This episode of the What the Health podcast dives deep into the hidden dangers of osteoporosis, a disease that significantly compromises bone health and increases fracture risks. Host John Salak interviews Dr. Doug Lucas, an expert in healthy aging and founder of Optimal Human Health. They discuss the causes, prevalence and misconceptions of osteoporosis, particularly emphasizing that it can affect not only mature adults but also younger populations due to lifestyle and dietary factors. 

Dr. Lucas sheds light on the shortcomings of current screening practices and the economic factors impeding a proper diagnosis. Importantly, they highlight that osteoporosis is reversible with the right commitment to lifestyle changes, diet and targeted medical interventions. Dr. Lucas advocates for a thorough understanding of individual risk factors and the pursuit of early screening to prevent severe outcomes. The conversation underscores the necessity of increased awareness and proactive measures to combat this silent disease.

00:31 Introduction to Hidden Physical Challenges

01:33 Understanding Osteoporosis

01:51 Interview with Dr. Doug Lucas

04:21 The Reality of A Osteoporosis Diagnosis

10:10 Factors Contributing to Osteoporosis

12:55 Gender Differences in Osteoporosis

19:52 Reversing Osteoporosis: Is It Possible?

22:59 Personal and Lifestyle Changes for Bone Health

29:41 Conclusion and Final Thoughts

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Ultimately, this leads to weak bones, which in turn increases the risk of fractures. Now, osteoporosis is most often associated with mature adults, which can lead to highly risky bone breaks and injuries. But the truth is that it isn't just limited to older adults. Lifestyle and diet issues are increasingly putting younger adults at risk as well.

Thankfully, there are ways to promote bone health at every age, but this takes a fair amount of personal commitment, whether you're 30 or 70. It also takes a commitment on the part of medical professionals to thoroughly check those at risk and adequately diagnose any lurking problems. But how can we effectively promote bone health?

Thankfully, we've lined up a leader in the field who's ready to break down the best ways to battle against osteoporosis. And get people back on their feet safely and securely. So keep listening.

Doug Lucas who is a specialist in many things, but primarily focuses on healthy aging and bone health he's also the founder of Optimal Human Health, which is a practice which specializes in these areas, and in addition to that has the Dr. Doug show on YouTube which is a podcast.

So Dr. Lucas, welcome to What the Health.

[00:02:30] John Salak: Okay, and today we're going to focus on an area that people read a lot about, hear a lot about affects millions of people, but I think it's one of those areas where people hear about, they're really not 100 percent sure what they're dealing with, and that's osteoporosis, which deals with bone health.

So we want to start out with the obvious. What exactly is osteoporosis? Does it come in a single form? Are there variations? What are we dealing with when we talk about this as it relates to bone health?

And that's really not, What it is. So yeah, there's a way to diagnose it, but really osteoporosis is essentially just a bone metabolism problem, meaning that you're losing more bone than you're growing or you're building over a long enough period of time where you lose enough bone density, enough bone strength, enough bone matrix that it puts you at increased risk of fracture.

So the, whole DEXA T score thing is kind of a whole separate conversation around diagnosis and prognosis, but really, osteoporosis is a bone metabolism problem. Does that make sense?

[00:03:51] Dr. Doug: Correct. In some ways, that's the end effect that results in osteoporosis but your bone is always turning over. So different ways to look at the statistics. Some people would say that you are replacing your bone every 10 years in your human body. So the body is breaking down and building a new skeleton every decade.

That's again, variable. But that's kind of the idea that we're always building up and breaking down bone, but osteoporosis is the result of breaking down more than you're building up over long enough to become in this sort of pathologic state.

[00:04:37] Dr. Doug: Yeah, that is also true. There's a couple of different ways to look at this. So you're correct in that we generally don't worry about osteoporosis until we start talking about a quote unquote older population.

But that number, that specific age is becoming a moving target because of our population. So we have an aging population, but we have a subsection of the population that's aging very gracefully. And then we have some individuals who are not aging very gracefully, which unfortunately is the majority of the population.

So if you go back a couple of decades, we used to talk about a 65 and 70 being the screening age for women and men respectively. Now we are taking a whole nother look at that and saying, honestly, we're seeing individuals who are in their 40s, 30s and 20s that already have osteoporosis.

So, to some extent, really, we should be monitoring this issue really going into early adulthood when peak bone mass occurs. We're not going to see it as often, but there are so many risk factors for osteoporosis that the majority of the population is exposed to, at least one or two of them, that really we're going to see it more and more.

So, this is a problem that is increasing in diagnosis. So that the number of people that have it is going up, but the number of people actually being diagnosed is going down if that makes sense. And that's because we're not screening for it. So there's just more people that have it that don't know.

[00:06:04] Dr. Doug: Think it's missed for two main reasons. One is that it's just not on most people's radar. We talk about cardiovascular health. We talk about dying from a heart attack, screening for cancer. We are checking all these boxes to make sure that we're doing the things to prevent the usual causes of death.

And so osteoporosis kind of gets overlooked . The other reason why screening is going down is that in the past, we've relied DEXA scans. As a, like a revenue stream for a practice, the cost of the machines has continued to go up. The cost of the reimbursement has gone down. And so now it no longer makes fiscal sense for a primary care doctor or even a small system to pay for a DEXA scanner that they're going to end up losing money on. And so I mean, you hate to say it, but it's driven by finances where it doesn't make financial sense to screen people for osteoporosis.

And so this is something that needs to be addressed at the top level of our healthcare system. But when we talk about why we're missing this, I think it's because we don't talk about osteoporosis enough. And that's why I'm out here as often as I can be on podcast, on stages, on my own channel, because when you look at the top three to four causes of death in the United States of adults, unintentional injuries is usually number three or four.

And as we age, falls and osteoporotic fragility fractures are the primary cause of unintentional injuries. So it really is a top three or four cause of death for adults as we age, and yet we really don't hear much conversation around it.

And I understand why people might think, oh, I'm 20 years old. I'm not going to have any bone issues. But are we not screening those mature adults as often as we have been in the past as well?

But essentially what they did is they looked at all the people that had fragility fracture. So there's a specific definition around those types of fractures and Of those people that had the fragility fracture, which is by definition from osteoporosis, how many of them carried the diagnosis at the time of the injury?

And it was less than 20%, meaning less than 20 percent of the individuals that had an osteoporotic fracture had a diagnosis of osteoporosis. And then to make matters even worse, Less than 20%. And even in some situations, less than 10 percent of the people that had a fragility fracture went on to receive a pharmacologic treatment, which they were clearly a candidate for in the traditional medical bottle.

Not how I treat it, but in the traditional medical model, they should have been offered a treatment and less than 10 percent in some scenarios were actually offered a treatment for their osteoporosis. So we're just not doing a good job of yeah. Diagnosing it or treating it again. It just sort of is like something that just comes into the office and patients walk away and they're like, Oh, they said to do something about that thing.

And I forgot what it was. And Oh, well, moving on.

[00:09:36] Dr. Doug: Yeah. The statistics would say that about 10 million American adults have osteoporosis. It's hard to know how many actually have osteopenia. So that would be sort of like runner up to osteoporosis on a bone density scale. I would argue it's probably double, triple or more of that because again we're doing a terrible job of screening for it.

So how could we possibly know?

[00:10:17] Dr. Doug: There's two main factors behind this. So one is are we achieving our peak bone mineral density in the first place? And let me just take a second to explain that. So as we grow through adolescence and early adulthood, our skeleton is a lot of, if you look at, Babies are ever, they're so pliable.

And if you look at an X ray of a baby for whatever reason, it's mostly cartilage, right? And so as we grow, our bones lengthen, our bones solidify, they ossify, and then they become solid and all the growth plates close and all that stuff. There is a peak bone mass that occurs in early adulthood.

That we really have to work hard to achieve throughout our adolescence and early adulthood. And as we get a more sedentary population, more people spending time in front of screens. And this includes kids in school. This includes, people doing less athletic endeavors, less activities in their recreational time that is athletic and more sedentary.

We're not doing the things that we need to do to achieve that peak bone mass. Additionally, if you've seen kids diets lately. Kids diets are terrible. And so we get kids that are eating a highly processed food diet, they're not getting adequate protein, they're not building muscle, they're not getting the nutrients they need.

So you add those two things together and they don't have peak bone mass. It's terrible. And so I think, if we were to screen globally, which will never happen, but let's pretend that you screened all of the, the adults in their twenties to thirties In the United States, I think we would see a large percentage of people that are set up for osteoporosis.

Either they have it now or they're going to have it in the near future because when you get to the second side of that equation, which is how quickly are you losing bone from your peak bone mass? So let's say that you did achieve peak bone mass. Congratulations. Now you have a long runway. You can lose bone gradually as you age and hopefully not achieve osteoporosis.

Thanks. But the rate of loss is going to be increased with variable factors, whether it be, exposures, toxins, poor diet, gut dysfunction, all the potential things that can expose you to more rapid bone loss. And that is so rampant because it includes again, all the things I just mentioned, but also hormone abnormalities, low testosterone in men, oral birth control in women, stress, particularly in women, which we know is a big deal right now.

So all of those potential lifestyle factors, as well as other additional exposures can increase your risk of, and rate of bone loss. And so again, you, maybe you had good peak bone density, but now you're losing it at a rate much higher than you would anticipate which is usually around 1 percent per year, but we see it clearly, 3%, 5 percent per year, and you're going to become osteoporotic very fast.

[00:13:03] Dr. Doug: So women are more likely to develop osteoporosis because they're going to have a lower peak bone mineral density to begin with. And so when we look at the statistics behind the T scored, I don't want to bore your audience, but when we look at some of the statistics, it is adjusted for both sex and race, but still you're going to find that Asian women, Caucasian women, if you look at the statistical average will fall into osteoporosis during the normal lifespan of a human.

So statistically they are likely to develop osteoporosis. Whereas if you look at say like an African American male. They could follow their normal statistical curve and live to 130 and never develop osteoporosis. So there is a difference for women versus men. I think the reason why women are going to be more likely to is because again, their bone mineral density is starting lower, even though they try to adjust for that, but they're more likely to lose it more quickly because of the clear hormone change that occurs around menopause.

So whereas men will lose testosterone gradually as they age, women lose estrogen and progesterone as if it falls off a cliff around menopause. And so that provokes a very rapid bone loss situation if we don't replace those hormones, which is a whole nother conversation. But also women are, I think are more sensitive to some of the societal and cultural things that are going on in our modern world, which is that some of the hormones, particularly testosterone and women is made primarily in the adrenal glands.

Okay. The adrenal glands are where we make our stress hormones. So I see adrenal dysfunction globally in women, especially in the perimenopause and menopause years, because of all the things that women are expected to do our society. Not only are women doing a lot of the traditional roles that women did, in the previous generations, but now they're also having careers.

They're taking care of their kids. They're taking care of their parents and all of that stuff adds up and they're now not only going to see the hormone changes that go along with perimenopause and menopause, but they're going to see the stress. That's going to negatively impact their testosterone as well.

Whereas men, we see that we're exposed to that as well, but we don't have that same negative impact, at least from an osteoporosis perspective. Women are also going to be exposed to other pharmaceuticals. They've been exposed to oral birth control frequently, which is going to have a negative impact on bone density.

And so the list just goes on and on, where it looks much worse for women than it does for men when it comes to bone health.

Why is it not growing, especially with the emphasis on mature health today? Or is it just . At a demographic segment that's aware of this. but I would just assume people were more aware of osteoporosis and how to control it and what the dangers were.

Granted, you don't see it and I guess a lot of people don't know they have a problem until they break something too.

I think one of the great movements that we're seeing right now, and I see a lot of this in my audience, there's a lot of crossover with the influencers in this space is the big push for education and treatment around menopause, you know, treating menopause, not as if it is a natural thing that occurs that you must suffer through, but it is a natural thing that occurs with symptoms that are manageable through lots of different avenues.

And so there is a huge push to help women to understand that this is not just something you need to suffer through. Let's actually look at what's going on and let's talk about the lifestyle supplemental, potentially pharmacological things that we can do to help you to get through this process and to optimize your health for the really what is the second half of a woman's life.

[00:16:48] Dr. Doug: It is a misconception. Although statistically men are less likely to fall into the osteoporosis range. But statistically, if a man does break a hip, does have a fragility fracture, he is more likely to die and he is going to have likely a less optimal outcome.

None of the outcomes are particularly great usually but men do worse off. Because I think that when a man loses bone fast enough, he is in a generally a pretty poor metabolic state to begin with because he had a longer fall. right? So not meaning that he's taller physically, but like his health was declining faster for him to actually achieve a state of osteoporosis.

So I think those men are generally going to be sicker than their female counterparts. It's definitely worth knowing about. It's worth screening for, it's worth doing early screening for. Cause again, I see hormone dysfunction and then going back into their twenties and thirties. So we see low testosterone and then because there are so many endocrine disrupting the things within our society, in our food, in our water, it is hard for men to have optimized testosterone and then testosterone is this substance which is really looked down upon.

If you're considering replacement of testosterone, people start to frown and say, Oh, you should not do that because testosterone is dangerous and it's for bodybuilders who want to, compete dirty. But that's not the case at all. And we really see this as an issue for men not to mention they also have poor lifestyle choices, which they are doing the same things as their women counterparts from that perspective, which is just trying to do too much.

Or is it just something like, as you said, a silent disease?

So, we do need to be cognizant as consumers of health care information that we really want to focus on prevention because once you have a hip fracture or a spine fracture, you're never the same. So we really do need to, encourage people to look for things other than symptoms because most people are not going to feel something again.

Some people will say that they feel like their bones are weak or they feel bone pain hard to know what they're really feeling. But overall, I would say that people are not going to be. symptomatic and that they should get screened if they have any risk factors, which honestly is almost all of us.

[00:19:29] Dr. Doug: Yeah, I would say, not really the disease itself cause as you run into issues with bone metabolism, the biggest thing is fracture. There are issues that come along with poor bone metabolism, but you're really going to see these more with the Pharmacological management.

So things like osteonecrosis of the jaw other dental issues because the quality of the bone in your jaw is so important when it comes to your teeth. But outside of that we're really talking about fracture prevention.

[00:19:58] Dr. Doug: Yeah, this is a, really important point. And I think probably the biggest takeaway from our conversation will be to educate people that osteoporosis is reversible. As long as you have the capacity to make change. And so there is a population of individuals who, maybe they are, I don't want to say too old, but that's kind of what we, how we would divide them.

But people who don't have the capacity to change their diet, to do exercise, to load their bones, to potentially consider hormone replacement for either women or men If you're beyond that, then pharmacological management might be the only option that you have, but where I see the biggest error in medical management of osteoporosis is our younger individuals, and I'm talking about particularly women, but men and women in their forties and fifties who get screened early for whatever reason.

And then their doctor says, well, the standard of care is to go on a bisphosphonate drug, which is a anti resorptive drug. It means it poisons the bone breakdown cells and it will increase your bone mineral density. As as you go forward in time, and it will reduce fracture risk. You can only use those drugs in particular for three to five years, depending on the form of the drug.

If you're 50 years old and you're a woman that just went through menopause, what are you going to do when you're 55? So the drug therapy has a lot of potential downsides. There's some risks. And the biggest issue is that it's just myopic in nature. If you have a drug that you can't use for more than five or 10 years, and you're 50 years old and you're at your essentially middle life.

What are you going to do for the rest of the time? And so we know within that population, if you look for the underlying cause of bone loss, you look for the hormone dysfunction, you look for the other potential causes of bone loss and bone metabolism dysfunction, and you address those things, then we see essentially everybody improving their bone health, improving bone mineral density and reversing osteoporosis.

So it is definitely reversible if you have the capacity to do the things that you need to do that.

[00:21:59] Dr. Doug: Yeah. And you, see that on imaging. So if you look at the DEXA, which is the traditional screening modality, that is essentially like an x ray that gives you the T score, which is your bone density. If you look at DEXA over time and people that are doing all the things that we train people to do, their bone mineral density will improve.

So we see patients that their bone mineral density is down in the negative twos, negative threes, negative fours, and they start to come up. Now it's slow. You can, we see people that are doing, 5%, 10 percent increase in bone mineral density per year, which is great. But even at that pace, it's going to be slow.

If you're, if your T score is down the negative four, negative threes, it's going to take you a decade, 15 years, to get out of osteoporosis, but you can make those improvements and continue to do those things. And the good news is these are the same things that you should be doing from a health optimization, longevity perspective.

It's building muscle. It's doing resistance training. It's eating the right diet. It's doing all of those things. That you're going to want to do anyway for healthy aging. So really I think that osteoporosis is more just a sign of some kind of underlying dysfunction that you need to address anyway.

[00:23:04] Dr. Doug: So the way that we look at this is that women in particular, men to some extent, but women in particular are going to pretty much be a victim of what they've been told for the last 30 years, which is you're going to be better off if you eat a low fat plant forward diet and reduce saturated fat and cholesterol.

Like that's the messaging we've heard for the last 30 years. And what that message does is encourages people to eat a highly processed food diet, avoiding eating protein sources. And they're going to become sarcopenic, which means loss of muscle mass, which then leads to loss of bone mass or chicken or the egg, hard to know which is which, but either way, we need to flip that upside down.

particularly in a metabolically disadvantaged state. We really need to focus on adequate protein sources is our primary thing. So we need to get our adequate protein source. I'm going to recommend from animal products cause that's both my bias, but also just what the literature supports is going to be better absorbed from an amino acid perspective.

So we recommend starting out most of our patients at one gram per pound of desired body weight. And a lot of our patients are underweight. We still have, we have overweight patients too, but we kind of aim for that. What is the desired body weight? So a lot of our women are going to be, around a desired body weight of 110, 120, 130 pounds.

They tend to be leaner and we're going to try to aim for that as our protein goal. And that's really hard for them to get. Most women are going to come into this program, eating 40 to 50 grams of protein if they're lucky. And so we really need to like double, potentially triple what they're currently eating to have them get enough of the building blocks to build muscle and bone.

That's the primary thing. Okay. And then we want to make it an anti inflammatory diet. We want to remove the potential toxins. So you're talking about the added sugar, the highly processed foods the seed oils, if that's an issue for someone and get them into eating a whole food diet that is protein forward, anti inflammatory.

That's the basis in broad strokes.

[00:25:01] Dr. Doug: I mean, kind of, right. So I think it to do a little education on your on your own to understand what your risk factors are would be helpful. And so if you went into your doctor and said, Hey, I'm concerned about my bone health. I was reading about risk factors for osteoporosis.

And I find that I was vegetarian for 20 years, which is a risk factor, or I had bariatric surgery, which is a risk factor, or I had an eating disorder when I was young, which is a risk factor, or I eliminated dairy and protein. And like, you could go down the line, or I've been on a PPI for GERD.

There are so many risk factors that if you have one risk factor, Then you can go into your doctor and say, Hey, I know I'm under 65, but I have this risk factor and I'm worried about my bone health. Would you order me a Dexa? And they should say yes. If they said no, there are other ways to get it.

One of the beautiful things about the United States is that we have a sort of rising cash pay system. So there are ways to get it outside of the traditional medical model without a doctor's prescription.

[00:26:09] Dr. Doug: This imaging modality is probably under 300 and in most areas probably under 100. So it's not like paying for an MRI in cash like that, thousands of dollars. This is something that most people should be able to do.

[00:26:36] Dr. Doug: Yeah. I think the biggest thing is that it can be reversed. And so this is the traditional medical model and the story I hear. Over and over again. And on our YouTube channel, people love leaving comments and I love our community there, but we hear this story, I mean thousands and thousands of times.

And the story goes like this, which is I got screened for, fill in the blank reason. And I had osteoporosis and it freaked me out. And I was really scared. And I went to my doctor and they told me I had to take this drug. And then I told them I wanted to do it on my own and naturally, and they said, that can't be done.

That's impossible. Take this drug. And then they pressure them into taking a drug and then they go home and they read about the drug and they get even more scared. And so they come to us with all this fear around fracture, around the drug, around the side effects, and they're freaking out. And then they go onto Facebook and they go on all these support groups for osteoporosis and hear all this conflicting information.

And they're just sitting there with their head spinning. And that is the biggest, negative thing we could to for people that are suffering from a diagnosis, anxiety, not necessarily the disease. They're just suffering from the diagnosis of the disease. And they have so much anxiety around what to do, how to do it, who to trust.

And so that's why, again, we started the things that we started because we want to put as much information out there as we can to empower people that. Diagnosis of osteoporosis is not the end. It doesn't mean that your life is over. It just means that we need to understand what's going on so that we can make a plan for moving forward with or without drug therapy.

The vast majority of our patients don't need drugs. But again, we have a specific subset of the population, but so many people can improve their bone health naturally that they don't need to be pressured into taking a drug.

[00:28:18] Dr. Doug: Yeah, so we're actually, we're all online. We launched this company right at the beginning of the pandemic. And when we did that, nobody wanted to go to the doctor's office. So we didn't start out by building a brick and mortar. And then we followed the telehealth laws that have, continued to change and evolve as the pandemic has ended.

And there's no compelling reason for us to have a brick and mortar. I would love to be able to see patients in person, but our, patient population is pretty evenly distributed throughout the country. So we're represented in all 50 States. And we've just built the telehealth company that way.

And that way we can serve so many more people.

[00:28:59] Dr. Doug: Thank you so much, John. It's been fun. I love talking about these topics. I think it's so important and I appreciate you getting it out there for people.

Now, signing up is easy and it's free. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar, and the sign up form will appear. Signing up will just take seconds, but the benefits can last for years. Okay, it's clear by now that osteoporosis is a hidden threat, and one that presents devastating Even life threatening risks in extreme cases.

The good news is that there are an increasing number of ways to lower the risk of related injuries and even build up better bone health at any age. Options include prescriptions, but they aren't the only way to battle back on bone health. Lifestyle changes that include increased activities and muscle development are important at any age.

Diet is another critical factor, especially making sure everyone gets enough protein in their diet. Then, of course, information and awareness are key, especially for those at particular risk. This means insisting doctors run diagnostic procedures to identify if you're suffering from bone loss before any injury occurs.

Remember. Osteoporosis is serious business, but it can be dealt with and even reversed. That wraps up this episode of What the Health. We'd like to thank Dr. Doug Lucas of Optimal Bone Health for breaking down the threat osteoporosis presents and the best ways all of us can improve our bone health. If you'd like to learn more about this issue, and we all should, please visit drdouglaslucas.

com. That's doctor as in D R. Douglaslucas. com. Also look for the Dr. Doug podcast show on YouTube. Well that's it for this episode of What the Health. Thanks for listening in and we hope you'll join us again.