Episode 27: How to Pivot When You Become “SUCCESSFUL” But NOT HAPPY and 3 ANTI-AGING Hacks with Dr. Douglas Lucas, Orthopedic Surgeon, and Longevity and Bone Health Expert

EPISODE 27

[INTRODUCTION]

00:00

Dr. Doug Lucas (DL): The biggest thing for me though, was the identity. Walking away from the identity of being an orthopedic surgeon was really tough. I couldn’t get over the idea that being an orthopedic surgeon was cool, that it was my identity. And it’s what I had trained for 15 years to do, you know. And so, I really had to work on what that new identity was. And so now when people, when I introduce myself to people, they’re like, ‘Oh, what do you do?’ I say, ‘I’m a physician entrepreneur, right? I think it can take time just to make sure you understand that you do need to make that switch.

[INTERVIEW]

00:37

ANNOUNCER: If you’re struggling with your vitality, energy, mood, focus, or sleep, this podcast is for you. Your host, Dr. Ann Tsung, ER doctor, and aerospace flight surgeon, will help you reach for the stars and remove the barriers or blockades that have been holding you back from living your best life. If you’ve been challenged by your health, relationships, or productivity, then it’s time for a breakthrough. So, here’s your host, Dr. Ann Tsung.

01:10

Ann Tsung (AT):  Hello, welcome to It’s not Rocket Science Show. And I am your host, Dr. Ann Tsung. And today, we have Dr. Douglas Lucas. He’s actually a trained orthopedic surgeon. And he did a fellowship, Anti-Aging and Longevity. And the reason why I wanted to invite Dr. Douglas Lucas on the show is because in the show, we’ve talked a lot about achieving fulfillment and peak performance at the same time. And a lot of times we’ve achieved that specific success, but we don’t feel fulfilled, we get to that point and we feel like, “Oh, this is what I’ve been working for so hard this whole time. And we get here and I’m not as happy as I should have been.” And Dr. Lucas has an amazing story, how he actually pivoted from his orthopedic training. And we’re gonna dig into a little bit about the why the reason why he did it, the end vision that he actually has for himself and his family. And also, how was he able to have the courage to actually pivot and create this whole entire new company that is really trying to improve the healthspan and lifespan of people around you. So, thank you so much, Dr. Lucas, for joining.

02:15

DL: Yeah, thank you so much, Dr. Tsung.

02:18

AT: And would you please give us a little brief introduction of what you do. And we can just dive right into, you know, the reason why you decided to pivot to the point where you are now.

02:29

DL: Absolutely. So yeah, thanks again for that. That was a great introduction. So really, what I do now is I practice in the field of health optimization. And my real focus is in the longevity and also in the bone health space. So, I really focus on those two things and have kind of two different groups of patients that I work with. But it’s as a completely telehealth company. I’ve built an amazing team, where we can create programs for people that run the range from pure lifestyle all the way through hormone optimization, and peptides and longevity medication. So really fun space to be in. But it is very different from where I started, which is I think it’d be a fun conversation today.

03:07

AT: Yeah, thank you so much. And so, tell us like a story from the beginning from going down to orthopedic surgeon path, what was that, there’s usually that one moment that pushes you over the edge that makes you make that decision. Right? So, what was that one moment? Was there a “why” in that one moment that came to you?

03:25

DL: So, getting out of orthopedics, you mean? So, I remember very clearly, the moment where I just I had it, where I broke and I was, I said I have to do something. And it was that “have to” moment that really did it for me. There was a lot of stuff leading up to that. But that one moment was one of those classic three o’clock in the morning on-call at a trauma hospital patient had a diabetic ulcer and was septic and needed a below-knee amputation. 

So, one of those kinds of urgent things and now that I know what I know about diabetes, you know, these things are totally preventable. But I was in there and this patient was morbidly obese, we had a hard time positioning him on the operating room table. It’s three o’clock in the morning, you have a skeleton crew, you know, I’m kind of I’m just like struggling to get a tourniquet around this guy’s leg and I’m just, you know, as I’m underneath this guy’s leg and just thinking about like, “What am I, what am I doing? This is crazy. I’m about to cut this guy’s leg off because he has an ulcer from a disease, which is totally preventable. I know how to help people do this. I’m on the wrong end of this thing.” And so we do the case and actually he ended up being a great patient and I really turned him around from a diabetes perspective. But ultimately, he you know, he lost his leg. And so that was it for me. But there was a lot of stuff leading up to that. Just kind of seeing that same thing over and over again. Where, as a foot and ankle sub-specialist in orthopedics, I just kept seeing it and the things that people were told were just not helping them.

04:52

AT: Yeah, I can absolutely identify with that. I think it’s the same reason why I went on my trajectory as an ER and ICU physician I see them bounce back over and over and over again. And we’re catching them way too late. And it’s like, they’re often not educated in the beginning and not even in school on what they can do. I think we need to start there with the kids, too. So, I can absolutely identify with that. And so, after you made that switch that day, did you have like a reason, that drive? What was the reason and drive behind everything that you tell yourself? Do you have a massive transformative purpose that you created for yourself?

05:28

DL: Looking back on it, you know, now I can, I can make much more sense of my path, it seemed very circuitous and confused at that time. But you know, when I look back on it, now, I can really see that ultimately, my purpose and my drive was to find a path in medicine and professionally, where I could really do what I’m good at. And I didn’t really understand what those were, I didn’t really understand what my “why” was when I started in training, and so I really had to figure that out to figure out who this is where I want to be. 

So, it was figuring out that I, what I really like to do is I really like to learn constantly. I like to educate, and I like to build. And that’s why I liked training to be an orthopedic surgeon. And I love to doing surgery because it was kind of the same thing. But the practice itself, I was not fulfilled in. So, that classic, “Yes, I worked really hard, I did all that stuff. And I did the fellowship at Stanford and achieved and had feathers in my cap. And then I started practice on and almost on day one.” I hated it. You know, because I was there. And so, I had to find something where I could continue to learn and to build and to grow. And you know, this space in this practice as a, you know, physician entrepreneur is, is there’s no ceiling. Right? Just continue to grow.

06:44

AT: Yeah, it’s very common. You know, some people are, I’ve heard from other people that I don’t know what my passion is, I don’t know what my calling, I don’t know what my purpose is. And it’s okay to not know what your purpose is. A lot of times, it’s a self-discovery journey, and that you just learn and explore. And then you learn, you have different perspectives, which sounds like what you’re doing. And then all of a sudden, you’d like this, and you’d like this, and you keep going down and you realize that I don’t know if that’s happened to you, but you realize that, you know, your passion is really the things that you love doing and you forget to eat, you forget to go to the restroom sometimes, and you’re just so absorbed in it. That’s really, you know, that kind of gonna give you a hint on what you love, essentially. I don’t know if that’s what happened to you.

07:29

DL: Yeah, no, that’s absolutely right. I mean, it’s, again, I love the learning side of it. My “why” was legitimate when I was training, but it wasn’t the right one. My “why” was I want to have a great profession where I can make enough money to live a great lifestyle and support my family. And that’s an admirable “why”, but it’s not a sustainable “why” once the other stuff falls out. And when the training fell out, when the challenge fell out, and then it was to being in practice in, you know, running the reps and making the widgets, that wasn’t enough for me. And so, I had to find more.

08:04

AT: What would you say is the one thing that was missing that now give you fulfillment?

08:11

DL: I think going back to the never-ending education and growth, that’s what I really enjoy about my day. When I look, you know, I journal, I’m one of these guys that journals. I tell my patients to journal, and when I look at, you know, the things that I’m writing down as non-negotiables. And then at the end of the day, I go back and I review it, okay, what were my successes, it’s always in that realm, what grew today? What opportunity expanded today? What did I learn today? What can I now offer my patients? So, I think that’s really what drives the business. And I think people are joining, our patients are joining this practice because they see that we are, this is where, this place where we can take new information, and we can add it to all the foundational stuff that we’re doing. And we can create something for them, it’s going to help them to reach their goals. And it’s unfortunately, where the traditional medical model is headed. It’s just, it’s so slow to change and sometimes for the right reason. But patients get really frustrated with that. And so, it really helps to create this space where we can really explore these things with patients.

09:08

AT: Yeah, because a lot of physicians are burned out because, you know, they think it’s the administration, it’s the paperwork, billing, you know, jam-packed with patients, too. You don’t really have time to educate them. And those are like what they call micro cuts, or yeah, death by a thousand cuts, essentially. And you want to do well for your patients. You want to be able to educate them. You want to see them feel better day after day, but you’re limited by their financials, their insurance, the system, the referrals, etc. So, you pointed out a great point. That’s why a lot of our health care professionals feel unfulfilled in their job. And I want to also touch base on you know, when you decided to pivot did you like have this end goal that you had in mind, this company that you built out that you mind-mapped, or how did you envision this to be like in 20, 30 years? 

09:58

DL: Yeah, I mean, so I go back and look at what my thought was. And it was not, it was not a big-scale thing, to begin with. My wife runs a company in weight loss. And so, there were a lot of clients of hers that were coming out of this program that I wanted to be able to help. And that was part of the training that I pursued was to be able to help people to maintain weight loss, you know, through hormone optimization, and thyroid and all that. And so my idea was, hey, I’m gonna get this training, I’m gonna create this practice, and then I will work with these patients. 

And part of my decision to pivot also had to do with my family obligations. And my wife, she runs a company, like I just said, and she’s very busy, we have three kids. And so what we needed more than an orthopedic surgeon income was my time. And so I was trying to find a way where I could meet all of my needs professionally, but also give more time to my family. And so that was a big part of it. So I wanted to create something where I had more time flexibility. So, I didn’t initially think I’m going to create something like I have the vision of now, my vision has changed for a number of reasons. But it started out being really small. And when I created it, I did not, you know, we can talk about suggestions for people that want to do this. I didn’t really seek out the right coaching initially, I didn’t go into it with the right idea of what kind of capital I would need, I may just go back and look at it. And I could have taken account of the first year of it, and really made it a lot smaller if I’d done it more smartly. But it worked out. We are where we are. And I you know, again, I’ve built a great team. So happy with it.

11:30

AT: Yeah, it’s essentially none of them are like mistakes. They’re all just lessons in life.

11:37

DL: And I look at it like, you know, tripping upstairs, and now you still go upstairs. You keep going.

11:41

AT: Yeah, yeah. It’s the next micro step. And then the next micro step, essentially? And what about now? What is your vision for your company and also your life in the very end?

DL:  11:54

Yeah. So, in the very end, I don’t know how far out that is, I run a longevity company. So, I think it’d be a long time out, right? So, from the company perspective, what I’ve realized is that this has to hit a certain scale in order to be able to support the team the way that I want to support them. And of course, as your scale gets bigger then your team gets bigger, right? And so, it’s, it’s almost a never-ending cycle. So, what I realized, though, is this idea of having a small, little niche thing is probably not going to work for me. And so now we’re looking at how do we scale. 

So my end goal really is to have a big enough team where we can serve the patients that we are acquiring, and that’s going to be multiple physicians, we just hired a second physician who I’m super excited to bring on board, and probably a team of coaches, I don’t know how big that’s going to be, but probably, you know, multiples, if not 10, or more, but to be able to pass on this information in the way that we want to do it, we’re going to really niche down into again, longevity and bone health, we used to be a little bit broader than that. But I really want to present myself as the authority and osteoporosis because what we built is so good for that group. And there’s just not a lot of offering out there for people in that group. So, I’m really excited to build that out. And I think if we do that in the right way, then it’s going to be a pretty high volume. And I’m really excited about that. 

For me my role, you know, I want to continue to see patients, I like seeing patients, but it’s not all that I like to do. And so, I think, having a minority of my schedule is dedicated to patient time, but the majority is going to be in building the business, growing, and being the authoritative speaker for the alternative approach to osteoporosis. And then, you know, being a great dad and being a supportive spouse. So, it’s all wrapped in there.

13:39

AT: And what is that vision like? I do want to really dig in, like, have you ever envisioned your life in like 50 years? What would you be doing?

13:46

DL: I’ve gone out five years, I’ve gone out 10 years, I’ve never gone out 50 years. So I’ll just, I’ll disclose it. I’m 44. And so, in 50 years, I’ll be in my mid-90s. And yeah, I think it’s a great exercise, I would love to say that, you know, at that age, I will still have the mental capacity to you know, get out and do the things that I enjoy doing the physical ability to do so without, you know, grave fear of falling. Yeah, I think that’s all real and possible.

14:17

AT: Yeah, I think a lot of times when I ask people, you know, or I’ve heard many times from other people, I don’t want to reach 80s or 70s. Or, you know, by that time I’m ready to pass on it will be miserable. And you know, I asked him if you could do the things you currently do now you have the mental capacity you currently have. And you can enjoy life just the same way as you are now would you mind being what 80s, 90s,100 Doesn’t matter. It’s just a number.

14:45

DL: Yeah. I mean, I look at it as it’s an opportunity to continue to grow and learn, right, like you’re gonna continue to see those around you to flourish and you know, watch those that you have an impact on, you know, continue to grow. I mean, I think that’s really exciting and it’s sad, this is the longevity side of me speaking, you know, to put a cap on it and say we were 75, you know, I’ve seen people over 80 and they don’t look happy. Yeah, me too, you know, I mean, I watched a lot of patients in their 80s and 90s. And a lot of those patients are miserable. But that’s a very biased perspective as a physician, because we see the patients that are struggling, right, but you don’t see other patients and I now in this space, I have patients in their 80s and 90s and they’re doing awesome, you know, and they’re, they’re very focused on staying as spry and as agile as possible, and they’re, it’s aspirational, you know, I want to, I want to be like that, you know, to be in my 90s, to look at 100 and say, yeah, I want to see my great, great grandkids. You know, like, just, it’s awesome. So, I think it’s great. And then you have to plan now, though, to be able to do that, then. And that’s where I see a lot of patients, you know, I see patients in their 50s and 60s, and even worse, if they’re a little bit older, and you know, they’re diabetic, and like, I want to live to 130. And you’re like, well, you burned a lot of bridges, you know, let’s see what we can reconstruct. So, it really pays to the earlier the better. And so, um, like I said, I’m in my 40s, probably better off if I were in my 30s. In fact, if I go back into my 20s, and not undergo some of the trauma I put myself through, that would be even better. But you can’t go backwards. 

16:15

AT: Yeah, yeah, yeah, the time to start is now, essentially, it’s today, not yesterday, not tomorrow, it’s today. And I definitely want to dig into some of the 80/20 of something that people could do now. And for course, for that bone health. Though, I wanted to share with you it’s so funny yesterday, just yesterday, I was driving to the ICU to work and right before that, I was just telling my husband, I was like, Well, you know, such it’s like a different world, when I go into the hospital, because we’re at the dog park, people are running around, kids are having fun. And all of a sudden, when I go in the hospital, it’s so much suffering. You know, everyone’s sick, everyone has, you know, they all have generally a poor quality of life, or a bounce back. And it’s just so much suffering in the ICU. It’s so different when you walk in. And I just felt like like you said, it’s like a different world that that’s all we see. So, we don’t want to, we don’t want to get to that point, essentially. So now that you have the vision of essentially having the vitality that healthspan and lifespan to enjoy life with your kids, grandkids, great grandkids, what was the first step you took? After you had that moment and how did you progress?

17:22

DL: So yeah, I think you heard me in a talk recently, you know, we talked about the foundations of longevity and the foundations of optimization. And you know, people are always interested in the new technology, the you know, the new drug, the new this, the new that, but I always tell people go back to actually the foundation, you know, the number one thing I did that actually corrected my thyroid dysfunction and corrected my low testosterone is sleep, right, like, oh, yeah, don’t forget to get an adequate amount of sleep. Like I hate saying that. It’s just so it sounds like so almost trite at this point. But, but it’s true, you know, and we measure everybody’s sleep. And then when they come to see us, and we start talking about sleep quality and quantity, and almost everybody short sleeps. It’s amazing. 

And so you know, starting there, number one, you can take so many things with that. So yeah, so that that’s the number one thing and then figuring out what diet works for you. And that’s a really long conversation. But you know, we work with people that want to do want to follow whatever philosophy you want to call it, but making sure that they’re getting an adequate amount of nutrition and adequate amount of protein, in particular, a big advocate for protein for diets. And then just looking at the quantity of processed food, added sugar, and garbage, inevitably, most people will eat and just eliminating it, and just saying, look, you know, don’t feel bad about these things, because we’re not designed to eat them anyway, you know, these things have been marketed to you, we need to get rid of them because they’re killing you slowly. So those two things out of the gate will fix so many problems. 

And then the last thing would be really the emphasis on resistance training. And how again, this is something that you know, some people do it. But most people when they think about working out our society is really kind of biased towards this idea of like, you have to be on a peloton you have to be on the treadmill, and it’s all about cardio, and it’s all about, you know, time with elevated heart rate. And that really is not actually very effective. The most effective tool for both longevity and weight loss, weight maintenance, aesthetics, almost anything is resistance training.

19:2019:20

AT: What do you say to a woman who says to you that I don’t want to get big muscles? 

19:25

DL: As they try it, prove to me that you can get big muscles. That’s not true. I know one, I have one patient who she started lifting pretty heavy. You know, she was working in a gym, she was lifting a lot. And I would say honestly, she actually still isn’t too big but she got really muscular. You know, but she was really young. So probably has pretty high levels of testosterone. But other than that, show me that you can get big muscles because it’s darn near impossible. So, women have been they’ve been worried about that. I mean, as long as I’ve talked to women about aesthetics and about weight loss, you know, oh, I don’t want to lift weights. I don’t want to you know, get big muscles. But you just don’t have enough testosterone, you just don’t, and you’re probably not eating enough calories, and you’re probably not eating enough protein, like, it takes a lot of effort and time to get big muscles, and you’re probably not putting that in. So, I’ve yet to see somebody prove to me that they can make too big of muscles that they’re uncomfortable with.

20:17

AT: So, what’s the 80/20 for osteoporosis? Would you say resistance training is? Or is there something else?

20:24

DL: It really depends on your starting point. You know, it’s that whole spectrum of, you know, are you in your 50s? And for whatever reason, decided to get an early DEXA and you’re, you know, borderline osteoporosis osteopenia, or are you somebody that’s in your 70s, and, you know, severe risk for fracture, and everybody had a fracture or spine fracture, hip fracture, whatever. So, there’s a big spectrum there. But I think the most important thing to understand about osteoporosis is that it is not just a pharmaceutically based answer, right? Like the problem of osteoporosis again, this one these challenging things It started back in your early adulthood with peak bone mass, you know, did you achieve peak bone mass, you know, what was your bone mass going into your middle age and into your later years. So, it’s difficult to pick it up wherever you are, because you don’t know your history. 

But regardless, I look at osteoporosis almost the same way that there’s kind of a new a new perspective. I don’t know if you’ve read Dale Bredesen is work on dementia and Alzheimer’s, really great book, The End of Alzheimer’s by Dale Bredesen kind of look at this almost the same way where he talks about holes in the roof for developing dementia, and I kind of look at it the same way where you have a certain amount of bone in your body. And there are a number of different reasons why you could potentially be losing bone. And so, I look at it almost like holes in a bucket, right. So, if you’re going to treat this leaking bucket, you know, you could take a pharmaceutical drug, which is going to fix maybe fix one hole. And there’s a role for pharmaceuticals, not saying there’s not, but you’re not addressing any of the other holes in the bucket. And so, there are a lot of reasons why we’re losing bone, whether it be diet, gut dysfunction, immune system, adrenal dysfunction, thyroid dysfunction, like it did, the list goes on and on and on. If you don’t address those things, you’re not going to get better. And if you’re only using pharmaceuticals, then you’re going to create bones that are not really naturally harder or less resistant to fracture, or more resistant to fracture. And so there’s just a lot of reasons to look at other things. So, the 80/20 is figured out all the other stuff other than pharmaceuticals, and then decide if you really need to be on drugs for osteoporosis, because the other stuff can be just as effective, again, depending on the starting point.

22:24

AT: And I really want to touch on that a bit about what patients or people who may be dealing with osteoporosis or have family members dealing osteoporosis or even dementia. Some people will say, well, it’s too late, I’ve already gotten so far, I already have osteoporosis, or they already have dementia. You know, I want you too. Can you give them a vision? Like what is possible, even if they start now that it’s not too late?

22:49

DL: Yeah, no, I would say it’s never too late, with the exception of you know, somebody who’s 90 years old and had their second hip fracture and you know, can no longer get out of a wheelchair, right? I mean, that’s a tough case. But beyond that, you can always reverse the causes of bone loss. And I’d be very clear when I say, you know, because people hear me say a lot reverse and osteoporosis, I’m saying reversing the causes of osteoporosis, right? So why are you losing bone, we can stop that and reverse it. And that should then improve your bone quality and quantity, there is always a way to improve it. And then just understanding what your risks are and where you are, I think it’s really important to have the data to understand how do I modify, you know what I’m doing so that I’m not at risk for a spine fracture, or if I’ve had a fracture, and now I’m at a really, I’m at a lot higher risk, you know, how can I mitigate that? So, I think it’s just talking with an expert who can really help you to figure that out other than say, here, take this prescription. And same thing with the dementia concept is that if you look at the Bresson’s literature, you know, with their the Recode Protocol that he created, you know, people that have both MCI and mild cognitive impairment, and outright dementia, you know, they actually meet the criteria can see improvement, obviously, the worse you are, the less there is, but I mean, why not? You know, these things are, they’re built around lifestyle or built around nutrition choices, like, it’s better for you anyway, like, why wouldn’t you do it? The problem is people just it’s so confusing, and there’s so much noise in the space of nutrition in the space of supplementation. You know, it’s really hard to understand what to do so a lot of people just throw up their hands, like, yeah, whatever.

24:24

AT: Yeah, in order to get a referral to go get a DEXA and maybe some people you might want to get that DEXA early, but it’s just really difficult to navigate that space and people who are actually trained in alternative management of osteoporosis or dementia.

24:38

DL: Yeah, well, and the thing to about and I talked about this in some of my videos, which is basically you have like the traditional medical model of osteoporosis, right? You go in, you have osteoporosis Here, take this drug, or then you say, well, I don’t want to take the drug and has these side effects and they say get out of my office, right, just like very negative. So, then these patients will then go outside of the traditional medical model, then you’re finding, you know, functional providers naturopaths, basically, everybody that has an option for this thing, but it only fits then in their wheelhouse because they don’t have the ability to prescribe all the things. 

And so, then you see, I see patients that have you know that I’ve been working with this, this functional medicine doctor, and I’m on hormone replacement, I’m like, oh, cool, then you start looking at what they’re on. And, you know, they’re on like, topical progesterone, because it’s a chiropractor that can’t prescribe, you know, pharmaceuticals. They’re on like a, you know, some sort of topical estrogen cream and it’s not doing anything, right? And so like, they think that they’re getting hormone replacement, but they’re not, you know, they’re getting like a skin cream, you know, and so it really pays to work with somebody who can paint that big picture who can prescribe pharmaceuticals if they really need to, but also do all the other things that fit into that package, which is actual hormone replacement, you know, talking about peptides for lean muscle mass, like the right supplements, the right amount of calcium, do the testing, like, it’s got to be a big picture thing.

25:53

AT: And do you ever meet people who just don’t want to know and they don’t want to get tested, they, they feel fine now. And they don’t feel like it’s a need to…

26:02

DL: That’s the challenge in osteoporosis is it doesn’t hurt. I mean, some people will say that, that it can, but for the most part, it’s there’s no pain with the diagnosis of osteoporosis. And then if there’s no pain then people don’t want to get better, but I think that the fear of fracture is real. And if they’ve seen somebody go through it, you know, if you’ve seen somebody lose your independence as a result of a hip fracture, like that’s a big deal. You know, seeing people that have persistent pain after spine fractures, or they just like they get like fracture after fracture after fracture. That’s measurable, you know, so I never like to push people by fear. But I think there’s enough of it, you know, and the older we get, the more our social group, you know, you start seeing these things happening. So, I don’t see that in my practice that people don’t want to get better, but they wouldn’t, you know, they wouldn’t walk through my door if they didn’t.

26:46

AT: Yeah, you already have like, niched down the population who automatically want to uplevel themselves. I’m just thinking, you probably push each other, right, your patient probably push you and you push your patients and you grow together with your patients.

27:01

DL: I do I have patients that email me every day, when because they’re doing research, and they want to know about this thing or that thing, or, hey, I saw this combination of this. It’s like, wow, cool. Send me that article. You know, it’s yeah, it’s great.

27:12

AT: Yeah, it’s a totally different practice when your patients are motivated to get better and to do their own research. And the other reason why brought that up you know, sometimes it’s hard to convince, because, yes, number one, you really, you want to start resistance training early, but you don’t want to build muscles, they have fear of building muscles. And number two, because, I mean, they’re, really you can’t see it, if you don’t measure it, you don’t know what you have. And right now, if people are young, in their 20s and 30s, they probably have good bone mass right now. Anyway, so… 

27:42

DL: Maybe, maybe. I just diagnosed it in a lady, she was I guess she’s just turned 40. But this is one of those patients, so you wouldn’t think, now she’s a Caucasian woman, so okay, she has those risk factors. But other than that, she’s an athlete, she’s muscular, she eats a great diet, doesn’t look like she has inflammatory problems whatsoever, you know, and then she tells me, she’s like, “Oh, I was getting these DEXAs for body composition, you know, every year for the last five years.” I was like, oh, cool. What I noticed on her labs is that she had a really high urinary calcium level. And gosh, there was something else. Oh, it was her genetics, her genetics, you know, that she had an increased need for bone support. I was like, huh, let’s just, let’s get a DEXA and see. She’s like, oh, I have a DEXA. Oh, cool. And so, the people that read the DEXA looked at her body composition, but didn’t look at the fact that she had osteoporosis in her hips, and didn’t say anything about it. And it’s been there for five years. Right. And they were just like, oh, your body, you know, your, your percent body fat looks great. Like, don’t forget about the bones. 

And so yeah, I mean, she’s had osteoporosis, that’s been getting worse over the last five years. And nobody said anything she didn’t know. And so, you know, now she’s in her early 40s. And maybe she’s gonna be fine. I mean, we can totally figure out I know, I know where the holes are. And so, we’ll plug the holes, and she’ll be fine. But that just goes to show, you know, like she’s early 40s, you know, she’s over 20 years out from ever getting the recommended DEXA screening for osteoporosis. And a lot is going to change in that 20 years. 

I have talks on this where I talked about, you know, primary osteoporosis, which is age related or hormone related osteoporosis, and does it really exist. Because if you look at all of the secondary causes of osteoporosis, I don’t know of a single person that doesn’t fit into one of those categories. You know, things like eating disorders, malnutrition and like, well look at our diet, who isn’t malnourished right now, right? I mean, in the general population, people are eating garbage processed food, I would say it’s mostly everybody. Chronic dieting. People chronically malnourished, you know, not getting adequate protein, you look at the entire non-animal based protein consumption, and the entire population of that group that’s protein deficient, amino acid deficient. So, there are so many people that should be screened early where I really feel like if anybody comes to my office, we’re talking about it, you know, no matter their age.

29:57

AT: Yeah. So, I wanted to summarize really all the 80/20 that you have said, you have said number one sleep, right? It’s very important to track your sleep, I’m not affiliated with Oura or I don’t get any compensation, but we both have the Oura ring to track our sleep. And also heart rate variability, your steps to assess your stress as well. So, number one is sleep. And you really just because it says tells you the duration of sleep doesn’t mean you’re getting adequate sleep, a lot of times we hear well, I’m getting like eight to nine hours, and then they get on the Oura, they’re barely getting like an hour of REM, they’re barely getting an hour of deep. So, it’s not restorative sleep. So, it’s very important to assess the stages of sleep that you’re in. 

And then number two, you have mentioned diet, like you know, from my philosophy, I’ve done lots of diets like lots of protein, lots of fat, no fat, and now my philosophy is really nonprocessed food, whole foods, and nothing from a box, something and I’m prepping or cutting up and higher fat content than usual. And I got to check out my protein content. I think it’s probably point seven five grams per pound. Right? And your target is one gram per pound. Yeah. All right. So, I’m gonna work on that. Yeah.

31:07

DL: Yeah. Yeah. For you, I would put you in a gram per pound for sure. Yeah.

31:11

AT: Okay. Okay, awesome. And then number three is resistance training. And when you’re talking about resistance training, are you talking about, how heavy are we talking? Like, what exactly do you have to do for somebody who’s been lifting? And for somebody who’s never lifted?

31:27 

DL: Yeah, so those are two interesting groups. And then that you have the bone health group in here too, which we have to be really careful of, you know, because it’s, it potentially could put you in increased risk for fracture, although I don’t believe in that data as much as some people do, but so I’ll just I’ll just put them in three different groups. So, basically the nonlifters right, people that have never lifted weights, the answer is you don’t have to do very much. Because you’re typically you’re you don’t have a lot of muscle mass to begin with. You don’t want to hurt yourself. And this is the group where I really recommend working with a trainer, you know, because it’s so easy, I might even just hit a recently where you know, where I increased my, I’ve been lifting for a long time, but I increased my weight, you know, probably wasn’t using great form and had a shoulder injury as a result, you know, and it’s just, it’s so easy to do if you don’t have somebody watching you. So, I would put people in that group, you know, just start with whatever it can be bodyweight, it can be bands, you know, something simple, like the ex(inaudible) bar relationship, the ex(inaudible)

32:19

AT: I got them right there, they’re hanging.

32:20

DL: Got one too, I travel with it’s awesome, right? Like, you can do a lot with the ex(inaudible) bar and those like, whatever, four straps, you know, and then you get to the next group. So, this is the like the frequent lifting group people that have been doing resistance training for a long time. And I think that basically, in this group, like I’m in this group, now, you’re probably in this group. And the reality is, is that we should always be trying to improve some aspect of our health, right, so some aspect of our physical capacity, whether it be training a specific body training for a specific event training for something, but your body gets so efficient, so quickly, that we really need to always be trying to do something else. 

So, I’ve been working with a group, this group called Battle Ready, which they came out of the thing I did several months ago called The Modern Day Knight Project, which is again, it’s just like, something to train for, it’s something to do. And so this battle rated group, you know, they’re shifting it all up for me, right, so I basically just follow them along, they tell me what to do, I’m always looking to do something new. And that’s been great. But we’re lifting pretty darn heavy. You know, like, we’re putting around big weights, always changing up what we’re doing, how we’re doing it. So I think if you’re in that group, you know, basically go as hard as you can, but don’t hurt yourself. Because those orthopedic injuries, especially as we age takes so long to recover. And avoiding surgery, you know, not at all cost. But avoid surgery if you can.

And then there’s the Osteoporosis group, and that’s going to again, really vary by where their starting point is, because some of these patients are, I don’t like to use the word brittle, but they have very little lean muscle mass that go that sarcopenia goes along with osteoporosis, right? So, we really have to start like I really encourage them to work with a trainer out of the gate, either in person or virtual, because they have to get you to just nail the mechanics before they start increasing weight.

34:01

AT: And yeah, I agree like, you know, if you’d have not worked out you know, you wouldn’t know what your deadlift looks like you wouldn’t know what your squats look like you don’t know how deep you’re going you think you’re going all the way down but you’re only like right above 90.

34:13

DL: That’s right especially with the first time I recorded myself doing a squat even a deadlift it was like oh, man, that form looks terrible. But now we you know there’s part of this group like we recorded it we posted all that you can go on my Instagram page and on my stories you can watch me doing a workout if you want to know I put it out there not for publicity sake, my obligation to my group.

34:38

AT: Yeah, I think it’s important to share it the same way to share like what you do but also the failures and to not exactly what we call failures. But it’s your practice because I was trying to post a post my workout and then I was filming my Snatch and I dropped it, but I posted it anyway. I was like, that’s just what happens. It’s not a failure. It’s just a lesson. Oh, well.

34:59

DL: Yeah, so yeah. I almost dropped fortunately, I had a bar underneath me but yeah, I was I like I went up, I was doing a squat and I went up and I like rammed right into you know, the bar. So, the bar support and it just like kind of like fell almost fell backwards with you know two 25 on my shoulders. Yeah, I posted that anyway.

35:16

AT: Yeah, yeah. Yeah, being authentic being authentic. So, thank you so much for that portion today I think it’s going to help a lot of people, whatever you’re doing now just get educated and get started on, you know, either bone towel or go into your cabinets right now and take a look at what are some of the names and the gradients, you don’t know what they mean. So, I think that’s a good first step or anything in the box. If there’s like an ingredient list that is too long for you to read. And you don’t have the attention span to read all of it. It’s too long. You don’t want to eat it.

35:51

DL: Yeah, or honestly, like more than three things right? Like, yeah, tomatoes and salt. You know what’s in here? Beef. Cool. That’s, that’s what you should eat.

36:01

AT: Yeah, instead of like peanut butter, cottonseed oil, sugar, salts.

36:08

DL: Food coloring, right, red dye number 40. Like, what? Why?

36:13

AT: Oh, you know, one thing to look up, okay, go Google after this, like 50 names for sugar. And then you’ll realize how many times a lot of those packages have fructose maltose corn syrup. I can’t remember. Like, there’s so many like, in a row.

36:29

DL: I play this game with my kids. So, we’ll read ingredient labels and we’re like, Okay, what’s the number one ingredient? They’ll call it out? Like sugar? What’s the number two ingredient sugar? What’s the number three ingredients? Sugar? I’m like, Yeah, you’re right. Like, it’s all these different things. Like, do you want it? They’re like, yeah.

36:45

AT: Oh, yeah, it tastes good. Yeah, it’s a good idea. I’m gonna teach my five month old starting when we go to the grocery store.

36:52

DL: Yeah, it is. My kids are they’re very savvy consumers. They know how to read an ingredient label.

36:52

AT: You know, that actually brings me to another question. A lot of times parents have a hard time getting their kids to eat healthy, like vegetables, and things when not processed or sugar. You know, do you have one thing that you do that allows you to give your kids the lifestyle trying to promote?

37:15

DL: Boy, I mean, it’s always a struggle. You know, I mean, we’ve struggled with that from day one, you know, and it’s just so tough in this world of highly processed, you know, super palatable foods. How do you get a kid to eat broccoli when they could eat Skittles? Like, it just it’s so tough, but, you know, the things that we do is obviously, you know, control what’s in the house, you know, so we don’t have Skittles, you know, unless, unless it was just Halloween, you know, and then we have those things around for a few days. And then yesterday, let the kids open up all the candy and stick it in a bowl and add water and they made you know; they made junk soup. And so, then we threw away all the candy, you know, so control comes into the house, you know, prep meals, so make them real meals, and then sit down and eat food together. You know, if you sit down, and then you’re modeling, you’re eating, you’re eating good food. And that’s another good topic too, is you could feed yourself, but eat good food, show them what eating real food looks like, and then model that for them. And then we do like we just kind of lean into like, look you can’t have and we have a three-year-old you know right now. So, it’s really tough, right? Like, you can’t have a treat until you eat protein, right? And then it’s the tantrum and it’s the pelvis stuff. But if you just do it consistently, I mean, now my 10-year-old or my eight year old, like they know, you know, like, they’re like, Okay, I have to eat this much protein I have to eat at least I have to try this vegetable. I have to try this other thing before I can have anything else. And it’s not like we deprive like my kids eat pizza and you know, chicken nugget, I do all that stuff. But they eat more of you know, a whole food based, you know, animal meat, protein product. And when they choose food out, they tend to choose those same things. So that consultancy,

38:53

AT: What about the food they’re exposed to in school? Like the school lunches and snacks in vending machines.

39:00

DL: Yeah, they unfortunately, our school doesn’t have vending machines, which is great. But you know, the cafeteria has stuff that we wouldn’t want them to eat. And again, like they’re pretty in tune with what makes them feel good. But like my middle guy, he’s pretty lactose intolerant. You know, and so like, he has ice cream on occasion, but he knows if he goes and has ice cream at lunch at school, then you know he’s gonna be gassy in the afternoon. He’s like this even as a you know, an eight-year-old, this doesn’t feel good. 

And my oldest guy, he has some issues with gluten. Right? And so, he’s, he’s on he is so on it when it comes to finding out if something has gluten in it because he feels terrible when he eats it. You know, and so they’re both really good. Now, do they eat sugar? Yeah, but like, when they try when they have juice, you know, somebody brings snacks for the school, or for their class and you know, it’s like whatever a cupcake and apple juice, you know, like they’ll take it and they’ll try it and they’re like, oh, that’s so sweet. It’s just off-putting it so sweet to them because they don’t drink juice at home, you know, and we don’t have soft drinks. So, for them, it’s like water or, you know, occasionally like a kombucha or like a Zvia is like the sweetest tasting thing that they’re gonna get. And so, when they taste something that’s, that’s super sweet. It’s like, oh man, that’s intense, you know, or like, my son is a soccer game, he came home with Gatorade. It was after their last game, and it was like, you know, like a tiny bottle of Gatorade and he drank like, half an ounce. And then he pulls it out of his bag, and he rolls it across the counter. He’s like, hey, can you tow this way for me? I’m like, yeah, sure. So, they just like it’s just not palatable to them, which is great. I mean, that’s a success, as long as they don’t have, you know, food dysphoria and don’t feel bad about what they eat.

40:40

AT: Yeah, I think you touched on a lot of good points. Number one is intuitive eating. If, you know, it’s so complicated, what you should eat, why you should not eat. There’s so many different opinions. Though your body I always believe ultimately knows if you feel good after eating something. There’s no food coma, then it’s good for you. But if you’ll feel terrible after you’re falling asleep, you’re bloated, you’re gassy. It’s not good for you. It’s very, very simple. 

Some people think that food coma is it’s normal. But it doesn’t have to be. Yeah, yeah, exactly. You should be you should feel energetic after a meal like ready to go for the day. And that’s the reason why I eat the way I eat. Because in the afternoon, I want to be productive. I want to be present with my family. I don’t want to this one time I ate pizza. And I fell asleep on a Valentine’s date after and we just missed the whole night I fell asleep. I’m like 8 pm and on. So, you don’t want to do that. 

I agree that you know, if you model to your kids and you expose your kids to real food, they’re going to know what real quality ingredients tastes like and what fake food the processed food or at you know, with a lot of sugar it just not palatable, like you said, like, if I’m gonna make pizza, it’s gonna be something with like, maybe Italian flour with San Marzano tomato sauce with buffalo mozzarella, fresh basil, etc. And then they’re gonna, like taste real food. And then they’re gonna do tastes like other types of pizza. And they can tell the difference. 

42:11

DL: Yeah. And then the challenge is like, when they get to those things, like highly palatable things, right? Like, I mean, I think of like, when I grew up Papa John’s pizza was, it was one of my, like, kryptonite foods, you know, like, you put a large Papa John’s pizza for me, I would eat the whole thing. Like, there’s, there’s no stopping me. And that’s just those things are highly palatable. So, but I think educating them and just saying, look, you know, these things are out there, you’re gonna be exposed to them, you know, there’s, there’s a way to deal with these in an appropriate way. And it’s just, it almost like dovetails into the conversation about like tobacco and drugs. And you know, it’s like, you’re gonna be exposed to these things. So, let’s have a conversation about them.

42:47

AT: Because I want to like call on the audience, if there’s one thing in your diet right now, that or what you’re drinking right now, or even, like you said, drugs, alcohol smoking, if there’s one thing that you think is not contributing to your help, that’s actually making you feel worse than what your potential could be. You don’t have to cut out cold turkey, you can just take one micro step to say drinking, like, you know, you can set a goal for yourself, because I used to like, you know, I was in a sorority, and I used to go out and we were binge drink. And I set a goal for myself, I haven’t drank for four years ago, and it took a year. And I told myself, Okay, I’m not going to have more than two drinking sessions a month, and no more than four drinks in a row. And it took a year to come down. So, you don’t just set a goal for yourself. If you drink five drinks, just kind of down to four, okay, for a week, and then you keep going to cut it down to three a week, et cetera, et cetera. So just do something, microsteps. 

And I know we have just limited time. So, I do want to pivot a little bit for the professionals out there who want to create, you know, maybe they’re still trying to find their passion, finding their identity, I want you to talk about what was the step that you took to start creating this company or you and I talked about maybe some coaching, it doesn’t have to be in healthcare, it can be other professionals who are not happy, who wants to pivot? And how did you deal with the identity shift, and also the shift within your relationship with your wife.

44:16 

DL: that was a big one. So, I’ll just want to make sure I hit all those. So, for me, if I were to go back and do it again, I would definitely want to get a better sense of what I was getting myself into before I started. So, and this would have actually helped with my relationship with my wife as I was doing it. So, if you want to learn from my mistakes, I would say that, you know, I basically decided that I was going to do this thing, didn’t really get full buy-in from her to do it. And so basically, it was like, I’m gonna do this, you know, and then I created this company, and sort of just dove into it, which I kind of had to but didn’t have a great plan and then kind of later asked for her buy-in and my wife and I have a great relationship. So, you know, we worked through this thing, but it was not the most graceful way to do it. So, I would say figure out what you want to do, learn as much as you can about it. And if you could really pick that, doesn’t have to be like the final end goal. But you know, but picking the end goal, and say, you know, lay it out, this is how I’m going to get here, you know, in a year, I’m going to have this company built, I’m going to use this platform, this is going to be my niche, this is what I’m going to need to build, this is the team that I’m going to need, these are the resources I’m going to need, I’m going to need this much in capital to do it, then really just lay out like a business plan like I would, if I were to do this, again, I would go to my wife with a business plan in place and say, okay, this is my business plan, this is what I want to build. These are the people that I’m going to get in place to help me to understand what I need, you know, and this is the capital that I need. Once you do that, then you just start marching on the pathway, you know? And so, for me, I got there, and eventually I got buy in. And you know, it was, it’s all been, it’s been great. But those were two big struggles. 

The biggest thing for me, though, was the identity, walking away from the identity of being an orthopedic surgeon was really tough. And I knew that I wasn’t doing it well, when I would meet somebody, and they asked me what I did. And I would say I’m an orthopedic surgeon, or like, I just couldn’t, I couldn’t get over the idea that being an orthopedic surgeon was cool, that it was my identity. And it’s what I had trained for 15 years to do, you know, and so I really had to work on what that new identity was. And so now when I introduce myself to people, they’re like, oh, what do you do? I say, I’m a physician, entrepreneur, right? They’re like, oh, that sounds cool. Like, tell me more, so that I can say, yeah, I created this company called optimal human health, and we’re in the longevity and the bone health space. And it’s super exciting. Let me tell you why. You know, and then it’s really engaging. But I really, that’s almost been in the last few months that I’ve really been able to confidently say that I’ve flipped that identity. And I can say that I used to be an orthopedic surgeon. So, I think it can take time. Just make sure you understand that you do need to make that switch, you know, and I’m sure for you like, you know, like, Am I an ICU doc? Am I you know, like what, what am I like? What is my identity? And knowing what that is can really help you with your “why”, can really help you with your, you know, all the things that resonate through your day.

47:07

AT: Yeah, I agree. Initially, it was like, okay, I’m an ER doc, and then I’m an ICU doc. And then I’m an aerospace doc, then I realized that a lot of times we define ourselves by our profession, and it shouldn’t be that way. Really, you know, it’s we’re not just a physician, we’re also a mom, or a father or a son or a daughter, where we can be entrepreneurs, we can be real estate investors, we can be coaches, we can be New York Times bestselling author, we can be nutrition gurus, I’m just reading off my list, I have it in my vision board.

47:38

DL: Is your vision board right there? 

47:40

AT: Yeah, it’s right there. And it has like, you know, sexy goddess to my fiancé, I gotta update that as my husband now. Yeah, so you can be multiple things and just know that it’s not going to be a switch, you are going to be working in your current job, probably. And as you’re exploring, it’s not going to be okay, I’m going to quit my job, I’m going to do this. It’s okay to explore your passion and things that you’re interested in, it’ll actually probably make you better in the profession that you’re currently in. It definitely made me a better physician when I see my patients. 

48:13

DL: So yeah, for me, I was able to find a part time orthopedic position while I was making this transition and doing my second fellowship. And it did I mean, when I, by the time I actually told them, I wasn’t going to be able to operate anymore that I had to stop seeing patients in clinic, I mean, heartbroken administration, they’re like, but, but you’re so good. Like, I know, it’s, you know, it’s, it’s this skill set that makes me good. It’s also the skill set that makes me not the right person to be here.

48:38

AT: Yeah. And, you know, do it for yourself. Like, if you don’t do it, don’t do things just because other people are expecting you to do it. Nobody is going to look out for your own well-being, your family’s well-being, nobody is going to look out for your own happiness and fulfillment as much as yourself, really. So, I want to also touch base on like how people can find you as well. Like, if they really want to learn more about what you do, how to optimize their health or bone health or longevity and health span. You know, where can people find you?

49:11

DL: Yeah, so the easiest place is our website at optimalhumanhealth.com. And so go there and have access to all of our free content, the blogs, sign up for our weekly email. So, I write on this, the concepts of longevity and bone health every week. And then we are launching a YouTube channel super excited about that working with a great company to start producing some fun content there. And that’ll be under all under my name, either Dr. Doug Lucas or Dr_Doug Lucas, same thing on Instagram and Facebook.

49:39

AT: Okay, fantastic. And is there one resource other than your website, of course, like a book, or a podcast that has really changed or help you change, you know, or pivot?

49:49

DL: Yeah, I think from a physician perspective, or for people that are really interested in the science behind stuff, listening to Peter Attia Podcast that drive, I mean, that was a huge, huge thing for me. One book that changed my life in the longevity space is Why We Sleep by Matthew Walker is a really good one.

50:08

AT: I haven’t read that. I will put that in my Audible.

50:11

DL: Anybody that questions or comments about sleep, go read Why We Sleep by Matthew Walker, he does a great job of walking the literature through. And you just come out on the other end of that book, and you’re like, oh, man, I gotta sleep more. I gotta sleep more. And that was Yeah, but it was one of the hardest things with figuring out how to work that out with my relationship with my wife, because she’s more of a night owl and more of a morning person. So, you know how to find that compromise. And it probably took us three years after I read that book to really hit that middle ground.

50:42

AT: Yeah, okay. Yeah, I just came off overnight shift, and I slept about five hours. So it’s a balance between

50:48

DL: It’ll have an impact on your desire to keep doing that, too.

50:52

AT: Yes, yes, I definitely want to do that less in the future. And so, you know, we talked about, you have to do all this, you definitely need more time. So, again, go to itsnotrocketscienceshow.com, you’ll have the resources that we talked about, you’ll have the show notes. You can go on YouTube at anntsungmd.com. And the video will actually be on here. 

And if you go to itsnotrocketscienceshow.com, there’s also a productivity course that I’ve created. It’s a seven-day video course masterclass, and how to, you know, figure out what is your Eisenhower quadrant and how to get more time in order to pursue your passion in order to have the energy to be present with your family, your loved ones after a long day’s work, etc. So, I really want to thank you for your time, your energy, all of the knowledge that you have shared, you have added so much value to not just, you know, a specific niche audience, but I think in general for you know, anybody who listens to at any stage in their life, so thank you so much, Dr. Lucas.

51:53

DL: Yeah. Thank you. It’s been fun. I know we could talk like this forever. So yeah, maybe we need to do a second version and focus on something else. But yeah, this has been great. Thank you. 

52:03

AT: Yeah, thank you so much. And remember that everything you need is already within you now.

52:09

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