Breta Alstrom: Alright. Welcome everyone. So if you're in slack, you know today, we're talking about putting together your osteoporosis plan and your timeline, and when to include different kinds of modalities. And hopefully, this is like a really good rollover from Edie's presentation on just trying to manage all the overwhelm and figuring out when and how and where to to put all these different components that we talk about.

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Breta Alstrom: So we're gonna run through our optimal bone health pyramid actually to kind of just frame this conversation. So I'm gonna go ahead and share that. So you guys should be able to see it.

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Breta Alstrom: And yeah, and so we'll talk about most of the things on this list today, particularly like these 6 pillars of health down here, and

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Breta Alstrom: in general. I think a lot of you guys are probably really focusing on these 2, the nutrition, the exercise components. And so we'll also outline how and when and where we can put these things in. So, Dr. Dodo, do you wanna start us out with just kind of

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Breta Alstrom: where do you think people need to be starting when it comes to Osteo process.

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Dr Doug: Do it. All. I'm just kidding.

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Dr Doug: That's the problem, right is that people will get the diagnosis. They start doing research. They find people on Instagram, Youtube, or just from their doctor, if they happen to have a fantastic provider that gives them a lot of information. And then everything starts to short circuit, because there's just too many things. I mean, this pyramid has. I don't know how many things it has in it, but within each of these things we could talk about

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Dr Doug: so many different topics. So it just gets overwhelming so fast. Because, as we've talked about before, osteoporosis crosses over so many different areas in health. And really it is

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Dr Doug: health span. This pillar. People here probably don't know this. But this whole thing was created before we had a bone health program. That's why at the top it says optimal human health. We have a version that says optimal bone health, too. But it was created to optimize anybody in the face of chronic disease and aging. So you can imagine how, then this crosses over everything but the reason why it is a pyramid, and it starts broad, and it works its way up. Is that, in my opinion, probably the most important things are the lifestyle things.

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Dr Doug: So this is why, when I do our master class. I say that the traditional medical model is flipped upside down, because if you look at where pharmaceuticals is, it's at the top.

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Dr Doug: But that's generally what they lead with, for all the reasons that they do, but without the nutrition exercise, and we could just even stop there. But without those 2 things pharmaceuticals are going to have, much less of an impact if any impact whatsoever.

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Dr Doug: And so we really need to start at the bottom, especially if we're not going to just use big hammers like pharmaceuticals, we're going to use more subtle things like supplementation hormones, etc. You really have to have the foundation to be able to allow those things to do the things that they can do. So really, starting with wherever your weakness is at the bottom.

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Dr Doug: For most people as they come into our program. What we're finding is that nutrition and exercise are 2 really common areas to start because there's a lot of question around what to eat, how to eat, how much to eat, etc. And then a lot of people with osteoporosis

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Dr Doug: after the diagnosis especially, they're really no longer exercising, because they've been told, because they have to worry about fracture. So that leads to anxiety, which then leads to worse stress.

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Dr Doug: It just keeps going from there. So I would say, starting with those 1st 2 is where most people should start. But then very quickly, we need to get into some of the other areas.

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Breta Alstrom: Yeah. So let's write that down, too. And you guys can in the chat, put your questions and we'll we'll get those kind of worked in, and we'll we'll start here at the bottom with the 6 pillars of health. So if you guys have particular questions about those things, we'll wrap that in I actually wanna jump over to mindset really quickly, cause I feel like we could like.

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Breta Alstrom: There's kind of like 2 splits in mindset, and, like the 1st one would be

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Breta Alstrom: believing that you can do this, and then the second part of mindset would be managing all of it. So let's talk about that 1st part. And for people. And I mean most people here, you guys are already taking those 1st steps. But when it comes to mindset around your health. What advice do you have? There.

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Dr Doug: Boy, it's such a tough topic. And when we created this the 1st time around there were 4 pillars, and it was nutrition, exercise, sleep and stress mitigation. And we're like we'll just put it all in that, because it is a lot of that. But mindset is such an important, unique thing that we did. We ended up breaking it out, and we work with our coaches. We have either one-on-one coaching or group coaching where we're working on mindset, because if you don't believe

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Dr Doug: that you can reverse osteoporosis, that you can improve your muscle mass, that you can improve your health, you won't just period, and that's been shown in study after study, after study. Where you believe you can go is where you can go, and if you don't believe you can get there, you won't.

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Dr Doug: So we see this in all sorts of areas in healthcare. So you're right. That 1st step of believing that you can is absolutely critical. I bet that most people here have probably crossed that bridge, or at least they're crossing that bridge. They see the evidence. They hear the stories they see the proof. They're thinking, man.

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Dr Doug: I bet I can do this, too. So at least they're probably on the way across that bridge. But then there's the daily mindset, the affirmations, the avoiding the fear, avoiding that inner dragon. You guys are probably seeing tattooed on my shoulder. That's the inner dragon right? That inner dragon is telling you that you're wrong, that you can't, that this is, you know you are going to fracture. You need to go back to your endocrinologist. You need to get the drug you have to, you know. Don't listen to this guy because he doesn't know what he's talking about.

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Dr Doug: All of that self-doubt, all of those things that creep up every day over and over and over again. That's the other side of mindset, and that's much tougher.

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Dr Doug: Taking a leap of faith is something you could potentially do once and stay on the other side. But that daily mindset

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Dr Doug: of staying in the right space being positive, listening to the right voices, keeping the other ones outside of your inner circle that takes work, and that's where having somebody who is helping you through. This is really helpful whether it be somebody in Hsn's a family member who's supportive a partner whatever, but finding somebody who can be that person to help you stay in the right space is really, really important.

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Breta Alstrom: Yeah, awesome. Alright. Let's. And as you guys are thinking about all of this stuff and and putting it together, I think one of the the best things that you can do because we're gonna go over a lot.

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Breta Alstrom: We know that everybody's already overwhelmed. But look at like the one or 2 things that you can do. And I think a lot of times, too, we get so specific and nitty gritty is like, especially when it comes to nutrition that it can get really overwhelming about. Like, I need to incorporate this food and this food and this food, when we can zoom out and take a bigger like a more broad approach to things, and make sure that you.

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Breta Alstrom: You have the basics down before you're trying to include all the like tiny things that you need to be doing. But let's start there with nutrition. And if somebody is kind of feeling frozen and stuck right now, what's the 1st thing we should be doing when it comes to nutrition. When we're kind of in that, that freeze response.

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Dr Doug: Yeah. So the 1st thing we do is in the program. We're asking you to tell us what you're eating. It's really hard if you just ask somebody to think back. What did I eat in the last 3 days? It's really hard. We have people prospectively look forward and write it down and tracking food is miserable. Let's face it, but it's a really helpful tool to understand what you're consuming, and I don't care if you're writing it down on sticky notes. It doesn't matter some way to track what you're consuming.

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Dr Doug: because what we see very consistently is that most especially women with osteoporosis are underconsuming protein for a whole bunch of reasons.

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Dr Doug: But that's the number. One thing out of the gate is, how much protein are you consuming and then working on on getting that protein level up with the things that you're comfortable with. So I just saw a question pop up like, can we talk about beef versus turkey. And this, this is like the nitty, gritty stuff, right? So you get into these little rabbit holes. And you're like, Well, what about the amino acids in this or this? Or what about like? It just gets it takes up so much brain power. But the big picture is.

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Dr Doug: are you getting adequate protein. And are you getting adequate nutrients period? Are you getting adequate energy because so many women also because of decades and decades of undereating, of dieting? Yo-yo dieting, worrying about weight, etc, are eating so few calories.

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Dr Doug: To begin with, that it's hard to get enough nutrition, especially enough protein.

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Breta Alstrom: Yeah. And I posted in the nutrition channel a few weeks ago. Now a little overview of like how you can use chronometer. So now that was a question. And yes, we do generally recommend tracking. Chronometer can make it really easy. You can, if it's stressful for you, though, to to put in stuff as you're going. There's a few different things you can do like, even if you write it down like Dr. Doug said, and then, like at the end of the week, you go in and put it in to see the

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Breta Alstrom: numbers. It's that way. You're not hyper fixating on those that can be really helpful.

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Breta Alstrom: if you're working with our team, you can actually request that they just turn the numbers off for you, and so you can track your food, and then they can see it, and then give you those recommendations.

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Dr Doug: Hmm.

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Breta Alstrom: Which can also be really helpful.

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Breta Alstrom: So yeah, that is, I think, a big component. And then, as you're doing that, you're not necessarily looking at. Okay today that I put my food in. Did I meet my goals at least in the beginning. But if you can zoom out and look and reflect on that and say, Okay, this is where I was. And if I want to make a 10%

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Breta Alstrom: better like a change here, what do I need to do to get there with the foods I'm already eating? That's generally the easiest thing to do. And then in that video, too, that I posted. I know there's some questions which will talk about kind of with heart, health, and everything. But if that is something you're concerned about, and you do have the genetic predisposition that you need to be looking at saturated fats and things like that. I in that video, I showed you how you can assess that using chronometer as well. So

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Breta Alstrom: keep some of those things in mind. We do have some good questions about nutrition, though, specifically, if

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Breta Alstrom: like, I I like this one from Gail. Am I gonna need to eat 150 grams of protein for the rest of my life?

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Dr Doug: I love. It's such a good question, and I think that and Gail.

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Joan Peet: Good.

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Dr Doug: Me if I'm wrong here. But you probably haven't been eating that much protein for a long time, as I would assume is where this question is coming from?

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Dr Doug: Never. Yeah, thank you. So

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Dr Doug: I think it's I understand. The perspective of this is so much more protein than I've ever eaten in my life, and it can be challenging. So do I have to do this for the rest of my life. Any change that seems daunting. And you think about? Am I have to do this for the next 2030, 50 years? I don't know if I'm going to be able to do this.

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Dr Doug: but let's not put the cart before the horse. We don't need to worry about 50 years from now, 30 years from now, even a year from now. Right now we're building bone. Right now we're building muscle. Let's worry about what your needs are a year from now, a year from now.

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Dr Doug: but we know that we do need to get adequate protein in order to build muscle and bone. 150 grams might seem like a lot. And so most of our patients aren't hitting 150 grams unless they have an ideal body weight of 150 pounds.

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Dr Doug: Maybe you're overshooting where you need to be. I don't know what your metrics are like, but getting at least a gram per pound of ideal body weight is sort of a it's a baseline. Some people do need more than that. So as we age, our gut becomes less efficient. Stomach acid levels go down, which means your Ph goes up.

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Dr Doug: We're not as efficient at breaking down protein. So actually, as we age, we do need more protein than we did when we were younger. We are fighting this downhill slide of aging, and we can't avoid that as long as we are still alive.

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Dr Doug: It is likely that you're going to continue to need more protein than you used to? The question is, is that 150 grams, or is that 100 grams, or is it somewhere in between? And so that's where that customizable solution that is flexible over time really matters.

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Breta Alstrom: Yeah. And

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Breta Alstrom: that's when you have that data you can look at. I've seen people who are getting, you know, 60 grams of protein per day.

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Breta Alstrom: The next day you don't need to eat 120 grams of protein, but if you can go from 60 grams of protein to 70 grams of protein. That's also going to make a difference. So as you're looking at your life, and you know what your long-term goal is. That doesn't mean you need to get there today because any improvement is going to be an improvement for your bone. Health

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Breta Alstrom: and then along with that, with eating more protein. Let's just talk about the heart disease component of that, and saturated fats and everything. And you can just go ahead and share your perspective. There.

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Dr Doug: Yeah, you can sense it in the chat where there's so much emotion around eating animals, and we can avoid just the whole animal part of it. And just talk about what about the heart disease? This is such a challenging space, because we have to eliminate the conversation around animals. That's a whole different conversation I'm happy to have. But let's just isolate them for now.

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Dr Doug: So if you're consuming animal products, you're going to be consuming more saturated fat for the most part. By default you can eat a lower saturated, fat version, but in general, if you're not super selective, you're going to get more saturated fat

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Dr Doug: for some genetic predispositions that will increase your cholesterol. In theory, if you believe in the cholesterol hypothesis, this is going to increase your risk of heart disease. However, we know that cholesterol is a biomarker of

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Dr Doug: cardiovascular risk, meaning that higher cholesterol, higher chances of having plaque and events. However, those data are not very good, and if you look at the alternative hypothesis around cardiovascular disease, which is, you have to kind of look for it because

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Dr Doug: we have pharmaceuticals for cholesterol. So you hear this messaging over and over and over again, cholesterol, cholesterol, cholesterol.

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Dr Doug: But really there is better evidence to support the idea that metabolic health is more important. So it's not your Ldl level so much as it is your Hdl. To triglyceride ratio. That's a much better predictor. So what we see is when people switch from eating a lower protein diet to a higher protein diet with more saturated fat is that for some people their Ldl cholesterol will go up, but their triglycerides come down, their hdl cholesterol typically goes up.

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Dr Doug: The ratio of Hdl to triglyceride, then looks better and actually looks amazing. So they have better metabolic health. And then other factors, like other biomarkers, like crp fasting, insulin a 1 c glucose. All these other biomarkers start to fall into line.

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Dr Doug: So the question you have to ask yourself is.

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Dr Doug: Am I more interested in my Ldl cholesterol than I am in the rest of my blood panel? Because that's usually what the trade-off is. And so for me, I would rather you eat the diet that supports your muscles, that supports your bones, that supports your metabolic health, because ultimately that's going to be better for heart health over time than is lowering your Ldl cholesterol.

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Dr Doug: And if you do have existing disease, if you've had a heart attack, if you have significant atherosclerotic disease in your heart, and you do need to lower your cholesterol because it is a risk factor for those individuals, then

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Dr Doug: we can use either supplementation or potentially, even pharmaceuticals, because we can lower cholesterol pharmaceutically and then still eat the diet that we know, is going to support ourselves otherwise. So that's the approach that we use.

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Dr Doug: But remember that animal products are not necessarily the cause of heart disease. Ldl cholesterol is not a good biomarker for heart disease. It's more metabolic health and the less carbohydrate you eat, the more animal product you eat, the higher protein you consume, the more likely you are to support metabolic health, even at the expense of cholesterol.

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Dr Doug: I hope that made sense.

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Breta Alstrom: Yeah. And I think, too, as we put this into the mindset.

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Breta Alstrom: the conversation. If this is consistently coming up for you where you're like always having this battle between yourself, like

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Breta Alstrom: I need to eat more protein. But I'm worried about my heart

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Breta Alstrom: first.st Do you have the data to support that. And I think Edie went over some really great things a couple of weeks ago. But looking at, do you have the data to support that? And then, second, that might be a really great place for you to spend time, like

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Breta Alstrom: maybe creating some affirmations around that, and like consistently trying to rewire your brain, or, if you are part of our program, bring that up with your health coach, because you're spending too much energy on that, like you're spending too much mental energy on something that might make no difference for you, and that's hindering your bone. Health results.

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Dr Doug: It's causing you stress. It's keeping you from sleeping. I love our approach to this with our patients, which is that we can learn so much about the arteries. So if we're worried about cholesterol, we just need to ask the question, well, what do my arteries look like?

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Dr Doug: So again, Ldl is not a good biomarker for risk. In fact, there's a big U-shape and low cholesterol is associated with more risk than is high cholesterol. It's a huge thing, but we can simply ask the question, what do my arteries look like? So we can get a coronary artery calcium score to look for calcification in the arteries of your heart, and then, if you want to go a step further and get really fancy you can do an AI generated map of the

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Dr Doug: the plaque that's in your arteries based off of another type of Ct scan that tells you exactly what's going on in your heart. We do this in our patients that are willing to do it. It's kind of expensive, and you have to undergo a Ct. With dye. I can't wave a magic wand and make that happen.

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Dr Doug: If you have the data, it's so compelling. Because we see this in our especially our sixties and seventy-year-old patients who want to start estrogen, and they're 20 years out from menopause.

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Dr Doug: Their arteries sometimes are just as clean as a whistle, and if they're worried about having a heart attack because they're starting estrogen, but they don't have any plaque at all in their arteries. I think we can lay that concern to rest.

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Dr Doug: and so you can really answer some questions with the data that's available if you have the resources to get it. And then we don't have to worry about the Ldl. And we do the same thing with people that have elevated. Ldl. They're saying, Oh, my gosh! My Ldl is 130, which 1st of all is not that high.

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Dr Doug: But, secondly, if their arteries are clean and they're 70 years old, and they haven't developed any plaque yet. That is not going to be the thing that kills you. We don't need to worry about your Ldl cholesterol, your cardiologist says, Go on a statin. You can say Thank you, but no, thank you, and move on, because that's not the thing that's going to kill you. Your osteoporosis is going to kill you much sooner than that.

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Breta Alstrom: Yeah. And I wanna move on to exercising just a second, but just based on the stuff in the chat. I want to. Just if you're asking specific questions about what about this food or this food or this food? I

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Breta Alstrom: because I want you to leave this session today feeling like you have actionable steps, and you know, saying, if

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Breta Alstrom: like, should you consume more of this or more of this, I do really want you to like, go home and track your intake by eating foods that you like that, you know, are like good for you. They're a whole foods based diet, and see where your nutrition is at. Don't just leave here thinking I have to increase my fish. I need to eat more nuts and seeds. I need to do this like, look at what you're doing, based on what you like.

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Breta Alstrom: and then use that data to make better choices and then bring those to our next session or bring those to slack, and then we'll talk about it based on, you know, some trends that you're seeing that everybody can learn from and then one final thing on nutrition. Let's talk about oxalates and other anti nutrients. And how can

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Breta Alstrom: how can we conceptualize that.

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Dr Doug: Yeah, this is a conversation that I used to really enjoy having. And now I get tired of having it, because there's not really a great answer here. So there's people. If you listen to the people in the carnivore community, they'll talk about oxalates and how they're out to kill you. They'll cause kidney stones, and they're binding to minerals, and you're going to not absorb nutrients, and they're ruining your diet.

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Dr Doug: And I think that's taking it a little bit too far, there is likely a spectrum of tolerance of oxalates. And so some people, obviously, there's people that are thriving on an exclusively plant-based diet that are consuming a lot of oxalates. They're doing fine. But there are also people that are much more sensitive to it. So this is a variable thing that we really have to

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Dr Doug: try to understand how we feel when we consume foods, which is hard because we're not used to doing that, we're actually eating, not mindfully. Just

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Dr Doug: shove it in your mouth and keep working, and I'm guilty of that, too. I'll sit here and work and eat at the same time, so I don't know what I'm feeling like when I eat. I try not to do that. But oxalates. I know if I consume in large quantities I don't feel good. So spinach, for example, I used to put in a smoothie like frozen spinach, like a quarter cup of frozen spinach in a smoothie that's actually a lot of spinach.

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Dr Doug: And when you do that, when I do that I feel terrible. So probably maybe that was the oxalates. Maybe it was the phytic acid? I don't know.

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Dr Doug: but some people are more sensitive to it. Is it the end of the world? No, you can also, the more you cook your vegetables the more you're going to cook oxalates out, so you can eliminate some of these things. Some of the antinutrients, by making sure that your vegetables are cooked rather than raw, depending again on how you tolerate them. So I think it's probably an overblown thing overall. We don't probably need to worry about it as much. But do listen to yourself, and if you are struggling with some foods.

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Dr Doug: then you can eliminate them for a while and see how you feel that's the beautiful thing about tracking, too, is, you can say, oh, man, I was having spinach and kale every day I eliminated them. And, man, I feel a lot better. I'm sleeping better. My stomach feels better, my bowel movements are better. There's so many ways to look at

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Dr Doug: how your food is impacting you.

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Breta Alstrom: Yeah, and also, too like.

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Breta Alstrom: make food that tastes good, and most of the time cooking your vegetables. They they just taste better, and they can be more enjoyable for you. So awesome. Alright! Let's transition to exercise real quick. Where? Where are we starting exercise? There's so many things, I think everybody, whether it's vibration therapy lifting weights, impact training heel drops all the things. If we're starting from 0,

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Breta Alstrom: what do we do.

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Dr Doug: Yeah, so and 0 is really common. So if you're here and you haven't worked out in 40 years, you are not alone. Lots of people in this space have not been active. That's 1 of the things that leads and predisposes to osteoporosis. So know that you're not alone there. I've been thinking about this bread. We don't need to do it, but I almost feel like we need to break the exercise block in half for the bone health side and be like

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Dr Doug: resistance, training and impact. They're 2 different things. And then there's all of the other types of exercise, right? And so I would say, if you have limited time limited focus, the most important thing from a bone, health perspective is actually probably impact.

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Dr Doug: And it's hard to jump into an impact training program without having some muscle mass. That's why we recommend people do both. But the impact stuff. You'll hear me talk about things as simple as like heel drops. More advanced. People are going to be doing things like box jumps. Please don't start there, but something that is going to provoke

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Dr Doug: the stimulus. Your bones. Getting hit by something is going to stimulate bone growth, and it has to be pretty significant. But even something as simple as a heel drop, or you're rising up on your toes, and you're dropping down onto your heels as hard as you can. You can generate 4 to 5 multiples of body weight that way. That'll stimulate bone growth.

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Dr Doug: So we can have these very, very simple little tricks and tools that cost absolutely nothing that you can do on your own, but you need to make sure you're doing them correctly, because if you're generating 5 multiples of body weight, and you've never done that before, you can definitely hurt yourself.

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Dr Doug: So we have to work into that thing. And that's where having some guidance is really helpful. And then the resistance training side. So muscle gaining muscle is really important. From a health span, perspective from a longevity perspective. I love the phrase that muscle is the organ of longevity. Without muscle everything falls apart, literally including our skeleton. However, training, resistance, training is not going to build bone by itself.

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Dr Doug: because in order to hit that 4 multiples of body weight to generate the force that your bones need to have the stimulus to grow, you would have to generate 4 multiples of body weight. I'm not lifting 4 multiples of my body weight, and I don't think anybody else in here is either. So resistance is going to build muscle which provides metabolic benefit. It's going to help with our glucose levels. It's going to help with our energy levels. It's going to keep us off the ground or get us off the ground should we fall?

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Dr Doug: It's going to pad our muscles. Sorry we're going to pad our bones. If we fall, it's going to help provide stability. It's going to give you better energy. It's going to give you a bigger basal metabolic rate, so you can consume more food and get more protein. The list goes on and on and on. Muscle is super important, but resistance training alone

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Dr Doug: will not build bone. But those are the 2 things where I tell people to start, and then you say, Well, what about the Yoga? What about the Pilates? What about the this? That, like all of it's good, all of it has benefit. But those are the 2 areas where we have people focus on to build muscle and bone.

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Breta Alstrom: Yeah. Somebody did ask, what about trampoline for impact?

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Dr Doug: Yeah. So this came up in our clinical meeting yesterday.

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Dr Doug: So there was also a question about vibration plate. And so I can kind of hit both of those. The idea that you want to use a tool to simulate impact is something that is, you know, we see that with osteostrong and biodensity with osteogenic loading. You see it in whole body vibration, and you see the attempt to do that with trampoline. So I'll back into the trampoline question through the whole body vibration.

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Dr Doug: the whole body vibration has evidence to support it. But when you think about the metrics that you need to obtain, so if you have a vibration plate that has a frequency of 30 hertz. That's kind of the sweet spot for bone. 30 hertz means it's moving up and down 30 times per second. You cannot do that on a trampoline physically. So a vibration plate is going to move up and down 30 times per second, and then there's the displacement which is really small. You're talking 2 to 3

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Dr Doug: for the displacement that I would like to see for the whole body vibration machines.

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Dr Doug: When you look at a trampoline, it's the rebounders, the little trampolines, or a big trampoline, whatever you're going to go up and down

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Dr Doug: once a second. And the displacement is huge. You're going up and down multiple feet. And there's so much time to slow you down. You're not getting impact. You are getting a workout. So there is muscular benefit, and there's studies. I've looked at this for bone. There are studies for muscular benefit, for frail people that can build muscle. Better balance. So it's not like there's no benefit of a rebounder or a trampoline, but

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Dr Doug: not going to build bone. And that's a common misunderstanding whole body vibration

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Dr Doug: can build bone, not a lot of bone. But it's better than nothing. And it's like I consider it simulated impact right? Because you're just getting this tiny little impact force. But if you think about it 30 times per second over the course of a 10 min workout, that's a lot of impact. So it does build up.

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Breta Alstrom: And then with the lift, more resistance exercises. How? How often should people be looking at doing those.

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Dr Doug: Yeah, I just reviewed. I'm going to record a video on one of the trials that I've not reviewed on our channel ever. And it was the follow-up to the Lyft Moore study, called the Medx, the Medx OP. Trial. So same study group.

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Dr Doug: So I just reviewed that this morning they do it twice a week. So high intensity, resistance and impact training their program is to do it twice a week, and I think they've increased the duration. So now it's an hour, and they have a whole program. Now. It's called O'neiro ONERO. It's not available much in the Us. Just on the upper east coast

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Dr Doug: because they're looking for like physical therapists and exercise physiologist to run it instead of trainers. So they're kind of having a hard time getting it integrated in the Us. But they're teaching people how to do this, and it is an hour long, but 15 min of that is sort of like mobility stretching, and then 45 min of high intensity, resistance, training and impact training.

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Breta Alstrom: And then with that on, how how often would you recommend doing a vibration plate.

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Dr Doug: So the research is, is not clear here, but

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Dr Doug: daily is our recommendation. And so, if you do, the recommendation from coming from power plate specifically, is to do 60 seconds on 60 seconds off. That's 1 cycle. Do that 10 times. So you're getting an exposure of 10 min. It takes 20 min to do the workout.

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Breta Alstrom: and then I would also say to just as you're looking at all of the stuff like, however, much

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Breta Alstrom: routine, you can build in and doing things every day is going to serve you so much better because you're going to be consistent than like, okay, well, I have to do this twice a week and this twice a week, and maybe you don't. Maybe you do the lift more exercises twice a week, but then you're at the same time you have that same exercise time, and you're doing something else. You are working on your mobility. You are doing some impact. But

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Breta Alstrom: I what I think we see the most often is everybody's trying to find a way to get out of lifting weights. And yes, for some of you it might not be safe. But it's also something that we really need to prioritize. Even if you start with 2 pounds. There's just a lot of, I think.

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Breta Alstrom: negative perception around that for a lot of our audience, when that can be so helpful for your health and longevity.

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Dr Doug: There was answering a question about vibration plate.

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Breta Alstrom: Very good, like.

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Dr Doug: Go ahead!

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Breta Alstrom: Well, I think the other question there is too like, What about a weighted vest?

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Dr Doug: yeah, so weighted vests have evidence to support them, too, and I can review those lip more exercises as well. There, Susan. So weighted vests have some evidence to support it. So it has been used in studies with a goal of 10% or 10 to 12% of somebody's body weight. So if you weigh 100 pounds, you know 10 to 12 pounds is the goal which is not very much.

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Dr Doug: but if you've worn a weighted vest. You know that it's crazy that 10 pounds really does add up over time. If you go for a walk with a 10 pound vest on, you'll feel it so. There is evidence to support it.

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Dr Doug: Robust. You're not going to get a 10 improvement in BMD in a year or anything like that. But it's just another lever. It's another tool, and they're relatively inexpensive, especially compared to a vibration plate.

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Dr Doug: Those Lipmore exercises, Susan. I did an interview. I wish I recorded that discussion I had with Belinda Beck from the Liffmore trial. We were just chatting, and it was this really great conversation. But anyway, so she kind of ran me through her perspective of this. Now she's been doing this. I don't remember when they started this like 15 years ago, or something. So I mean thousands and thousands of people.

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Dr Doug: And so the exercises that they do in there. The primary exercises are 3. So one is a true deadlift. So just a classic barbell bent over proper form. Deadlift.

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Dr Doug: The other one. Was it deadlift? Oh, back, squat! So, Barbell again across your back, and you're doing back, squat down as low as you can with proper form, and then the 3rd one is again Barbell overhead. Press

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Dr Doug: and

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Dr Doug: If you look on Hsn. Dawn does a great job of posting videos of herself doing these, and she has great form, so probably better than looking at my Instagram for the form. But those are 3 exercises that they do. Those 3 exercises are hard to do with good form, especially the deadlift. I've been working on deadlift for years. I still can't do it right, but don't like

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Dr Doug: this, was Belinda's concern. She's like telling people to do these exercises is dangerous, because if you're using the wrong form, you can definitely get yourself into trouble.

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Dr Doug: So this is where working with somebody, even a trainer who doesn't know anything about osteoporosis. They do know deadlift right? So they should know how to do a deadlift to back, squat, and overhead, press.

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Dr Doug: Any trainer should know that working with somebody who can help you to look at form. This could even potentially be done virtually, somebody who, if you record yourself doing it. This is what I do with my trainer. That's why my workouts are on Instagram. I record myself. I put it on Instagram. I tag her. She sends me feedback. I never show the feedback, because it's not very positive.

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Dr Doug: Somebody who can help you look at it and say, you need to work on this. This. Your head needs to be here, shoulders here, whatever. It's really important with these, because you can definitely hurt yourself. But the other thing to remember about Liftmore is that it's high intensity, resistance and impact training. That's what the it and high-ret stands for. So impact training means that they were literally pulling up on a pull-up bar and letting go and landing as hard as they could on their heels.

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Dr Doug: which seems like a broken calcaneus to me. But if you work up to it, and you do it with the right supervision. I think that's the part that actually stimulated the bone growth in that exercise. And Belinda says the same thing.

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Dr Doug: So it's the impact that's going to stimulate bone growth. But those full body exercises, those 3 exercises are going to hit every muscle on your body. And if you can do those 3 things right, then. They are fantastic exercises to add in, but you have to do them right.

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Breta Alstrom: Yeah, okay, I wanna touch base on a few things in the chat. Let's just take a little bit of this mindset time, cause we're gonna like.

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Breta Alstrom: get overwhelmed with all of this.

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Dr Doug: Hmm.

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Breta Alstrom: There's

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Breta Alstrom: There's obviously plenty of small things that you can do as you're incorporating things, whether it's like what muscles you're focusing on, or how you can like slightly increase your weight.

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Breta Alstrom: don't make it so complicated. The goal is just to start. It's to build muscle. You wanna train all of your muscle groups. So there's not gonna be one thing that's particularly best when it comes to the weight training.

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Breta Alstrom: You want to do the lift more exercises. You also want to build up the muscle in the rest of your body if you're only doing the lift more exercises

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Breta Alstrom: that is going to help build bone. But it's going to cause other problems for you at some point, too, because you want to focus on. You know this whole body wellness. So instead, start with. If you want to reach out to a personal trainer that would be amazing. Do a full program with them, do their programming, just have them incorporate these with more exercises at least twice a week, and that would be a great spot for you to start. And

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Breta Alstrom: the other this is a good question would putting the barbell on your shoulders, compress your spine, and how could that be? Okay for osteoporosis? I think that's a great question to answer.

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Dr Doug: Yeah. So that's actually the point. So we want to load our spine so you can load your spine with dumbbells. If you're holding a dumbbell. It's pulling through your scapula. It's pulling on your spine. So you're loading your spine whenever you're carrying anything in your arms.

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Dr Doug: but literally sticking it right here on that Cervicothoracic junction is literally loading your spine, and that's the point. So is it safe with osteoporosis. It depends on your starting point. So if you have a t-score of negative 6, and you have multiple vertebral fractures, it probably wouldn't stick a barbell up there. But if you haven't had a vertebral fracture, and you are already active. It's reasonable to start low and progressively overload and build up again, probably with supervision, to be safe.

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Breta Alstrom: Awesome. And then this, let's see.

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Breta Alstrom: Let's pause on exercise here because I feel like we're gonna get

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Breta Alstrom: a little too nitty gritty.

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Dr Doug: We're gonna get rabbit holed.

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Breta Alstrom: Yes. So let's move on to sleep and benefits of sleep and phone health. And maybe just some common issues that we're seeing.

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Dr Doug: sleep. Disturbance is extremely common for especially postmenopausal women with osteoporosis. This is a lot of our group, right? We have some perimenopausal women in their forties and early fifties as well. But for the most part we're dealing with a postmenopausal group or men, and when you lose progesterone through menopause.

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Dr Doug: sleep. Disturbance is extremely common. Estrogen also plays a role here. Testosterone could potentially play a role here. You're set up for poor sleep because Progesterone can really help with sleep extremely common. What do we do? Well, 1st thing we do is we ask people about

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Dr Doug: your sleep hygiene. It's really easy to slip into this, especially if somebody's retired. You slip into this. I just had this conversation yesterday, this nighttime routine that just kind of goes on forever. And so this patient I was talking to yesterday. She has dinner at 6.3 0, which is great, and they eat for an hour. Family style together. Good social connection awesome. But then she goes to bed at midnight. What do you do between 7.3 0 and midnight?

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Dr Doug: And essentially she has, like an entire like work day of the things that she likes to do in her retired life, which is great.

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Dr Doug: But then she wakes up at 5.

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Dr Doug: She's like, I'm getting terrible sleep. I'm like, well, you should go to bed at 9. All that work that you're doing between like whatever 8 and 11 you should do between 5 and 8 in the morning, and be awake for it, and then get better sleep because the deep sleep you get the 1st part of your sleep

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Dr Doug: cycle the full night you get in the 1st 3, rd and if you're going to bed at midnight, you're missing deep sleep, and that's the most important sleep that's going to help your body heal. So sleep. Hygiene is a huge deal. So there's all kinds of different things you can talk about, and that's where coaches can be great. There's great books on that

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Dr Doug: as well that we could point you in the direction of. But sleep. Hygiene is huge, but then, also, if someone is a candidate for Hrt. For women, this is a big deal, too, adding in Progesterone and optimizing Estradiol for somebody with sleep, disturbance is usually going to fix the problem, even if they still have terrible sleep. Hygiene. So just such a powerful tool for women that aren't on Hrt.

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Breta Alstrom: Awesome. And

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Breta Alstrom: I, the mindset component also ties into this like a lot of times, we see people with sleep, disturbances outside of like the Progesterone and everything and their nighttime routine purely because they're stressed and anxious. And they're thinking about things, whether it's like their daily life or their osteoporosis life, or, as we talked about a couple of weeks ago, those things are inseparable. So you know, paying attention to

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Breta Alstrom: to those components and and these foundations. And if we're missing things here, like if you're noticing that like, Oh, I'm like, especially with nutrition, sleep, and exercise. If you are missing that

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Breta Alstrom: start there, and really double down, and and do some like exploration and reflection on how you can make those improvements and and try to find what's going on in your body, and then let's move on unless anybody oh, actually, I did have a question very early on about sleep. How could sleep apnea impact osteo process.

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Dr Doug: Sleep. Apnoea impacts everything. So the good news is that for the most part sleep. Apnoea is treatable with cpap. So if you have sleep. Apnea.

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Dr Doug: or I see this often, too, with our women that have osteoporosis, and their husbands have sleep apnoea. This is a problem, because it comes with storing and storing will disrupt your sleep, even if they're sleeping just fine. So whoever has sleep apnea in the room, I would encourage you to treat that use a cpap, because, yes, sleep. Apnea will indirectly impact osteoporosis by disrupting sleep. If you can't sleep, you're not going to be able to build

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Dr Doug: bone muscle. Heel de stress, adrenal dysfunction on and on and on.

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Breta Alstrom: Awesome, alright. And then why do we have the social connection? Pillar.

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Dr Doug: This was a big thing that actually kind of grew out of the pandemic. So especially in the older population, people got real isolated, and we can avoid any controversial comments around Covid. But what we saw very clearly is that isolation is hard for humans. We need that social connection.

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Dr Doug: And so a lot of people, once they got disconnected, they didn't reconnect. So we see a lot of people that are coming to us that have, you know, they no longer interact with the people they used to interact with. And that could be a church. It could be a golf crew, it could be a whatever. But people have lost that, and without that social connection you lose, 1st of all, some cognitive function, because you need to communicate.

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Dr Doug: But, secondly, you kind of lose this like desire to continue to get better. A lot of people feel like without that social connection. You just sort of get into a downward spiral, where you just sort of lose your the impetus for life. You lose that zest, that zeal, that mission

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Dr Doug: being around other people can reconnect. You can reinvigorate you. And I think it's really important. So it's something that's easy for us to treat. We're not really treating it. We're just pointing it out like, how often are you seeing other people? How often are you having dinner with other people? How isolated are you?

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Dr Doug: It's so easy to fall into that because we are in a virtual world, right? Like, how many of our team members have I met in person?

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Dr Doug: Not that many, but we're going to fix that. But it's so easy to do because we have such great technology. But we still have to push beyond that and connect with other people outside of virtually

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Dr Doug: this. This doesn't really count.

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Breta Alstrom: Yes, yeah. And you know, having our online community is great for connecting with people, accountability partners and people who understand the journey that you're on. But yes, like, we gotta find some ways to get out and get that in person connection. And I think, too, that makes a lot of the other stuff

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Breta Alstrom: easier like if you go to a workout class where you get to see people and meet people and make friends like that makes your exercise easier. And it gives you that social connection. There's just so many different ways to connect with people. And that's made like a huge impact in my life, and in my health, too, with having really really great social connection, and predominantly like through doing activities. But

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Breta Alstrom: do you have any tips for people here to build that social connection in real life.

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Dr Doug: Gosh, I'm not a good role model. So I'm working on this myself. And the challenge is, Yeah, how do you engage? And so a couple of tricks that I've used for myself. Is we schedule like a couple's night or a date night, or some kind of a dinner with friends at least once a week.

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Dr Doug: so we have it on our schedule. If we don't have somebody in there, we'll put somebody in there, and this is my responsibility for the family of making sure that we're connecting with other families same thing with our kids. It's so easy for our kids to do the same thing. So making sure that they're engaging with others that they're actually talking with people. And we're getting their parents' phone numbers and that stuff

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Dr Doug: for people that are outside of our demographic. Then again, I think, if you have like, if you go to a golf club, if you go to a church, if you go to whatever is your thing. Just make sure you're getting out and actually seeing people, usually so many businesses now will offer an in-person event and a virtual version. Don't do the virtual version, if you can avoid it, go out and see people. It is so much better in the real world.

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Dr Doug: at least I think so.

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Breta Alstrom: Yeah.

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Breta Alstrom: Oh, I feel like the level of social engagement I have is not

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Breta Alstrom: It's a lot, and it's not easily replicatable. But yeah, so I but I I can't like shout that more from like the rooftops. And like, Go do activities with other people.

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Breta Alstrom: Yeah.

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Breta Alstrom: So that's awesome. I think I have social activities

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Breta Alstrom: 5 nights a week

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Breta Alstrom: which is great, but.

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Dr Doug: But it's great aspirational.

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Breta Alstrom: Yeah, and then onto mindset, we talked about that a little bit. But let's actually, let's skip that we'll circle back to mindset. Let's talk about spiritual health really quickly, and your intentions are here.

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Dr Doug: Yeah. So this is an area where again, it's 1 of these things like we don't talk about in medicine

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Dr Doug: because we don't talk about politics. We don't talk about religion, but this isn't about religion. This is about spiritual health, and yes, that can certainly include religion, and it does for a lot of our patients. But there are a lot of people who without. Because again, this kind of goes back to like, why do we choose to continue to live. Why do we want to live optimally? That's our whole tagline of aim for optimal, not average

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Dr Doug: spiritual growth. Any kind of growth for me is important. Spiritual growth is a part of that. But for people that aren't plugged in, especially to a church who are just sort of on a religious path which is great in its own right. But so many people are on a different path.

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Dr Doug: and it's hard to find that spiritual growth outside of that and sometimes within religion too. But I find that this is part of that overall that mindset position of I want to continue to get better. I want to have a reason to continue to go outside, to be socially active, to be there for my kids. I want to continue to grow and engaging in some kind of spiritual activity, and that could be as simple as meditation.

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Dr Doug: simple as your own space of journaling that could be as engaged in a group like a religious group, but some kind of spiritual growth where you're growing that side of your brain because it is very different than the other types of growth. We're talking about the academic growth, the physical growth.

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Dr Doug: It balances everything out, and it gives you a little bit of purpose or a lot of purpose depending on the situation.

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Dr Doug: Yeah.

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Breta Alstrom: And if you guys have I I know

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Breta Alstrom: Dr. Don has some really great tips on this, too. So maybe we can follow up on some of those things as well in in slack, and she can share a few different things there. Cause I think she'll have some really great insight. Here, let's move on to the top of the pyramid, though. Let's start with supplementation. Since that's the core. I know everybody has questions about supplements? And

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Breta Alstrom: these questions also get really nitty, gritty. Am I taking the right supplement? Am I doing the right things? What about this brand? How can we start with our supplements.

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Dr Doug: Yeah. So this is where we love to use biomarkers because we kind of divide things out into a foundational core group. And that's going to be? Not necessarily bone specific. What does your magnesium levels look like? Where's your B 12. What's your folate? What do your Omega? 3 to 6 ratio look like

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Dr Doug: these kind of like core foundational things, where, if you don't have magnesium like, you're not going to build bone, and we can measure that.

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Dr Doug: You could also just say, Well, nobody has enough magnesium, and I'm gonna take it, anyway. But that's probably okay for magnesium, but not necessarily for other supplements. So that's why we use biomarkers whenever possible. There are some supplements that we won't have biomarkers for. But we try to use biomarkers to figure out what the foundational stuff is. And then we kind of layer on top of that. So we have foundational stuff. We have bone-specific stuff. And that's where you're gonna get into like the algae cow products, your fat, soluble vitamins.

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Dr Doug: what kind of minerals do you need? And then what kind of other things that we can use to help build bone like the French maritime pine bark extract.

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Dr Doug: melatonin, lactotherin. Like all these kind of cool little things that have an impact on p. 1 and P that we can leverage. But then it starts to get a little bit too in-depth. And we start talking about like cardiovascular supplements. We start talking about like cognitive stuff. And we start talking about like renal health. And so then you create this list. That's like 150 supplements long.

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Dr Doug: So that's where working with someone who can say, Look, this is not that important? Right? Now, let's focus on these things, and oftentimes we'll end up with a list of like 15 things, and then we'll pair it down to like your top 5. And so supplementation can be a really tough area. But I would encourage people to take a supplement stack that they're comfortable with that fits in their budget that fits in their comfort zone of how many capsules and liquids and powders can you consume in a day and know that supplementation is not as important as the lifestyle? That's why it's higher up on the pyramid.

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Breta Alstrom: Yeah.

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Breta Alstrom: And

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Breta Alstrom: when I mean

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Breta Alstrom: taking what you're comfortable with taking with what you can afford, that is, you know, the best place to start.

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Breta Alstrom: There's a lot of options out there that are gonna be more affordable. But they also might be a waste of your money, because you don't need that. So if you're trying to like, get the

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Breta Alstrom: biggest supplement stack that you can for the most affordable, you might actually be better off getting the most effective supplement stack that's gonna cost you the same. But it's fewer supplements. So if you're trying to incorporate, I don't know, like

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Breta Alstrom: pine bark and Herbals, and, like all these little things, you you might actually be better off starting with the basics and making sure you have a solid foundation before adding in extra things.

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Breta Alstrom: and we do have quite a few questions on hormones, and I think we're doing hormones

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Breta Alstrom: next week. I can't remember if we're talking for months next week or the week after that. But we're gonna do a full in depth. Like session on Hrt.

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Breta Alstrom: Hrt. Labs what to look for all of that stuff. So for the purpose of today, I really just want to focus on

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Breta Alstrom: hormone optimization. Why is this included on the pyramid? And then, like just broadly, what should people be looking at.

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Dr Doug: Yeah, so it's important. I'll keep this short. I think these are some of the most powerful tools we have. Arguably, I could actually put hormone optimization below supplementation and make it more important than supplementation. But I think even without the foundational things where the hormones still aren't going to be able to do the things that they're supposed to do regardless men women. It's important for everyone to optimize these things, but this is such a murky space. I have a book that I'm just sitting on, that I've written and rewritten and rewritten and rewritten

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Dr Doug: because it's such a challenging space to provide direct guidance. So, yeah, this is a toughie. So I look forward to digging into this in depth, and I'll just stop there.

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Breta Alstrom: Yeah.

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Breta Alstrom: And then peptides.

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Breta Alstrom: when? Where are we using Peptides right now?

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Dr Doug: Yeah. So this is what happens with us when we get to Peptides is by the time we've talked about lifestyle, we've talked about supplementation. We've talked about hormones. By the time we get to Peptides people are tired. They're like, Oh, my gosh, I have way too many things. Let's just not do this, and so I would say, I don't know. Maybe

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Dr Doug: 25 of our patients have played with some kind of a peptide, and so I look at them like icing on the cake. Where I get frustrated is when people providers will say, Oh, take this peptide for your bone. Health. 1st of all, there's very little evidence for Peptides and osteoporosis directly. Secondly, you're missing out on the big picture, which is why we have this pyramid. You need to start with the basics don't just jump on a peptide because it looks cool and sounds cool.

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Dr Doug: So I look at these as an opportunity to grow muscle so they can help, certainly, for people that are struggling to put on muscle mass because there can be growth hormone and igf, which stands for insulin-like growth factor one levers, so you can really provoke a stimulus there.

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Dr Doug: Pretty darn safe. Some of them have great safety studies behind them. They're not as well studied as pharmaceuticals, but some are used for pharmaceuticals, so they do have good studies behind them. Those are the ones we generally will use. It's a tool. It's icing on the cake. And again, most of our patients aren't using them, just because by the time they get there, whether it be cost or just exhaustion, pill fatigue, or some of these are given by injection, and that's a hard no, for some people as well.

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Dr Doug: So they're cool. I like them. I think they're fun. I think they're great tools, but we certainly don't use them in everyone.

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Breta Alstrom: and if we, there's a couple of other questions on supplementation, here a lot of them are around algecal and I think we've talked about algecal in depth pretty recently, and I have all that stuff to add to the content vault, so I can share some of those clips there as well. But in general, I mean, when

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Breta Alstrom: people are having cost restrictions with supplements, what is the next best thing they can do, or how can

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Breta Alstrom: they find affordable options.

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Dr Doug: Yeah. So obviously, we get this question a lot, you know. And people are, people have to live on a budget. And I totally respect that. So from a supplement perspective, then

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Dr Doug: we just work with our patients to start eliminating the things that are going to be the least impactful. If we have supplements that aren't driven by biomarkers. Those go 1st because we don't know that they're working

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Dr Doug: things that are driven by biomarkers. A lot of the basic foundational ones are pretty darn cheap, like magnesium B vitamins. These things are inexpensive, so probably worth it to have that foundational stack in there. But when you start getting into the supplements like algae cowl. You're like, Hmm! This is 100 bucks. This is a real expense. And so

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Dr Doug: the way that I look at. This is trying to combine as many things as you can into one supplement. And that's why we have gone back to Algecal. Because if you look at Al Jacal, plus it checks a lot of boxes, right? So if you were to break that apart into cheaper products, you're going to end up taking more capsules, getting more filler, and probably getting less of the same stuff. But you're going to spend up more money eventually, because you're breaking them apart. So that's why, like Al Jacal plus and the Algecau d. 3 complete. That's a whole lot of things in what is essentially 5 capsules a day.

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Dr Doug: So I look for those opportunities as well, and then just know that supplements are not the most important thing. There are lots of people that have reversed osteoporosis, probably without taking a single supplement. If you eat good food, if you do the right training, you're probably going to be in a better place than most, so don't try to outsupplement poor lifestyle, I think, is the common error. There.

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Breta Alstrom: Yeah, yeah, go back to that nutrition first.st And then can you just really quickly on Peptides, explain what Peptides are? And maybe the difference between that in college and Peptides.

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Dr Doug: Yeah, yeah. Well, they're all Peptides. So a Peptide just simply a short chain of amino acids. So when we think about protein proteins are chains of amino acids. Peptides are short chains of amino acids, so technically, they're proteins. But once they get under, I think it's 50 or 40 amino acids. Then they're considered peptides and a peptide in the body functions as a signaling molecule. So it doesn't get broken down into the specific amino acids and go into build muscle. That's not how it works.

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Dr Doug: It's basically like a signaling molecule. Excuse me like a hormone. So a lot of these Peptides actually are fragments of hormones, so like, for example, some of the ones that we're using now like hexorellin, for example, hexerellin is a fragment of growth hormone we've used in the past. Aod aod is a fragment of growth hormone, so the hormone receptors can pick up on these Peptides. It will provide a partial signal, not a complete signal.

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Dr Doug: and it'll have a predictable impact on the body. That's why these things are so safe is because they are using natural receptors. It's a natural, endogenous hormone that's given exogenously from the outside.

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Dr Doug: But it's very predictable what that's going to do. That's why hormone replacement, for example, is generally pretty darn safe because we're giving something that the body already makes on its own as opposed to using a synthetic drug which can have these weird things like taking, for example, strontium citrate versus strontium, rhanolate strontium. Rhanylate's the drug in Europe. The ranylate part is synthetic, and it turns out it does some weird stuff.

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Dr Doug: Strontium citrate doesn't seem to do those things, and so

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Dr Doug: something natural is going to have a much safer profile. So Peptides, then we can use to achieve certain goals. But again, from a pharmaceutical perspective, they're not as well studied because they generally haven't gone through the FDA approval process. They're naturally occurring so they can't be patented. So for the most part, drug companies aren't interested in them. So that's why they haven't been studied like drugs, even if they are impactful and helpful.

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Dr Doug: They're a little bit murky, because the FDA only controls pharmaceutical drugs. FDA does not like it. When doctors are prescribing things that they can't control. So you get into this kind of murky gray area where occasionally the FDA will come in and say, no, you can't prescribe this peptide anymore, and it's not that we can't prescribe it. What they're saying is that the pharmacies can't make it, and it's not because of a safety concern. It's more of a power play which is really annoying. But that's the world we live in. So Peptides are again

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Dr Doug: fun tool. I like to use them when we can, but generally these are gonna get peeled out because of just capsule fatigue overload and cost.

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Breta Alstrom: Yeah, awesome. And then pharmaceuticals, what's your perspective there? And how are those incorporated into our program?

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Dr Doug: Yeah, there's a time and a place the challenge is. And people have probably heard me talk about this, that this is the go-to from the traditional medical model perspective. So you get a t-score of less than negative. 2.5. You meet criteria for pharmaceutical management. You're recommended to bisphosphonate

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Dr Doug: doesn't seem to matter if you're 45 years old or not. And so the challenge with the pharmaceuticals is that for the most part they decimate bone turnover. So if you're taking abyssinate or proleea, or even avinidity, it will in the end slow down bone growth. So while it might increase your bone mineral density. You're not going to be able to grow bone. And that's ultimately what you need in the long term.

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Dr Doug: So you're kind of trading long-term success for short-term Bmd, and that's a very myopic view from my perspective, especially for our younger patients. And when I say younger, I'm meaning anybody that has a lifespan expectancy of over 10 years. So that includes people in their seventies, eighties and potentially nineties. So unless you have an expectancy of 10 to 20 years, and that's it.

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Dr Doug: Pharmaceutical management is going to run out. You're going to run out of options because you can only take bisphosphosphonates for 5 to 7 years. You can only take Perlea with safety data we have up to 10 years. And after both of those drugs, maybe you're 15 years into this process. But now your bone. Turnover has been squashed for 15 years, and it's almost impossible to grow bone, and then the risk of side effects goes up and up and up.

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Dr Doug: There's a time and a place for people that are rapidly losing bone. But I would only recommend pharmaceuticals with a specific time frame. For example, you're being treated for breast cancer. You're on an aromatase inhibitor for 3 years. You're going to take a bisphosphosphonate for 3 years to counteract the bone loss that makes sense. Yes, there's risks, but that still makes sense

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Dr Doug: probably better than the alternative which is to rapidly lose bone for 3 years, and then pick up the pieces when you're done. So there's a time and a place, but in general I think they're widely overprescribed, and there's no conversation about the rest of that pyramid. What are the other things that we can do to help improve your bone?

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Dr Doug: Not because the doctors aren't interested or because they're bad people. They just simply don't have the time and the training. So time and a place quick note about the anabolic drugs. So forte Timlas, are drugs that we will occasionally recommend. They don't squash bone metabolism.

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Dr Doug: they hyperdrive bone metabolism, which is cool. You just can't use them forever. So I like them as a short-term solution. Short-term being 2 years but a short-term solution to help get somebody out of a deep, dark hole with their bone density, and we can help push them in the right direction. But my goal is to help is to use these drugs for one to 2 years and then not use an anti-resorptive drug on the back end.

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Breta Alstrom: yeah, awesome. I think. Well, we're basically at time here, but tons of great questions in the chat, if your question wasn't answered, and you still are hoping for a little bit more conversation around this. Take those questions, put them in the appropriate slack channel, and then I know doctor Doug has to run to see some patience, but I can stay on for another 10 min if anybody has any tech questions. And Doctor Don, you can go ahead and jump on here, too. Hold on.

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Dawn Aragón, PhD: Hi, guys. Sorry I couldn't figure out how to get my video on today. So sorry. Yes, please join us on slack Brett and I try to answer as many questions as we can, and then we hook in, Dr. Doug if both of us sort of need the big, the bigger picture ideas.

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Dawn Aragón, PhD: And yes, I'm kind of the one known for the physical stuff. But my true like passion is around mindset and spirituality. So I'm kind of wanting to do, even though I I get called to do the physical stuff. Cause. That's easy for me. I'm really. I really would love to develop the mindset and the spirituality channels.

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Dawn Aragón, PhD: So I'm gonna try to pop on there for those things a little bit more. I am a retired psychologist. So there's that but I think that I would love to see some activity in the mindset and the spirituality, because they are. They are part of the 6 pillars, and we focus like bread. And Dr. Doug, we're trying to not rabbit hole on the nutrition and exercise cause. That's where everyone gets kind of hyper focused.

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Dawn Aragón, PhD: So anyway, see you all on slack and I love working with you all. Bye.

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Dr Doug: Thanks, thanks, Don. I am going to hop off here. But so Don, is not technology lacking. I actually turned off her camera at the beginning.

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Dr Doug: because we weren't recording yet. And so that was totally my fault. So, Don, I apologize.

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Breta Alstrom: Awesome. Thank you. Guys. See you, Doctor Doug, and then everyone else feel free to jump off. If you have any tech questions. Happy to answer those, and then take all your questions. Put them in slack. We'll get to those. There's been lots of good stuff. And then, just as a little update. I know we had talked about july 8

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Breta Alstrom: or 7 might be 17, th whatever that Wednesday is. We talked about doing hot topics and nutrition. But I'm actually gonna see if Edie will come back on that day to finish her mindset presentation, and then we'll do hot topics on nutrition a different day. So just so, you guys know, we might switch that up a little bit to get the rest of those mindset tools in there. But the next 2 weeks we're talking deep dive on cardiac markers and bone, health and hormones and all of that, and then we'll do a deep dive on hormone replacement.

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Breta Alstrom: therapy and labs and what to look for. So just so you guys know what's coming up the next 2 weeks, and all of that's in slack.

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Breta Alstrom: Alright! Have a great day, everyone. I'm just gonna hang out here if you have tech questions, but feel free to jump off.

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Al Kral: So when you said to adjust the stack.

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Al Kral: you know, cause the algae Cal's pretty expensive. If you really don't need calcium.

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Breta Alstrom: Yes, but the other thing would be, too, is, are you? Which

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Breta Alstrom: you can look at your diet? So if you've been spending a lot of time and energy, putting like into getting the extra calcium in your diet.

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Al Kral: Not. It just happens to be.

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Breta Alstrom: So if that just happens, you might not need algecal. But you wanna look at the other ingredients in the algecal, because, like Boron and I can't remember all the other things in there. But the stuff that's actually in the algecal product you are gonna want to incorporate, because that's part of the reason why they get their results is because of the extra minerals in there. It's not just the calcium. So just fill in with those other minerals, and we have plenty of options. I think there's like a boron supplement. There's like a trace mineral complex.

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Al Kral: Trace mineral. It has just a little bit, you know, of everything.

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Breta Alstrom: Yeah, the recommendation for Boron might be like 3 milligrams or something like that. So you can just check in on those things and make sure you're getting all the stuff that you need.

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Al Kral: Yeah, I'm not getting 3. I might be getting

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Al Kral: one and a half 2, but.

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Breta Alstrom: Sure, and 2.

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Al Kral: The d. 3, the algae, count d. 3 thing you know.

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Breta Alstrom: Right? Right? So yeah, you could probably drop that out like when you. And that's the good thing, too, about like looking at your nutrition data, right? Is like, you can see, okay, what am I getting diet wise?

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Breta Alstrom: What do I not need from my supplements? How can I reduce my stack. What we found, though, is

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Breta Alstrom: even with

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Breta Alstrom: the more expensive products. Cause I I've spent hours doing this for people.

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Breta Alstrom: I in trying to get you all of the things that you need to make a difference through other products that might be cheaper. It actually only ends up saving you probably $20, and you know, and you're taking 4 or 5 more pills

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Breta Alstrom: to get all of the different micronutrients that you need to. So it just, you know depends if you're not gonna get all of the micronutrients that in some of those more expensive products totally fine. Just keep that in mind that if you're really looking to minimize the cost of your supplement stack, you are gonna be missing out on some of those nutrients.

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Al Kral: Unless they just take it. Only take one of them and don't take.

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Breta Alstrom: You know.

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Al Kral: I mean just to get a little.

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Breta Alstrom: Well, that's true. Yeah, you can always adjust the dose, too, and see how that that works for you. If you only take one, and you're already getting like some of the Boron and the extra stuff through your trace minerals, and then you have the full amount, and then you're good to go.

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Breta Alstrom: and Dr. Doug just posted a video on Monday, I think, about Laura on Youtube.

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Al Kral: How that!

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Breta Alstrom: Goes in algecal. So it's just at the top of my mind right now.

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Al Kral: Yeah, that's what got me thinking about the Boron. And then looking at what foods you get it from, and everything else. I I could get it if I could eat more sugar or carbon.

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Al Kral: but that's what it's in.

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Breta Alstrom: Oh, I know that's the bumper with most things

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Breta Alstrom: awesome. Any other questions you guys have.

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Sharon: So what is the

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Sharon: work? Sign into your workspace for slack.

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Breta Alstrom: Yeah, if you go to slack.com. Well, have you set up a slack account before.

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Sharon: Well, I got on it, and then I'm on my when I've tried to log on on my

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Sharon: phone with the app or to the browser.

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Sharon: It won't take my password on this. It's different from my phone health. One.

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Breta Alstrom: Yes, so slack is going to be different. But you can make them the same like they can be the same one. But slack is technically a separate login. But if you go to

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Breta Alstrom: slack.com and hit login, if you've been in slack before, and you've like seen the messages. That is, I think, generally the biggest issue is just go to slack.com hit login, see if it will take your credentials, and if not send us an email at Hsn support@ohhmd.com, and we'll make sure that you get access to slack or like. Make sure that you can re-access slack, cause it is. I mean, there's a ton of valuable information in there for that community. So.

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Sharon: So are you saying my credential is my the email that I use for.

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Breta Alstrom: So you would.

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Sharon: Help.

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Breta Alstrom: You would have set up an

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Breta Alstrom: that is, that depends. So you would have gotten a

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Breta Alstrom: e like. So when you go into actually, I'll just show you. Let me share my screen. That'll be much easier.

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Breta Alstrom: Let's see.

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Breta Alstrom: great.

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Breta Alstrom: Okay.

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Breta Alstrom: So when you're in

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Breta Alstrom: health Span Nation on the website.

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Breta Alstrom: Okay, there is the health span nation slack community right here. So at some point you would have needed to set up a slack account. If you haven't set up a slack account yet. You'll want to create a slack account right here.

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Sharon: Well, that's how I've gotten in there, but I can't get in there through the app, or if I'm trying to get on on the browser on my phone, because the apps not

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Sharon: yeah, letting me.

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Breta Alstrom: So now. If you've created an account for me, it auto redirects me. I've had some people have trouble with the auto redirect. So if instead, you go to slack.com

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Breta Alstrom: and then go to

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Breta Alstrom: hold on it normally takes you to their homepage, and not this. But since I'm logged in but there's a little button up here in the top that you can click on login and then you'll just put in the credentials that you created your account with which could be different than how you created your bone. Foundations or health span nation account. Those passwords might be different. You. It just depends on what you originally put in.

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Breta Alstrom: I'm gonna circle back to that. But if you're still having issues accessing it, send send an email to Hs, yeah, to Hsn support at Ohm. Dcom. And we can investigate all the little things based on your email cause. That's really how we I just need to know what email you used, and we can figure it all out. And, Diane, you had a question.

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Diane Gould: Yes,

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Diane Gould: I'm supplementing. I'm thinking, that the what Doctor Doug was saying earlier about different supplements and what's really important. And I do remember hearing him talk about magnesium before. And I did have a low

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Diane Gould: right.

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Diane Gould: Now, supplementing with 800 milligrams.

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Breta Alstrom: Bye.

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Diane Gould: Okay.

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Diane Gould: Okay, cause it's like, I gotta tell you when I don't take that 800,

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Diane Gould: my, my cows and my my feet cramp at night. It's bad as before, but even just one, or maybe a day or so it happens. So 800,

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Diane Gould: I guess what I'm i i'm not worried about it, but I guess I just want to be reassured that I I it's not. I'm not going to hit a toxicity level.

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Breta Alstrom: No, and generally with magnesium. The toxicity is all gonna be based on gi symptoms, and that's really like the adverse effect. So as long as you're tolerating it. Well, you're not having loose stools.

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Breta Alstrom: and then, like we'll, we'll have people on up work like on around like a thousand milligrams of magnesium if they can tolerate it. Normally, we run into tolerance issues before we get anywhere close to that. But that would be one component. And then the other thing you can do, too, is just like looking like a little bit of a zoom out. What else might your body need there. And so, like we were talking about some of those trace minerals. There's

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Breta Alstrom: You could explore that, too, like I I know Dr. Doug's talked about the beam minerals product. That has, like the full.

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Diane Gould: I do. I do every day like I'm I'm the good quality electrolytes that I can't remember if I went the beam or the ultimate but

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Diane Gould: and

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Diane Gould: So I take the magnesium. I can never say the the bi

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Diane Gould: glist, whatever.

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Breta Alstrom: Yeah, that's bison

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Diane Gould: In that form be for the gut, because I I do have a history of gut issues.

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Diane Gould: Should

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Diane Gould: should I? Can? Can that, taking that form, that much actually bring on some gut issues.

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Breta Alstrom: It just depends on how well people absorb it. So generally the this glycanate is going to be much more gentle on your gut compared to something like a magnesium oxide or a magnesium citrate. But some people still will have issues. But if you don't have issues, then it's not a problem for you, and you're good to go.

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Diane Gould: Well, can I have an issues right now? And I'm trying out, if it's like, from an emotional thing, or if it's like, I didn't even think about it being the magnesium. I did. And I was like, Nope, can't be that because I got the right form.

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Breta Alstrom: Yeah, yeah, it it can still be for some people, because, like your body won't always absorb all of that. You can also try breaking up your dose throughout the day, too. So you're not getting much at one time.

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Diane Gould: I take 400 at a time. Right? So maybe I need to think about that. Right? So, okay, no, I appreciate that. That's that's helpful for me to play around with.

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Breta Alstrom: Yeah, awesome. And then you can also look at a topical magnesium, too. Like, if you're experiencing like physical cramping. So you could try like a magnesium lotion.

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Diane Gould: Didn't know that existed. I'll definitely look into it.

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Diane Gould: It's great. Thank you.

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Breta Alstrom: Yeah, of course.

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Sharon: Is, that is, magnesium citrate. Have any problems like like Dr. Doug was talked about, calcium citrate, and.

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Breta Alstrom: So. No,

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Breta Alstrom: hey? I I can't tell you like the exact, what like, what and where the citrates coming from, but generally no like. What?

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Breta Alstrom: How we think about magnesium more often is, you know, generally for us the best forms are going to be like a biscannate or a magnesium 3 innate because those are going to be gentler on the gut. And we're going to get better like

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Breta Alstrom: blood brain barrier conversions. You're gonna get like different absorption, like better absorption from those things

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Breta Alstrom: with the caveat that you have to think about what your symptoms are, because magnesium can be helpful, for, like a lot of things. And so if you look at your symptoms and all the things that you're working on, and what's making a difference for you. And of course, when we get into gut health, there's a lot of complexity there that we would want to explore.

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Breta Alstrom: But something to think about is if you are constipated and you're trying to increase your magnesium for your bone. Health, and, you know, overall just like stress management. It helps regulate the Hpa access in your body. Then maybe you do want a form that does help get a little bit

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Breta Alstrom: softer stools, you know, if that is an issue for you versus if that's not an issue for you, and you have really great, healthy, regular bowel movements, then maybe you want to prioritize a different form. But as we do, you know.

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Breta Alstrom: as we just talked about, if you can get a high enough dose of magnesium, you can still maybe experience some of those Gi issues, anyway. But it's really just about looking at your whole body on basically what the form is. We generally never recommend magnesium oxide, though I will just say that. But like a lot of the over the counter supplements, you're gonna find that, like the grocery store or the pharmacy, they could be magnesium oxide, because a lot of people are picking those up as a laxative. So.

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Sharon: Yeah, because the the fit rate is more affordable and and it's absorbable.

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Sharon: pretty absorbable from my understanding. And I I don't have a problem with it. And I it helps me with like getting muscle cramps at night, because I drink a lot of water.

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Breta Alstrom: Yeah, definitely, it's just about finding out what works for you. Like, if you are maybe experiencing a lot of or like chronic anxiety and different things like that. Like focus issues. Then we might explore something that's gonna have better blood, brain barrier conversions like the glycine, the 3 and 8. But if it's working for you, and you're getting the results that you want, your body still gonna be absorbing that magnesium. And that's the end goal. Really? So it sounds like, that's a great kind of pathway for you.

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Sharon: Well, I don't know that it's helping my brain.

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Breta Alstrom: Well, it is it? But that it depends on like how much of an issue that is for you, right like, it's about looking at the whole picture and picking the thing that's going to impact the most at one time. And also, if that happens to be, you know, if if one of the impacts that you're looking for is affordability. That's also totally fine to look at.

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Sharon: Well, I think sleep is my biggest brain impact.

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Breta Alstrom: Gotcha. Then you might wanna switch up your form and look at a magnesium 3 and 8 or

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Breta Alstrom: potentially, too, though like that's not gonna be that might not be your only issue right? Like Dr. Doug talked about Progesterone. Sleep, hygiene, mindset. All of those other things can go into sleep, too, and I know that, like we kind of bridge that overwhelm there pretty quickly. But if we can zoom out and say, what am I doing right like? Where am I hitting all the boxes? And then where could I make improvements? And then I always recommend to people pick the thing that you think is going to

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Breta Alstrom: be the best for you, cause that's half of it. It doesn't matter what I think is the best for you. It matters what you're gonna do. And you're gonna stick with doing and starting there. So if you had like a whole long list, and you're like, Well, I'm most interested in this one thing or these 2 things. Those are the things that you should focus on, because all of it's gonna create a positive impact.

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Sharon: Yeah, I'm trying to get.

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Sharon: I'm I'm trying to figure out the labs and where I'm gonna get those and

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Sharon: but I can get the bhrt right away. I it's just like well, she seems like I need. I should probably look at the data.

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Breta Alstrom: Sure.

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Sharon: And she's not. She's not she's not. She didn't order up estrogen or progesterone cause she says, I know you're going to be low.

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Sharon: So she's just like, just, you know, I can. So just take that, you know, I could take the S. Then.

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Breta Alstrom: Yeah.

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Sharon: And she did test. I did request, test Sato, and she did add that.

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Breta Alstrom: Yes, and we

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Breta Alstrom: that is the thing we we like to look at the data. I mean, do we know you're probably gonna be low. Yes, mostly we're gonna look at change over time. And then we like to use those things to to evaluate symptoms if we can. However, there's or like to look at physiological dosing and stuff like that. But most of the time most changes to your hormone regimen are gonna be symptom driven. So there's a lot of like nuance that goes into that that our team helps people like walk through, and how they make adjustments on their bhrt.

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Sharon: Yeah, cause I was thinking, it's pro. It might be good to have a starting point, like we're now.

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Breta Alstrom: Yeah, for sure. And we include all of those in our supplement stack or in our initial labs. I think they removed Progesterone from our initial labs for a little while, just because Progesterone, so based on where you're at in your cycle, if you're premenopausal. And so the numbers are kind of hard to read, if that's the case, and then postmenopausal women, you pretty much don't have any. And so we did pull that back. But we are adding it back in into our lab set. So

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Breta Alstrom: yeah.

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Sharon: Okay, well, I could. Probably I'm hopefully, I can get to my match path.

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Breta Alstrom: Yeah. Yeah. And I think somebody else asked this in the chat, too. But if you're not part of our program and you're hoping to get labs, you should be able to order them through lifeextension.com dot. They even have the bone turnover markers there for you, too.

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Breta Alstrom: And then it's just cash pay, and I'm not exactly sure where they contract with like for getting your labs, but generally you can do like a lab requisition, and take it into any place that does phlebotomy or a lot of even like outpatient labs will let you bring in

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Breta Alstrom: extra stuff, and then you just have to pay a draw site fee, which is generally anywhere from 30 to $70, and then they'll draw your labs. You just need to know if there's like a Fedex drop off location there, or however, life extension does their like shipping in the labs.

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Breta Alstrom: So if it's if you go to a site that has Fedex drop off. They'll basically ship it for you, because you'll have paid for a prepaid shipping label. If they don't have Fedex drop off, or whatever life extension needs. Then you'll have to take it to a Fedex location, and you'll just want to like pay attention to the instructions on like the hard cut off on the time you need to drop off your labs like that's just kind of like the nitty gritty. But there's a lot of different options for getting that and then there's also services that do mobile phlebotomy. And it's

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Breta Alstrom: in the grand scheme of things. Not the most expensive. I think a lot of times you could get it for just over a hundred dollars, a hundred $25. It depends on the person and the company and the service, but they'll come to your house, and they'll draw your blood, and then you'll be good to go.

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sjcsr: I just wanna say I'm sorry to interrupt you, but I did a test at life extension for the hormones, and when I took on.

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Breta Alstrom: Susan, you dropped out.

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Breta Alstrom: We can't hear you anymore.

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Breta Alstrom: Sharon. If you wanna go ahead and do have a.

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Sharon: Oh, I was. I was gonna suggest I found out from my natural path that

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Sharon: she has a contract with Lab Core and can order them or private pay. So if you, if your primary care provider has that, or you could find one.

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Sharon: that yeah, that's another option. And then.

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Breta Alstrom: Yeah. And if you're primarily.

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Sharon: Just go to latter part.

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Breta Alstrom: Yeah, if your primary care doctor will order them for cash pay, anyway. You can always do that. So it just depends, and not everybody's close to a lab core cause we've had, like a few issues with that with our since we see people nationally depending on where you live may or may not be an option for you, but if you can, it's the easiest thing to do.

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sjcsr: Can you hear me now?

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Breta Alstrom: Yes.

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sjcsr: Okay, I just wanna say that I did. I took it upon myself to take a life extension female hormone panel

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sjcsr: because it was time for my blood to get done, and when I took it to the functional medicine doctor they called me and told me they wanted to bump up my progesterone, because time and again they can't rely on life extensions, female hormone panel. So that was just my experience. I think you're much better off going a lab core

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sjcsr: somewhere else.

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sjcsr: because I never heard such a thing before, and I would be afraid to go back there again.

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sjcsr: And he's been doing these hormones for decades.

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sjcsr: So I wanna ask you, Brett. Oh, just a quick question. I'm taking the Mk. 4 and the Mk. 7, and I was a little confused about the k. 1.

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sjcsr: What that does is.

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Breta Alstrom: Was so.

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sjcsr: Some formularies have k. 1 and K. 2 together.

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sjcsr: and I just wondered if you have any thoughts on that.

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Breta Alstrom: Yes, but I we have a really specific explanation that I'm not gonna be able to give you. Now I'll post the explanation in slack because dr. Doug did like a whole deep dive on the in one of our sessions on the k. 1 k. 2, and.

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sjcsr: A.

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Breta Alstrom: They are the Mk, 4 and the Mk, 7 especially, based on like what's in algecal, and how you're kinda like reading those numbers, so I think it'll be more eloquently said, if I just give you that clip in slack. But you do want both if you can. I mean all the forms are, gonna be good. It's just that. Generally the k 1 is found in plants. And K 2 is not found in plants. So K. 2 is a lot harder to get. But if you can get a good balance that is ideal in kind of.

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sjcsr: The only reason I ask is because I do take a lot. You know I do. I do follow a lot of protocols. I do weights. I do classes, and in the last couple of weeks my legs, the back of my legs. I'm getting like it's just very uncomfortable. I've never had that before, and I just was thinking it might be the K. Because I'm not doing the K. For clotting. I'm doing the Mk. 4 and the Mk. 7, but not the k. 1. So I'm thinking, maybe I'm causing a problem. There.

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Breta Alstrom: I know you're causing a problem. I mean, it's hard to know without looking at your labs or having a good understanding of yourself.

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sjcsr: Right.

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Breta Alstrom: But it's probably something else, and I would not get too pigeon hold into like, just like that. One thing. Yeah.

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sjcsr: Thank you. Yeah, thanks.

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Breta Alstrom: Child.

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Breta Alstrom: you know.

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Sharon: When I first, st

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Sharon: when I 1st got on the foundation course, I'm not sure if it was there or is an email.

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Sharon: I thought I saw somewhere, it said, the workbook is being updated.

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Breta Alstrom: Yes, is.

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Sharon: That Co. How? When is that?

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Breta Alstrom: That is a good question. I we're hoping to have it out by the end of July.

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Breta Alstrom: And the thing is, though, like, well, we're gonna reformat it a little bit since Dr. Doug's like Redone, all of the bone foundations videos. But don't get like if you've gone through the bone foundations. Course. The current workbook is gonna be like a really great

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Breta Alstrom: tool for you to like. Quick look up stuff. But when it comes to like again, like back to this managing the overwhelm. It's there as a tool. Don't get bogged down in like all the nitty, gritty details. Of everything, you know, unless that's where you're at in your journey, and you're ready for that like, just as like a broad

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Breta Alstrom: like a broader like discussion point. And then when we make the new workbook there will be a lot more, I think, engaging opportunities. So for you to write stuff down in it. And things like that if you wanted to print it off. But i i i don't think

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Breta Alstrom: I just don't want you to feel like the workbook, being updated or not is like the missing piece to your bone health journey, because it's honestly just going to be a next. An extra layer of stuff for you to sift through so, and if anything, I would use it as like a quick reference, guide instead of something that you need to read, all of cover, to cover.

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Sharon: Well, mostly. What I'm wondering is the lab panel in there? Your current one.

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Breta Alstrom: It is not our current current one, but it's not that much different than our current one. So if you were to take that in it's I think I'm trying to think what's not gonna be on there. Vitamin. It's the active form of vitamin D, which is 1 25 hydroxyd has been added to the lab panel, and then

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Breta Alstrom: there's a few other. I think they maybe. Yeah.

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Breta Alstrom: The the B vitamins are the same cause. We went back to that, those versions of the B vitamins.

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Breta Alstrom: and there might be like a few extra things that actually won't make a big difference for you on there too, so I would keep that in mind if your provider doesn't know how to use them. But I, the cardiac panel, is going to be really helpful in there in general for just making all your choices, and then the bone turnover markers are also going to be really important. And then, if you are working with a naturopath, you're going to want to get the labs that they know how to use and interpret.

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Breta Alstrom: And then on top of that probably the bone health markers, too.

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Breta Alstrom: yeah, because our team, the way we, our labs, are specifically designed to build our protocols, the way we build our protocols. So if your provider doesn't have those protocols, not all of those labs are going to be important.

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Sharon: So what was the active d?

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Sharon: One more.

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Breta Alstrom: 5. Hydroxy, d. Hydroxy, vitamin, d.

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Sharon: Okay.

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Breta Alstrom: And I think most often people are getting just a regular

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Breta Alstrom: 25 hydroxy d.

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Breta Alstrom: So we get both.

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Sharon: How how good is a dexa with Tbs versus rams.

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Breta Alstrom: It depends on what you're looking at. This isn't. I would go back to the imaging

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Breta Alstrom: the imaging module in bone foundations cause Dr. Doug covers all of that. It just depends on what you've had and what you're looking at. So the dexa with a Tbs is, gonna be better than just getting a dexa alone. If you've had a dexa before, and that's your baseline. You wanna compare apples to apples.

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Breta Alstrom: Because there's not really a good comparison between Dexa and rams. So what we would have people do, most likely, especially if your time, if it's time for your dexa and your insurance is gonna cover. It is you've had your dexa that you probably got your diagnosis with. And then when it's time in that 2 years, you get your new dexa. Maybe in the interim you've gotten a rems and then we would do follow ups again with the rems, and so we would compare to rams and dexas, to Dexas.

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Sharon: Right? Yeah, I just. I'm just wondering what more information?

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Sharon: I know to compare

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Sharon: Dexa with Dexa and runs. I found out I have. There is a place that has the dexa with Tbs.

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Breta Alstrom: Yeah.

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Sharon: And I thought, Well, should I? Just?

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Sharon: I've only had one Dexa scan.

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Sharon: And so did I. Just like, Go, okay, I won't go back there. I'll go where I can get the Tbs, you know.

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Breta Alstrom: Yeah, I think getting the Tbs is really great. But just know, too, that there are like machine differences. And they're pretty significant. And there's also

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Breta Alstrom: like there's machine differences. And then there's technician differences, too. So making sure that you're not like, I wouldn't probably come if you're if your bone density gets worse on the new dexa with the Tbs.

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Breta Alstrom: Try not to let that impact your mindset around everything because there's gonna be significant differences

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Breta Alstrom: potentially just based on the machine. So it's just

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Breta Alstrom: harder to interpret the data that is really, I think, the the biggest takeaway there is like. Don't let it stress you out.

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Sharon: Well, I'm wondering more.

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Sharon: what what kind of ben and information? What would I benefit from? A Tbs versus a RAM?

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Breta Alstrom: I

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Breta Alstrom: I will! I don't.

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Breta Alstrom: I don't have the best explanation for that cause that's out of my scope. But like, go back to the bone foundations module. On imaging. Dr. Doug talks about that. We generally recommend. People get rams, cause we want to look at bone quality. Now, the triacular bone score the Tbs is. It's better than just having a dexa on its own but we recommend rems.

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Sharon: Okay, then I'll just go back to the same Vexa and

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Sharon: and get around. Yeah.

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Breta Alstrom: Okay. Yeah.

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Sharon: And it's covered by, and it's covered by my insurance.

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Breta Alstrom: Yes, those are all I mean really big factors, too. And if you want to, in the labs and imaging Channel on slack ask people what their experience has been when they've gotten both, and how that impacted. You know what they've been doing, or if it, if they notice that their results were very significantly different, too. I think that'd be an amazing conversation to have.

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Sharon: Thank you. Yeah.

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Breta Alstrom: Perfect. Any other tech questions?

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Breta Alstrom: Okay, awesome.

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Breta Alstrom: send me a DM on or a message on slack. If you guys do have tech questions. You can use the tech support channel you can reach out to us at Hsn support@ohmd.com.i want to make sure you have access to everything. If you don't have access to slack, let's get on slack, because I think there's been a ton of really great info shared there recently. And then we're

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Breta Alstrom: we're going to do another drop of content vault videos soon, and we'll give you guys a rundown of the next few sessions as well. So you guys know what to prepare for. You can leave your questions on slack, so we can pull some of those things, too. But I think today was a really great session, and we're going to pull a few things to make some, some guides for you as well, based on the info that Doctor Doug shared about the pyramid, and I will see you all next week.

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