Asking for a Friend - Health, Fitness & Personal Growth Tips for Women in Midlife

Ep.156 Osteoporosis Isn’t Inevitable: Midlife Bone Health Strategies That Work

• Michele Henning Folan • Episode 156

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Think Bone Loss Is Just a Part of Aging? Think Again.

This episode of Asking for a Friend is sponsored by Better Help. https://betterhelp.com/askingforafriend

If your doctor’s only advice for bone health is “take calcium, vitamin D, and wait,” this episode is your wake-up call. I’m joined by Dr. Doug Lucas—former orthopedic surgeon turned bone health specialist—who’s on a mission to help women prevent and reverse osteoporosis with science-backed strategies that actually work.

In this powerful conversation, we dive into the root causes of bone loss in midlife, why waiting until 65 for a DEXA scan is far too late, and why hormone therapy outperforms traditional bone medications in head-to-head studies. Dr. Lucas breaks down the real risks of GLP-1 medications on bone density, what the research says about weighted vests, and how to exercise safely with low bone mass or an osteoporosis diagnosis.

We even cover what every mom should be telling her daughter now to lay the foundation for lifelong bone strength. If you want to stay strong, independent, and fracture-free well into your 70s, 80s, and beyond, this episode is a must-listen.

👉 Don’t wait until a fracture forces you to take action. Hit play now and learn how to protect your bones—and your future—starting today.

You can find Dr. Doug Lucas at:

https://www.osteocollective.com/

https://www.youtube.com/@Dr_DougLucas or on any podcast platform

https://www.instagram.com/dr_douglucas/

This episode of Asking for a Friend is sponsored by Better Help https://betterhelp.com/askingforafriend

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mfolanfasterway@gmail.com

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*Transcripts are done with AI and may not be perfectly accurate.

**This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.

Michele Folan:

This episode of Asking for a Friend is sponsored by BetterHelp. Let's be honest midlife is a season of transition, whether it's changes in your body, your relationships, your career or just the weight of trying to hold it all together. Sometimes you need more than a good walk or event session with a friend. You need a safe space and a trained professional to help you process it all, and that's where therapy can be a game changer. Betterhelp makes getting started simple. Just fill out a brief questionnaire and get matched with a therapist in as little as 48 hours. You can message your therapist anytime and schedule sessions that fit your lifestyle no commuting, no awkward waiting rooms and if you don't click with your first match, you can switch therapists to find the right fit. With a 4.5 star rating on Trustpilot and thousands of positive reviews, betterhelp is a convenient, trusted option for those ready to take a step toward better mental health. Visit betterhelpcom forward. Slash Michelle for a 10% discount off your first month and take the first step today. Therapy isn't just for crisis moments. It's for anyone who wants to feel better, think clearer and navigate life with more confidence Health, wellness, fitness and everything in between.

Michele Folan:

We're removing the taboo from what really matters in midlife. I'm your host, Michele Folan, and this is Asking for a Friend. Welcome to the show everyone. If you're a woman in midlife, chances are you've been told to take calcium, vitamin D and maybe get a DEXA scan. But have you ever truly understood what's going on with your bone health?

Michele Folan:

This week, on Asking for a Friend, we're diving deep into a topic that doesn't get nearly enough attention osteoporosis. It's often viewed as an inevitable part of aging, but it doesn't have to be. Bone loss can begin earlier than most of us think, and by the time we're in our 50s or 60s, the decisions we made decades ago can catch up with us. But here's the good news there are real, practical steps we can take to protect and even rebuild bone at any age. I've invited Dr Doug Lucas, an osteoporosis and hormone optimization expert, to help us make sense of it all From understanding your DEXA scan results to the latest insights on hormone therapy, supplements, nutrition and the truth about weight training.

Michele Folan:

Dr Lucas brings clarity to a subject that can feel overwhelming. We also talk about what to tell our daughters so they can build strong bones early and avoid the struggles so many of us are facing now. If you've been confused, frustrated or just curious about what's happening to your bones in midlife. This episode is your guide to staying strong, mobile and empowered for the long haul. Dr Doug Lucas, thank you for being here today.

Doug Lucas:

Yeah, thank you, Michele, and we have a lot of work to do if we're going to cover all those topics.

Michele Folan:

No, I know and I have like you know how your eyes are bigger than your stomach. This is what happens when I get a guest on my show. I have way too many questions, so we'll kind of dig in and we'll get to everything that we can, but first of all, tell us a little bit about where you're from and then your career path into medicine, and then what led you into the world of osteoporosis.

Doug Lucas:

Yeah, so right now I live in beautiful Asheville, North Carolina. So at this phase we're still recovering from the big hurricane in the fall. But everything is on track and people are recovering well, so still very happy to be here. My professional trajectory is a little bit abnormal, so I'll give you kind of the quick version of it, which is I started off not in the medical field at all. I started off actually in the fine arts. So I was a professional ballet dancer by trade. I left that, went to medical school as I realized that it's really hard to make a living in the fine arts. So I was a professional ballet dancer by trade. I left that, went to medical school as I realized that it's really hard to make a living in the fine arts.

Doug Lucas:

In medical school I was thinking that I would do something more along the lines of primary care. I really liked the idea of musculoskeletal manipulation. I went to a DO program instead of an MD program for that reason and I did learn those tools. But then I happened to. I had to do an orthopedic surgery rotation as a medical student and just fell in love with the operating room, the power of surgery, the power of being able to fix something that is broken literally is broken I can fix it, and it was so black and white. So that became my clear purpose moving forward and did the traditional residency and fellowship and started practice as an orthopedic surgeon and did that for about a decade.

Doug Lucas:

But in that process realized that one of the things that I was really missing in my practice is being able to spend time reading, doing research, educating and then actually educating my patients, and I found that I really enjoyed talking about prevention more than talking about how I could fix their problem or at least make their problem different. And so I was able to, for a lot of different reasons and circumstances, get out of the traditional medical model, start a practice that's specific for health optimization, so we do essentially a ton of prevention. And then that practice eventually actually pretty quickly became very specialized in osteoporosis because of my background in orthopedics. So it was this combination of kind of functional medicine, integrative hormones and a bone health background that culminated into this program to help people to prevent and reverse osteoporosis. For the most part, naturally, that led to the YouTube channel, that led to me communicating with all the leaders in the bone health space and really loving this kind of niche that we've built out around osteoporosis, because there's so much need and there's so much to talk about.

Michele Folan:

Oh my gosh. Okay, so I got to back up. So as an orthopedic surgeon, you had to see some pretty scary bones, you know. When you were doing surgery did that like were the bells ringing at that point for you? You?

Doug Lucas:

know, what's amazing about you know, being in the subspecialties in medicine is that you are, you are told to, and you really have to create walls around you so that you can do what you do efficiently for as many people as possible. And that is we are all, as physicians, surgeons, we're cogs in the system. And so, even though, yeah, I absolutely saw poor quality bone and there were cases where literally I feel like you know, I'm putting plates and screws on bone and it feels like you're screwing something into a marshmallow, but yet when you, you know you're doing the surgery and you do the best you can technically and then at the end of that you tell the patient wow, you have some bone quality problems. You should really see someone about this.

Doug Lucas:

And that's kind of it right, because as an orthopedic surgeon, it's not my specialty. I mean, I knew about the drugs but I didn't prescribe them. I would send them to. Actually, one of my PAs developed a concierge bone system around that, but we didn't have a place to send them and I thought that was isolated to where I started practice. But it turns out that it's actually a national and truly a worldwide problem where nobody wants to talk about osteoporosis because nobody has a specialty, nobody really enjoys treating it, because they don't have great tools, they're not trained to and don't have time to talk about the lifestyle pieces that need to be talked about.

Michele Folan:

Well, and I shared with Dr Doug before we started and some of you listeners have already heard me tell this story but two years ago I had my first DEXA scan and it came back with osteoporosis. Maybe no surprise, based on family history and European descent light highs, small frame, whatever. Blah, blah, blah. And so when the primary care doctor who was filling in for my regular healthcare provider said okay, well, we're going to up your calcium, up your vitamin D, we're going to put you on Fosamax or a bisphosphonate and we'll see you back in two years. That's what I got a bisphosphonate and we'll see you back in two years. That's what I got. So, listening to you talk, you saw that there was this huge void and you've addressed it.

Doug Lucas:

We're trying to address it. I think we are. We're doing a great job with where we are. There's more that we can do. We'll talk about that. But what you experienced, Michele, is absolutely the standard of care, and I think it is substandard. I don't think it's adequate, but I never disparage doctors for making those recommendations, because that's what they're trained to do and that's all that they know to do. They want to prevent fracture, just like I want to prevent fracture, but we're using different tools.

Michele Folan:

So, on that note, what are some of the biggest misconceptions you hear from women when it comes to osteoporosis? What are they hearing and what do you have to kind of change in terms of mindset when they come see you?

Doug Lucas:

Yeah, I think, hands down, the biggest thing is that women are told by their doctors, usually or by their friends, that bone loss is inevitable. You said that out of the gate, that you disagree and I want to bring that up again, but that bone loss is inevitable. Especially if you have a family history, you will develop osteoporosis. If all of us live long enough, we will develop osteoporosis. That's the number one thing that I hear that we need to flip the script on, because osteoporosis is absolutely preventable and all of us, if we have the capacity to do the things that we need to do, can absolutely change the trajectory of bone loss and build bone. I see it in my practice every day in our patients, women and men ages 50s, 60s, 70s, 80s. We can do that and we don't have to accept that bone loss is inevitable as a part of aging.

Michele Folan:

All right, so there is a genetic component, though, correct?

Doug Lucas:

Absolutely yes.

Michele Folan:

All right, and you brought up men and at four o'clock this morning, when I was awake, unfortunately, I started thinking about I wonder how often you are treating men. And then I started thinking well, is that hormonal? Was it because they had celiac disease early in life? Like what are you seeing in men versus women?

Doug Lucas:

Yeah, so it could be both of those things. The difference between men and women is that it just generally happens later, unless they have one of those underlying things, and you just mentioned probably the two biggest ones, right? So some kind of gut dysfunction could be celiac, you know, or low testosterone, which in men results in low estrogen, which will cause rapid bone loss, and so, yeah, those are the two most common things. If you look statistically, the vast majority of humans diagnosed with osteoporosis are women. We're talking 80%, probably or more, but I think that we have more bone health issues in men than we know Now. They have a higher starting point.

Doug Lucas:

So this is good, but I think, especially with the low testosterone epidemic that we're seeing, with the lifestyle, the challenges, the stress, the sleep, all the things, I think we're probably going to see, if we can start screening young adults, more men that are affected than we know. In my practice we're still I mean gosh, I haven't looked at the statistics but probably 95% women, because those are the individuals who are getting screened, who are concerned about their future going to the doctor, right? Men just like to not go to the doctor, so they're still mostly women, but we do have some men in our program and I do hear a lot of comments in our community and on our YouTube channel from men who are concerned about bone health.

Michele Folan:

And then one other question about men. Is there any connection with men? I just see you start talking and you get my brain going With men with disordered eating, or perhaps extreme athletes that aren't getting in enough nutrients.

Doug Lucas:

Yeah, absolutely so. Those things are true for both men and women, but the population of men that we see this in is going to be men A lot of times. They have an endurance athlete background. They could be cyclists. Professional cyclists are notorious for low bone density. They could be cyclists, marathon runners, ultra marathon runners. All the same things that cause this in women can cause it in men. We just don't see it as often again because they have a higher starting point.

Michele Folan:

All right, I want to talk about the DEXA scan. Yeah let's, because we get our scores back and we have no freaking idea what these numbers mean. And is there really a concern? Or where is that on the threshold? And I do want to ask you this real quick too Does it matter that we get our DEXA scan from the same place each time to make sure that we're using the same kind of machine and calibration?

Doug Lucas:

Yes, so I'll answer that backwards. So DEXA is, it is the current standard I hate to say gold standard, because it's definitely not gold, but it's the current standard. It's what most people have access to. It's covered, you know, medicare, commercial insurance, if you meet the age requirements, etc. So dexa's not going anywhere. But dexa has a lot of problems. It is an x-ray, just a low you know low radiation x-ray, but it's still an x-ray and it can only tell certain things because of the technology limitations.

Doug Lucas:

One of the the challenges, as you mentioned, is if you go from machine to machine you'll get a different T-score. So if you're repeating a DEXA scan and you go from one machine to a different company's machine, they have different algorithms which are going to spit out a different T-score. Now they're going to be close, but they're not going to be the same. And if you are looking for improvement, if what I'm doing is beneficial, is my T-score going to improve over time? It should. But if you're going from a different machine to a different machine, you don't know, because the difference between the machines could be two, four, some studies even say 6%, and if you saw a 6% improvement you'd be doing jumping jacks and unfortunately that might not be real if you're just using DEXA, especially if you're going to different machines.

Doug Lucas:

Now, even within that on the same machine, position matters the person who's doing the scan matters. Updates to the software can make a difference. There's all of these different variables that you, as the consumer, have no control over. So DEXA is needed because it gives us the T-score and then we can use that T-score to extrapolate some kind of fracture risk. And that's what we're ultimately worried about is what is your fracture risk? The problem is it's not that accurate, it's not that sensitive or specific to fracture risk, but it's all that we have for the vast majority of people. But there are some alternatives that we can talk about.

Michele Folan:

Okay, down the street from where I live, a place opened up. It's called DexaFit. Are you familiar with this company?

Doug Lucas:

I am.

Michele Folan:

Okay, what's the difference between me going to the local hospital and getting a Dexa scan and then going to this place and going to DexaFit?

Doug Lucas:

I haven't seen a report from DexaFit. I've heard the name of the company. My concern with Dexa, outside of the conventional medical model, is that oftentimes they're mostly looking at body comp. So they're looking at body composition. They'll tell you about your visceral fat and your subcutaneous fat and all these things, which is great. There's value in that. But I don't know that that's going to give you the right lumbar spine, vertebral T-score, hip T-score, total hip, femoral, neck, et cetera. I don't think they're going to break it down like that from a bone perspective. I could be wrong because, again, I haven't seen their report, but generally they're mostly looking at body comp.

Michele Folan:

All right, I might run down there one day and just talk to the owner and say- yeah, get a sample report.

Doug Lucas:

Yeah and send it my way. I'd love to learn more about it because it is becoming more available. They're opening that up a lot.

Michele Folan:

All right. Other alternatives to the DEXA scan.

Doug Lucas:

There's basically right now, there's almost like three things that you can do. So you can do a DEXA scan In the conventional system. Some places are doing CTs, so quantitative CT, which can tell you about your bone quality and your density and actually can estimate strength of your bone, and that is an option. It's very accurate, but it's mostly used in research, to be honest. And then there's the ultrasound devices. So the company Ecolite out of Italy has a product called REMS, which is an acronym, and REMS is an ultrasound device that looks just like the abdominal ultrasound wand that you would see at your OBGYN or in your emergency department, and you can look at bone with that device because they have a specific algorithm, proprietary algorithm, that can tell you both density but also bone quality, which, again, is ultimately probably more important, because what we want to know is fracture risk, and if you can get both of those variables, you can much more accurately predict fracture risk.

Michele Folan:

And are those starting to be more readily available here in the US and covered by insurance?

Doug Lucas:

Not covered right now, which is one of the challenges. It's difficult in the US to get past what is the gold standard or the current standard in our system, because everybody has a DEXA right. Like, dexas are globally available, covered by insurance. So insurance companies don't want new technology and DEXA companies don't want new technology, so it's going to be really hard for them to penetrate the market. I think that it will happen, but the way that it needs to happen is that we need to essentially create the demand. To create the demand, you have to put the device all over the country, and the United States is a big country. So this is going to take a lot of investment from entrepreneurs who want to bring this technology to their clients, and this is happening.

Michele Folan:

Oh good, okay, I'm like, sign me up. I like new technology, if you could tell. All right, we're going to take a quick break and when we get back I want to talk about when the time is. We should be concerned about when bone loss starts. Ladies, I'll be honest After menopause I didn't recognize my skin anymore.

Michele Folan:

The glow was gone, the elasticity was fading and I started to think maybe it was time for a trip to the dermatologist. But then I tried RIMAN and everything changed In just a few weeks. My skin felt firmer, looked brighter and I actually looked forward to my skincare routine again. And I'm not alone. My clients have been sending me their before and after photos and the results are amazing Clean, science-backed and created with real skin changes in mind. This line is just too good not to share. Want to know where to start? I've got you. Just reach out or check the show notes for the link. Okay, we are back. Before we went on the break, I really want to know about when does bone loss typically begin and how early should women be thinking about their bone health?

Doug Lucas:

That is such an important question and maybe you know the answer. So for me, when I started looking at this, one of the reasons why we really niched into the space of osteoporosis is that the recommendations they just don't make sense. They just are illogical Because right now in the United States and this is true across most of the recommendations they just don't make sense. They just are illogical Because right now in the United States and this is true across most of the globe but in the United States the recommendation is to screen for osteoporosis for women at the age of 65 and for men at the age of 70. And the most recent USPSTF is that it Preventive Services Task Force. So the USPSTF recommendations was to screen all women and maybe men at 70. It was like eh, if you want to, what's crazy about that and so illogical is that we know that women on average will go through menopause at the age of 50, maybe 51, right? So if you wait until you screen for 15 years and you know that, what's happening predictably if a woman is not using hormone replacement therapy, is rapid bone loss for the first five years, maybe 10 years, and then it's going to kind of plateau out at the 15-year mark, you have already missed your opportunity to prevent bone loss with HRT. Estradiol is FDA-approved for prevention of osteoporosis in women, but if we're not screening, how do we know to use it? And so it's mind-blowing to me that this is the recommendation. Now I understand, from a public health perspective, that you want to screen for diseases when you're likely to see them. So yeah, that makes sense, except that we don't want to just identify it, we want to prevent it, because you can build bone from an osteoporosis starting point but hey, let's prevent it instead or let's catch it earlier and let's have a better starting point. This is the difference between the conventional medical model, which is let's identify disease and treat it with a drug or a surgery, versus the health optimization model or the integrative model, which says let's prevent disease in the first place and then, if we find it, let's catch it early so we can do something about it with maybe something less aggressive, with less side effects. So that's the big issue with screening From my perspective.

Doug Lucas:

Then the follow-up question is well, when should we screen? For me, I would say 30 years old. For all men and women. We should know what's happening with bone health, because your peak bone density occurs in your 20s. If you don't know where you are in your early 30s, then you don't really know what you should be doing about it as an adult. You already said you know gradual bone loss is expected. I kind of mentioned that already too. It's true. If you look at the statistical average, we start to lose bones slowly from about the age of 30 onward for women, until about 50 when it accelerates and for men it just kind of slowly accelerates for the duration of their lifespan.

Doug Lucas:

But if you don't know your starting point, you don't know if you should be doing something different and that would definitely impact the way you choose. Potentially for women, you know oral contraception, which is bad for bone If you're, if you have a dysfunctional cycles and you're not ovulating, you're going to pay closer attention to that. If you have low bone mass to start with, what is your diet looking like? Like is it okay for you to continue to? You know binge and purge and go through the diet wars and all these things. You know if you're watching your bone and considering bone health as a biomarker of health span, if you're losing bone, something's wrong. But we don't know that that's true unless we're screening. So I think and this is the value of having an ultrasound device on the market we should be screening every adult at the age of 30. And if they have low bone density, screening them again on a regular basis, because if they're losing bone, something's wrong and we need to figure out what it is.

Michele Folan:

Yeah, because it could be anything. I mean, it could be. You're not absorbing nutrients, your diet is just poor. And then should we be telling our daughters right now lift weights, get enough protein. What else should we be telling them?

Doug Lucas:

I mean, the good news about bone health is that the bones are telling us a story, they're giving us signals, but you have to listen to them and unfortunately that means imaging and blood work.

Doug Lucas:

But the other side of that is the way to resolve bone loss is mostly lifestyle.

Doug Lucas:

You just said two of the biggest pieces. So diet and exercise are two of the biggest pieces. When it comes to bone health and when we build out our program for patients, the most important things that we tell them is we have to initially track what you're eating so we know what you're eating, and then make recommendations and universally unless they've been watching my YouTube channel for the last two years universally. They're under eating protein and we need to start there, get them to an adequate amount of protein and then build the rest of their diet around that. And then, from an exercise perspective, absolutely we all need to be doing resistance training because we lead sedentary lives. Unless you're a manual laborer and you're out there working in the fields or in construction or whatever. Most of us are behind a desk, sedentary, not stressing our muscles and bones, and that will result in bone loss in all of us. We have to do resistance training to stress that and it has to happen on a regular basis.

Michele Folan:

All right, Any of my clients who are listening and are tired of me talking about lifting weights and eating enough protein.

Doug Lucas:

if you don't believe me, listen, you can't talk about it enough I know, I know, I know.

Michele Folan:

But you know, it's kind of fascinating because I will sometimes have clients when they really don't know how much protein they've been eating. I'll have them track their protein for a couple days, or just in their macros in general for a couple days, before we really dive into things, and you would be shocked. Like, well, maybe not shocked. Well, I wouldn't be shocked. No, you wouldn would be shocked. Well, maybe not shocked.

Doug Lucas:

Well, I wouldn't be shocked, no, you wouldn't be shocked.

Michele Folan:

But they're shocked because they think, well, maybe I'm getting about 60, maybe 75 grams and they're getting like 40. 40. Yeah.

Doug Lucas:

And that's 40 is the magic number. Actually, we see it all the time yeah, 40. Yeah, oh my.

Michele Folan:

God and you know what. I'm not dogging anybody because, frankly, a lot of women haven't had that awareness about what they're eating, and plus we've diet culture and everything else that we've had to deal with all these years. So, anyway, I got to get to HRT, because this is a biggie right. What role does HRT play in not just preventing but reversing bone loss?

Doug Lucas:

Yeah. So I have to be careful what I say, because the FTC doesn't like it when I say that you can use hormones to reverse bone loss, because it's not FDA approved for that. But let's be clear it is FDA approved for the prevention of osteoporosis, meaning that we know that it has a significant impact on bone, and I travel around the country on stages talking about the impact of estradiol and progesterone in the research and it is so, so crystal clear. It outperforms bone drugs every time Actually, not every time, but any time a study is done. Well, it outperforms bone drugs, even in the own bone drug studies, and I have some of these studies that I like to talk about.

Doug Lucas:

I'm actually recording on this today, where you know where Fosamax, the manufacturer of Fosamax, tried to show that Fosamax was better than HRT and it just failed so miserably. And it just goes to show that, like, the standard of care is to use these bone drugs. But we should, in my opinion, have a different perspective, which is hmm, let's talk about, like, the risk benefit of HRT for all women post-menopause Not that all women have to do it, but let's have that conversation Because over the last 24 years, women have not been getting that conversation. It's getting better, but it's still very, very rare and we need to have that conversation, knowing what's going on with our bones, because, again, if we don't know, we can't have that conversation.

Doug Lucas:

So, if you look at the literature, estradiol, when used as a single intervention, with progesterone when needed, but if you're using HRT as an intervention, can have up to a 10% increase in bone mineral density on average over the course of 12 months. That is a massive increase with what is actually, in my opinion, not well done HRT increase with what is actually, in my opinion, not well done HRT. So I think we could use this as a tool to improve bone quality, improve bone density. We can use it to reverse osteoporosis I can tell you what that definition means for me but we can use it for those purposes. Obviously, these are off-label according to the FDA, but so is everything that I do, so that doesn't bother me, it doesn't bother my patients. We're looking at this through the lens of healthspan, not just isolated at let's look at your bone density. But there's so many potential benefits of HRT that this is a conversation that absolutely has to be had with every woman, with the perspective of bone health, healthspan, cardiovascular health, brain health, et cetera.

Michele Folan:

All right. Patch versus oral.

Doug Lucas:

Yeah, I'm not a fan of oral, just not because it doesn't work, but because it goes through extensive metabolism. So everything you consume orally, if it gets absorbed into your gut it'll go through the liver and when it goes to the liver it gets metabolized into byproducts. The liver is really, really good at metabolizing things. It's what it does. So whenever you take something like estradiol, for example, it goes through the liver. I forget what the actual percentage is, but it's somewhere between 80, 90% probably. That is no longer estradiol. So that estradiol didn't actually do you any good. So you're getting a smaller percentage. You're getting all these byproducts of estradiol which in some women is fine. In some women it's not.

Doug Lucas:

Some studies it shows that there's an increased risk of blood clot. But if that was all we had, then we would say, okay, let's consider the risk benefit. But fortunately we do have topical. So now commercially prepared topical is through patch. So these are kind of time release patches.

Doug Lucas:

You swap them out twice a week and it's going to provide estradiol at variable doses depending on the strength that you're given. And it gives you a pretty good level of estradiol at the higher dose strengths and the downside for me is that it's going to vary quite a bit from woman to woman how it's absorbed and you're kind of going to get a rise and a fall over the course of the couple of days that the patch is on. So patches aren't perfect, but they are generally covered by insurance and they're inexpensive. So that's an option that certainly could be considered. My preference is actually to use a cream that's applied twice a day but that gets into the kind of compounding pharmacy bioidentical space. I think that's more physiologic but it's more work. So you got to kind of find the balance there of what works for you.

Michele Folan:

Do you have a dosage that you think is optimal, based on studies that they've done?

Doug Lucas:

Yeah. So here's the funny thing about estradiol levels and this is oddly controversial and this is where I should spend less time on social media because people will call me out for this. I don't know. I guess it's good because we can bring it up, but it's such an unnecessary argument. But we like to measure estradiol levels and there's plenty of providers that say don't measure estradiol, it doesn't do you any good, just talk about symptoms. From my perspective, I wanna know what it's doing. I don't necessarily change my treatment based off of estradiol alone, but we're measuring estradiol. We're doing testosterone free testosterone, dhea, fsh, ctx, p1 and P. We're looking at the bone turnover markers and the other hormone markers to get a sense of what's happening in the big picture. So what we've found that's really interesting is that the strength of the cream or patch or whatever can be extremely variable from woman to woman, what the impact will be on the hormone levels in the blood. And this is why some doctors say, well, don't measure because they're all over the map. Well, kind of, they are all over the map. But the big picture starts to get clearer when you get adequate biomarkers.

Doug Lucas:

So some women I just had a patient this week. She's taking like a half a milligram of topical estradiol a day, which is a very, very low dose, and her levels are through the roof. So she's just a hyper absorber, so she absorbs it really well through the skin. Her estradiol levels are pretty high, but her FSH is actually not at goal. So she's a unique case where she actually has pretty high levels of estradiol but it doesn't seem like it's having the impact we want it to, and that's a receptor thing and there's different ways you can deal with that.

Doug Lucas:

But this is why working with a provider who understands hormones very intricately is really important, because most doctors and actually my team did the same thing. They looked at that and they were like, oh my gosh, she has to reduce her dose. I said no, she doesn't, her FSH isn't at goal, her receptors aren't saturated, she actually needs more estradiol. And so it's this challenging balance. But then we have the flip side of that too, where some women will be on high strength either the highest patch strength that's available, or a cream at a very high dose, and they just don't have much in blood and so it just takes more and more for them. Or potentially, some women actually use injections, or some women will go on to pellets for this reason, but you might need a different delivery system depending on what's going on.

Michele Folan:

All right, speaking of pellets, then what about testosterone in the mix of all this?

Doug Lucas:

Testosterone is interesting. So there are some. I just interviewed a physician yesterday, dr John Robinson, and his wife, Christina Bosch. They're out in Scottsdale. They spoke at our Osteocollective retreat this last year and they're they're a pellet practice, so they do mostly pellets. They do some injections, but for the most part they're offering pellets and it's really interesting, you know we have. The reason why I interviewed him is we have the same goals but we use different tools to achieve them, which I think is so interesting.

Doug Lucas:

Because if you again go on social media and you hear this back and forth of pellets are bad, creams are bad, compounding, blah, blah, blah, there's all this infighting in the hormone space. But what's great about me talking to John and Christina is that we can see, look, they're doing it totally differently but achieving the same results, and they might even be doing it better than me. And this is where it's great to actually listen to your peers who are doing something different to say, oh well, I hadn't thought of it that way. So they're using a pellet like this and using progesterone like this. But to get back to your question, they're big advocates of testosterone, but their patient population is younger, and so this is where there's a difference between testosterone from a pellet.

Doug Lucas:

Yes, it can be done wrong. Yes, high doses can be problematic, but for some women can provide great relief, whereas we like to use creams. But creams are going to convert more to DHT and there's the potential for more issues with acne or hair loss as a result of that conversion when it's coming through the skin. So for us, we find that our older patient population doesn't do as well with testosterone creams. Maybe they would do better with pellets, right? So it's just kind of an interesting like art of medicine here and trying to figure out what works for different populations with the different tools that we have.

Michele Folan:

Don't say hair loss, god, that is the scariest thing, and I and I. I just went back on topical testosterone because my libido went in the tank and it was time to get things going again and I I hesitated because of the hair loss thing, so I'm fine, it's been a couple months, I'm okay.

Doug Lucas:

And there are tools to help block that DHT conversion. So there's ways around it. But we do find that, especially as our patients get older, they tolerate less and less testosterone. But I'm intrigued by John's approach of using lower-dose testosterone pellets in older women. Now you have to be careful because you can't get that pellet out. So you got to know what the dose is. But I'm intrigued by this potential to use this. And then the other side of it too is we're all telehealth, and through telehealth, because testosterone is a controlled substance, it's getting harder and harder to use it as a tool. It's getting shut down state by state by the local state DEAs, and so that's becoming a bigger issue as well from telehealth practices. So there's some conversion to different tools as a result of that.

Michele Folan:

Got it. And then one last question about the hormone therapy. If I'm, say, I'm 68 and I get diagnosed with osteoporosis, is it too late for me at that point to start using hormone therapy?

Doug Lucas:

Oh my gosh, that's the million dollar.

Michele Folan:

Sorry.

Doug Lucas:

No, no, it's good. So I addressed this. Actually, we have a masterclass we do every couple of weeks and this is one of the things I talk about, because I hear this story probably more than anything else, that story that you just described. Right, 65, mid-60s, I finally get screened for osteoporosis. I have the disease. I go to my doctor, I tell him I read about hormones. I listened to this Dr Doug guy on YouTube and he said I should be on estradiol and their doctor says no, that's crazy, you're too old for that. What a catch-22, right. But here's the thing. So we address this all the time, and what I love about this conversation is I was kind of learning about it sort of, as the literature was really changing. And then what was a slam dunk for me is last year, in 2024, the Women's Health Initiative 20-year follow-up publication came out, and they did a great job in there breaking down the risk in this intervention group of women who were on these two synthetic products. So not great HRT to start with, but this is the data that was used to say you shouldn't start at 65. So now you can look at that same data broken out by decade compared to placebo, and what's really interesting here is that I think doctors just kind of get this wrong. If you look at starting HRT in the WHI within 10 years of menopause, there was a protection from cardiovascular disease. True, if you started between 10 and 20 years out, you lost that protection. So, based off of that comparison, yes, it is riskier. But if you look at the data of women 10 to 20 years out who are on HRT or starting HRT versus placebo meaning the women who were not on HRT or not starting a placebo there was no difference in cardiovascular risk. So it's not riskier than placebo or non-users. So, while, yes, I could say "'Michelle, it would be more dangerous for you to do it now "'than 10 years ago, but I don't have a time machine, I can't take you back 10 years ago. So that's the wrong question. The right question is how much more dangerous is it now for you to do this than do nothing? And for most women 10 to 20 years out, the answer is there is not increased cardiovascular risk.

Doug Lucas:

Now, that said, you have to look at individual risk factors. I had a great patient, I think, a couple weeks ago, who's a good example of this, because we start a lot of women in their 60s on HRT. But this is a woman who wanted to start on HRT. She was mid-60s, 15 years out from menopause, but she had been a type 2 diabetic for the last 20 years. Her A1C was not well controlled, her inflammatory markers were elevated. So you start stacking up these other risk factors. She had high blood pressure, right, so she's kind of a metabolic mess. Over the last 20 years she's probably developed significant disease.

Doug Lucas:

So what do we do with her? Well, we said, look, I think there might be risk here that we probably don't want to take. We can look under the hood, scan the coronary arteries and see what they look like. And we're doing that. And unfortunately I don't think that they're going to look good. But we're going to look and we're going to see, and if they look bad, then we won't move forward with estradiol. Now that doesn't mean we can't potentially do other things, but HRT specifically optimized with estradiol, progesterone and testosterone if needed.

Doug Lucas:

That's not a picture that she would. That she'd be a good candidate for even though she's in her 60s. That same thing is true for women in their 70s. But the individual risk factors really start to stack up, so it becomes less likely for women who are 20 plus years out from menopause, although it happens when we've started women who are in their 80s on hrt because their coronary arteries looked better than mine, you know. So what risk am I preventing them from having? So it's a really interesting conversation. I hope to continue to bring this to the market and demonstrate that the research does not show that, especially for women 10 to 20 years out, that it is more risky than placebo.

Michele Folan:

So real quick, before I go on to GLP-1s, because I want to make sure we talk about that too. I want to make sure we talk about that too when you talk about risk versus risk. If I am 72 and I have a fracture, what is my prognosis? In general, it's terrible.

Doug Lucas:

Yeah, it's terrible and that's a great point. Thank you for bringing that up. So if you're in, I mean, it doesn't actually matter, but if you're in your 70s and you have a hip fracture, for example, the likelihood of you passing away, dying in the next 12 months is around 30%. 30%, that's high. There's not a lot of diagnoses that have that high of a mortality rate. The likelihood of losing independence meaning you either die or you lose independence is going to be around 60% or potentially even higher. The other 30% that regain independence are usually not the same. So a hip fracture is a life changer, potentially a game ender, but it's definitely a life changer and this is what we absolutely have to avoid. I have fixed I don't know how many hundreds of hip fractures and I've only had one patient who seemed like she bounced back, but she was very young. So this is the risk benefit conversation that I'm having with patients, which is and this is a great way. I'm glad you said it If you think about the risk of hormones.

Doug Lucas:

So, for example, some people would say that there's an increased risk of developing cancer. I don't think that's true. Your cancer might grow faster, but you can argue. You know, maybe there is a little bit of increased risk. Some people would argue it's you know, it's a rare. It's a rare risk thing, okay, fine, but you know what's not a rare risk fracturing your hip with osteoporosis, which has has a higher mortality rate. Hip fracture right, which has a higher rate of losing independence. Hip fracture, which one is well-treated with HRT osteoporosis. So for me it's a very clear picture and I don't wish a case of breast cancer or any kind of cancer on anybody. But we all get scared around the big C word but we forget about the fracture and what happens with the fracture, and that's really, really powerful.

Michele Folan:

Thank you for clarifying all that, because that's one of those things that, just again, it just doesn't get talked about enough is the long-term risk factors with fracture. All right, I said I wanted to talk about GLP-1s because I am wondering about are there any risk factors? Good, easy for me to say risk factors with GLP-1s and extreme weight loss, and then, on the flip side of that, is there any data out there suggesting that GLP-1s may actually help with bone density?

Doug Lucas:

Yeah, I'm going to answer those backwards. So there is evidence to support the idea that GLP-1 drugs, or GIPs, are beneficial for bone health. The evidence is not strong and it's mostly just theoretical. But if you think about the way GLP-1s work, when they increase the GLP-1 hormones, the GIP hormones, the result is improved insulin sensitivity. Obviously there's weight loss, but that's going to result in reduction in inflammation, reduction in oxidative stress. So we know that inflammation, oxidative stress and poor insulin sensitivity are associated with osteoporosis. So it makes sense that man, if these drugs can do this, they should improve bone health.

Doug Lucas:

But that's not what we see clinically. So for me, in my practice, most of my patients are underweight, so I don't have a lot of patients on GLP-1s. But sometimes we'll have a patient come in who's had a weight loss journey, who is on a GLP-1, maybe a maintenance dose or maybe a microdosing or whatever is on a GLP-1, maybe a maintenance dose or maybe a microdosing or whatever, and they want to stay on it. Early on we said, okay, that's fine, I think that we can be successful because of all this data that says that we should be able to be successful. But I can tell you that not one of those patients has been able to improve bone density while on a GLP-1. Now, again, this is a small subset of our patient population. I'm not saying this is true across the board, but we are a practice, that is, we're talking about doing the things that you need to do to not lose bone, while on GLP-1s we're talking about doing resistance training, eating adequate protein. They're tracking their food and yet they're still not growing bone.

Doug Lucas:

This is really concerning for me, because there are millions of people on GLP-1s, right, yes, and so you know. We're not screening young adults. We don't know what their bone looks like when they start, so we don't know where they are. Now. I already think that there is a kind of a tsunami of osteoporosis that we don't even know about, and I think it's just getting worse and worse and bigger and bigger because of all the people on GLP-1s. If you are not eating adequate protein, you're not doing resistance training, you are losing bone. In fact, the studies are very clear on this. They talk about the percentage of your weight loss that comes from lean mass. Some studies say 40%, some say 60%, whatever, and people say it's muscle. No, they didn't say muscle, they said lean mass. Lean mass includes muscle and bone.

Michele Folan:

Yikes.

Doug Lucas:

So I'm very concerned about it. I would love to know what the dose is that is beneficial to bone. I think it's going to be a very low dose. I think it's a micro dose, a half of the starting dose or a quarter of the starting dose or something like that. I think it's probably out there and we're going to figure this out over time because I don't think these drugs are going away. But right now my concern is, if you're at a commercial dose the regular dosing schedule that you are likely losing bone and you should really get screened.

Michele Folan:

Okay, great advice. Appreciate that very much, because I you know. I have clients that are using them and I am telling them I don't care if you're not hungry, you still have to eat the protein.

Doug Lucas:

Eat more.

Michele Folan:

Yeah, I'm like eat more please. All right, I want to just do a quick rundown of supplements, because this is the question I get all the time. Michele, what are you taking? And I'm like don't listen to me, I'm not a doctor, so you are the doctor. Calcium, I'm a doctor.

Doug Lucas:

Yeah. So let me just lead into the supplement conversation by saying this Nobody's going to supplement their way out of osteoporosis, right, right, it is not a supplement deficiency problem. I like them, we use them, we recommend them, we have great affiliates and we'll talk about those companies, but nobody's going to supplement their weight of osteoporosis. This is a lifestyle problem and then we can supplement on top of that. So we'll start there Now with calcium. Calcium, obviously, like you were recommended calcium and the recommendations from the Bone Health and Osteoporosis Foundation here in the US is 1,200 milligrams of calcium if you're over the age of 60 and 800 IU of vitamin D. The research isn't great that that's actually doing much, because osteoporosis is, I already said, not a supplement deficiency. It's also not a calcium deficiency for most people.

Doug Lucas:

So my thoughts on calcium is we need to look at what you're eating and if you're getting adequate calcium through diet, don't supplement it. You don't need to, and what that means for me is anywhere over 800 milligrams a day and if you do need it, then consider calcium more like a mineral complex that you need. So if you look at our favorite products like AlgaeCal makes a good product. There's some other companies that make some good products with whole food forms of calcium, but they're essentially multi-mineral products, not just calcium by itself. So the idea of taking calcium citrate or calcium carbonate alone or with vitamin D, I think, is really missing the big picture, because our bones aren't just made of calcium, they're made of so many minerals and we need all those minerals if we're going to build back bone.

Michele Folan:

All right, k2.

Doug Lucas:

Love K2. Challenge with K2 is that we don't really know what the right dose is, and so I just did an interview with John Neustadt.

Michele Folan:

He's one of the oh, he's been on my show.

Doug Lucas:

He's been on your show, yeah. So he's a big fan of K2 as MK4. I generally talk about K2 as MK7 because of the longer half-life, you don't have to dose it as frequently, et cetera. His perspective is there's more research on MK4, and he's right. But the dose you have to take of MK4 is very super physiologic these big doses of MK4, but it seems to be very safe. If you look at how much K2 we get through food, it's not very much. You're talking like a couple dozen micrograms, right? So my preference now is really to say look, if we're going to take K2, we need to take K2 as MK7 and MK4. Let's just bridge the gap. Let's do them both. What's the downside? There's no risk of blood clot. There's really no other downside of taking an adequate amount of K2. And that super physiologic dose of MK4 doesn't seem to have any negatives because it is actually pretty well studied.

Michele Folan:

All right, well, that's what I'm taking. Of course I'm taking his product because that's what he told me to take. So I listen, I do listen. All right, collagen, but specifically Fortebone collagen. Is there any data besides the study that they sponsored themselves?

Doug Lucas:

Besides their study? No, no, there's not. Not that I found. I still like collagen, though I think it's a health span play. I use collagen every morning and Fortibone's part of that. But there is only that one study and it was sponsored by Gelita, who makes Fortibone. So make of that what you will. The other challenge I have with Fortibone is Gelita doesn't disclose where they get their bones, so we don't really know how they're sourcing their bones. We don't know what those cows ate, we don't know what they were exposed to. So we're kind of caught here where, yeah, fortibone is the studies behind it or the study behind it, but other products are clear about their sourcing. I would love to put those two together, but right now you got to pick one or the other.

Michele Folan:

All right, well, I'm taking that too. Me too. I'm like, oh well, okay, creatine.

Doug Lucas:

I love creatine.

Michele Folan:

All right For bones.

Doug Lucas:

Yeah, directly for bones. I actually have this pending as a topic to review At this time. I've not seen evidence to say directly that it helps with bones. I honestly can say that I haven't looked at it deeply but it definitely hasn't come across my desk. But I like it both for muscle mass strength, cognitive function. Creatine for me makes a lot of sense.

Michele Folan:

All right, I want to talk about the weighted vest. It's not a supplement, but everybody's got one.

Doug Lucas:

It is a supplement, Supplemental weight it is. I talk about this a lot and it kind of is. Again, this is a social media thing where my Instagram thinks I'm a 60-year-old woman, so I get all these advertisements for all kinds of stuff. Most of the people that I follow are women in the menopause space, because this is my audience. Weighted vests are everywhere. They're everywhere. Everybody's got a weighted vest. You should spend your entire life in a weighted vest.

Doug Lucas:

The research that is usually cited about weighted vests and bone health, I think is misrepresented. It does show that it slows down bone loss, so I don't think that there's nothing here, but it does not help build bone independently. So I think we have to be clear on what it is. It might help you to slow down bone loss, that's true, but the problem I have with weighted vests is that if you're looking at an overweight population, we say gosh, if you could lose 10% of your body weight. We know that it would dramatically improve your joint pain, how you feel, your energy, your activity level, and there's a lot of reasons for that, but yet then we're telling every postmenopausal or premenopausal woman to put on 10% of their body weight and then wear it throughout the day.

Doug Lucas:

So for me it's a little bit of a conflict where I'm concerned about your joints, concerned about what the potential negatives are. Are you going to put yourself into a dangerous situation for those that are truly fragile and frail with a weighted vest? And I think it's certainly possible. And so for me, when a patient asks about it, I say look, if your joints are doing great, then absolutely, because it's probably going to help you. But if you're concerned about your joints, you have knee pain, hip pain. Adding a weighted vest is probably going to make that worse. So it's not that powerful. We have other tools. I'm not a huge fan, but we do have patients that use them.

Michele Folan:

Okay, yep, I've got one. I've got one of those too, but I do want to say this, knowing a lot of people and myself that have been diagnosed with osteoporosis there is this hesitancy to lift weights. We're afraid we're going to hurt ourselves, we're afraid we're going to fracture. How do we approach that? Do we go to physical therapy and have someone walk us through that, based on what our scores are?

Doug Lucas:

Yeah, this is one of the hardest things we've had to deal with because, again, we're all telehealth. We're nationwide telehealth, we're working with our patients through Zoom, and this is not a particularly techie population to begin with. So we're asking a lot to say. We're going to help you figure out how to lift weights. For someone who's never lifted weights before, who has a diagnosis of osteoporosis and has been told not to lift more than five pounds or they're going to break their spine, this is a really challenging starting point.

Doug Lucas:

The good news is that the human body is amazing and we can start with some very, very basic things, especially for those that have not been exercising, people that have no history of activity. You can start very, very basic, very, very low and progressively overload and see tremendous improvement. So that's sort of our approach is we start with body weight exercises, we're looking at form. We have now a trainer. Her name's Daisha Enos and she's been in this space for a long time, so she has office hours and people will send videos and talk about form and this doesn't feel good. What about this strap or whatever? So we can kind of guide them through this very simple kind of thing and then they progressively overload and we have multi-phases in our program that we can expose them to. So I think most people can do really well with just that.

Doug Lucas:

Now, if you need extra help, yes, having the right trainer who can look at form, put their hands on you and be like you know your hip no, it must come back like this, you know, those things are really helpful. Physical therapists can be helpful if it's the right physical therapist. And this is the hardest thing is who do I go to locally? And that's really hard for me to say.

Michele Folan:

Yeah, and I did do that. I did go to a physical therapist and I worked with her personally. But you know insurance doesn't cover that. I had to pay that out of pocket but I wanted to make sure that I wasn't putting myself at risk. Now I just pretty much just go and do and I think hopefully I don't fracture right. But I know I need to do this because I need to build my bone.

Doug Lucas:

And that's the hardest thing is, our goal is to prevent fracture, but in order to stress our bones, we have to stress our bones. And this is where some people say, well, I won't do anything that will put me at risk of fracture. And I say, well, then the best thing you can do is to go on a bone drug and cross your fingers. But the truth is that they don't really prevent fractures that well either. Yes, statistically better, but people still fracture on bone drugs. So you got to find that, find out what's right for you. But it is hard because, yes, you're putting yourself at risk.

Michele Folan:

I will not do a box jump okay. Because that scares me. I'm afraid I'm going to fall and chip a tooth, but I do jump rope and I enjoy it. I only do like five minutes but it gets my. That's hard. Yeah, it is hard, but I do that. I do heel drops. Anything else I can be doing for impact?

Doug Lucas:

Yeah. So impact is probably the hardest thing, and so we have a whole impact progression program too, and we start with heel drops and we work people up to assisted hanging drops like they do in the Lift More trials. So there's a whole spectrum of things you can do from an impact perspective, but honestly, some of the best literature is just on heel drops. You can develop a tremendous amount of force by simply dropping onto your heels and all that force runs up through your spine, so I don't think you necessarily need to do more than that. For those that want to do more than that, we talk about the modalities like the osteogenic loading and the whole body vibration, power plate, bio-density, et cetera. Those are cool tools if people have access to them, but similarly they're an investment. They can be relatively expensive, not covered by insurance, et cetera.

Michele Folan:

Let's talk a little bit about your practice, because you did mention telehealth. You see patients in person. What other services do you offer within your practice there?

Doug Lucas:

Yeah, so I think I can announce this, and you're going to be the first place that I've announced this, so I'm very excited.

Doug Lucas:

So we have two practices, or we had two practices.

Doug Lucas:

We have Optimal Human Health, which is the health optimization company that became an osteoporosis clinic, essentially, and we have a company called Pema Bioidentical, which is our women's hormone company either people that have graduated from Optimal Human Health or have come in who only need the HRT side.

Doug Lucas:

So what we were doing in those two practices was relatively novel and unique, and we got picked up by a large telehealth platform called LifeMD, who's been mostly in the weight loss and men's health space, and so we met with the leadership of LifeMD, explained what we were doing. They absolutely loved it, knew that that was a direction that they wanted to go, and the only way to make that happen is for them to acquire our companies and our team, and then we are now in the process of building out this platform or these services on their platform. So we will be able to do this not only at scale, but also with commercial insurance and with Medicare. The details of that I can't talk about yet, but that's our big picture goal is to create a women's health division, so my title is literally the VP of Women's Health. We're gonna create a women's health division that can address hormone optimization and bone health not as an afterthought but as a primary perspective and endpoint of care.

Michele Folan:

This is so exciting for you.

Doug Lucas:

It is.

Michele Folan:

I mean to be recognized that, hey, this is a missing piece in our organization. All this hard work that you've put into this, the passion has truly paid off, and for your team, because I know you lovingly have put a team together as well. So congrats.

Doug Lucas:

Yeah, thank you and the team's very excited. We have been really fighting. We've been fighting the good fight to grow this in a cash pay model and it's great. Our program is great as it is, but it's expensive and it's not like the company makes a lot of money. We essentially run even. It's hard to provide these services, which are high-level services, in a cash-pay model because the cost really adds up. I'm excited to get this done at scale leverage the resources of a large telehealth platform to be able to negotiate with the LabCorp and the companies that we need for the labs and the data and all the platforms. We can bring down the cost significantly and then add in insurance where it'll cover some of these services. We can create hybrid models, very excited about what's to come, because there's truly nothing on the market like it.

Michele Folan:

Oh, that's fabulous. Well, congrats again. Yeah, thank you. I do have a personal question for you. What is one of your own self-care non-negotiables? What's something you do for yourself?

Doug Lucas:

I train. I train every day, and what I mean by train is either lift, weights, mobility, sauna. I have a power plate and red light. I have to do that every day. It's absolutely non-negotiable. If I don't do it, I'm a bear to be around, and I don't want to do that to my family.

Michele Folan:

Self-awareness, that's good.

Doug Lucas:

It was not sudden and I learned that over decades. So there you go.

Michele Folan:

I love it. See, it's not just women. Men need to do the self-care thing too. All right, tell us a little bit about the Dr Doug Show. Where can we find that?

Doug Lucas:

Yeah, so Dr Doug Show, mostly designed for YouTube, so it is a few interviews. It's mostly me talking about research and the subtitle is Bones, Hormones and Health Span, so you can kind of let that speak for itself. But mostly on YouTube, it is available on podcast as well.

Michele Folan:

Perfect. I will put all of that in the show notes, Dr Doug Lucas. Thank you so much for being here today.

Doug Lucas:

Thank you,

Michele Folan:

Hey, thanks for tuning in. Please rate and review the show where you listen to the podcast, and did you know that Asking for a Friend is available now to listen on YouTube? You can subscribe to the podcast there as well. Your support is appreciated and it helps others find the show. Thank you.