Understanding Osteoporosis: An In-depth Discussion on Bone Health, Prevention, and Future of Healthcare

Parker Condit: 0:00

Hi everyone and welcome to Exploring Health macro to micro. I'm your host, parker Condit. In the show I interview health and wellness experts and by the end of each episode you'll have concrete, tangible advice that you can start implementing today to start living a healthier life, either for yourself or for your loved ones. And that's the micro side of the show. The macro side of the show is discussing larger systemic issues that are contributing to health outcomes here in the US. So an example of that probably the most obvious example of that is understanding that our system is largely reactive and most money goes towards fixing health problems and there's almost no money that goes towards prevention. And that's something we discuss in today's show. My guest today is Dr Doug Lucas. Dr Doug is the founder and CEO of Optimal Bone Health in Asheville, north Carolina. He's a board certified anti-aging and regenerative medicine physician. He's also a board certified orthopedic surgeon. So as a former surgeon, he said that he ended up starting his own company with the goal of teaching patients so they could avoid the types of surgeries that he was actually trained to perform. So in this episode we have a central theme of bone health. As a orthopedic surgeon makes sense, we end up talking about why bone health needs a new PR firm, and that'll make sense. Within the first minute of this episode we talk osteoporosis and osteopenia, the difference between them, how they're measured and how they're diagnosed. Dr Doug goes over his pillars of health exercise, nutrition, sleep and connection. He discusses how men and women differ when it comes to bone health and preventative measures, and we also get into how patients can be their own best advocates in a healthcare system that does not put patients at the center of care. So if you're interested in longevity or if you have aging parents, this is a very important episode to listen to. Bone health does not get nearly the attention that it deserves, but this conversation will hopefully bring a few important points and topics to the front of mind for many of you. So that's enough of me talking, let's just get to it. Please enjoy my conversation with Dr Doug Lucas. Dr Doug Lucas, let's just start with some of the basics around osteoporosis. I think it's going to be helpful for people to understand what it is. Some basic stats around it basically getting people invested in like why should people care about this? I think everyone's pretty bought in on heart disease, everyone's bought in on cancer, but I'd love for you, just to explain what you can around osteoporosis.

Dr. Doug Lucas: 2:21

Yeah, well, yeah, thanks so much for having me and being able to talk about this topic, because you just actually nailed it. So there's so much conversation around heart disease and around cancer and around dementia and there absolutely should be but in those top four killers of us as adults, as we age, is falls from osteoporosis. It's right in there with them, and yet almost no conversation. It's like it's absent from the communication and I think it's sad because it is absolutely preventable for the vast majority of people. Arguably, so is heart disease, but yeah, so, yeah, the statistics are scary, and when I talk about who is likely to have a fracture, that is a big group of people. So we're talking 50% of women and 25% of men will have a fragility fracture, which is the fracture that happens with osteoporosis in their lifetime. So that's a huge number. And people could argue oh well, that's when we're 90 years old, but no, it's actually. It really starts early on, really in your 60s and even in your 50s for some. And some of those fractures, like hip fractures, have so much morbidity associated with them, meaning that people don't do well. A third of people with hip fractures die. A third of people never regain independence Only a third of people even get back to the living situation that they were in, and even then they're not the same. So being able to prevent these things and having a plan around how to deal with this for the rest of your aging life is really important.

Parker Condit: 3:52

Yeah, I think I was so curious to talk to you and excited to have the opportunity to talk to you because I read something a few weeks ago I saw it on Instagram but maybe you can confirm this but it was an alarming number. It was that anyone who has a hip fracture who's over 65, there's a 15% to 30% chance they will die within the next 12 months.

Dr. Doug Lucas: 4:11

Right, it's like it's absolutely true.

Parker Condit: 4:13

That's alarming and, like you said, most people don't talk about this and maybe it's because I'm 34, but I feel like I'm relatively well plugged into the health space and it seems like the osteoporosis and the bone health and bone density PR firms aren't doing what cancer is doing out there. It just seems like it's not getting that sort of attention.

Dr. Doug Lucas: 4:34

No, and the truth is cancer is a really tough problem not to downplay cancer, but the truth is bone health it's actually a pretty simple problem that there just isn't much funding behind. Okay, so if you look at the government agencies that have the ability to do the megaphone communication, they just don't have the resources and so it's just a really under discussed issue that really has a pretty simple solution, okay.

Parker Condit: 5:01

We're going to get to solutions at some point, certainly, but I'd love to be able to discuss kind of the implications and the differences between men and women, because I had a woman health expert on a few weeks ago, so that was a very interesting conversation. Are there differences between men and women as far as like risk factors when you need to start caring, things like that?

Dr. Doug Lucas: 5:19

Yeah. So if you look just statistically, women suffer from this earlier than men and there are some different, numerous reasons why you could argue, but the biggest one is that women go through menopause at a relatively predictable time, even though it's a range. Men go through andropause, which is the loss of the male sex hormones, at a much slower pace. So, like men will go through andropause for decades and, depending on their starting point, they're not going to have issues with loss of sex hormones until much later in life, whereas women, when they go through menopause, it's like boom, it's over, and so they suffer the loss of estrogen, testosterone and progesterone, and all three sex hormones play a role in bone metabolism. So, depending on their starting point, we see a lot of women who are perimenopausal and early postmenopausal who already have osteoporosis, so it's a bigger deal for them much earlier on, and that's the big difference between men and women. Also, men generally have a higher starting point when it comes to just bone mineral density and we can talk about what that means and why it's important or not, but they have a better starting point as far as fracture risk goes. So they're also less likely to suffer a fracture earlier in life, but this does become an issue for them later in life.

Parker Condit: 6:30

Okay, this is me going off cue already. So you said suffering a fracture earlier in life. If you suffer a fracture earlier in life, are you at a higher likelihood for a repeat fracture?

Dr. Doug Lucas: 6:42

Absolutely. Yeah, I mean, the biggest risk factor for a fragility fracture is a previous fragility fracture. Okay, interesting.

Parker Condit: 6:50

So this is kind of piggybacking off of what I learned about the women's health initiative and sort of the resulting effects of that of hormone replacement therapy basically stopping in 2002 or right around 2002. Can hormone replacement therapy help with osteoporosis and help sort of you were talking about like the very precipitous decline? Can this sort of ease that and help with bone density for women?

Dr. Doug Lucas: 7:15

Yeah, so I'll choose my words super carefully in case the FTC is listening. So hormone therapy as a whole is not FDA approved for osteoporosis, although estrogen or estradiol therapy is alone, although you can argue why. But estrogen and progesterone and testosterone the whole package, if that's what you're using in a bioidentical perspective is not FDA approved for osteoporosis. As I mentioned earlier, though, each of those hormones plays a different role in bone metabolism. So estrogen will slow down osteoclasts those are the cells that break down bone. It'll slow down osteoclast function. So maintaining estrogen after menopause through hormone replacement will slow down bone loss undeniably. It was used as the primary tool for osteoporosis for decades prior to the women's health initiative. Progesterone also plays a role in osteoblasts, that's, the cells that make bones. So osteoblasts both function and differentiation, meaning like from stem cells to become osteoblasts. And then testosterone somewhat directly on bone but more indirectly through muscle mass. We know that sarcopenia, or loss of muscle mass as we age, is strongly associated with bone health. You could almost argue like chicken or the egg, but testosterone has such an impact on muscle mass that will obviously have an impact on bone health too.

Parker Condit: 8:35

Okay, yeah, I appreciate you kind of being able to dive into that, and it's funny how a lot of these conversations are now dovetailing largely towards the same things. So I guess from there is, can you start discussing some of the lifestyle factors that are associated with this and maybe also diving into your? You rattled off some ages earlier 50s, 60s. Obviously, if you're there already, it's not too late, right Like you can always do stuff to mitigate future risk. But when should be like in an optimal scenario, when should people start being proactive about bone health?

Dr. Doug Lucas: 9:09

Yeah, so I get this question a lot and people look at me funny when I answer. But honestly, the time to start knowing where your bone density is is in your early you know 20s and 30s, your early adulthood, and the reason for that is we reach peak bone mass at that age. So if you know that you don't have good bone mass like, for example, I was osteopenic in my 20s and it's because I had a crappy diet growing up and so I know that I have osteopenia Now. I also know that my bone mass hasn't changed over the last 30 years. But I knew. I knew what my starting point was, and it's because I was a research subject in my wife's PhD thesis. But if you know that you have a low starting point, then you know that you need to be much more careful about things that affect your bone over time. Should you take those steroids or not? Should you go on a PPI or not? Should you be on some kind of a supplement to help to metabolize bone? Should you take a birth control pill? No, you know, like all those things, and so you can know where your starting point is earlier on. You're going to be better off. So, realistically, though, most of the people listening to this. If they saw osteoporosis and the title, you know they're going to be probably in their 40s, 50s or beyond. So when does that group get a dexa scan? And if? My response would be if you haven't had one now, because everybody is at risk.

Parker Condit: 10:29

Really, if you look at the risk factors for osteoporosis, yeah, I asked that question assuming the answer was like a lot earlier than most people would probably consider. But most of the people who are our customers probably your customers are listeners, they have kids, they can pass along that information to their kids and sort of you know, relay the fact that the earlier you start the better. And it is interesting to know like the frame that I've always used to think about sort of muscle mass and bone density, I guess, is you kind of climb to a certain point and you were saying that's in your 20s, I suppose, and I think in your 30s for muscle it's really hard to build a ton of new muscle beyond that and then from there it's basically a fight to hang on to what you have. That's how I've always thought of it Build, build, build, build and then you just have all your work after that. It's just fighting to hang on to what you have.

Dr. Doug Lucas: 11:18

That's the frame I've always used for it. That's a great way to look at it. And you're right, muscle mass it does. It comes after. And I think you know for my guys I'll tell them because I have a lot of patients in their 40s and 50s sort of in the other side of my practice for health optimization, and you know I'm telling those men look, if you're in your 40s and 50s you get as muscular as you can. Okay, because once you kind of like peak in your 50s, if you're working really hard, it's a downhill slide and you got to fight every day to slow it down. So, yeah, same thing, you know, learn what your starting point is. It's just easier to see with muscle, sure.

Parker Condit: 11:54

And it's definitely worth re-adhering, in fact, that it's definitely possible, if you're in 40s and 50s, to put on muscle mass, and that should be a goal for most people in this country. I think this country is very undermuscled is probably the best way to put it. So, it's definitely possible. It's never too late to start. I feel like a lot of people can go sort of a lifetime without exercising. They're like why bother, why now? And it can make a massive difference, starting in your 40s or 50s, yep, so thank you. You mentioned diet, like childhood diet. Can you just talk about the influence of diet kind of growing up and it sort of spins my head off into. I wonder if there's even like like really early childhood considerations like duration of breastfeeding, delivery, like birth delivery method? I bet there's. Is there any research around like those types of things that have considerations to long-term bone density?

Dr. Doug Lucas: 12:49

Yeah, it's interesting, I haven't seen it. Go back to delivery method, you know, but it's, you know, you could argue right Like it's, if you have. If you underwent a C-section and that was your welcome into this world was a you know, quote unquote non-traumatic although I don't know if you've seen a C-section but still not the same as going through the birth canal. Yeah, it's gonna put you in a different starting place. But no, I've not seen any research on that. But definitely you're eating in activities through childhood and adolescence will play a major role in your peak bone density development. Yeah, absolutely, if you look at, even like gymnast and you could argue, you know you mentioned about diet. So this is a group that obviously struggles with adequate nutrition in some spaces, but the way that they are active and the impact that they impart on their bones, their bone density in general, is really good. So then you take your, let's take your. You know female gamer who has a poor diet, like what's her bone mineral density? Like it's terrible. And so then there's genetic factors associated with that too. But absolutely, you know we, because I have a four year old, right, so I watch her and I'm looking at her diet and I'm thinking okay, how do I get more protein in her and is she getting adequate minerals and nutrients? You know, because it's I don't know if you have kids, but man, it's really tough to feed kids good food. I have a four, nine and 11 year old and they're all on different stages of challenging eating.

Parker Condit: 14:10

So what are the considerations that you mentioned? If you like, what are these boxes that you're trying to check from a nutritional standpoint? If you can just rattle off some of those, yeah, number one being adequate protein man.

Dr. Doug Lucas: 14:21

this is the first thing we do when somebody enters into the program is we have them track food and we figure out how much protein they're eating and across the board, without fail, they're all protein deficient. That's almost changed a little bit because people are coming in by listening to my YouTube channel and so they've heard me say this, you know, I don't know how many times. So now they're coming in they're like no, no, no, it's a gram per pound. I promise, I promise I'm eating a gram per pound, you know, but they just started that. So that's the number one thing, because you have to have adequate and adequate protein to build muscle, adequate protein to build bone. Right, bone is 50% protein by mass. So that's the number one thing. And then the second thing is gonna be honestly, in this group this is different from the rest of the population, but in the bone health group it is really adequate nutrition. Just overall, they tend to be a nutrient depleted group for whatever reason. Again, chicken or the egg. So just making sure that they're getting enough calories and that those calories are coming from good food sources. So those are the kind of the two big things out of the gate.

Parker Condit: 15:18

Okay, you said it, but can you just give us, like, what is your protein threshold that people should be eating? Yeah?

Dr. Doug Lucas: 15:23

so one gram I said it really fast one gram per pound of desired body weight. And so again for this bone health group, actually generally we're pushing that upwards of their actual body weight. Of course, you know, if you're talking about a weight loss group it's gonna be lower, but yeah, so a gram per pound of desired body weight is sort of our starting point. And then obviously we have to take into consideration, you know, do they have kidney disease and what other issues? But that's the general starting point that we're gonna aim for for people.

Parker Condit: 15:49

Okay, very helpful. And then I would assume that you do sort of lifestyle assessments. Do you check how much people are walking? How do you sort of judge their levels of daily physical activity? If you will?

Dr. Doug Lucas: 16:02

Yeah, so we have questionnaires on questionnaires. Onboarding into our program is, let's just call it, work, because we have to get a lot of information, you know, and they're meeting with coaches, and so sometimes this takes multiple visits, but pretty quickly we can identify where people are falling short. In the activity side, a lot of people will wear trackers. We don't mandate it. I love it when people will wear something like a, you know, like a whoop, or even an Apple Watch, something where we can get a sense of how active they are. But ultimately, what we're looking for is how much resistance training are you doing? How heavy of things are you moving around? You know, are you doing any kind of impact training? Are you just getting out and moving? You know, those are sort of the basic fundamentals. And then, of course, we dive into, like, the rabbit holes of all the different modalities and things that people can do.

Parker Condit: 16:48

Yep, All right. So I come from a personal training background, so let's dive into resistance training. Do you have like a minimum days per week that you want people to be doing? Do you have a standard split that you start people on? For people who have never exercised before?

Dr. Doug Lucas: 17:03

Yeah, this is the tough thing, right. So you know, obviously there's a massive range of ability level coming in and we struggled with this early on because I just didn't have a tool that I could apply to. You know, I have high level athletes in one side and then I have people that literally just don't get off the couch on the other. You know, how do you train that whole group through a telehealth platform, and I didn't have the answer to that. But now we have created a couple of different things. So we have some of our patients will work with some videos made by Rebecca Rotstein, who founded a company called Buff Bounds, and so these are very specific to bone health and to fall prevention and they're really great foundational videos and they're Pilates based, and so that's an opportunity that we have for people and that's easy because anybody can pretty much do that. And then we have another level up and this is a level that we've recently created and Nick Truby, who is a PhD in exercise physiology and runs a training program, a virtual training program. He now will meet with our patients and do an initial, you know consultation with them and kind of figure out what their starting point is. And now we have content and different starting tracks. So we'll say, look, this is your starting point, this is your track, and then we just program them from there. And then of course they have follow-up coaching. So they're just going to continue to kind of march down this programming pathway that's just launched recently, though so too early to say you know how we're doing with that, but I would say in general we're kind of hitting. You know, I would love to see people do three to four days of resistance training a week, if their body can tolerate that, and that's way more than most of this age group is doing, it For sure.

Parker Condit: 18:42

You know I was thrilled to get people who were relatively active to if they were training with me two days a week, to get them to do two additional days per week. That was a big ask for a lot of people. So yeah, I think three to four days a week is an ambitious goal for most people but I think also attainable. Yeah, can you speak to how sleep affects your bone health? I'm asleep affects everything. I'm assuming there's a big influence on it. I'm guessing it sounds largely like you subscribe to, like the bio-psycho-social model where there's a lot of things it's not just purely the food you're putting in your body and the exercise but, like stress and environmental factors are going to play a big role in your overall health and bone health is going to be a part of that. So it is sleep a factor.

Dr. Doug Lucas: 19:31

Absolutely yeah. So when we, if we define our framework, we kind of have two different versions. But the framework that includes sleep is how do we reverse bone loss? And the answer to that is you have to start with the foundation, and that foundation is nutrition, exercise, sleep and then connection and can dig into that. But the sleep part is critical and, as I'm sure you know from working with people, that if they're not sleeping it doesn't matter how good anything else is right. You just nothing is going to work. They just feel terrible. So, yeah, sleep's really important. And what's really interesting in this group is that I find that they really struggle with sleep and I think that there's so much fear and anxiety with having osteoporosis and not having the this security to know that you can do an activity and not have a fracture. Now they're just sort of lying in weight of this like impending doom. That's out there and it's a pretty crappy way to live. So a lot of these patients they will they have that kind of difficulty falling asleep, ruminating thoughts, wake up at 3 am with elevated cortisol. We have to battle those things. So it definitely plays a role in bone health because we know that chronic inflammation, chronic cortisol, and then this course is going to impact how you eat. All of those things are directly tied to how well you sleep.

Parker Condit: 20:44

Yep, sleep is definitely one of those, has a like a very cascading effect, positive and negative. When you're sleeping a lot better, everything else just seems easier. You're going to be more motivated to exercise, eat better, and the same is true on the opposite side as well. Yeah, so you're talking about sort of the connection side of things. Can you speak to that? I have a framework of like six pillars of things that people should be doing, and one of them is healthy relationships. I'm assuming that's what you're speaking to as far as the connection.

Dr. Doug Lucas: 21:19

Yeah. So I've struggled and I've renamed this pillar I don't know how many times. So it started out as stress mitigation, because stress is important, right. And then I realized it's not really. It's not just stress, you know, really underneath stress is for, in my opinion, for a lot of people it's spiritual health, right. Like, do you have something that you have faith in, that you can believe in, that you know there's a bigger, a greater or whatever right? It doesn't matter what it is religious or not, but some kind of spiritual connection. But then that's not really it either. And then I've kind of come to this idea of connection, because it's connecting with source, with God, with people, with your community, with your children, with my dog, you know, like it's all of these things that can help to really keep us strong and keep us moving forward and having purpose. So I've really named it recently connection.

Parker Condit: 22:07

So that's what I mean, that seems like a very good catchall bucket to throw those into. Yeah, I personally have healthy relationships in one bucket and then stress mitigation in another, so it's two sides of the same coin, for sure. Yeah, just more pools. How do you introduce people to that if you feel like they don't have a great support system or it's all very inwardly focused and there's not that sort of something greater than themselves to work towards? Do you have any tricks to yeah.

Dr. Doug Lucas: 22:36

So I mean, the hardest thing is just even bringing it up, you know. And so when I the way that our program works, they meet with the coaching team first and then I come in after they've met with the coaching team, and sometimes this has been pieced out already, you know. Sometimes people, they just come out that they're like this is the thing. But I always kind of go through the pillars and see what people connect with, and a lot of times these patients are coming in, they're just, they're really dialed in. You know that I'm doing this exercise, my diet's, like this, I mean like cool, and then I ask them about well, you know, tell me about your spiritual health. And I phrase it in different ways depending on the person. And a lot of times people are like, oh, dialed right, like I have a meditation thing and I pray, and they do this and they're awesome. But a lot of times people will say I don't do anything, you know, like they don't have an answer, you know. And then you know like, oh, okay, well, this is probably a weak point and I have found you can dial everything else in and if that piece is truly missing, they're going to falter, you know, they're just not going to be able to thrive. And so then the question and I don't know the answer to this, but the question is then what do you do about that? Because that's really hard from with the tools that I have available, that's really hard to do something with.

Parker Condit: 23:48

Yeah, it's similar to sleep, in that if you're not addressing a way to mitigate stress and if you don't have those healthy relationships, it's a very challenging thing to duplicate elsewhere, like it's hard to just ramp up other these other pillars that we're talking about to just fill in the cap for that. Yeah, it's, that's a tough nut to crack for sure.

Dr. Doug Lucas: 24:09

Yeah, yeah, I have ideas, so I'm exploring some things, but I don't have an answer yet.

Parker Condit: 24:13

Yeah, well, that's good. That's a very worthwhile problem to work on. So can we go back to sleep for a second? Do you have any sleep hygiene tips or tricks or tools that? There's so much out there, but you've probably had to distill it down to something somewhat reasonable with you know, just you see people repetitively.

Dr. Doug Lucas: 24:33

So what do?

Parker Condit: 24:35

you do for people who aren't sleeping particularly well.

Dr. Doug Lucas: 24:37

Yeah, in general, I kind of kick this to my coaches because they have the accountability side and that's their thing and I have time in our meeting to discuss it. Then, yeah, I start with you know what leads up to sleep, and it's almost like your entire day, right? It's almost like we need to plan from the beginning of the day when we're going to go to sleep and how we're going to get there. I really like the framework that Craig Ballantine uses. I don't know if you've heard this 10, 3, 2, 1 rule, so make sure I can get this out right. So the 10, 3, 2, 1 rule is 10 hours before bedtime no caffeine. 3 hours before bedtime no food. 2 hours before bedtime no work. 1 hour before bedtime no screens, right. And so I like it because it's not so rigid that you can't follow it. You know some people will say, like, turn off your lights and wear red glasses and feel like you're blah, blah, blah. You know it's like, wow, like I don't live in a cave, but I like it because you can still live your life, like you can have dinner at. You know, like, let's say, you have dinner at 6 and then your bedtime is, you know, between 9 and 10, and then you can, you know, hang out with your kids and you can even potentially, watch a little TV although not a huge advocate of that but you wind things down. And then you have that hour of truly winding down no work, no screens, truly unplugged, connecting with your spouse, if that's an opportunity that you have and then you're getting yourself into bed and really like preparing yourself to launch into sleep, you know, and then you're setting the stage of you know what does your sleep chamber look like? And you know, do you have a TV in there and do you have other lights in there? Like it's such a big deal, like to have a cold, dark sleep chamber. You know, and it's critical, and I see crazy stuff that people are like I have this, like Mary, go round in my bedroom, like what are you doing in there, and so I think those are the biggest things out of the gate. And then we have to figure out like, okay, well, where are your struggles, you know, and is it the 2am wake up? And is this a cortisol thing? And then you can really start diving in. But that's the biggest thing out of the gate is just setting your bedtime being absolutely consistent, both weekdays and weekends, and sticking to it and having the right sleep hygiene to get there.

Parker Condit: 26:44

This is something I go back and forth on all the time Also. First, I want to mention how much I like that you refer to it as a sleep chamber and not a bedroom. It's just like such a good way to reframe it to get people to think of the importance around sleep, which they should. Is there like a good comparison between like diabetes and pre diabetes and osteoporosis and osteopenia? Because, like, a lot of these can be just terms and like if people aren't wildly involved in the healthcare space and be like, ah, it's just a term. It's a term I've heard.

Dr. Doug Lucas: 27:11

Yeah, I mean, gosh, you could. There's a lot of discussion around, like even the word osteoporosis and like why is it defined the way it's defined and how did we come up with this T score thing based off of DEXA? So let me just dig into that a little bit. The short answer to your question is yes, there's a thing and it's called osteopenia, and if I had, I wish I had like a whiteboard behind me or they'd draw this out. But basically what happens as we age predictably although arguably doesn't have to happen this way, but this is what happens is that our bone mineral density like we said, it's your peak bone mineral density is in your early adulthood, right Early 20s to 30s, and it starts to decline in your 40s, reliably in everybody. Then when you see the chart that is, it's this is what when you get a DEXA score or an DEXA scan this is the screening imaging for osteoporosis you'll see this chart and the chart has age on the bottom and then it has T score and I'll define that a minute on the vertical side and then you can see that the average T score will drop over time, right. And so the T score is a statistical analysis of bone density compared to that of a early 20 year old in your same gender and ethnicity. So for me would be a Caucasian guy, me now compared to where I was in my 20s and there isn't a lot of difference because I'm in my mid 40s. But as you age it starts to drop down. On either side of that average there is a kind of a shaded bar and within one standard deviation. So we can talk about statistics. But within one standard deviation is, quote, unquote, normal. Between negative one and negative 2.5 standard deviations is osteopenia and then less than negative 2.5 is osteoporosis. Now, those numbers were relatively arbitrarily chosen not that long ago, and so we created this definition of osteoporosis based off of the statistical analysis of an imaging study that was adopted try to remember, but I think it was like late 90s, so not that long ago and there's a lot of suspicion around, you know this, like it was the drug companies and they had the drugs and they wanted to make a diagnosis that fit with the you know, and like I don't know if that's true because it does also coincide with fracture risk. So it's interesting. So, yeah, there is a thing, and how important is that thing? Like I said, like I technically have osteopenia. Am I worried about fracture risk? Not at all. And you have to understand too, like, as you age, osteopenia is normal. Arguably, I'd love to see it not happen, but it's still normal. And I see people, you know, I see women in their 60s and 70s and they get diagnosed with osteopenia, which is not an ICD code. There is no diagnosis of osteopenia and they're freaking out right and they're scared of fracture. And it's frustrating because that is totally unnecessary fear and anxiety because it's totally normal and they are probably not at risk of fracture. And yet we kind of instill this fear of this thing called osteopenia, which is actually normal. Deviation from average bone marrow density.

Parker Condit: 30:18

Okay, so I'm actually explaining that. It's just kind of giving people an idea that this is something that is on a spectrum, so it's not just a binary, this or that, it's the long spectrum, and then, as you said, there's new odds to it as well. Even if you fall and somewhere in the spectrum where there's this word osteopenia, if you have the expertise or you have a provider with the expertise, they can tell you whether or not it is or is not a concern.

Dr. Doug Lucas: 30:42

Hopefully, yeah, and may just say. One more thing about that is that osteopenia can be a problem depending on how early you are with it and what your trajectory looks like. So if you were barely osteopenic two years ago and now you're severely osteopenic, almost osteoporotic, that is a big problem. So I wouldn't say don't worry about osteopenia, but it's a delta thing. What's the difference from one test to another? Another reason to get tested early which is such a great point.

Parker Condit: 31:09

That's where the nuance and the context comes in. So is your average primary care provider going to be well versed in this? Are they even testing for it? And you mentioned before what the test is for. Can you explain a little bit what a DEXA is? So I think it's important for people to be their own best advocates to understand what is the test I should maybe be asking for if it's not standard.

Dr. Doug Lucas: 31:30

Yeah, so the standard test is DEXA. It's available worldwide and easily accessed in pretty much any community, so it's around. So we have to use it because it's there. The downside of DEXA is a few big ones, and one of them is that it's only measuring one aspect of bone strength, and what we want to know is how strong are your bones and what is your risk of fracture? Dexa is essentially an x-ray, so all it's measuring is the body's ability, or the skeleton's ability, to absorb or not absorb x-rays, and that's all based on mineral density. That's why we call it bone mineral density. That's what it tells you, but it doesn't tell you about bone strength, and there are several examples where you could point out that improvement in bone mineral density does not necessarily improve fracture risk, and vice versa. You can see improved fracture risk with some therapies that don't improve bone marrow density. So we know that there's a whole other side to this thing, but DEXA is globally available, so we use it. It's there. There are a couple other ways to measure it. We can answer those in a separate question, but that's what a DEXA is.

Parker Condit: 32:38

Okay, yeah, that's a good explanation. Out of very personal note. I've been getting DEXA scans for years. I hate the way they print out. Do you use your own printouts or do you plug in the data that you care about into a certain chart?

Dr. Doug Lucas: 32:51

I pretty much just look at a few points. You've probably been doing them also for body comp, I would assume right, yeah, yeah, so some of the body comp DEXAs don't even give a T-score. It's kind of like it's challenging when people say you know, I got this DEXA, can you take a look? And it's like oh well, I can tell you what your visceral adiposity is, but I can't tell you what your T-score is, so you do have to find the right one. And that can be a challenge for us too, because, again, we're telehealth nationwide, so I don't know all the providers, yep.

Parker Condit: 33:19

Yeah, just for years. I'm like this is a useless printout, largely speaking. I just use an Excel sheet and kind of plug in the things that I care about, right? So yeah, if you could kind of explain the other ways to measure, the other metrics that you look at, to sort of get a more well-rounded view of not just bone mineral density as you've been talking about through DEXA.

Dr. Doug Lucas: 33:38

There are. So there are kind of there's three things to talk about. So some people will talk about this thing called TBS or Trabecular Bone Score, and this goes with a DEXA. So DEXA is the traditional thing. You can have a kind of a software add on called TBS. It, in theory, will look at bone quality. I just, personally, I'm not real impressed with what that data actually provides me. I don't really know how to interpret it, and it's not because I haven't read about it. It just doesn't really seem to make a lot of sense to me. It also has the downside of being manipulated by arthritis and deformity, and so it just it doesn't give me a lot of good information. The one that I really like, if people have access to it, is a ultrasound study called REMS, and REMS is an ultrasound, like I said, and so there's no radiation, and it gives you both bone density and T score, but it also gives you a fragility score, so it tells you what your bone architecture is like and it's it's pretty solid, it's been studied compared to DEXA, and there is some difference, differentiation or difference between the two. I would argue that probably REMS is likely better, but once something has been labeled as the gold standard. You can't say that something is better or worse, you can only say that it's different. So we don't really know. The downside of REMS is that it's just not globally available. There's just not a lot of them out there. And then the last thing that we do for understanding what's happening with bone metabolism is actually to look at biomarkers. So not even doing imaging, just saying what's happening with your osteoclasts, what's happening with your osteoblasts. And there are bone, bone turnover biomarkers that we can get in blood and they're great. So I can tell you, you know, are your osteoclasts slowing down? Are your osteoblasts building up? You know, what does our ratio look like? What does our metabolism look like? And that's really what I'm looking at, more so than imaging. I care what happens to your DEXA, but I more care what happens to your bone turnover biomarkers as we go.

Parker Condit: 35:27

Interesting. So what are the tests for that? The biomarker tests.

Dr. Doug Lucas: 35:31

So the the acronyms are CTX, and that's C-telopeptide, and that's the osteoclast or bone breakdown test. And then the other one is P1NP, which stands for Pro Collagen, type 1, pro something, something. P1np. There you go and it's. It actually is listed. It's different no matter where you look at it, but anyway, p1np is the bone building osteoblast biomarker. So they change relatively slowly. You can get this nice trend over time and we can really see big changes with with therapy in a couple of months, rather than saying like, oh well, you have to wait two years to do a DEXA to see a difference, you know, and then wondering like, did the DEXA actually show me what I think it showed me? So the bone term bone biomarkers are way better for short term progression.

Parker Condit: 36:20

Yeah, I think that's great and also very important in that I think a lot of the interventions and like measurement protocols within the space are they're just kind of slow. So I love like a more iterative process where you can be like all right, well, these are the interventions I prescribed. I can see their adherence or not and then see whether or not, based on these blood tests, whether or not things are moving in the right direction or not. It's just a. It creates a faster feedback loop, which I think is much needed in healthcare.

Dr. Doug Lucas: 36:45

Yeah, and it just provides that, like you know, the feedback that what you're doing is working right, and I see people just get such fatigue because it takes so long to see improvements in DEXA.

Parker Condit: 36:54

Yeah, I can imagine that's very frustrating for something that's not even a complete view anyway, right, so I kind of glossed over this, but I want to go back to it is are these things that your general primary care is going to be able to identify or know about, or are they going to refer out to specialists?

Dr. Doug Lucas: 37:12

So it's kind of a challenging answer. So most primary care doctors, internists, obviously they know about the disease, they have a plan, but that plan is generally going to be based off of pharmaceuticals. And this is where I see so much contention in the patient population because their expectations were not met by their doctor. I see it doesn't matter if it's primary care, internist, endocrinology, whatever, but you have to remember if I'm talking to the patients to say that the medical system is what it is right, we have a medical system that is designed around diagnose and treat and that treatment is going to be whatever we can do to achieve our goal in the least amount of time possible, and that's generally going to be pharmaceuticals. So I see patients frustrated to say, well, my doctor didn't even talk to me about nutrition and exercise and stress management and sleep and supplements and peptides and heart. I'm like, well, it's seven minutes, like how are they going to have that conversation? And so I think the expectations are fortunately just off and our system is not good at treating things that require a comprehensive lifestyle solution. Right Like this is diabetes. This is dementia prevention, cardiovascular prevention right, these things our system is not good at preventing. It's good at not dementia but cardiovascular. You know, if you have a heart attack, man, you can get stented in under like 60 minutes. That's amazing, right, like you're in a car accident and you have a trauma and you could be in the surgery. You could be in the OR getting fixed up in less than an hour. Like that is phenomenal care. But is it phenomenal to throw a bisphosphonate drug at somebody who's paraminopausal with osteoporosis, that just barely has it and doesn't have any other work up? I don't think so, you know. So yeah, they have a tool, they have an approach, but it's not an approach that I would probably agree with.

Parker Condit: 38:56

Okay, yeah, now I think it's just great for people to. It's just helpful for people to be able to have this information so they can better navigate the healthcare system. Even if it is, it is just what it is, exactly like you said.

Dr. Doug Lucas: 39:07

What did.

Parker Condit: 39:07

We're saying, Like you mentioned, we're awesome at trauma in this country. I don't want to get in an accident in any other country, but this one we're very good at that. That's right. Preventing things is that's the next step.

Dr. Doug Lucas: 39:21

It's just a totally different approach.

Parker Condit: 39:22

Mm-hmm.

Dr. Doug Lucas: 39:23

Yeah, yeah.

Parker Condit: 39:24

For sure. So I'd love to kind of go into your company now and now that we have a bit of a framework around what this is and also a pretty good understanding of, like, the healthcare industry so you just described it I'd love to see, like, where you fit in and sort of like how, also your background as to how you ended up here. I think there's a great line to say, like you're now preventing, you're trying to teach people about the things to prevent people from getting the surgeries that you were constantly doing. So if you could just explain a bit more about your company and your background. I think that'd be a great place to go, yeah.

Dr. Doug Lucas: 39:58

Let me just start with, like how I got here, which is I'm an orthopedic surgeon by training, so board certified, and orthopedic surgery. I did that for seven years in practice before I finally jumped ship, and I did. I treated fragility fractures and so that's hip fractures and that's, you know, wrist fractures and all the stuff that comes along that needs to be fixed. In that practice I was continuously frustrated by the lack of care that my patients could get in things like osteoporosis but also the other things. Like you know, diabetes was another one that just drove me bonkers. And so, you're right, I was doing the fragility fracture work, but in the diabetic patients I was cutting off legs, you know, and I'm talking to these patients and saying, look, diabetes doesn't even need to be a disease, right, this is a nutrition problem and it can totally be put into remission. This doesn't have to happen. But they weren't there to hear me talk about that. So after watching my wife, who is in the nutrition space, totally turn people around and I was seeing this opportunity to help people to optimize their health rather than just do surgery I decided to start making some moves. So I did a second fellowship and got board certified in anti-aging and regenerative medicine. That fellowship was in functional medicine, did some more training in hormones and then started part time, kind of started the health optimization side part time to sort of like my feet wet and just loved it, you know. And then sort of the pandemic happened and we're like, well, you know, telehealth doesn't sound so bad right now, and so that was sort of my impetus to actually to make this leap. Very early on in that health optimization practice I realized that what we were doing was perfect for bone health and that the model that we had created with our health optimization period that I kind of described earlier was the way that you slow down and potentially reverse bone loss and reverse osteoporosis. So we started kind of reaching out to people that had it. We had some of those patients coming to see me because they knew me from fixing their fractures. So we kind of tested it out and it was awesome and I'm like, wow, this is like, this is amazing. So we started trying to message both messages in one platform and it was just sloppy and ugly and so we ended up creating a second company. So now we have the optimal human health side and we have the optimal bone health side, the YouTube channel is optimal bone health with Dr Doug, and that's where we just we're putting so much energy and effort there to help educate, because we kind of have two missions One is to provide amazing patient care, but the other is just to educate globally, and YouTube is the platform to do that, and so started doing this on a bigger scale. Now over half of our patients are all patients with osteoporosis and we use this framework called the 4R framework that I haven't really mentioned yet. And the 4R framework is just to recognize why we're losing bone, reverse those causes of bone loss, retest to make sure you're headed in the right direction and then to revive your life and live without the fear of fracture. That just putting that out there like that speaks so much to the people that are just searching, searching, searching for the answer, because they are desperate. A lot of times there's so much fear around having this thing. Their doctor told them to take this drug and they had a one, two and other doctors going to break up with them. They're like bullying them into taking drugs and it just so unnecessary. And the way that I look at osteoporosis is that if caught early enough, it really is reversible in most people there are circumstances where bone losses is going to happen. You know things like cancer treatment and chronic steroids and stuff like that. But for most women and men this can be reversed and somebody can be put on the path to really have no issues with osteoporosis and fragility fracture.

Parker Condit: 43:37

That's great. I think people should be hugely optimistic about that, and I want to kind of go back to your point of like how tragic it is that people live in fear of, like not being able to live their lives in the way they want to. So this goes back to a question that I wanted to ask earlier, which is about exercise. Did you find a lot of people were avoiding exercise because they were worried their body couldn't handle it?

Dr. Doug Lucas: 43:56

No, totally. The recommendations from their doctors were so counterintuitive and conflicting because they would say you need to do resistance training, take calcium, vitamin D and take this drug, and they'd be like, oh, and don't lift anything more than three pounds. I'm like, wait, what? So I'm gonna do resistance training with a three pound dumbbell. Yeah, so they just don't know and honestly it is hard and I put this on Nick, you know our exercise guy, and I'm like, hey, look, man, you're, you're making the call here like how much can they lift? It's really hard to know, you know. But the truth is you start low, you go slow and you build up and you'll get stronger, your bones will get stronger. You know, will somebody probably fracture at some point doing an exercise that my team told them to do? Probably right. But we're pushing in the right direction and we're doing everything we can to put people on the on the path that's gonna get them there safely.

Parker Condit: 44:48

Mm-hmm had to think about the, the cost of not doing exercise. So that's usually, that's always how I frame it, because you're not gonna build bone without it.

Dr. Doug Lucas: 44:56

Right, and this is where I see people like you know, people that are taking the drugs and they take these anabolic drugs like Forteo and Timlis that are. They're cool and they're tools that we do use occasionally. But even then, like, you've got to have the right diet, you've got to supplement with the right things. If you're not getting it through diet and you still need to stress your bones, you know, like you're not, if you just take the drug, it's gonna. It's gonna do something, but it's not gonna do nearly as much as if you feed your, feed your metabolism what it needs.

Parker Condit: 45:24

Yeah, so you can't do it without resistance training and you can't do it without adequate protein intake. Right, that's right. You need the building blocks to be able to, to build what is the stress? The bones.

Dr. Doug Lucas: 45:34

The bones are like every other tissue in the body. They respond to stress. You know, the more you stress them, the more go grow.

Parker Condit: 45:39

Yep and that just happens in the training world. So it's progressive overload where you just start at something tangible stress it to a certain point, let the body adapt. Stress it more. Let the body adapt, yada, yada, yada. That's right, all of personal training in a show right there. So what? What sort of model like financial model do you guys operate in? Are you sort of cosy airs, are you? Do you accept insurance? Do you accept health savings accounts, flexible savings accounts, anything you share about that? So people know sort of the resources that are available through your company.

Dr. Doug Lucas: 46:12

Yeah, so this has been a challenge, because the care that we offer I mean I've kind of described it a little bit, but it's I'll just say it's awesome Right like this is how, when I was in practice in the traditional medical model, this is how I wanted to treat people. Right like you bring them in, you take care of them, you answer their questions in a timely manner, you treat them like people, you provide them with coaches, you help with accountability, you order the stuff that's hard for them to get on their own for them and you have it delivered to their house. Right Like this is how I want to be taken care of. The problem with that is it's expensive, like that's a tough team to run, and so, yeah, so we have our full service program, which is what I just described, and that's gonna. The price is gonna vary depending on on where you're coming in and what you're coming in for, but what we've been really trying to do is to find that, like what's the? What's the next level down that provides people with as much as we can and a very cost efficient manner. So what we've come up with, which we're launching in mid-August I don't know when this will come out. But so it's. We're gonna launch our beta program mid-August and it's gonna be a Group coaching. So group coaching is not gonna have physician interaction, but it'll give us give people access to all of the video training that we have. So we have an entire library of educational videos. Give them access to the physical training, either through Nick Truby or through Through buff bones. They'll give them access to our coaches. It'll give them access to you know how to get all the tests done and kind of guide them through that. So like, these are the tests, this is how you get them, this is how you interpret them right. So kind of like a little bit of self-service. You'll have coaching calls, live calls from our, my PA, and then access to all the training, the nutritional guides and etc. So it is a program that I think most people would Likely be able to do the majority of the work themselves. And then those that want that next level service, well, we'll be there for that. But our the demand is so big right now that we you know I can't get more people in at this point. So we need to be able to bring people in and have a group coaching model where it's gonna help the people that don't need as much help.

Parker Condit: 48:14

Yeah, no, that's really smart. I think it's a really clever model and by the time this comes out, that will be available. So also, before I forget, we're gonna link to your website or else gonna like to your YouTube channel in the showdose, just because, largely, the purpose of this podcast is to provide people with just all these different avenues of education and me finding people who are reliable sources of that information. So that will definitely be available. I'd like to know, like, what your thoughts are on sort of the future of health care, because obviously you're doing something where you moved out of the traditional model of health care and you described it perfectly like you're. You created a business where you can treat people the way you want to the. I think that needs to happen more, but it is happening in this very it's always cash pay. I'd love to hear your thoughts on where you think the the industry is going, if direct primary care is gonna be a very viable model in the future, anything like that.

Dr. Doug Lucas: 49:06

Yeah, are you familiar with Peter Atia? Do you know that? Yeah, so I love the way that that Peter kind of puts it in his book. If people haven't read it, outlive is awesome.

Parker Condit: 49:17

I'll link to that as well.

Dr. Doug Lucas: 49:20

Yeah, I view how we should take care of health span very similarly as he does. I love one of the things he talks about in there very extensively is this idea of a new medical system, and he calls it medicine 3.0, with 2.0 being the system that we're in now and 1.0 being the system that preceded ours. You know, preceded pharmaceuticals and used like bloodletting and stuff, and so we're in. You know, our traditional model is 2.0, and he sees this 3.0, and he sees the way that I imagine that he treats patients, and the way that I treat patients, as how we will be able to treat everybody. I think that's amazing. I am not that optimistic, though, and the reason why is because, as I just said, to have the team in place to do the work that I want to be able to do for people requires two important things. One is resources, because I got to pay my team, but the other is the patient has to care. While I'm very fortunate that my patients are, all you know, they're self-selected, right, so they're paying cash. They're coming to me like they want to get better, but I very clearly remember when I was in practice, like I mentioned, the diabetic patients, so I would tell them like this is the secret that you can reverse Diabetes and put it into remission. And they look at me like I have two heads because I'm talking about what to eat. We have to remember that. You know us in this big health and wellness space, most of our the people listening probably are interested in getting better and will likely do something to actually do that. But most of the population is not like that and most the population doesn't really want me to tell them how to work out or how to live their life or, you know, not to binge watching Netflix before they go to bed and to get their TV out of the room. You know like they don't want to hear that. So, while I would love for medicine 3.0 to exist, I'm not optimistic that that's the future. I think the future probably is more something along the lines of 2.0 just sort of continues to do what 2.0 does, and we have this, this service, and I think it will likely eventually become globally available so that there will be no lack of resources for people. But the quality of care is going to continue to come down and we're going to have to start drawing a line in the sand because the system will go bankrupt if we continue to offer the things that we're offering at the, the way that they are continuing to increase in cost, and so I think we're going to see a system that sort of devolves into a base level of care and then a a new system that you can buy into, and that new system is going to probably have a different type of insurance. Right, be like an insurance company that does cover what I do, right, but the people that are buying into that insurance are paying I don't know if they could be higher premiums the one I pay for my current insurance, but you know what I mean like it's going to be a different tier of care, and and how that all happens I have absolutely no idea. Yeah it's.

Parker Condit: 52:01

It's arguably one of the most complicated problems in our country. Um, it's certainly the most financially burdensome, but sure do you see You're describing that sort of base level of care. Do you see that being like a single payer system? Yeah, I do. Okay, so you think that's the direction we're going? I do.

Dr. Doug Lucas: 52:25

For, for better or worse, for better or worse, yeah, I mean. So the drawbacks are. So I have friends in Canada and Britain and it's interesting. So now this youtube channel, um, which is is really taken off with worldwide um comments, stories about people all over the world. So we have a big Australian, canadian, I've a Netherlands contingent, I don't know why, and so I get these stories about, about healthcare across the world and it's it's really interesting and and what I hear is the systems that have a single payer system, they don't have access, like they can't, they don't, they can't get the tests. So they want to come, they want to. This is an amazing thing. So if you have a worldwide audience, you know people are going to start flying to Asheville, north Carolina, to see me get a blood draw. You do the functional test, have a consultation, right, and then we can do a follow-up once they're home, because they just don't have access to the stuff that we have access to here. So that that's the drawback. There's just very little further development and pushing the needle on it, um, and they just don't have access and if they do, the waiting time is so long that it's it's very difficult to get care, um, but if you have an accident, you don't pay anything, right? If you get sick, you don't have to worry about it, right? And you know, I mean, we pay almost $3,000 a month in insurance premiums for I have a healthy family that doesn't need care, right? That's insane, and so, yeah, I, you know, I don't know what the answer is.

Parker Condit: 53:48

Yeah, neither do I. Uh, I think single payer systems are uh incorrectly hailed as some sort of panacea, but it only solves, like the, the problem of a good like negotiation. Uh, yeah, you get a lot more negotiating power, uh, with the, you know, payers. But yeah, the access problem is a real one. It's a very real one. I don't can. In, uh, one of the places up there, they tried capping um, how much physicians could make, and then so it was like by like September, right In a calendar year, by September every doctor was on vacation. They're like they hit their cap and that access, they would go to the US.

Dr. Doug Lucas: 54:24

They all got US licenses and would come practice in the US. So I know several doctors, several surgeons. They would cap their procedure number and so they would hit their procedure number and it'd be like middle of the year and they're like, well, I'm gonna go to the US and do you know, they come do cash, pay practices or do whatever right, come here do research, or you know. So, yeah, it's really tough.

Parker Condit: 54:44

Yeah, it's hard to know the answer. And do you look at these models around the world? Like you said, there's benefits and drawbacks. What's the Australian model, if you happen to know? I?

Dr. Doug Lucas: 54:53

don't know, I'll stop in my head. I would not want to speak incorrectly. Yeah, no worries.

Parker Condit: 54:59

One of the things I want to go back to is about sleep. This is the question that I was trying to figure out how to phrase. Do you guys have like different tracks of thinking around, like there's different sleep problems? Right, there's sleeping through the night, there's waking up with cortisol in the middle of the night, there is trouble falling asleep. So you have like different tracks Be like based on this particular problem. I'm gonna take them down like this set of protocols.

Dr. Doug Lucas: 55:20

Yeah, so yeah, we definitely would treat people differently that have those kind of three. There's kind of three clear things, right? It's like my sleep onset's terrible, right. It takes me two hours to fall asleep. And then there's the middle, there's the two to three am cortisol, and then there's the I'm waking up at four am and so, yeah, they all require different modalities, potentially even different supplements, or potentially even pharmaceuticals, right, for people that truly have insomnia, and I'm not an insomnia specialist. But we go down this pathway and I'm as aggressive as I need to be because, like we said earlier, it's one of the foundational things If you can't figure this out, then you're not gonna be successful.

Parker Condit: 55:59

Yeah, yeah, definitely gotta figure out a way to address it one way or the other. Do you think anything around AI is interesting or do you have any like interesting technologies you're seeing in the space where you're like maybe this will help people at scale? This will help me be more efficient in my practice, anything you're excited about from sort of a technology standpoint?

Dr. Doug Lucas: 56:17

Yeah, I'm excited about AI from an educational perspective. So AI content and I play with chat, GPT and I use it. I don't have none of my content is AI created, but I'll create stuff through AI and I'll kind of like proof it and I'm sort of in this, like this in between mode, where I'm thinking, gosh, there is a way that I could leverage AI and educate people faster for cheaper, right, and I'm just not. I'm a little concerned about about what the content is. Sometime, like, I still wanna read it all. So I'm definitely the limiter there, but I think there's certainly a role for that. There's a role in blogs and audio content and even creating potentially like scripts for me in the future, like just because it does such a great job of putting it together. You know I wrote a book. We should mention my book. I wrote a book that's coming out and will actually not be out yet, maybe I think our launch date is September 18th. But you know, I would plug some of these things into AI and look at what it would print out and I'm like, man, it's not bad, right, Like it's not bad. So I think there's definitely a space for this. I haven't figured out the right way to use it for us yet, but it is a tool that I think a lot of people could use too, and this is almost something that, when I get all these questions on YouTube, I almost wanted to tell people like, stick that into the chat, GPT, like you're gonna get a pretty good answer, you know, like you can train it to, like you can actually train it to talk like me if you want to. And so, yeah, I think there's definitely gonna be a role for that in the future, but I don't think it's gonna supersede the expertise of opinion and somebody who's been able to sort of figure their way out of the weeds of the research and kind of come up with their own plan, Cause if you ask AI how to treat osteoporosis, for example, it'll tell you to take drugs, you know Treat. Ask AI, you know what the right diet is, and it'll give you an answer. That I don't agree with, but it that way Okay.

Parker Condit: 58:25

Yeah. So I mean, yeah, it's definitely a promising area, but I think it's just gonna be, at least in the near term. I think it's gonna be people like you who are learning how to leverage it to increase their output and education Cause, like you said, do you have very little faith in medicine 3.0 happening? I don't necessarily disagree. I think it's gonna be driven by the needs of the public and, like you said, most of the people who are listening to something like this, they're already sort of on the healthier end of the spectrum, but maybe the YouTube algorithm will accidentally push this to somebody who meant to be watching something else and we'll get them hooked. But that's just the hope that you have to have with these things. So, getting towards the end of this, I do wanna wrap up. Is there something that you like if you were a ruler for a day and you could just make anything happen in this country? Like, what would you wanna implement to make the country healthier in a very collective manner?

Dr. Doug Lucas: 59:19

Yeah, I think the biggest underserved thing in the in our country probably worldwide, but our country for sure is just getting outside and doing some kind of activity. Like I think if we all got out in the morning and got some kind of UV exposure in the morning and did some kind of activity that we found enjoyable, I think that the whole world would be a much, much better place.

Parker Condit: 59:45

I've kind of joked for a few years with my co-founder where I was like if we can get the collective people on our platform to on average walk 8,500 steps a day, I'm like I think we're gonna win health.

Dr. Doug Lucas: 59:57

Yeah, totally.

Parker Condit: 59:59

It's like it's very simple, things like that. So getting sunlight walking, yeah, I think it's a great message.

Dr. Doug Lucas: 1:00:03

It's still under leveraged by so many people.

Parker Condit: 1:00:05

Yeah, exactly, and it's like it's free, it's very accessible. We talk about social determinants of health, like walking. I understand they're on the unsafety of roads, but it's a different conversation. The last thing I wanna ask you is, like, if you couldn't have been a physician, surgeon, entrepreneur, what else could you see yourself doing in this world? I know I just crossed off a lot of things.

Dr. Doug Lucas: 1:00:28

Yeah, no, no, no, no good. So actually, when I was making this transition out of orthopedics, I had days where I didn't tell I didn't know if this was gonna work out. So I was asking myself that question like what would I do, like, if I didn't have to work? What would I do, you know, if I didn't have to make money? What would I do? And honestly, I think the answer would probably be farming. That's really interesting.

Parker Condit: 1:00:46

I have nine acres. I have chickens out there.

Dr. Doug Lucas: 1:00:48

I was like I'm gonna get some goats, I'm gonna get some cows, I'm just gonna start raising food.

Parker Condit: 1:00:54

I'm really jealous. I grew up in New Jersey so there was always farm fresh eggs available. Now we're out in Scottsdale.

Dr. Doug Lucas: 1:01:01

It's so good. Yeah, I bet it's awesome having your own eggs right in your farm there, that's a great answer.

Parker Condit: 1:01:06

Yeah, farming, that's a really good answer. I still might do that someday. Yeah, no, I think it'd probably incredibly gratifying and just force yourself into that sort of daily activity and a very strict routine. I don't think people, because I kind of grew up working on farms, so it's just like the animals just force a routine on you. Yeah, like a very pleasant way. Yeah, no, it's great. I think it's sort of a lost art in this country. So I guess the last thing I'll ask also, we're gonna this will be out after your book is released too, so we'll link to that as well, if you can provide me that link.

Dr. Doug Lucas: 1:01:38

The book is out. Well, I'll give you the link. Yeah, it's not. We don't have a link right now, but just in case we don't, it's called the osteoporosis breakthrough the natural way to reverse bone loss and build stronger bone. Wonderful, wonderful.

Parker Condit: 1:01:52

The last thing I wanna say, before I kind of get your closing thoughts, is that I think it's easy for people to get overwhelmed with talking about all these lifestyle factors having to manage nutrition and daily activity and exercise and sleep and relationships and connection. But the good news is this was all in conversation related to bone health and the good news is like if you do those things, you're checking a lot of boxes for pretty much everything else. All the metabolic disease states diabetes, heart disease so it may seem overwhelming that I've kind of always having these conversations around specific disease states, but it's the lifestyle factors, or if the overlap were a Venn diagram, it would be a circle, Right? It's so much of the same things, so I'd love to just get your closing thoughts. Anything else you just wanna share before I let you go.

Dr. Doug Lucas: 1:02:43

Yes, I mean, I think in this space, the most important thing is to be an advocate for your health, but don't stick your head in the sand. And what I mean by that is so many patients. As I mentioned earlier, they get scared by the diagnosis of osteoporosis and they go to their doctor. Their doctor says, hey, you should take this drug. And then the initial fear is predominantly global about these drugs, for good reason, first of all. But here's where I think people really get stuck is that they don't wanna do it, or they do it and they don't wanna do it, and then they stop doing it. But then they don't keep going or they don't take the drugs. And then they look up and they're like, oh well, I'll take this one supplement, but I'm not gonna change anything else. So you have to be an advocate for yourself, and if you don't wanna take the drugs, explain that to your healthcare provider. And if they then give you this like guilt trip, then you have to find somebody that can help you create a comprehensive plan. It doesn't have to be me, but there are other people out there that can help you through all the lifestyle stuff. The custom supplements talk about hormone optimization and the risks and benefits. And if you're a candidate for that, consider peptide therapy, which is awesome for muscle mass and will indirectly impact your bone. There are so many tools out there. Just don't stop Keeping an advocate for yourself. Retest, if it's blood tests, if it's dex, if it's whatever, but have a game plan and just like knock it down. Just keep going.

Parker Condit: 1:04:08

That's great. Yeah, I really appreciate you sharing that and that's kind of one of the common messages I'm getting from a lot of people that's been on the show Like a lot of the questions end up sort of ragging on the healthcare industry. It's like this isn't great, this is inefficient, but we still live in a place with eight hun of resources. So we are in a very resource rich country. There are plenty of options available and people do need to be their own best advocates and just trying to find the right combinations of providers and practitioners and people surrounding them to get them to optimal health. So this has been a really fun conversation for me. Dr Doug, I really appreciate you coming on and sharing your knowledge and again, we're gonna link to a lot of the resources we mentioned in the show and I really appreciate you being here.

Dr. Doug Lucas: 1:04:49

Yeah, awesome. Thanks so much for your time. This was great.

Parker Condit: 1:04:53

Well, to those of you still listening. That is all for today's show. I wanna thank you so much for listening. I really hope you enjoyed today's conversation. If you wanna learn more about today's guests, please visit the website wwwexploringhealthpodcastcom. There you can find show notes for today's episode, links to the guests and our full episode archives. If you enjoyed today's show and you wanna hear more, make sure you subscribe on your favorite podcast platform. I really appreciate each and every one of you listening Until next time.