start the Hrt.

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Dr Doug: It's not the. It's not the in. It's like, it's not the amount like the positive, or even, you know, if it's like 13 versus 100 versus a thousand.

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Dr Doug: It has to do more with their risk factors. And how far out is so a woman, for example, how far out is she out for menopause if she has a very high calc.

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Dr Doug: but she has low risk. Factors otherwise calcify plaque is actually pretty stable, right? I guess you don't know that. So calcify plaque is stable plaque. It's the soft plaque that's unstable. So if someone had a high calc number, I would strongly encourage them to get a ccta. So we understand more about what's going on in those arteries. And then it might be that they've had longstanding disease. It's calcified. The arteries are wide open. It looks good. That person is probably not at high risk.

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Dr Doug: but there is more risk there than somebody has a 0 for sure. So it just depends on the situation. So there's no certainty cut off.

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Dr Doug: Anybody that has a positive number is going to have a different conversation than somebody that has a 0 number.

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Breta Alstrom: Yeah. And if you're worried about it, go get the Ccta. And, like, you know, just just get clear on your choices and make your choices and move on. Don't let the stress kind of way down there.

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Dr Doug: It's it's a hassle to do but it it. The data is so good.

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Breta Alstrom: Yeah. And then can you reverse calcium in your like arteries like, if you already have

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Breta Alstrom: hardened plaque?

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Breta Alstrom: Can you reverse that.

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Dr Doug: The answer is, there are reports of it. There's studies that show it. I wouldn't plan on it, and it doesn't really. Once you have a positive number. I don't think anybody's ever reduced it to 0. I don't think that happens so like, can your number go from? What are you like 45 to 30. But, like, what does that mean?

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Dr Doug: So I wouldn't plan on it. I wouldn't make that your goal. I think you just have to start mitigating risk factors once you have a positive number and then just understand, this is everybody. Eventually we will all develop plaque if we live long enough so not to freak out about it. We just need to understand what the risks are.

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Breta Alstrom: Yeah, awesome. Alright on to the next. One more question on calcium itself. Form the best form of calcium, and if so, I'll run through the the options that they presented. And if you think they're okay or not, so microcrystalline, hydroxy appetite tricalcium, phosphate and calcium fructobate

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Breta Alstrom: any thoughts on those versions of calcium.

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Dr Doug: Sorry I was trying to multitask, and that was a terrible idea. Can you repeat that question?

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Breta Alstrom: Yeah, so forms of calcium. And if you would recommend them, I know generally we opt for algae and I. I'm blinking on the form of algae. But it cause it's we're just like it's a whole food form from algae. But if you know what yeah, it's actually called feel free to jump in. But the

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Breta Alstrom: The question here is, is calcium from microcrystalline, hydroxy, appetite, or tri-calcium, phosphate or calcium fruct.

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Dr Doug: Yeah. So

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Dr Doug: gosh, so low we'll just write the top there. So the hydroxy appetite calciums are the calciums that I went to.

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Dr Doug: We really started with Algic cowl out of the gate when we developed the program, and then we switched to the hydroxy appetite forms.

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Dr Doug: And the reason why I did that is that I didn't understand the literature from Al Jacal, and it didn't make sense. The studies didn't make sense. And so, without having

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Dr Doug: a resource in the company to talk to. I was like, your research doesn't make sense, so I can't support your product. So I looked for alternatives, and the alternative was the microcrystalline hydroxy appetite. So the Mchc. Forms of calcium, because there is more literature on that than there is on like calcium carbonate and citrate, and what you see in that, because it is a kind of a whole food form, if you consider eating bones, whole foods.

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Dr Doug: But that whole whole natural form is going to not spike blood, glucose like sorry blood, glucose, blood, calcium, like carbonate and citrate. The other thing that was interesting about that for me is that if you get it from certain formulations of Mchc. It comes with

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Dr Doug: the proteins and the growth factors that are in bones. Naturally so the less it's processed, the more it's actually more like a supplement that has other cool stuff in it. But then you get into like, well, where did the cows come from and like, what do they do to the bones? And what does that processing look like? And so then there's just a lot of variables there, and there wasn't a great product we used for those of you that have been in the program for a while. We had several different versions. Jarrow has a version.

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Dr Doug: There's another one that we use quite a bit.

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Dr Doug: But it was just a little bit hard to know. And then I met the people at Ajal, and then I went back to it. So that's that whole full circle thing. The other ones in there, like the Fructobori and the 3rd one in there, Bretta. I've looked at them. There just isn't as much data. And so I don't know if companies are using them just trying to stand out from the crowd. If that's trying to create a competitive edge, I don't know that there's any particular benefit there.

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Breta Alstrom: Awesome. And then, Audrey, and a fact check on my end. The calcium for Tobora is really Gonna be your source of boron. So

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Breta Alstrom: separate. It's just, you know, attached to the calcium molecule. So just for everyone, knowledge there, awesome. Okay. Next supplement to talk about is gonna be Lactoferrine, and are you still recommending that.

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Dr Doug: Yeah. And Alan, just put in here. Osteopreb was that other Mchc product that we used for a while, and that one Alan, that Osteoprev, they specifically state that's Mchc. It's the calcium only in that form it doesn't have the other proteins in there

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Dr Doug: which I wish it did.

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Dr Doug: So then let's get into Lactoferrin. So yeah, Lactoferrin, if you look at the literature, look at those videos, the the amount of benefit

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Dr Doug: of lactoferrin is really high. I forget what the actual numbers are, but intervention studies on lactoferrin, increasing bone, mineral density as a single intervention. So it's pretty remarkable as a protein.

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Dr Doug: and it kind of makes sense to think about where it comes from. So this is a protein in milk or in dairy, but it's a protein in milk that is

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Dr Doug: pasteurized out. So when you pasteurize and process dairy that this gets broken down and it goes away.

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Dr Doug: And so there are a couple of different ways to get it. But whether you're getting it from whole milk or you're getting it for supplementation, it seems to have a unique and independent impact on bone health. The other thing that it seems to also do well is bind iron. So for women that are struggling with iron overload, which can be hard to figure out.

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Dr Doug: But if you're struggling with iron overload, you can reduce oxidative stress and mobilize iron better by using lactoferrin because it grabs it, and it helps it to get it moving and get it into tissues and out of the blood, etc.

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Dr Doug: Yeah.

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Breta Alstrom: Okay, awesome. And that is it on our supplements. So now we're gonna dive into some bigger food topics. And let's start with your best foods for osteoporosis.

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Breta Alstrom: Just did a whole Youtube video on that.

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Dr Doug: I know I'd have forgot what I said.

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Breta Alstrom: Well, luckily I just watched it, so prunes and dairy are 2 and oh, I'd have to. Oh, and then protein, I think, is the 3rd one.

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Dr Doug: What was the 1st one?

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Breta Alstrom: Prunes.

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Dr Doug: Oh, Perons, I have perons!

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Dr Doug: Prunes are a crazy food. I don't know why there's so much research on prunes. It's like the prune industry. I don't know. It just really surprises me that there are so many like placebo out of that placebo control, just multiple level studies. They can't be placebo control.

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Dr Doug: but multiple studies, showing it as an intervention in different doses, which is hard to do. So you need a lot of people, and you got to tell them to eat prunes for a long time, and then have the money to get imaging before and after. It just blows my mind that there's that much interest in prunes. But prunes do increase bone mineral density independently as an intervention.

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Dr Doug: When we started making this recommendation, our dieticians got really not upset. But let's just say they gave us some feedback. They were very concerned about the amount of carbohydrate in the prunes. So one of our coaches actually, Edie, for those of you that are in our program.

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Dr Doug: So Ed was gracious to do a test for us, because she was wearing a Cgm continuous glucose monitor at the time, and so on an empty stomach. She ate 50 grams of prunes, which is like 5 or 6 prunes, and watched what her blood sugar did, and it was surprisingly low. So it did go up, as you would expect by consuming that much carbohydrate, but because of the fiber content and the natural form of carbohydrate. It didn't spike it like she was anticipating. And that's sort of the concern from our dieticians. Is that man like

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Dr Doug: not everybody with osteoporosis is very carbohydrate, tolerant. Not everybody with osteoporosis can tolerate eating 50 grams or 100 grams of prunes.

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Dr Doug: and you can see that in the literature where the compliance rate at 100 grams was pretty low, so 100 grams probably too much like eating 10 prunes a day, probably over the limit. 5 prunes a day. I don't know up to you, so I don't actually like to eat prunes, and I don't think we actually recommend them very often, Brett. I don't know.

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Breta Alstrom: I don't think people are recommending them. I think people are coming in eating a lot of prunes because of your Youtube videos.

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Dr Doug: Yeah, so yeah, so I should, I should get.

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Breta Alstrom: And.

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Dr Doug: From the prune industry.

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Breta Alstrom: The question is to whole prunes daily versus prune powders. Would you perceive that there would be a difference between those.

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Dr Doug: This goes back to that very 1st question. Right? So like once you

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Dr Doug: get rid of the fiber, grind it up, get rid of the water content. Whatever's left after you dry a plumb.

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Dr Doug: Is it going to have the same impact? I think you'd have to study it? I don't think you can assume that it would.

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Breta Alstrom: awesome. On

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Breta Alstrom: one more supplement question. Homocysteine. Is that still something you're addressing via supplementation.

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Dr Doug: Yeah, yeah, that's a good one. So yes, through supplementation, because we don't see that diet makes a huge difference in homocysteine. And so Homocysteine for those not familiar with that biomarker. So Homocysteine is really a biomarker associated with B vitamin metabolism. So if you look up the like b vitamin metabolism wheels really complex biochemical thing. But we need all the not all. But we need a lot of the B vitamins. B. 6 b. 12

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Dr Doug: to go into this process of doing this thing called methylation. So methylation is adding a carbon and 3 hydrogens to a molecule, and it will have an impact on that molecule it can activate or deactivate. It's how we wind and unwind our DNA. So you can imagine this happens like, I don't know millions of times. Probably in a second.

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Dr Doug: You need b vitamins for all of that.

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Dr Doug: Homocysteine gets produced when you don't have enough of something in that cycle so that could be a b vitamin. Oftentimes it's B 12. It could be folate. And there's some other B vitamins in there. B, 6. Specifically.

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Dr Doug: So we definitely do supplement those B vitamins because we just burn through them. I think it's just hard to get enough.

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Dr Doug: even if you're eating a carnivore diet, and all you eat is meat. I think we still burn through those b vitamins. And then also, it could be that we need more of something like choline can help. There's an element called trimethyl glycine, which I don't know where that actually exists in nature. Do you know, Brett, is that a natural product.

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Breta Alstrom: I don't know. Try method license cause. That's not normally how we get our immuno assets. It's not normally how it breaks down.

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Dr Doug: Yeah. So I think that's a synthetic play. And then creatine is another component of that. So like, you need all of those things to methylate. Well, that's another reason why animal products that comes with choline, creatine and B vitamins can be helpful, and why some people do better than others.

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Dr Doug: because they can process those better. So yeah, we definitely still supplement our way out of Homocysteine and being elevated.

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Breta Alstrom: Yeah.

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Breta Alstrom: fantastic. And let's talk about water and electrolyte imbalances.

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Dr Doug: We? We kind of skipped over the rest of food. Can we talk more about food.

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Breta Alstrom: Yes, okay, we can. Yes, I have a lot of stuff about food. So it's just the order on my list is a little bit out of order. Okay, let's talk about protein then. So, or did you want to talk about dairy?

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Dr Doug: Either way.

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Breta Alstrom: Voice. Okay, we'll talk about protein. Let's just start with the basics. What are your protein recommendations?

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Dr Doug: So as per your Instagram post this morning.

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Dr Doug: one grand per pound of of. We've sort of gone to ideal body weight is that the term we're using now? So one grand per pound of ideal body weight. And there's some challenging terminology here because

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Dr Doug: there's ideal body weight. There's sort of like goal body weight. And then there's current body weight

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Dr Doug: for most people with osteoporosis. This isn't a population where there's as much overweight and obesity, but still understanding like, if you have an extra 2030, 40 pounds on your frame.

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Dr Doug: your protein needs shouldn't reflect that. So you need to aim for really, what is your ideal body weight? And there's an actual calculation for that. And if it freaks you out because it seems so much lower than where you think you need to be. That's okay. We're not. This isn't a weight loss program. So ideal body weight. And that gives you an idea. So, you know, for somebody who's 5 ' 4, it could be 1, 1520 pounds. So therefore, one gram per pound, 120 grams. Just easy, peasy math.

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Dr Doug: but that is a starting point. And so this is where this really needs to be customized. So take, for example, somebody who's coming in, who's been eating 40 grams of protein if I tell them to eat 120 grams of protein, not a chance. They're gonna be able to consume that much protein in a day. So we really have to work our way up, and then also probably evaluate the gut and figure out like, do you have enough hydrochloric acid? Can you actually break this stuff down?

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Dr Doug: Excuse me, what are your pancreatic enzymes?

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Dr Doug: Because one of the reasons why people stop consuming protein is because they just can't consume it. They don't feel good when they eat it, but that's a sign of gut dysfunction. Not that you don't need the protein.

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Dr Doug: So remember, we are in this.

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Dr Doug: this Osteopodic state, this low muscle mass state. We need to push those things forward, and you have to have the building blocks to do that. So the absolute number one most important thing, if you're going to track anything, if you're going to change anything in your diet is to get adequate protein.

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Dr Doug: The second component to that is, what about animals versus plants. So animal protein is valuable as it's coming from another animal, because the amino acid profile, meaning that the building blocks of those proteins are the same in animals as they're going to be utilized in humans. So you don't have to mix and match different protein sources. You can just, you know, assume that you're getting all of those amino acids. It is as a complete protein coming from animals.

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Dr Doug: When it comes from plants they're going to have different amino acid profiles, so it is possible to mix and match plants to get that same amino acid profile. But you've got to be pretty intentional about what you're eating.

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Dr Doug: or you're going to eat. What are the what is really the only it's kind of 2 complete proteins in the plant world. So one would be soy and the other would be pee. If you can grind it up and consume a lot of pea protein, so it's possible to do through plants. But it's harder. So generally, when people are eating a plant-based or plant exclusive diet.

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Dr Doug: We're going to move that one gram per pound up, and we're going to move it up to like 1.5 1.6, based off of some literature that shows very clearly what the usual amino acid deficits are. So then you're talking 1.6 grams per pound of ideal body weight, which gets much harder right? So now that same 5 4 woman who was consuming 120 grams of protein. Now it's like, whatever the math is right, 170, and that's really hard to do through plants.

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Dr Doug: So that's

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Dr Doug: that's why we recommend animal protein. If people are open to it and can tolerate it, and protein in general is the most important thing.

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Breta Alstrom: Yeah, I wanna talk about a couple of things on that front with digestion. If

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Breta Alstrom: you can't tolerate that full amount that you're supposed to get

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Breta Alstrom: one. Go up slowly. 2. Investigate your gut health stomach acid drops as you age. That's gonna massively impact how you digest protein. And then, like. The other part of that is that we need to have the right enzymes. And some people won't. Some people those to kind of like as you age. If you don't have enough stomach acid. Some of those things aren't activated so definitely. Explore all your options there and then, when it comes to your ideal body weight. If anybody did wanna calculate that I would just

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Breta Alstrom: you basically just do the Bmi equation backwards, which I won't put out there. But you're gonna use. I would recommend just using a Bmi of 23. Technically, you have a range of 18.5 to 25, and then you just do the math backwards until you get to what the weight should be. And that wait would then maybe doesn't need to be what your weight should be. But that should be. How much protein we want you to eat.

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Breta Alstrom: and you can also do that if you're underweight, too, which might mean that you need more protein than your actual body weight right now, if you're, you know, 100 pounds, 105 pounds, your actual protein intake might be higher than what your current weight is. So keep that in mind, too.

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Breta Alstrom: Awesome. And we talked about. I know you. I'm glad you touched on the plant based options, because that was a question that came up in slack today. So I think we'll.

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Dr Doug: And there's i i wanted to say to Caitlin I mentioned to kino is another

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Dr Doug: complete protein from an amino acid perspective. The challenge with quinoa is that it's not in large quantity, is not going to be tolerated very well.

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Dr Doug: whereas soy is potentially tolerated. But it just ends up being a primary food source. So with the potential antron, so it's got to be organically, it's hard to find good, soy. And then you have to eat it every day.

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Breta Alstrom: Yeah. And there's also

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Breta Alstrom: there are the amino acids that are found in plants, and then they're the amino acids that are absorbable from plants, and generally for the amino acids absorbable from plants, even from quinoa chickpeas and soy, which technically have complete amino acid profiles. The complete amino acid profile isn't absorbable. So just keep that in mind. I mean, if you're gonna eat plants, don't don't get too into the weeds, just, you know, eat and go from there and focus on the protein first? st

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Breta Alstrom: but I I do think that brings up a good point about the amino acid profiles. And should people be doing an amino acid drink.

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Dr Doug: Yeah, I was just chatting about this yesterday. So we definitely do talk to people about essential amino acids. Or you also see, this is Bcaa branch chain amino acids.

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Dr Doug: all essential amino acids, or when I talk about a complete protein, it's those amino acids, right? So, however, many of them. There are the real geeky people in this community know how to know what each of them are and what ratio.

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Dr Doug: I'm not that geeky. So the essential amino acids is all of them. Branch chain is a subset of those, and one of those is leucine, which is arguably the most important from a muscle, protein synthesis, perspective. So you can kind of hijack the muscle protein synthesis.

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Dr Doug: perspective of protein by using an amino acid drink. So it's like a powder. It kind of has, like a

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Dr Doug: kind of a sour-ish flavor if you've ever tried one.

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Dr Doug: But the research is pretty good, and I think I have a video out there on this. If not, it's coming out. But the research is pretty good. That shows it, even for anabolic, resistant meaning, like

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Dr Doug: older individuals who can't put on muscle mass, which might ring true for a lot of people here for anabolic, resistant people. If you use an Eaa drink around whatever the common like the scoop. Whatever the scoop is, it's all the same in almost every product

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Dr Doug: that will help to increase muscle, mass, and strength as a single intervention. So we do like them.

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Dr Doug: Now, the caveat to that is, if you're consuming adequate protein, you probably don't need it. So if you're hitting that one gram per pound, and you're seeing results. Don't waste your money on an Eaa drink. It's expensive. But if you're struggling with protein or you're not seeing results, then, yeah, that's where I think it does make sense.

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Dr Doug: Yeah.

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Breta Alstrom: Awesome.

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Breta Alstrom: okay, perfect. And then what about on low appetite? And not getting well? No. Sorry you want me to finish the question, dairy. Let's talk about dairy. Do you recommend dairy for osteoporosis?

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Dr Doug: Yes, moving.

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Dr Doug: So Gary is really controversial.

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Dr Doug: because there's a number of studies association studies that that show that dairy is negatively associated with osteoporosis, and what I mean by that is more dairy consumption.

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Dr Doug: lower bone, mineral density. And then to look at these population studies and say, well, this population doesn't consume dairy, and they have better bone mineral density than this population.

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Dr Doug: The problem with all these, these like big population-based studies is that when you are when you're looking at a population you're looking at one factor. There's, of course.

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Dr Doug: you know, an unlimited number of other variables which the researchers can try to control for. But it's basically impossible. That's why we have to take

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Dr Doug: observational studies for what they are. But then you need to look at intervention studies intervention. Studies are going to be better to show an actual relationship of directionality or causality.

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Dr Doug: And so, when you look at the intervention, studies the intervention studies, especially in an older population, look pretty good. So you can take people who have limited independent function, feed them dairy as an intervention, as a supplemental intervention, and actually watch their muscle mass get better their bone mineral density get better even in a population that isn't able to do anything else.

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Dr Doug: So from an intervention perspective. It actually looks pretty good.

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Dr Doug: But the the reality for people in the real world is that not everybody tolerates dairy consuming dairy as an adult is

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Dr Doug: intrinsically unnatural.

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Dr Doug: right? We are the only species that consumes dairy from another species. We're also the only species that consumes it. After you know the beginning of life.

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Dr Doug: If you think about what dairy is there for breast milk is to make babies grow quickly right. It is the only natural food product that is high in carbohydrate, dietary, fat and protein.

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Dr Doug: Nothing else has all 3, except for, like

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Dr Doug: protein baked into a cake. Yeah, like baked goods. Now it can do that. But naturally it's the only thing that has all 3. So it makes things grow quickly. So it makes sense that it would actually help us to grow quickly if we wanted to do that as an adult.

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Dr Doug: But we lose the enzyme lactase to break down lactose. And then there's other proteins in there that can also be potentially inflammatory, and some people don't tolerate

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Dr Doug: definitely. Don't have to consume dairy, but if you tolerate dairy, it can be a tool to push you into this anabolic phase to get you into the side of building muscle and bone. So I do like it for people. But I also worry about the quality of dairy if it's pasteurized.

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Dr Doug: and then they get into the raw milk thing, but once it's pasteurized, it loses some of the benefit. If you strip out the fat it loses some of the benefit. So I think more natural, better. It doesn't have to be milk, and so that gets you into like. Well, can I consume.

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Dr Doug: you know, unpasteurized products? Well, then, we get into like the raw milk world, which for

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Dr Doug: there's this whole controversy around raw milk, and is it safe? And I think if you're getting it from a farmer that knows what they're doing? The answer is, Yes, but I can't tell you what farmers do and what farmers don't.

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Dr Doug: We consume raw milk? I give raw milk to my kids, but I know where it's coming from.

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Dr Doug: We also look at people who are saying, Well, I have access to like raw cheese. Well, raw cheese is probably going to be safer right? It's fermented to some extent it's processed to some extent, but it will still contain some of those proteins that you can't get if you're using pasteurized products. So there's a whole slew of different things. You can do right. So like cottage cheese and yogurt, and you start getting into all the different variations

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Dr Doug: most people can tolerate some version of dairy. It just depends on how much lactose and how much protein is in there that they can't tolerate. So I do like it. But it's definitely variable.

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Breta Alstrom: Yeah, awesome.

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Breta Alstrom: Okay? And then thoughts on using like lactate. If you are intol, like, purely intolerant, not sensitive, you just can't digest it.

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Dr Doug: Yeah, I'd be curious. Your thoughts on this, too, Reddit. My, my perspective is, if you don't tolerate Lactose, you're probably not tolerating other proteins in there, too.

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Dr Doug: So for people that are lactose, intolerant, taking a bunch of lactate and then consuming dairy is probably still inflammatory, would be my guess. I've never seen any evidence on that. What do you recommend for people running.

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Breta Alstrom: Yeah, I'm pretty sure what our dietitians recommend is, it's or as with any enzyme like, say, we, we're taking something like a an enzyme for vod maps or something like that, although we don't normally have people on like a low fod map diet. But it's great

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Breta Alstrom: when you need it. If you are going to say like, you're mostly avoiding dairy, and then you're going to have it for whatever reason and then taking it then. But if you constantly have to take it, it's probably not the best solution for you, and that we'd be better off avoiding it so that way you're not constantly putting your body under stress. But

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Breta Alstrom: yeah, nice. Okay.

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Dr Doug: Lactose, intolerant, and she just she'll just walk around with like

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Dr Doug: I don't know, like a bottle of lactate, and eats whatever she wants, but then takes lactate.

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Breta Alstrom: Yeah.

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Dr Doug: Like. I don't

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Dr Doug: think that's probably helping you.

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Breta Alstrom: Yeah, it also. Yeah. It adds to your pill burden all the things.

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Dr Doug: I was like my stomach hurts. I'm like.

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Breta Alstrom: Yeah, and there's actually quite a few questions from slack on protein. But I'll tell you guys what like, next time Doctor Doug is traveling. We'll just do a full session on protein and all the ways to incorporate it. How to slowly increase how to like. See if you can tolerate it. Saturated fats, all of that stuff. We'll just do a deep dive, a whole session on protein next time Doctor Doug is gone.

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Breta Alstrom: and let's

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Breta Alstrom: switch gears a little bit here. Your thoughts on. Yeah, these are 2 things I really wanna make sure we get in same thing with chronometer we can do. There is a chronometer deep dive that we did, and if we want to do another one, we can definitely do that sometime as well, and we can do some live workshopping there. But let's talk about caffeine and bone, health or coffee and bone health.

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Breta Alstrom: What'd you find.

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Dr Doug: So I I did it. You're welcome. I risked my own

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Dr Doug: coffee consumption to find out the truth. So it's it's still a controversial space. But the evidence is pretty clear from my perspective, which is that as long as you're keeping under, I think 300 milligrams of caffeine is sort of the the threshold.

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Dr Doug: If you're keeping it under 300 milligrams of caffeine, there's no increased risk.

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Dr Doug: There's some evidence that over that that maybe there is potentially some reduction in bone bone health specifically bone mineral density.

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Dr Doug: but under that seem to even be protective. Tea was more protective than coffee. Probably some other reasons for that. Tea drinkers tend to have other healthy habits, but it doesn't matter if the caffeine is coming from tea or coffee under 300 milligrams. You're probably fine. That's usually like 2 to 3 cups, maybe 4 cups, depending on the type of coffee that you're drinking. It's probably one cup from Starbucks for those that are Starbucks lovers.

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Dr Doug: But yeah.

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Dr Doug: didn't change me for drinking coffee. Put it that way.

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Breta Alstrom: I will. I, you know, for 300 milligrams. I think I could probably maintain my current coffee consumption.

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Dr Doug: Probably breach 300 milligrams every day. But just barely.

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Breta Alstrom: Well, well, we won't talk about my coffee consumption. But what about chocolate? Any thoughts on chocolate being good or bad for phone health?

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Dr Doug: This is a painful one. I'm almost afraid to answer this, because I might get stuff thrown at me, so I'm sort of not liking chocolate these days, because I think it's just hard. It's hard to get something that I'm not sure is adulterated with toxins.

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Dr Doug: and the chocolate industry is pretty terrible where they get chocolate from, how it's processed, what's in it. I think it's just. It's sad, but I don't know that we can reliably get safe

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Dr Doug: chocolate from one perspective, and then

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Dr Doug: remember that it is. It does have caffeine in it for those that are caffeine, sensitive. I have a hard time with moderation just in general. So for me, I just don't want to have it around, but it's in my house. My wife eats it, I think, in general, it's not something that we should eat a lot of, but in actual small quantities like for those of you that are in Europe. Whoever's in Europe in here can show us what an actual

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Dr Doug: bit of chocolate should look like.

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Breta Alstrom: And I'm gonna send this to the chat. But the Hsn. That Carrie, one of our dieticians, did on toxins. She does talk about chocolate, and then some potential brands that you can check out as well. And I can always

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Breta Alstrom: get those from her, and like put them in the canvas and slack as well. So Stephanie.

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Dr Doug: Just dropped in there. The Japanese have tiny squares, too.

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Dr Doug: and but they and they also drink. This is like the the tea versus coffee thing right? So like they also drink green tea, and they also go to bed early. Japanese have incredible lifestyle.

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Breta Alstrom: Yeah.

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Dr Doug: Society.

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Breta Alstrom: A few more things that we got that I'm just gonna direct people to other places. If you have questions about anti nutrients, check out that module in bone foundations because there are handouts in there on how to reduce any anti nutrients, oxalates, vitates, lectins, all of that stuff, so check that stuff out, and then let's just end on

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Breta Alstrom: seeds and osteoporosis.

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Breta Alstrom: Do they add protein? Are you recommending seeds yeah, like nuts and seeds? We'll do nuts and seeds.

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Dr Doug: Seeds. Man, I'm not a big fan of seeds in general, except for maybe chia seeds.

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Dr Doug: I find that nuts and seeds. I I my concern is that if you look at the nutrient value, it's certainly there, right, is there protein and nuts?

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Dr Doug: Yes, but there's a lot of fat. There are a lot of dietary fat. So it's a very calorie, dense source of protein. So when people say like, Oh, my kids, I hear them out there right now. I guarantee you somebody out there is eating peanut butter and telling me that it's a protein source, despite the fact that I've told them over and over again. It's a dietary, fat source.

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Dr Doug: so there is value in them. But it is. You have to understand what it is, and then how much are you actually absorbing? Because from an antinutrient perspective, there's more in nuts and seeds than there is in anything else. Right? Those are the things that plants don't want you to eat the most don't eat my babies.

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Dr Doug: so they tend to protect them, but they are consumable. But this is where, like working with somebody to help you figure out which one can you tolerate which ones are actually helpful? I, personally don't eat any, but certainly some of our patients do.

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Breta Alstrom: Awesome. Well, perfect. I you know what? No, I'm gonna cause we've been. We're not gonna have time for an audience question. So you guys send the rest of your questions to the slack chat. The slack channel for live session. Follow up. But I do wanna finish on one more

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Breta Alstrom: quick!

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Breta Alstrom: Quick comment from you on how much water you recommend. People drink and

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Breta Alstrom: electrolyte imbalances and just overall perspective. There in our last few minutes.

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Dr Doug: Yeah, we actually have a calculation for this. And I don't know what it is, Bretta, what we're recommending from an ounce perspective. But it's definitely it's based off of size.

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Dr Doug: you know. So like how much water I need versus how much water Lorna needs is very different.

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Dr Doug: quantity. But I forget. Do you know what it is, Brett? Or can you look up what our calculator.

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Breta Alstrom: I can find it.

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Dr Doug: So while you're doing that, let me talk about electrolytes. So water is another area where you know we used to. If you go back whatever you know, thousands of years right like we got water from creeks, and we stored water in cisterns, and

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Dr Doug: we get natural water from rain. Well, now everybody's water is adulterated. Right? You have city water. It's been, you know. It's been run through the toilet and then through the cleaner and then chlorinated, and it has estrogen and like birth control like, it's just

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Dr Doug: freaking toxic. So I definitely recommend filtering your water with the best filter possible. And but then, once we do that. So now it's not mineralized. Now it, you know, like it's not. It's almost not even water anymore, like it has hydrogen and oxygen in it. But what is it really? And so getting

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Dr Doug: natural water, I think, is a challenge. I think remineralizing with some kind of an electrolyte is not a bad idea how often it's going to really vary on your needs and how much you know. Are you sweating? Are you losing versus how much you're consuming. It's a really tough thing to figure out for me. I end up consuming.

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Dr Doug: you know, 60 to 80 ounces of water a minimum a day. I basically just work all day with my oh

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Dr Doug: bottle beside me, and I drink about 4 of those, and I put electrolytes in, you know, 2 or 3, and sometimes drink some plain water as well, but it's all filtered, and I try not to drink out of plastic water bottles.

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Breta Alstrom: And I am not

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Breta Alstrom: finding our fluid goals. It's always just increase fluid. So.

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Dr Doug: Or.

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Breta Alstrom: You're probably not drinking enough awesome, alright, guys. Well, that's all the time we have. I know Doctor Dog has to go see patients. I will send you guys some follow up things in slack, like some

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Breta Alstrom: animal based protein shake options for you. We have some links and codes. You can also find those on the Hsn website under products and tools. And I have a few other things to look at like snips for Vitamin K. And I will also send you some updates on the old reports of algae and lead, and all of that stuff. That we have. But send your questions to the slack channel and we'll get connected there. And yeah, we'll we'll wrap up for today. Have a great have a great rest of your week, guys.

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Dr Doug: Thanks, everybody! Bye, bye.

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