5 Hidden Causes of Bone Loss (#4 Is a Shock) - Dr. Douglas Lucas

**Dr. Douglas Lucas** (0:00)
I saw the circle and the trap that I had put myself in, where I was doing great surgery. I love the operating room. But I felt like I was really cleaning up metabolic mess over and over and over again. He was young, he was listening to his doctors, he was following their advice and their advice was killing him.

**Dr. Gabrielle Lyon** (0:18)
We are going to see an epidemic of osteoporosis and sarcopenia that no one is prepared for.

**Dr. Douglas Lucas** (0:26)
Our bone is not something that we need to consider. We are going to lose as we age for the most part.

**Dr. Gabrielle Lyon** (0:31)
What's wrong with that approach?

**Dr. Douglas Lucas** (0:32)
The conventional medical model is what it is. It has been for over 100 years, diagnose, treat with pharmaceuticals or surgery. That's the system.

**Dr. Gabrielle Lyon** (0:41)
Why are we losing bone? And specifically, selfishly, I want to know how much this has been very controversial, calcium.

**Dr. Douglas Lucas** (0:48)
Most cases of osteoporosis are not a calcium deficiency issue.

**Dr. Gabrielle Lyon** (0:53)
The biggest misconceptions that we have heard over the years is that protein is bad for bone. What else is it an absolute, if you want to destroy bone, here's your playbook.

**Dr. Douglas Lucas** (1:03)
Yeah, if you want to destroy bone, under eat protein, right? Eat an inflammatory diet, high, you know, ultra processed food, high quantities, get poor sleep, live in chronic stress.

**Dr. Gabrielle Lyon** (1:12)
Are there a handful of medications that people take routinely that affect bone?

**Dr. Douglas Lucas** (1:17)
The ones that I would say that surprise people would be.

**Dr. Gabrielle Lyon** (1:28)
Dr. Doug Lucas, formerly a Stanford surgeon, you're an orthopedic surgeon, you went to Stanford, and you gave that up.

**Dr. Douglas Lucas** (1:37)
I did.

**Dr. Gabrielle Lyon** (1:38)
Unusual.

**Dr. Douglas Lucas** (1:40)
Very.

**Dr. Gabrielle Lyon** (1:40)
Why?

**Dr. Douglas Lucas** (1:41)
I saw the circle and the trap that I had put myself in, where I was doing great surgery. I love the operating room.
But I felt like I was really cleaning up metabolic mess over and over and over again. Foot and ankle was my sub-specialty. There's probably not a sub-specialty that is more perfect to see this issue than looking at the foot because of the combination of all of the downside of diabetes, metabolic disease, and how that plays out.

**Dr. Gabrielle Lyon** (2:10)
Was it different than you thought as an orthopedic surgeon? Also, you're a very fit guy. If you guys are listening to this, you should watch him. I always have a ton of respect for physicians who practice with a preach.
When you went into orthopedics, were you thinking it was going to be sports?

**Dr. Douglas Lucas** (2:26)
I knew I was going into foot and ankle, but it is very different once you're in practice than it is when you're in training. In training, you see new patients all the time. You only do the surgery. You have short follow-up. It's very exciting. But in practice, you follow patients for a much longer time, and you see how the surgery that looks so good doesn't end up having the effect that you hope it would over the long term.
It can be quite a letdown both for you and the patient.

**Dr. Gabrielle Lyon** (2:52)
Yeah. To be fair, Stanford is one of the most competitive orthopedic surgical residencies. To even get there is a long and arduous and full of sacrifice road.
To then get there, it's very, I would say very few times in our lives where we go, I've really worked so hard for this and I've dedicated years. I mean, that's over 10 years to say, no thanks. Was there a moment?

**Dr. Douglas Lucas** (3:28)
There was a moment. Just to be clear, I did a fellowship at Stanford.

**Dr. Gabrielle Lyon** (3:32)
Even better.

**Dr. Douglas Lucas** (3:34)
So my residency was at Ohio University in Columbus. But yeah, going from there into practice and then starting to understand what was happening with my patients, the moment that the switch flipped for me was an emergency case, middle of the night, 3 a.m., diabetic patient, foot ulcer gets infected, they call me in to do an amputation. And I remember very clearly skeleton crew, middle of the night scenario, nobody was prepared to do what we were doing. I remember the patient almost falling off the table, not enough people to keep him on the table. I was underneath his leg, this unfortunately very overweight individual trying to put on a tourniquet so we could literally save his life. Time was of the essence. And I stopped right then and I thought, what the hell am I doing?