IMPACT TRAINING & OSTEOPOROSIS | OsteoStrong Research with Dr. Doug and Dr. John Jaquish

Full Transcript #

Dr. Doug: Last time I interviewed with Dr. Jaquish from Osteostrong. We got a lot of comments and questions, and I wanted to bring him back so that we could ask him specifically some of the questions about what kind of research has been done on Osteostrong and answer the critics who say that there hasn’t been enough research done on Osteostrong. And then what kind of research we can expect in the future on osteogenic loading and Osteostrong stick around? I’m going to ask him these questions. We’re going to talk about the research, some of the principles, and then what to expect moving forward with osteogenic loading. Stick around for this.

All right, so we have Dr. Jaquish back for another video that we’re going to put out on the Bone Health YouTube channel. And the reason why I brought Dr. Jaquish back is that we had such a response to our initial interview. And if you haven’t seen that interview yet, we go into full detail, which we’re not going to do again today. But some of the comments that we got pointed us towards videos that were critical of some of the research that was supporting Osteogenic loading and Osteostrong.

And I thought it was relevant for me to dig back into this topic a little bit. We kind of glossed over this in the original interview, and so I want to dig into some of the research that led up to the development of the equipment and the franchise model of Osteostrong. And then I want to talk a little bit about some of the research that’s coming. And we know we’ve seen some of the data from some pending publication research, so we can’t talk about that in full detail, but we can talk about it at least a little bit.

So with that said, I wanted to welcome you back, John, onto the YouTube platform here. And let’s just start by, gosh, what’s the best starting point I think would be maybe just getting into the first research study that showed the value of osteogenic loading. We’re going to go back a couple steps here and then we’ll just march our way forward.

Dr. John Jaquish: Great, and thanks for having me. Initially was my PhD dissertation, so I had some anecdotal case reports, 12 of them in there, and anecdotes are the beginning of research, but it was really what I really published was a narrative review of bone loading and results from bone loading. Now, bone loading covers impact dating back to the 1890s.

Some of, us talked about this at dinner the other day where Dr. Julius Wolf was looking at people who jumped off of carts that would carry hay. So these guys would bale hay, they’d load ’em on the cart, and then they’d jump on the cart, move the bale of hay to the back, and then jump down, which was about a three-foot drop. When they would jump, they would receive an impact level force that was significant, many multiples of their body weight above 4.2 multiples of their body weight, very specifically, which is the minimum dose response that we know based on more modern research is the minimum threshold for triggering bone growth in the hip joint.

So both the pelvic bone and the top of the humerus. So that’s of course the most commonly broken place where people can break a hip, and that has the greatest ties to mortality. So that’s why anybody wonders why we’re always looking at the hip joint. It’s because that’s the most important for living. So when looking at all that in the narrative review in my dissertation, which can, by the way, be downloaded on my website, doctorj.com, when that sort of narrative review, at that point, I wanted everybody to pay attention to the logic of the device because I knew that no matter what, we’re not going to be able to afford to do pharma level studies with hundreds of thousands of people and spend tens of millions of dollars on these big studies like a drug company.

Now, there are a few reasons why the burden of proof should not be like that, like a pharmaceutical.

We’re not giving people a chemical that’s not found in nature. We are giving people the stimuli that they would normally be getting in youth so that they can continue to grow bone, they’ve lost bone density, they can grow it back to where it was once they get there, and they can even grow it higher than where they were potentially at peak bone mass, which is what your bone mass is at 30 years of age. So everything we know about bone has to do with impact-level loading and mechanical loading. So it’s like what’s the justification of Osteostrong?

It is the absolute beginning middle and end of everything we’ve ever researched having to do with the way bone works when bone absorbs forces that are specifically in the lower extremities, also specifically over 4.2 multiples of body weight. We see incredible changes and the bone density going up.

So there are so many studies that show this. I didn’t want to say, oh, look at the studies that were done on osteogenic loading, because there are a handful. It’s like, look, this is a principle of human physiology that we’re enacting. The burden of proof is just not there. And that worked out for a lot of physicians who bothered to read my dissertation, which is 206 pages. I mean, it’s not a fun read, but if you’re interested in bone density, if you’re an orthopedic surgeon, the orthopedic surgeons were the biggest fans, even though the book was sort of in some cases giving them less business because people would recover, damaged joints feel less pain, and then they wouldn’t need joint replacement surgery.

Dr. Doug: And I don’t think any orthopedic surgeon is hurting for business for the most part. So it’s usually not an issue of getting more people in general as an orthopedic surgeon. I can say this in general, if we can prevent a fracture, especially a hip fracture, then we’re going to do whatever we can. Sorry to interrupt this interview, but if you haven’t already and you want to know more about how we handle osteoporosis as a practice, take a look at the link below for the link for our masterclass. Our masterclass is where people can learn about our whole process from beginning to end, ask questions that I answer live, and get a sense of how they can do so many things for bone health on their own and then learn about some of the things that they’re going to need to potentially some help with.

Let’s fast forward a little bit. Let’s get into some of the work that you did in London with a couple of other authors and walk me through the size. It’s something that I hear criticism about is, oh, well, the studies weren’t big enough and you mentioned that to do a pharma level study would require tens or honestly probably hundreds of millions of dollars, which as a non-pharma or government entity, nobody’s going to fund that.

Dr. Doug: But let’s talk about the studies that did happen.. Again, these are also linked on the website. We’ll send people there Walk us through what you did in those studies and how impactful they were for both you and ultimately.

Dr. John Jaquish: I mean, there were observational studies. So everyone acts as their control, sort of like the control is the starting point. I mean, that’s not a randomized control trial. So if somebody has a problem with that, but again, you shouldn’t need that type of thing. We’re enacting a principle of human physiology. So there’s a level of obviousness that what would we have the control group do? Nothing like, okay, well, we know what happens when people do nothing. We have acres of data on that.

So I don’t know really what people want or what people expect, but what we studied, if I recall correctly, was back in 2015, it was about 23 people, and they all found positive adaptations in either the spine or the hip, or the majority of them both. So we reached statistical significance. One thing that a lot of physicians don’t understand is what statistical significance means about your sample size. So part of the reason that pharma studies will have 10,000 participants in the study is not to make it a more powerful study. It’s a weaker study if you see statistical significance with a large population versus a small one. Because if you see statistical significance with a small population, that means the difference from whatever you’re using as the control, which in this case was the people before the intervention versus after, has to be huge to show statistical significance.

So when someone says the sample size is too small, can I hang a sign on you that says, I don’t know anything about statistics? That’s what you’re telling me. You don’t anything about statistics?

Dr. Doug: Here’s a great example of that. For those who have listened to my videos, I talk a lot about the women’s health initiative. We talk a lot about hormones and breast cancer. And so that study had 160,000 people in it, and then they showed this not even statistically significant increased risk of breast cancer, but when you have a study that large, that small of a signal is clinically about as irrelevant as it gets. Now, I’m not going to say I want anybody to get breast cancer, but the point of that coming out of that is to say there was a massive study and you pick up a tiny little signal, which might be relevant, but it’s such a small signal versus out of 23 people, if there’s a signal it’s very clinically relevant. Yeah. So that’s great. So then that was both of those studies. I got ’em listed right here

Dr. John Jaquish About the same sample size.

Dr. Doug: Okay, perfect. So we had those two studies, observational in nature, and then just another for those that aren’t that familiar with the difference when you’re looking at observational stuff, you are still moving forward over time. So these are still very commonly done types of studies. They are impactful. You can see a difference, and you can make clinical decision-making based on these. They are not RCTs or randomized control trials. But we have one of those coming out. Again, I’m not going to say much about it, but there is one coming out in the future on Osteostrong specifically. But before we get there, walk me through this even smaller study, the study that you did with Dr. Sung, who’s a friend of both of ours, but Anne Sung did a study with you, and I think that unless I skipped over anything

Dr. John Jaquish: No significant standpoint, I began to look at the force production adaptations, the changes in one’s ability to put force through a kinetic chain, like a chain being upper extremities, lower extremities, core, and spine, which is the way we absorb impact is through those kinetic chains. When we look at a kinetic chain and we can change the ability for a person to absorb force in those positions comfortably, voluntarily, and comfortably absorb forces, that’s a measure of functional bone performance, which honestly is a hell of a lot better than dexa. DEXA is a picture of your maybe healthy, maybe not healthy bone, but it’s just a picture. Whereas we’re testing the tolerances of bone. So I started referring to these measures that the medical devices at Osteostrong capture, it’s a measure of functional bone performance. I not only biased opinion here, I’m the inventor. So what we have is a way to treat bone density and bone loss, but we also have a superior diagnostic. The number that comes off of it that somebody gets every week is a measure. Now, I mean, we’d have to look at what the normatives are in a certain population. There would need to be a lot of data, but guess what?

Dr. Doug: Data. We’ve got a lot of data.

Dr. John Jaquish We have 11 million sessions logged. Wow. So that data’s there. Somebody would need to really dig into that and so understand what the averages are, fracture likelihood, and they’d also have to have data on all of these people and whether they fractured or not, but we’re going to know that the people with a higher level of functional bone performance are going to be less likely to fracture.

Dr. Doug: That would be a cool study. Yeah.

Dr. Doug: So then that’s what led to working with Dr. Sung, and that was at NASA. Right. And so this is a very different population. So now we’re talking about a younger population. I don’t want to disclose her age, it’s in the paper, but she’s young, and I heard you talk about her. We were in New York and you were talking about her, and what was interesting about her is that she is an athlete, and she’s worked with me for a while. So she’s an athlete, she is a powerlifter. She’s just a monster in the gym for not a big person. And so she comes in with a very high-end physical state, gets on the equipment, and then walks us through what happened.

Dr. John Jaquish Well, her first session was sort of like, wow, that’s interesting. I’ve never had that level of force through my body. But then week by week, that functional bone performance number kept changing. It kept getting bigger and bigger and bigger. And then of course all her lifts went up significantly. Most of that is for neurological reasons. She’s training the body to fire more musculature in synchronous, but that’s also a measure of functional bone performance because your bone mass will not let you switch on enough muscle to create an injury in the bone. Sort of like you can’t squeeze a fist hard enough to break your finger, your neural inhibitory processes stop you from doing that.

So the neural inhibition gets further and further away as you go week by week through the therapy because you’re just able to switch on more because your bone is allowing you to switch on more because the bone is becoming denser or these things, they pace each other.

Dr. Doug: And stronger. Right. So stronger. And I think that’s a really important way to look at it too because people ask me, they get all kinds of fun questions on YouTube, and I do love ’em. So please leave your comments, leave your questions. I do love the community that we have, but what’s interesting is when people are asking me just how is it possible that a small frail person can start to increase strength and increase, and people will say they’re like, the gains that they report are too big to be believable, but it’s because the osteogenic loading and the impact from a neural perspective are so different than what they’re doing in any other format. Even if it’s heavy weightlifting, even if it’s impact training, it is significantly different. Is that an adequate way of saying that?

Dr. John Jaquish Yeah, yeah. So impact is the most powerful intervention. For the most part, weightlifting just can’t get there. I know the guy in the heavyweight class category who holds the world record squat, and he does not even pass that.

Dr. Doug: Four points. He can’t get there.

Dr. John Jaquish The strongest guy in the world cannot put 4.2 multiples of body weight through his hip joint via lifting weights. But if he’s going to do a box jump, he can do it 50 times in five minutes. Well, and **Dr. Doug ** Let me ask you this question. I get this all the time. I have videos on the Lift More trial that publications around heavy weightlifting and impact, and people I think forget that a lot.

Dr. John Jaquish The protocol impact is that weightlifting doesn’t do anything.

Dr. Doug: The protocol for that study involved heavy weightlifting and impact, and it was not insignificant. I mean, they were, I’m sure you know this, but for the people that haven’t read it, doing potentially an assisted and then letting go of the pull-up bar impacting what a straight leg is possible, which sounds terrible to me.

Dr. John Jaquish: I’m surprised that made a pass on the ethics board. **Dr. Doug ** Yeah, yeah. So anyway, yeah, it’s the impact that does it. So, all right, that’s helpful. So then let’s just round this out by what would we like to see. I know that when you and I talk about this, we really, encourage people to use Osteostrong because I feel like any intervention has risks, and if the benefit is significant, or even in this case the benefit is mild, the risk is so low that the benefit outweighs the risk. And that’s what I look at all interventions as. But if we were to try to convince others who have come out to say, well, there’s not enough research, there’s not enough research, having a randomized control trial would probably satisfy most of, probably not all, but most of the critics out there.

Dr. John Jaquish Man, they’re going to find something.

Dr. Doug: Complain. They’re going to find something. I know, but there’s a study coming and I’m just not going to say anything cause I don’t want to get in trouble or get anybody else in trouble. But there is a randomized control trial hopefully be published early next year. I don’t even know what we’re allowed to say, but I’ll just say that it’s bigger than a couple dozen people, and it is a randomized control trial, and I’ve seen some of the data. It looks promising, but I won’t say what they show. How does that sound?

Dr. John Jaquish: Perfect.

Dr. Doug: Yeah, yeah. Good. Okay. I mean, I think that kind of rounds it out. Again, for me, it just comes back to, as a practitioner, somebody working with hundreds of people with osteoporosis and seeing improvement in bone health. Everything is a risk-benefit. There’s a risk to taking calcium, right? There’s a risk to walking down the street. There’s a risk of not doing any of it. I would argue that the cost of inaction is much greater than the cost of any of the actions that we talk about. So for me, it’s just a no-brainer. If people have access to an Osteostrong location, I encourage for them to be a part of their program because it is such a powerful single intervention.

Dr. John Jaquish: Also, it is the benefits without the risks. Ultimately, if people didn’t care about the risk of injury or if they weren’t likely to be injured, if you jump from greater than 24 inches and absorb the force bent knee and not a stiff leg, the stiff leg thing is so irresponsible. It’s just an injury waiting to happen. But you can jump down off of a sort of table or a parked bench that’s tall enough and you can get this kind of stimuli. I mean, there’s even an app that does it fracture-proof. It’s on the Apple App Store. It tracks you enter your body weight and then you hold it on your hip and you jump, and then it’ll show you how many multiples of body weight you created.

Dr. Doug: I’ll have to check that out. I haven’t seen it.

Dr. John Jaquish Yeah, no. For most people, they don’t get there. They don’t get to 4.2 multiples body weight because they’re deconditioned. It’s not as abrupt as it should be to stimulate bone. And that was just a way to teach people about the kind of safe loading that Osteostrong provided, that if you were trying to get it in any other way, it just wouldn’t be safe. So the whole objective was impact-level force without the risk of impact.

Dr. Doug: Yeah. Well, that goes back to your beginning thesis, right? You look at a gymnast and you’re like, okay, mom, you need to be a gymnast.

Dr. John Jaquish Not practical advice.

Dr. Doug: No, not a good idea. Alright, well, I think let’s stop there unless you have anything else that you would like to add to that, but I think that sums it up for people. And if you guys have questions or comments, just leave ’em in the comment section below and we’ll get all to ’em. And then we’ll have John back if we have additional questions and we need to keep answering ’em.

Dr. John Jaquish Awesome.

Dr. Doug: Awesome. Thanks, man. Appreciate it,

Dr. John Jaquish: Doug. Yeah, see you.

Dr. Doug: Thanks so much for making it to the end of this video.